The risk of stroke recurrence in patients with atrial fibrillation and reduced ejection fraction
Authors:   RAF and RENO-EXTEND Investigators, Paciaroni Maurizio , Agnelli Giancarlo , Caso Valeria , Becattini Cecilia , Mosconi Maria Giulia , Giustozzi Michela , Tsivgoulis Georgios , Seiffge David Julian , Engelter Stefan T. , Lyrer Philippe , Polymeris Alexandros A. , Dittrich Tolga , Zietz Annaelle , Putaala Jukka , Strbian Daniel , Tomppo Liisa , Michel Patrik , Strambo Davide , Salerno Alexander , Remillard Suzette , Buehrer Manuela , Bavaud Odessa , Vanacker Peter , Zuurbier Susanna M. , Yperzeele Laetitia , Loos Caroline M.J. , Cappellari Manuel , Emiliani Andrea , Zedde Marialuisa , Abdul-Rahim Azmil H. , Dawson Jesse , Cronshaw Robert , Schirinzi Erika , Del Sette Massimo , Stretz Christoph , Kala Narendra , Reznik Michael , Schomer Ashley , Mac Grory Brian , Jayaraman Mahesh , Yaghi Shadi , Furie Karen L. , Masotti Luca , Grifoni Elisa , Toni Danilo , Risitano Angela , Falcou Anne , Petraglia Luca , Lotti Enrico Maria , Padroni Marina , Pavolucci Lucia , Lochner Piergiorgio , Silvestrelli Giorgio , Ciccone Alfonso , Alberti Andrea , Venti Michele , De Magistris Ilaria Leone , Cancelloni Virginia , Kargiotis Odysseas , Rocco Alessandro , Diomedi Marina , Marcheselli Simona , Caliandro Pietro , Zauli Aurelia , Reale Giuseppe , Moci Marco , Antonenko Kateryna , Rota Eugenia , Tassinari Tiziana , Saia Valentina , Palmerini Francesco , Aridon Paolo , Arnao Valentina , Monaco Serena , Cottone Salvatore , Baldi Antonio , D’Amore Cataldo , Ageno Walter , Pegoraro Samuela , Ntaios George , Sagris Dimitrios , Giannopoulos Sotirios , Kosmidou Maria , Ntais Evangelos , Romoli Michele , Pantoni Leonardo , Rosa Silvia , Bertora Pierluigi , Chiti Alberto , Canavero Isabella , Saggese Carlo Emanuele , Plocco Maurizio , Giorli Elisa , Palaiodimou Lina , Bakola Eleni , Bandini Fabio , Gasparro Antonio , Terruso Valeria , Mannino Marina , Pezzini Alessandro , Morotti Andrea , Magoni Mauro , Ornello Raffaele , Sacco Simona , Popovic Nemanja , Scoditti Umberto , Genovese Antonio , Denti Licia , Flomin Yuriy , Mancuso Michelangelo , Ferrari Elena , Caselli Maria Chiara , Ulivi Leonardo , Giannini Nicola , Vadikolias Kostantinos , Liantinioti Chrysoula , Chondrogianni Maria , Carletti Monica , Karagkiozi Efstathia , Athanasakis George , Makaritsis Kostantinos , Lanari Alessia , Tatlisumak Turgut , Acciarresi Monica , Vannucchi Vieri , Lorenzini Gianni , Tassi Rossana , Guideri Francesca , Acampa Maurizio , Martini Giuseppe , Sohn Sung-Il , Mumoli Nicola , Tadi Prasanna , Letteri Federica , Maccarrone Miriam , Galati Franco , Tiseo Cindy , Gourbali Vanessa , Halvatsiotis Panagiotis , Orlandi Giovanni , Giuntini Martina , Corea Francesco , Bellesini Marta , Baronello Mario Maimone , Karapanayiotides Theodore , Rueckert Christina , Csiba Laszló , Szabó Lilla , Rigatelli Alberto , Imberti Davide , Zabzuni Dorjan , Pieroni Alessio , Barlinn Kristian , Pallesen Lars-Peder , Barlinn Jessica , Doronin Boris , Volodina Vera , Deleu Dirk , Bonetti Bruno , Porta Cesare , Gentile Luana , Eskandari Ashraf , De Marchis Gian Marco 
Published: May 2023

Background: Atrial fibrillation (AF) and congestive heart failure often coexist due to their shared risk factors leading to potential worse outcome, particularly cerebrovascular events. The aims of this study were to calculate the rates of ischemic and severe bleeding events in ischemic stroke patients having both AF and reduced ejection fraction (rEF) (⩽40%), compared to ischemic stroke patients with AF but without rEF. Methods: We performed a retrospective analysis that drew data from prospective studies. The primary outcome was the composite of either ischemic (stroke or systemic embolism), or hemorrhagic events (symptomatic intracranial bleeding and severe extracranial bleeding). Results: The cohort for this analysis comprised 3477 patients with ischemic stroke and AF, of which, 643 (18.3%) had also rEF. After a mean follow-up of 7.5 ± 9.1 months, 375 (10.8%) patients had 382 recorded outcome events, for an annual rate of 18.0%. While the number of primary outcome events in patients with rEF was 86 (13.4%), compared to 289 (10.2%) for the patients without rEF; on multivariable analysis rEF was not associated with the primary outcome (OR 1.25; 95% CI 0.84–1.88). At the end of follow-up, 321 (49.9%) patients with rEF were deceased or disabled (mRS ⩾3), compared with 1145 (40.4%) of those without rEF; on multivariable analysis, rEF was correlated with mortality or disability (OR 1.35; 95% CI 1.03–1.77). Conclusions: In patients with ischemic stroke and AF, the presence of rEF was not associated with the composite outcome of ischemic or hemorrhagic events over short-term follow-up but was associated with increased mortality or disability.