Rheumatic mitral valve disease is associated with worse outcomes in stroke: A Thailand National Database Study

Adrian D. Wood, Gurdeep S. Mannu, Allan B. Clark, Somsak Tiamkao, Kannikar Kongbunkiat, Joao H. Bettencourt-Silva, Kittisak Sawanyawisuth, Narongrit Kasemsap, Raphae S. Barlas, Mamas Mamas, Phyo Kyaw Myint

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Background and purpose: Rheumatic valvular heart disease is associated with increased risk of cerebrovascular events, although there are limited data on the prognosis of patients with rheumatic mitral valve disease (RMVD) following stroke. 
Methods: We examined the association between RMVD and both serious and common cardiovascular and non-cardiovascular (respiratory and infective) complications in a cohort of hospitalised stroke patients based in Thailand. Factors associated with in-hospital mortality were also explored. Data were obtained from a National Insurance Database. All hospitalised strokes between 1st October 2004 and 31st January 2013 were included in the current study. Characteristics and outcomes were compared for RMVD and non-RMVD patients. Logistic regression, propensity score matching, and multivariate models were employed to assess study outcomes. 
Results: In total, 594,681 patients (mean (SD) age=64(14.5) years) with a diagnosis of stroke (ischemic = 306,154; hemorrhagic= 195,392; undetermined = 93,135) were included in this study, of whom 5461 had RMVD. Results from primary analyses showed that following ischemic stroke, and controlling for potential confounding covariates, RMVD was associated (P<0.001) with increased odds for cardiac arrest (OR(95%CI)=2.13(1.68-2.70)), shock (2.13(1.64-2.77)), arrhythmias (1.70(1.21-2.39)), respiratory failure (2.09(1.87-2.33)), pneumonia (2.00(1.81-2.20)), and sepsis (1.39(1.19-1.63)). In hemorrhagic stroke patients, RMVD was associated with increased odds (fully adjusted model) for respiratory failure (1.26(1.01-1.57)), and in patients with undetermined stroke, RMVD was associated with increased odds (fully adjusted analyses) for shock (3.00(1.46-6.14)), respiratory failure (2.70(1.91-3.79)), and pneumonia (2.42(1.88-3.11)). 
Conclusions: RMVD is associated with development of cardiac arrest, shock, arrhythmias, respiratory failure, pneumonia, and sepsis following acute stroke.
Original languageEnglish
Pages (from-to)2695-2701
Issue number11
Early online date4 Oct 2016
Publication statusPublished - Nov 2016


  • complications
  • epidemiology
  • mortality
  • rheumatic heart disease
  • stroke

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