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      Silent Cerebral Infarctions with Reduced, Mid-Range and Preserved Ejection Fraction in Patients with Heart Failure

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          Heart failure predisposes to an increased risk of silent cerebral infarction, and data related to left ventricular ejection fraction are still limited. Our objective was to describe the clinical and echocardiographic characteristics and factors associated with silent cerebral infarction in patients with heart failure, according to the left ventricular ejection fraction groups. A prospective cohort was performed at a referral hospital in Cardiology between December 2015 and July 2017. The left ventricular ejection fraction groups were: reduced (≤ 40%), mid-range (41-49%) and preserved (≥ 50%). All patients underwent cranial tomography, transthoracic and transesophageal echocardiography. Seventy-five patients were studied. Silent cerebral infarction was observed in 14.7% of the study population (45.5% lacunar and 54.5% territorial) and was more frequent in patients in the reduced left ventricular ejection fraction group (29%) compared with the mid-range one (15.4%, p = 0.005). There were no cases of silent cerebral infarction in the group of preserved left ventricular ejection fraction. In the univariate analysis, an association was identified between silent cerebral infarction and reduced (OR = 8.59; 95%CI: 1.71 - 43.27; p = 0.009) and preserved (OR = 0.05; 95%CI: 0.003-0.817, p = 0.003) left ventricular ejection fraction and diabetes mellitus (OR = 4.28, 95%CI: 1.14-16.15, p = 0.031). In patients with heart failure and without a clinical diagnosis of stroke, reduced and mid-range left ventricular ejection fractions contributed to the occurrence of territorial and lacunar silent cerebral infarction, respectively. The lower the left ventricular ejection fraction, the higher the prevalence of silent cerebral infarction.

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          Most cited references 18

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          ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC.

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            Characterization of heart failure patients with mid-range left ventricular ejection fraction-a report from the CHART-2 Study.

            The new category of heart failure (HF), HF with mid-range left ventricular ejection fraction (LVEF) (HFmrEF), has recently been proposed. However, the clinical features of HFmrEF, with reference to HF with preserved LVEF (HFpEF) and HF with reduced LVEF (HFrEF) in the same HF cohort, remain to be fully examined.
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              Chronic heart failure and ischemic stroke.

              Chronic heart failure (CHF) is one of the leading causes of hospitalization, morbidity, and mortality worldwide. This review summarizes current knowledge with regard to CHF as a risk factor for ischemic stroke. CHF is associated with an increased risk of thrombus formation and is accompanied by a 2- to 3-fold increased risk of stroke. Moreover, stroke in CHF patients is associated with poor outcome and higher mortality. Available evidence for additional "vascular" stroke risk factors in heart failure patients is inconsistent and is mostly derived from cohort studies or retrospective analyses. Current guidelines recommend anticoagulation for CHF patients with concomitant atrial fibrillation but not for those in sinus rhythm. Prospective studies are needed to test whether early detection and optimal treatment of CHF reduces the burden of stroke-associated neurologic and neuropsychological sequelae.

                Author and article information

                Arq Bras Cardiol
                Arq. Bras. Cardiol
                Arquivos Brasileiros de Cardiologia
                Sociedade Brasileira de Cardiologia - SBC
                September 2018
                September 2018
                : 111
                : 3
                : 419-422
                [1 ] Escola de Enfermagem da Universidade Federal da Bahia, Salvador, BA - Brazil
                [2 ] Hospital Cardio Pulmonar, Salvador, BA - Brazil
                [3 ] Hospital Universitário Professor Edgard Santos (HUPES) - Universidade Federal da Bahia, Salvador, BA - Brazil
                [4 ] Hospital Ana Nery - Universidade Federal da Bahia, Salvador, BA - Brazil
                [5 ] Programa de Pós-graduação em Medicina e Saúde - Universidade Federal da Bahia, Salvador, BA - Brazil
                [6 ] Ambulatório de Cardiomiopatias e Insuficiência Cardíaca - Universidade Federal da Bahia, Salvador, BA - Brazil
                Author notes
                Mailing Address: Márcia Maria Carneiro Oliveira , Escola de Enfermagem da Universidade Federal da Bahia. Rua Dr. Augusto Viana, S/N. Postal Code 40110-060, Canela, Salvador, BA - Brazil. E-mail: marcia.carneiro@ , marcianinhas@

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Brief Communication

                heart failure, cerebral infarction, stroke volume, stroke


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