Gender differences in the risk of stroke during support with continuous-flow left ventricular assist device.
BACKGROUND
There is increasing recognition that the risk of stroke after left ventricular assist device (LVAD) implantation varies based on gender, with a higher risk in female patients. We reviewed our own data to determine gender differences in the risk of stroke.


METHODS
Frequency of stroke, including intracranial hemorrhage and ischemic stroke, was retrospectively evaluated in 110 heart failure patients (mean age 49.6 ± 13.6 years, 32% women) discharged from the hospital after implantation of a HeartMate II (N = 74) or HeartWare (N = 36) LVAD. Competing outcomes analysis was used to determine which clinical risk factors were associated with the risk of stroke and death, with the primary end-point being time to first stroke event.


RESULTS
During a median follow-up of 1.3 years, 26 patients had a stroke (23.6%, 0.14 case per person-year). The median time to first stroke was 0.7 (interquartile range 0.3 to 1.4) years. After adjusting for covariates, risk of stroke was higher for women than for men (hazard ratio 3.1, 95% confidence interval 1.4 to 6.9; p = 0.007). There was no difference in overall survival between men and women.


CONCLUSIONS
The risk of stroke after LVAD varies based on gender, with a higher risk in female patients. More research is needed to fully understand these differences, and whether device management strategies should be tailored based on gender.
Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia. Electronic address: aamorr3@emory.edu.
Alanna A
AA
Morris
Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
Ann
A
Pekarek
Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
Kris
K
Wittersheim
Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
Robert T
RT
Cole
Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
Divya
D
Gupta
Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
Duc
D
Nguyen
Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
S Raja
SR
Laskar
Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
Javed
J
Butler
Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
Andrew
A
Smith
Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
J David
JD
Vega
D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology*
gender; healthcare disparities; heart failure; left ventricular assist device; prognosis; risk factors; stroke