title: Silent strokes in patients with heart failure.
abstract: BACKGROUND
  The prevalence of asymptomatic strokes detected by brain imaging in a large cohort of patients with congestive heart failure (CHF) and reduced ejection fraction (EF) is unknown.
  
  
  RESULTS
  The present study was conducted to assess the prevalence of cerebrovascular accidents (CVA) diagnosed by routine brain imaging in neurologically asymptomatic patients with CHF who were being evaluated for heart transplantation. A comprehensive review of clinical data in a consecutive case series of 168 adult patients being evaluated was conducted. Patients at a high risk of having cerebral infarction (ie, history of transient ischemic attack or stroke, paroxysmal or chronic atrial fibrillation, intracardiac thrombi, and prosthetic valves) were excluded. Brain imaging was performed as part of a routine pre-heart transplant evaluation protocol. The prevalence of silent ischemic strokes was 34%. Multiple logistic regression analysis revealed a 2.3 (95% CI 1.05-5.03) times increased risk of silent strokes if a patient was African American. Traditional risk factors such as age, gender, hypertension, and diabetes mellitus were not predictive of CVA in this population.
  
  
  CONCLUSIONS
  Patients with CHF and a left ventricular EF less than 20% being evaluated for heart transplantation have a high prevalence of ischemic CVA. The role of anticoagulation in this high-risk group of patients should be further explored.
authors.affiliation: Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Siachos
authors.forename: Adrian
authors.initials: A
authors.lastname: Vanbakel
authors.forename: David S
authors.initials: DS
authors.lastname: Feldman
authors.forename: Walter
authors.initials: W
authors.lastname: Uber
authors.forename: Kit N
authors.initials: KN
authors.lastname: Simpson
authors.forename: Naveen L
authors.initials: NL
authors.lastname: Pereira
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000368:Aged; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006333:Heart Failure / Q000150:complications* / Q000208:ethnology / Q000628:therapy; D016027:Heart Transplantation; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D012307:Risk Factors; D013022:South Carolina / Q000453:epidemiology; D020521:Stroke / Q000150:complications / Q000175:diagnosis* / Q000208:ethnology; D013318:Stroke Volume / Q000187:drug effects; D016896:Treatment Outcome; D044465:White People
chemical_list: D005343:Fibrinolytic Agents