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. 2025 Jun;10(2):478-486.
doi: 10.1177/23969873241290440. Epub 2024 Oct 13.

Stroke-heart syndrome and early mortality in patients with acute ischaemic stroke using hierarchical cluster analysis: An individual patient data pooled analysis from the VISTA database

Hironori Ishiguchi  1   2   3 , Bi Huang  1   3 , Wahbi K El-Bouri  1   3 , Gregory Y H Lip  1   4 , Azmil H Abdul-Rahim  1   3   5 ; VISTA Collaborators*
Collaborators, Affiliations

Stroke-heart syndrome and early mortality in patients with acute ischaemic stroke using hierarchical cluster analysis: An individual patient data pooled analysis from the VISTA database

Hironori Ishiguchi et al. Eur Stroke J. 2025 Jun.

Abstract

Background: The patient clinical phenotypes at particularly high risk for early cardiac complications after a recent acute ischaemic stroke (AIS), that is, stroke-heart syndrome (SHS), remain poorly defined. We utilised hierarchical cluster analysis to identify specific phenotypic profiles associated with this risk.

Methods: We gathered data on patients with AIS from the Virtual International Stroke Trials Archive, a global repository of clinical trial data. We examined cardiac complications within 30 days post-stroke, including acute coronary syndrome, heart failure, arrhythmias and cardiorespiratory arrest. We employed hierarchical cluster analysis to define distinct phenotypic risk profiles. The incidence/risk of SHS and 90-day mortality were compared across these profiles.

Results: We included 12,482 patients (mean age 69 ± 12 years; 55% male), yielding five phenotypes: Profile 1 ('elderly and AF'), Profile 2 ('young and smoker'), Profile 3 ('young'), Profile 4 ('cardiac comorbidities') and Profile 5 ('hypertension with atherosclerotic comorbidities'). Profiles 4 and 1 exhibited the highest risk for SHS (adjusted HR (95% CI): 2.01 (1.70-2.38) and 1.26 (1.05-1.51), respectively, compared to Profile 3), while Profiles 5 and 2 showed moderate risk and Profile 3 had the lowest risk. Although Profiles 1 and 4 were at the highest risk for most SHS presentations, Profile 5 had the highest risk for cardiorespiratory arrest (adjusted HR (95% CI): 2.99 (1.22-7.34)). The 90-day mortality risk was stratified by phenotype, with the highest risk observed in Profiles 5, and 4.

Conclusions: Hierarchical cluster analysis effectively identified phenotypes with the highest risk of SHS and early mortality in patients with AIS.

Keywords: Hierarchical cluster analysis; ischaemic stroke; stroke-heart syndrome.

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Conflict of interest statement

Declaration of conflicting interestThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: HI, BH, WKE, JD and AHAR report no conflicts of interest.GYHL reports Consultant and speaker for BMS/Pfizer, Boehringer Ingelheim, Daiichi-Sankyo, Anthos. No fees are received personally. He is a National Institute for Health and Care Research (NIHR) Senior Investigator and co-PI of the AFFIRMO project on multimorbidity in AF (grant agreement No 899871), TARGET project on digital twins for personalised management of atrial fibrillation and stroke (grant agreement No 101136244) and ARISTOTELES project on artificial intelligence for management of chronic long term conditions (grant agreement No 101080189), which are all funded by the EU’s Horizon Europe Research & Innovation programme.

Figures

Graphical abstract
Graphical abstract
Figure 1.
Figure 1.
Dendrogram obtained from hierarchical cluster analysis. The horizonal line indicates the cut-off line the whole cohort dividing five profiles.
Figure 2.
Figure 2.
The comparison of the incidence of stroke-heart syndrome across five profiles: (a) The Kaplan-Meier curve and (b) Plot of hazard ratios adjusted for age and sex, with 95% confidence intervals. SHS: stroke-heart syndrome. Asterisk indicates statistical significance (*p < 0.05, **p < 0.001).
Figure 3.
Figure 3.
The comparison of the incidence of cardiorespiratory arrest across five profiles: (a) The Kaplan-Meier curve and (b) plot of hazard ratios adjusted for age and sex, with 95% confidence intervals. Asterisk indicates statistical significance (*p < 0.05).
Figure 4.
Figure 4.
The comparison of the incidence of mortality across five profiles: (a) The Kaplan-Meier curve and (b) Plot of hazard ratios adjusted for age and sex, with 95% confidence intervals. Asterisk indicates statistical significance (*p < 0.05, **p < 0.001).
See this image and copyright information in PMC

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