Left-sided valvular heart disease and stroke outcomes: a nationwide cohort study from Sweden

Abstract Background/introduction As the global life expectancy increases, so does the burden of valvular heart disease, especially degenerative left-sided valvulopathy1. Both the pathophysiology of and treatment options for these conditions entails a risk of stroke2. An analysis of the baseline risk of stroke in this population, as well as post-stroke morbidity and mortality, is therefore essential for treatment planning. Purpose To investigate the relationship between left-sided valvular heart disease (LS-VHD) and ischaemic stroke, with special consideration to disabling stroke and all-cause mortality. Methods Our population consisted of all ischaemic strokes registered in the Swedish Stroke Registry between 1995-2012. Follow-up data on functional status after stroke expressed by the modified Rankin Scale (mRS) was obtained from the registry, while information on LS-VHD and all-cause mortality was collected from the National Patient Register and the Cause of Death Registry, respectively. Using the Kaplan-Meier estimate and the Cox proportional hazards model, we examined the effects of a diagnosis of (LS-VHD) on the risk of death and stroke severity in the population. Results A total of 258,260 stroke patients were included. Data on stroke severity at three-month follow up were available for 162,195 survivors. Notably, 12,543 patients (or 4.86 %) had a LS-VHD. Those with LS-VHD had significantly higher rates of death and disabling stroke. A diagnosis of a LS-VHD was associated with worse survival across all groups of stroke severity (Figure 1). The multivariable adjusted risk of disabling stroke (defined as mRS 4 or 5) was significantly increased for degenerative mitral stenosis (OR = 1.57, 95 % CI = 1.15-2.15). In multivariate analysis adjusted for major confounders (Figure 2), several LS-VHD increased the risk of death after stroke, with the greatest association observed in degenerative mitral stenosis (HR = 1.31, 95 % CI = 1.17-1.46), aortic stenosis (HR = 1.12, 95 CI = 1.09-1.15) and rheumatic mitral stenosis (HR = 1.21, 95 % CI = 1.06-1.38). Conclusion(s) In this stroke population, LS-VHD and especially degenerative mitral stenosis and aortic stenosis, was associated with an increased risk of death, even after accounting for stroke severity and established risk factors.Survival grouped by stroke and VHD Multivariate Cox regression