title: Systolic blood pressure on discharge after left ventricular assist device insertion is associated with subsequent stroke.
abstract: BACKGROUND
  Stroke is a significant complication in patients supported with continuous-flow left ventricular assist devices (CF-LVAD) and hypertension is a significant risk factor for stroke, but the association between blood pressure and stroke in LVAD patients is not well characterized.
  
  
  METHODS
  We identified 275 consecutive patients who survived implant hospitalization between January 2005 and April 2013. Patients were grouped according to systolic blood pressure (SBP) as above a median and below a median of 100 mm Hg by their averaged systolic blood pressure during the 48 hours before discharge from implantation hospitalization. The groups were compared for the primary outcome of time to stroke.
  
  
  RESULTS
  The above-median SBP group had mean SBP of 110 mm Hg and the below-median SBP group had mean SBP of 95 mm Hg. There were no significant between-group differences in body mass index, smoking, vascular disease, hypertension, atrial fibrillation, or prior stroke. During a mean follow-up of 16 months, stroke occurred in 16% of the above-median SBP group vs in 7% of the below-median SBP group (hazard ratio, 2.38; 95% confidence interval, 1.11-5.11), with a similar proportion of hemorrhagic and ischemic strokes in each group. In Cox proportional hazard models adjusting for age, diabetes, or prior stroke, the hazard ratio remained statistically significant. SBP as a continuous variable predictor of stroke had an area under the curve of 0.64 in a receiver operating characteristic curve analysis.
  
  
  CONCLUSIONS
  In this large, CF-LVAD cohort, elevated SBP was independently associated with a greater risk of subsequent stroke. These results identify management of hypertension as a potential modifiable risk factor for reducing the incidence of stroke in patients supported by CF-LVAD.
authors.affiliation: Division of Cardiology.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Nassif
authors.affiliation: Department of Medicine.
authors.forename: Anjan
authors.initials: A
authors.lastname: Tibrewala
authors.affiliation: Division of Cardiology.
authors.forename: David S
authors.initials: DS
authors.lastname: Raymer
authors.affiliation: Department of Medicine.
authors.forename: Adam
authors.initials: A
authors.lastname: Andruska
authors.affiliation: Division of Cardiology.
authors.forename: Eric
authors.initials: E
authors.lastname: Novak
authors.affiliation: Division of Cardiology.
authors.forename: Justin M
authors.initials: JM
authors.lastname: Vader
authors.affiliation: Division of Cardiovascular Surgery, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Akinobu
authors.initials: A
authors.lastname: Itoh
authors.affiliation: Division of Cardiovascular Surgery, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Scott C
authors.initials: SC
authors.lastname: Silvestry
authors.affiliation: Division of Cardiology.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Ewald
authors.affiliation: Division of Cardiology. Electronic address: slarue@dom.wustl.edu.
authors.forename: Shane J
authors.initials: SJ
authors.lastname: LaRue
mesh_terms: D001794:Blood Pressure; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D006973:Hypertension / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*
keywords: continuous flow; hypertension; left ventricular assist device; stroke; systolic blood pressure