Stroke Risk Following Infection in Patients with Continuous-Flow Left Ventricular Assist Device

Sung-Min Cho, Nader Moazami, Stuart Katz, Adarsh Bhimraj, Nabin K. Shrestha, Jennifer A. Frontera

Research output: Contribution to journalArticle

Abstract

Background: Infection has been associated with stroke in patients with left ventricular assist devices (LVAD); however, little data exist on the timing, type and mortality impact of infection-related stroke. Methods: Prospectively collected data of HeartMate II (N = 332) and HeartWare (N = 70) LVAD patients from a single center were reviewed. Only strokes (ischemic or hemorrhagic) that occurred within 6 weeks following a LVAD infection were considered in analyses. The association between LVAD infections (wound, pump pocket, driveline and/or bloodstream infection [BSI]), specific pathogens and ischemic and hemorrhagic strokes was evaluated using multivariable logistic regression analysis. The impact of infection-related stroke on cumulative survival was assessed using Kaplan–Meier analysis. Results: Of 402 patients, LVAD infection occurred in 158 (39%) including BSI in 107 (27%), driveline infection in 67 (17%), wound infection in 31 (8%) and pump pocket infection in 24 (6%). LVAD infection-related stroke occurred in 20/158 (13%) patients in a median of 4 days (0–36 days) from documented infection. In multivariable analysis, ischemic stroke was associated with wound infection (aOR 9.0, 95% CI 2.4–34.0, P = 0.001) and BSI (aOR 7.7, 95% CI 0.9–66.0, P = 0.064), and hemorrhagic stroke was associated with BSI in 100% of cases (P = 0.01). There was no association with driveline or pump pocket infection. The cumulative survival rate among patients with infection-related stroke was significantly lower compared to those with LVAD infection but no stroke (log-rank P < 0.001). There was a trend toward shorter stroke-free survival among patients with LVAD infection. Conclusions: LVAD infections, particularly BSI, are significantly associated with stroke, and infection-related stroke conferred significantly lower cumulative survival.

Original languageEnglish (US)
Pages (from-to)72-80
Number of pages9
JournalNeurocritical care
Volume31
Issue number1
DOIs
StatePublished - Aug 15 2019

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Heart-Assist Devices
Stroke
Infection
Wound Infection
Survival

Keywords

  • HeartMate II (HM II)
  • HeartWare (HVAD)
  • Hemorrhagic stroke
  • Infection
  • Ischemic stroke
  • Left ventricular assist device (LVAD)
  • Stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

Stroke Risk Following Infection in Patients with Continuous-Flow Left Ventricular Assist Device. / Cho, Sung-Min; Moazami, Nader; Katz, Stuart; Bhimraj, Adarsh; Shrestha, Nabin K.; Frontera, Jennifer A.

In: Neurocritical care, Vol. 31, No. 1, 15.08.2019, p. 72-80.

Research output: Contribution to journalArticle

Cho, Sung-Min ; Moazami, Nader ; Katz, Stuart ; Bhimraj, Adarsh ; Shrestha, Nabin K. ; Frontera, Jennifer A. / Stroke Risk Following Infection in Patients with Continuous-Flow Left Ventricular Assist Device. In: Neurocritical care. 2019 ; Vol. 31, No. 1. pp. 72-80.
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abstract = "Background: Infection has been associated with stroke in patients with left ventricular assist devices (LVAD); however, little data exist on the timing, type and mortality impact of infection-related stroke. Methods: Prospectively collected data of HeartMate II (N = 332) and HeartWare (N = 70) LVAD patients from a single center were reviewed. Only strokes (ischemic or hemorrhagic) that occurred within 6 weeks following a LVAD infection were considered in analyses. The association between LVAD infections (wound, pump pocket, driveline and/or bloodstream infection [BSI]), specific pathogens and ischemic and hemorrhagic strokes was evaluated using multivariable logistic regression analysis. The impact of infection-related stroke on cumulative survival was assessed using Kaplan–Meier analysis. Results: Of 402 patients, LVAD infection occurred in 158 (39{\%}) including BSI in 107 (27{\%}), driveline infection in 67 (17{\%}), wound infection in 31 (8{\%}) and pump pocket infection in 24 (6{\%}). LVAD infection-related stroke occurred in 20/158 (13{\%}) patients in a median of 4 days (0–36 days) from documented infection. In multivariable analysis, ischemic stroke was associated with wound infection (aOR 9.0, 95{\%} CI 2.4–34.0, P = 0.001) and BSI (aOR 7.7, 95{\%} CI 0.9–66.0, P = 0.064), and hemorrhagic stroke was associated with BSI in 100{\%} of cases (P = 0.01). There was no association with driveline or pump pocket infection. The cumulative survival rate among patients with infection-related stroke was significantly lower compared to those with LVAD infection but no stroke (log-rank P < 0.001). There was a trend toward shorter stroke-free survival among patients with LVAD infection. Conclusions: LVAD infections, particularly BSI, are significantly associated with stroke, and infection-related stroke conferred significantly lower cumulative survival.",
keywords = "HeartMate II (HM II), HeartWare (HVAD), Hemorrhagic stroke, Infection, Ischemic stroke, Left ventricular assist device (LVAD), Stroke",
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T1 - Stroke Risk Following Infection in Patients with Continuous-Flow Left Ventricular Assist Device

AU - Cho, Sung-Min

AU - Moazami, Nader

AU - Katz, Stuart

AU - Bhimraj, Adarsh

AU - Shrestha, Nabin K.

AU - Frontera, Jennifer A.

PY - 2019/8/15

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N2 - Background: Infection has been associated with stroke in patients with left ventricular assist devices (LVAD); however, little data exist on the timing, type and mortality impact of infection-related stroke. Methods: Prospectively collected data of HeartMate II (N = 332) and HeartWare (N = 70) LVAD patients from a single center were reviewed. Only strokes (ischemic or hemorrhagic) that occurred within 6 weeks following a LVAD infection were considered in analyses. The association between LVAD infections (wound, pump pocket, driveline and/or bloodstream infection [BSI]), specific pathogens and ischemic and hemorrhagic strokes was evaluated using multivariable logistic regression analysis. The impact of infection-related stroke on cumulative survival was assessed using Kaplan–Meier analysis. Results: Of 402 patients, LVAD infection occurred in 158 (39%) including BSI in 107 (27%), driveline infection in 67 (17%), wound infection in 31 (8%) and pump pocket infection in 24 (6%). LVAD infection-related stroke occurred in 20/158 (13%) patients in a median of 4 days (0–36 days) from documented infection. In multivariable analysis, ischemic stroke was associated with wound infection (aOR 9.0, 95% CI 2.4–34.0, P = 0.001) and BSI (aOR 7.7, 95% CI 0.9–66.0, P = 0.064), and hemorrhagic stroke was associated with BSI in 100% of cases (P = 0.01). There was no association with driveline or pump pocket infection. The cumulative survival rate among patients with infection-related stroke was significantly lower compared to those with LVAD infection but no stroke (log-rank P < 0.001). There was a trend toward shorter stroke-free survival among patients with LVAD infection. Conclusions: LVAD infections, particularly BSI, are significantly associated with stroke, and infection-related stroke conferred significantly lower cumulative survival.

AB - Background: Infection has been associated with stroke in patients with left ventricular assist devices (LVAD); however, little data exist on the timing, type and mortality impact of infection-related stroke. Methods: Prospectively collected data of HeartMate II (N = 332) and HeartWare (N = 70) LVAD patients from a single center were reviewed. Only strokes (ischemic or hemorrhagic) that occurred within 6 weeks following a LVAD infection were considered in analyses. The association between LVAD infections (wound, pump pocket, driveline and/or bloodstream infection [BSI]), specific pathogens and ischemic and hemorrhagic strokes was evaluated using multivariable logistic regression analysis. The impact of infection-related stroke on cumulative survival was assessed using Kaplan–Meier analysis. Results: Of 402 patients, LVAD infection occurred in 158 (39%) including BSI in 107 (27%), driveline infection in 67 (17%), wound infection in 31 (8%) and pump pocket infection in 24 (6%). LVAD infection-related stroke occurred in 20/158 (13%) patients in a median of 4 days (0–36 days) from documented infection. In multivariable analysis, ischemic stroke was associated with wound infection (aOR 9.0, 95% CI 2.4–34.0, P = 0.001) and BSI (aOR 7.7, 95% CI 0.9–66.0, P = 0.064), and hemorrhagic stroke was associated with BSI in 100% of cases (P = 0.01). There was no association with driveline or pump pocket infection. The cumulative survival rate among patients with infection-related stroke was significantly lower compared to those with LVAD infection but no stroke (log-rank P < 0.001). There was a trend toward shorter stroke-free survival among patients with LVAD infection. Conclusions: LVAD infections, particularly BSI, are significantly associated with stroke, and infection-related stroke conferred significantly lower cumulative survival.

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KW - HeartWare (HVAD)

KW - Hemorrhagic stroke

KW - Infection

KW - Ischemic stroke

KW - Left ventricular assist device (LVAD)

KW - Stroke

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