1
|
Tütüncü S, Olma MC, Kunze C, Dietzel J, Schurig J, Rosenkranz M, Stingele R, Maschke M, Heuschmann PU, Kirchhof P, Laufs U, Nabavi DG, Röther J, Thomalla G, Veltkamp R, Endres M, Haeusler KG. Heart failure, recurrent vascular events and death in patients with ischemic stroke-results of the MonDAFIS study. Intern Emerg Med 2024; 19:1247-1254. [PMID: 38619714 PMCID: PMC11364684 DOI: 10.1007/s11739-024-03594-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 03/20/2024] [Indexed: 04/16/2024]
Abstract
Heart failure (HF) is associated with poor outcome after stroke, but data from large prospective trials are sparse.We assessed the impact of HF on clinical endpoints in patients hospitalized with acute ischemic stroke or transient ischemic attack (TIA) enrolled in the prospective, multicenter Systematic Monitoring for Detection of Atrial Fibrillation in Patients with Acute Ischemic Stroke (MonDAFIS) trial. HF was defined as left ventricular ejection fraction (LVEF) < 55% or a history of HF on admission. The composite of recurrent stroke, major bleeding, myocardial infarction, and all-cause death, and its components during the subsequent 24 months were assessed. We used estimated hazard ratios in confounder-adjusted models. Overall, 410/2562 (16.0%) stroke patients fulfilled the HF criteria (i.e. 381 [14.9%] with LVEF < 55% and 29 [1.9%] based on medical history). Patients with HF had more often diabetes, coronary and peripheral arterial disease and presented with more severe strokes on admission. HF at baseline correlated with myocardial infarction (HR 2.21; 95% CI 1.02-4.79), and all-cause death (HR 1.67; 95% CI 1.12-2.50), but not with major bleed (HR 1.93; 95% CI 0.73-5.06) or recurrent stroke/TIA (HR 1.08; 95% CI 0.75-1.57). The data were adjusted for age, stroke severity, cardiovascular risk factors, and randomization. Patients with ischemic stroke or TIA and comorbid HF have a higher risk of myocardial infarction and death compared with non-HF patients whereas the risk of recurrent stroke or major hemorrhage was similar. Trial registration number Clinicaltrials.gov NCT02204267.
Collapse
Affiliation(s)
- Serdar Tütüncü
- Center for Stroke Research Berlin, Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Manuel C Olma
- Center for Stroke Research Berlin, Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Klinik und Hochschulambulanz für Neurologie mit Abteilung für Experimentelle Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Claudia Kunze
- Center for Stroke Research Berlin, Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Joanna Dietzel
- Center for Stroke Research Berlin, Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Johannes Schurig
- Center for Stroke Research Berlin, Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Michael Rosenkranz
- Klinik für Neurologie und Neurologische Frührehabilitation, Albertinen-Krankenhaus Hamburg, Hamburg, Germany
| | - Robert Stingele
- Department of Neurology, German Red Cross Hospital Berlin Köpenick, Berlin, Germany
| | - Matthias Maschke
- Krankenhaus der Barmherzigen Brüder Trier, Klinik für Neurologie und Neurophysiologie, Trier, Germany
| | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, University Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Center & Clinical Trial Centre Würzburg, University Hospital Würzburg, Würzburg, Germany
| | - Paulus Kirchhof
- German Atrial Fibrillation Network (AFNET), Münster, Germany
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, Medical School, University of Birmingham, Birmingham, UK
- Department of Cardiology, UHB and SWBH NHS Trusts, Birmingham, UK
- University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Darius G Nabavi
- Department of Neurology, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Joachim Röther
- Department of Neurology, Asklepios Klinik Altona, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roland Veltkamp
- Department of Neurology, Alfried Krupp Krankenhaus, Essen, Germany
- Department of Brain Sciences, Imperial College London, London, UK
| | - Matthias Endres
- Center for Stroke Research Berlin, Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Klinik und Hochschulambulanz für Neurologie mit Abteilung für Experimentelle Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Center for Neurodegenerative Diseases, Partner Site Berlin, Berlin, Germany
- German Center for Cardiovascular Diseases, Partner Site Berlin, Berlin, Germany
- Excellence Cluster NeuroCure, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | | |
Collapse
|
2
|
He G, Wei L, Lu H, Deng J, Wang F, Zhu Y. Core overestimation of CT perfusion in patients with cardiac insufficiency who had a stroke is mediated by impaired collaterals. J Neurointerv Surg 2023; 16:31-37. [PMID: 36898828 DOI: 10.1136/jnis-2023-020096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 02/28/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND We hypothesized that left ventricular systolic dysfunction (LVSD) would lead to an ischemic core overestimation in patients with acute ischemic stroke (AIS), and impaired collateral status might partly mediate this effect. OBJECTIVE A pixel-based analysis of CT perfusion (CTP) and follow-up CT was undertaken to investigate the optimum CTP thresholds for the ischemic core if overestimation was found. METHODS A total of 208 consecutive patients with AIS with large vessel occlusion in the anterior circulation, who received initial CTP evaluation and successful reperfusion, were retrospectively analyzed and divided into an LVSD (left ventricular ejection fraction (LVEF) ratio <50%; n=40) and a normal cardiac function (LVEF≥50%; n=168) group. Ischemic core overestimation was considered when the CTP-derived core was larger than the final infarct volume. We investigated the relationship between cardiac function, probability for core overestimation, and collateral scores using mediation analysis. A pixel-based analysis was undertaken to define the optimum CTP thresholds for ischemic core. RESULTS LVSD was independently associated with impaired collaterals (aOR=4.28, 95% CI 2.01 to 9.80, P<0.001) and core overestimation (aOR=2.52, 95% CI 1.07 to 5.72, P=0.030). In mediation analysis, the total effect on core overestimation is composed of the direct effect of LVSD (+17%, P=0.034) and the mediated indirect effect of collateral status (+6%, P=0.020). Collaterals explained 26% of the effect of LVSD on core overestimation. Compared with relative cerebral blood flow (rCBF) thresholds of <35%, <30%, and <20%, a rCBF <25% cut-off point had the highest correlation (r=0.91) and best agreement (mean difference 3.2±7.3 mL) with the final infarct volume to determine the CTP-derived ischemic core in patients with LVSD. CONCLUSIONS LVSD increased the possibility of ischemic core overestimation on baseline CTP, partly due to impaired collateral status, and a stricter rCBF threshold should be considered.
Collapse
Affiliation(s)
- Guangchen He
- Department of Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liming Wei
- Department of Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haitao Lu
- Department of Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiangshan Deng
- Department of Neurology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feng Wang
- Department of Neurology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yueqi Zhu
- Department of Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
3
|
Tirziu D, Kołodziejczak M, Grubman D, Carrión CI, Driskell LD, Ahmad Y, Petrie MC, Omerovic E, Redfors B, Fremes S, Browndyke JN, Lansky AJ. Impact and Implications of Neurocognitive Dysfunction in the Management of Ischemic Heart Failure. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:101198. [PMID: 39131066 PMCID: PMC11308118 DOI: 10.1016/j.jscai.2023.101198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 08/13/2024]
Abstract
Neurocognitive dysfunction is common in heart failure (HF), with 30% to 80% of patients experiencing some degree of deficits in one or more cognitive domains, including memory, attention, learning ability, executive function, and psychomotor speed. Although the mechanism is not fully understood, reduced cardiac output, comorbidities, chronic cerebral hypoperfusion, and cardioembolic brain injury leading to cerebral hypoxia and brain damage seem to trigger the neurocognitive dysfunction in HF. Cognitive impairment is independently associated with worse outcomes including mortality, rehospitalization, and reduced quality of life. Patients with poorer cognitive function are at an increased risk of severe disease as they tend to have greater difficulty complying with treatment requirements. Coronary revascularization in patients with ischemic HF has the potential to improve cardiovascular outcomes but risks worsening neurocognitive dysfunction even further. Revascularization by coronary artery bypass grafting carries inherent risks for delirium, cognitive impairment, neurologic injury, and stroke, which are known to exacerbate the risk of neurocognitive dysfunction. Alternatively, percutaneous coronary intervention, as a less-invasive approach, has the potential to minimize the risk of cognitive impairment but has not yet been evaluated as an alternative to coronary artery bypass grafting in patients with ischemic HF. Therefore, it is paramount to raise awareness of the neurocognitive consequences in ischemic HF and devise strategies for recognition and prevention as an important target of patient management and personalized decision making that contributes to patient outcomes.
Collapse
Affiliation(s)
- Daniela Tirziu
- Yale Cardiovascular Research Group, Yale School of Medicine, New Haven, Connecticut
| | - Michalina Kołodziejczak
- Yale Cardiovascular Research Group, Yale School of Medicine, New Haven, Connecticut
- Department of Anesthesiology and Intensive Care, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Torun, Antoni Jurasz University Hospital No.1, Bydgoszcz, Poland
| | - Daniel Grubman
- Yale Cardiovascular Research Group, Yale School of Medicine, New Haven, Connecticut
| | - Carmen I. Carrión
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | - Lucas D. Driskell
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | - Yousif Ahmad
- Yale Cardiovascular Research Group, Yale School of Medicine, New Haven, Connecticut
| | - Mark C. Petrie
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Redfors
- Department of Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Jeffrey N. Browndyke
- Department of Psychiatry & Behavioral Sciences, Division of Behavioral Medicine & Neurosciences, Duke University Medical Center, Durham, North Carolina
- Department of Surgery, Division of Cardiovascular & Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
- Center for Cognitive Neuroscience, Duke University Medical Center, Durham, North Carolina
| | - Alexandra J. Lansky
- Yale Cardiovascular Research Group, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
4
|
Gamble FN, Aufan MR, Sharifov OF, Williams LJ, Reighard S, Calhoun DA, Gupta H, Dell'Italia LJ, Denney TS, Lloyd SG. Diastolic function: modeling left ventricular untwisting as a damped harmonic oscillator. Physiol Meas 2022; 43:10.1088/1361-6579/ac4e6e. [PMID: 35073533 PMCID: PMC9066283 DOI: 10.1088/1361-6579/ac4e6e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/24/2022] [Indexed: 11/11/2022]
Abstract
Objective.We developed a method using cardiovascular magnetic resonance imaging to model the untwisting of the left ventricle (LV) as a damped torsional harmonic oscillator to estimate shear modulus (intrinsic myocardial stiffness) and frictional damping, then applied this method to evaluate the torsional stiffness of patients with resistant hypertension (RHTN) compared to a control group.Approach.The angular displacement of the LV during diastole was measured. Myocardial shear modulus and damping constant were determined by solving a system of equations modeling the diastolic untwisting as a damped, unforced harmonic oscillator, in 100 subjects with RHTN and 36 control subjects.Main Results.Though overall torsional stiffness was increased in RHTN (41.7 (27.1-60.7) versus 29.6 (17.3-35.7) kdyn*cm;p = 0.001), myocardial shear modulus was not different between RHTN and control subjects (0.34 (0.23-0.50) versus 0.33 (0.22-0.46) kPa;p= 0.758). RHTN demonstrated an increase in overall diastolic frictional damping (6.13 ± 3.77 versus 3.35 ± 1.70 kdyn*cm*s;p< 0.001), but no difference in damping when corrected for the overlap factor (74.3 ± 25.9 versus 68.0 ± 24.0 dyn*s/cm3;p = 0.201). There was an increase in the polar moment (geometric component of stiffness; 11.47 ± 6.95 versus 7.58 ± 3.28 cm4;p<0.001).Significance.We have developed a phenomenological method, estimating the intrinsic stiffness and relaxation properties of the LV based on restorative diastolic untwisting. This model finds increased overall stiffness in RHTN and points to hypertrophy, rather than tissue- level changes, as the major factor leading to increased stiffness.
Collapse
Affiliation(s)
- Forrest N Gamble
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - M Rifqi Aufan
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Oleg F Sharifov
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Lamario J Williams
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Shane Reighard
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - David A Calhoun
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Himanshu Gupta
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, United States of America
- Valley Medical Group, Paramus, New Jersey
| | - Louis J Dell'Italia
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, United States of America
- Birmingham Veterans Affairs Medical Center, Birmingham, AL, United States of America
| | - Thomas S Denney
- Department of Electrical and Computer Engineering, Auburn University, Auburn, AL, United States of America
| | - Steven G Lloyd
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, United States of America
- Birmingham Veterans Affairs Medical Center, Birmingham, AL, United States of America
| |
Collapse
|
5
|
Rivas A, Lauw MN, Bonin-Schnabel R, Crowther M, Van Spall H. Stroke and Thromboembolism in Patients with Heart Failure and Sinus Rhythm: A Matter of Risk Stratification? Thromb Haemost 2022; 122:871-878. [PMID: 35045579 DOI: 10.1055/a-1745-2083] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Patients with heart failure (HF) in sinus rhythm (SR) experience an increased incidence of thromboembolic events including stroke. Among patients with HF, high-quality evidence supports the use of oral anticoagulation when atrial fibrillation (AF) is present, but the benefit of anticoagulation in SR in absence of other known indications for anticoagulation is unclear. In four randomized controlled trials (RCTs), warfarin did not improve a composite of clinical outcomes compared with aspirin or placebo in patients with HF with reduced ejection fraction (HFrEF) and SR. A recent RCT assessed the efficacy of the direct oral anticoagulant rivaroxaban versus placebo in patients with HFrEF (including mildly reduced ejection fraction), SR and coronary artery disease. While rivaroxaban had a neutral effect on the primary composite outcome of MI, stroke, or all-cause mortality, exploratory analyses revealed a significant reduction in strokes. It is thus possible that a subgroup of patients with HFrEF who are at high risk of stroke may benefit from anticoagulation. The challenge is to adequately identify this subgroup and to balance the potential benefit of anticoagulation with the risk of major bleeding. There is also an unmet need for evidence around anticoagulation in HF with preserved ejection fraction (HFpEF) and SR. This review explores the current evidence around anticoagulation in patients with HF and SR, identifies challenges regarding outcome definitions and patient selection, and offers suggestions for future research.
Collapse
Affiliation(s)
| | - Mandy N Lauw
- Hematology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Renate Bonin-Schnabel
- Cardiology, Universitätsklinikum Hamburg Eppendorf Universitäres Herzzentrum Hamburg GmbH, Hamburg, Germany
| | | | - Harriette Van Spall
- Medicine, McMaster University, Hamilton, Canada.,Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.,Population Health Research Institute, McMaster University, Hamilton, Canada
| |
Collapse
|
6
|
Park JH, Hwang IC, Park JJ, Park JB, Cho GY. Left Atrial Strain to Predict Stroke in Patients With Acute Heart Failure and Sinus Rhythm. J Am Heart Assoc 2021; 10:e020414. [PMID: 34187174 PMCID: PMC8403314 DOI: 10.1161/jaha.120.020414] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Stroke is a major comorbidity in patients with heart failure (HF), especially in those with decreased left atrial (LA) function, and thus, identifying patients highly at risk of stroke can prevent its occurrence. We evaluated the predictive value of global longitudinal strain of LA (LAGLS) in patients with acute HF and sinus rhythm. Methods and Results In this retrospective study, 2461 patients (53.3% men, 69.7±14.4 years old) with sinus rhythm and LAGLS among 4312 consecutive patients with acute HF from 3 tertiary hospitals were included. HF phenotypes were defined as HF with reduced ejection fraction (EF) (left ventricular EF ≤40%), HF with midrange EF (40% <left ventricular EF <50%), and HF with preserved ejection fraction (left ventricular EF ≥50%). Primary outcome was new‐onset stroke. The mean left ventricular EF was 39.4%±15.6%. Moreover, 1388 (57.5%), 342 (14.2%), and 682 (28.3%) were classified with HF with reduced EF, HF with midrange EF, and HF with preserved EF, retrospectively. LAGLS was 17.2%±10.4%. During the follow‐up duration (mean: 30.3±25.4 months), 100 patients experienced stroke. Patients with stroke had higher LA diameter (P=0.031) and lower LAGLS (P=0.010) than those without stroke. In the univariate analysis, age, diabetes mellitus, LA diameter, LA volume index, and LAGLS were significant risk factors for stroke. In the multivariate analysis, each 1% decrease in LAGLS was associated with a 3.8% increased risk for stroke (hazard ratio [HR], 1.038; 95% CI, 1.013–1.065; P=0.003). When applying a LAGLS cutoff point of 14.5%, patients with LAGLS <14.5% had approximately twice the risk for stroke after adjusting other significant variables (HR, 1.940; 95% CI, 1.269–2.965; P=0.002). Conclusions In patients with acute HF and sinus rhythm, decreased LAGLS (<14.5%) was associated with an increased risk for stroke, with an annual incidence of 2.38%.
Collapse
Affiliation(s)
- Jae-Hyeong Park
- Department of Cardiology in Internal Medicine Chungnam National University HospitalChungnam National University College of Medicine Daejeon Korea
| | - In-Chang Hwang
- Cardiovascular Center & Department of Internal Medicine Seoul National University College of MedicineSeoul National University Bundang Hospital Seongnam Korea
| | - Jin Joo Park
- Cardiovascular Center & Department of Internal Medicine Seoul National University College of MedicineSeoul National University Bundang Hospital Seongnam Korea
| | - Jun-Bean Park
- Department of Internal Medicine Seoul National University College of MedicineSeoul National University Hospital Seoul Korea
| | - Goo-Yeong Cho
- Cardiovascular Center & Department of Internal Medicine Seoul National University College of MedicineSeoul National University Bundang Hospital Seongnam Korea
| |
Collapse
|
7
|
Tan BYQ, Leow AS, Lee TH, Gontu VK, Andersson T, Holmin S, Wong HF, Lin CM, Cheng CK, Sia CH, Ngiam N, Ng ZX, Yeo J, Chan B, Teoh HL, Seet R, Paliwal P, Anil G, Yang C, Maus V, Abdullayev N, Mpotsaris A, Bhogal P, Wong K, Makalanda HLD, Spooner O, Amlani S, Campbell D, Michael R, Quäschling U, Schob S, Maybaum J, Sharma VK, Yeo LL. Left ventricular systolic dysfunction is associated with poor functional outcomes after endovascular thrombectomy. J Neurointerv Surg 2020; 13:515-518. [PMID: 32883782 DOI: 10.1136/neurintsurg-2020-016216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/15/2020] [Accepted: 06/18/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Endovascular thrombectomy (ET) has transformed acute ischemic stroke (AIS) therapy in patients with large vessel occlusion (LVO). Left ventricular systolic dysfunction (LVSD) decreases global cerebral blood flow and predisposes to hypoperfusion. We evaluated the relationship between LVSD, as measured by LV ejection fraction (LVEF), and clinical outcomes in patients with anterior cerebral circulation LVO who underwent ET. METHODS This multicenter retrospective cohort study examined anterior circulation LVO AIS patients from six international stroke centers. LVSD was measured by assessment of the echocardiographic LVEF using Simpson's biplane method of discs according to international guidelines. LVSD was defined as LVEF <50%. The primary outcome was defined as a good functional outcome using a modified Rankin Scale (mRS) of 0-2 at 3 months. RESULTS We included 440 AIS patients with LVO who underwent ET. On multivariate analyses, pre-existing diabetes mellitus (OR 2.05, 95% CI 1.24 to 3.39;p=0.005), unsuccessful reperfusion (Treatment in Cerebral Infarction (TICI) grade 0-2a) status (OR 4.21, 95% CI 2.04 to 8.66; p<0.001) and LVSD (OR 2.08, 95% CI 1.18 to 3.68; p=0.011) were independent predictors of poor functional outcomes at 3 months. On ordinal (shift) analyses, LVSD was associated with an unfavorable shift in the mRS outcomes (OR 2.32, 95% CI 1.52 to 3.53; p<0.001) after adjusting for age and ischemic heart disease. CONCLUSION Anterior circulation LVO AIS patients with LVSD have poorer outcomes after ET, suggesting the need to consider cardiac factors for ET, the degree of monitoring and prognostication post-procedure.
Collapse
Affiliation(s)
- Benjamin Y Q Tan
- National University Health System, Singapore.,National University Singapore Yong Loo Lin School of Medicine, Singapore
| | | | - Tsong-Hai Lee
- Stroke Center and Department of Neurology, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan 333, Taiwan
| | - Vamsi Krishna Gontu
- Departments of Neuroradiology, Karolinska University Hospital and Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Tommy Andersson
- Departments of Neuroradiology, Karolinska University Hospital and Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Departments of Radiology and Neurology, AZ Groeninge, Kortrijk, Belgium
| | - Staffan Holmin
- Departments of Neuroradiology, Karolinska University Hospital and Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ho-Fai Wong
- Neuroradiology, Division of Neuroradiology Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital; Linkou,Taiwan, Taoyuan, Guishan District, Taiwan.,College of Medicine and School of Medical Technology, Chang Gung University, Taoyuan, Taiwan
| | - Chuan-Min Lin
- Division of Neuroradiology, Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chih-Kuang Cheng
- Division of Neuroradiology, Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ching-Hui Sia
- National University Singapore Yong Loo Lin School of Medicine, Singapore.,National University Heart Centre, Singapore
| | | | - Zhi-Xuan Ng
- National University Singapore Yong Loo Lin School of Medicine, Singapore
| | - Joshua Yeo
- National University Singapore Yong Loo Lin School of Medicine, Singapore.,National University Heart Centre, Singapore
| | - Bernard Chan
- National University Health System, Singapore.,National University Singapore Yong Loo Lin School of Medicine, Singapore
| | - Hock-Luen Teoh
- National University Health System, Singapore.,National University Singapore Yong Loo Lin School of Medicine, Singapore
| | - Raymond Seet
- National University Health System, Singapore.,National University Singapore Yong Loo Lin School of Medicine, Singapore
| | - Prakash Paliwal
- National University Health System, Singapore.,National University Singapore Yong Loo Lin School of Medicine, Singapore
| | - Gopinathan Anil
- National University Health System, Singapore.,National University Singapore Yong Loo Lin School of Medicine, Singapore
| | - Cunli Yang
- National University Health System, Singapore.,National University Singapore Yong Loo Lin School of Medicine, Singapore
| | - Volker Maus
- Department of Radiology, Neuroradiology and Nuclear Medicine, University Medical Center Langendreer, Bochum, Germany
| | | | - Anastasios Mpotsaris
- Neuroradiology, Rheinisch Westfalische Technische Hochschule Aachen, Aachen, Germany
| | - Pervinder Bhogal
- Department of Interventional Neuroradiology, Royal London Hospital, London, UK
| | - Ken Wong
- Department of Interventional Neuroradiology, Royal London Hospital, London, UK
| | | | - Oliver Spooner
- Department of Neurology, Royal London Hospital, London, UK
| | - Sageet Amlani
- Department of Neurology, Royal London Hospital, London, UK
| | | | - Robert Michael
- Department of Neurology, Royal London Hospital, London, UK
| | - Ulf Quäschling
- Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | - Stefan Schob
- Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | - Jens Maybaum
- Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | - Vijay Kumar Sharma
- National University Health System, Singapore.,National University Singapore Yong Loo Lin School of Medicine, Singapore
| | - Leonard Ll Yeo
- National University Health System, Singapore.,National University Singapore Yong Loo Lin School of Medicine, Singapore
| |
Collapse
|
8
|
Chou YL, Liou JT, Cheng CC, Tsai MC, Lin WS, Cheng SM, Lin CL, Lin CS, Kao CH. The association of ischaemic stroke in patients with heart failure without atrial flutter/fibrillation. Heart 2019; 106:616-623. [DOI: 10.1136/heartjnl-2019-315646] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/02/2019] [Accepted: 09/10/2019] [Indexed: 11/03/2022] Open
Abstract
PurposeThis study evaluated the association between ischaemic stroke (IS) and heart failure (HF) in the absence of atrial fibrillation (AF) or atrial flutter (AFL) using a population-based nation-wide cohort database.MethodNewly diagnosed patients with HF without previous stroke and acute myocardial infarction (AMI) were enrolled. Based on the propensity scores matching age, sex and all comorbidities, our studies comprised 12 179 patients with HF and 12 179 patients without HF. Cox proportion hazard regression models and competing-risk regression models were used to evaluate the risk of IS among patients with HF without AF or AFL.ResultsIn the multivariable analysis, older age (adjusted HR (95% CI)=1.05 (1.04 to 1.05)), male sex (adjusted HR (95% CI)=1.36 (1.24 to 1.50)), diabetes (adjusted HR (95% CI)=2.22 (1.97 to 2.49)) and hypertension (adjusted HR (95% CI)=1.60 (1.41 to 1.82)) were markedly associated with IS in patients with HF. The HF group had a markedly higher risk of IS than did the non-HF group (subdistribution HR (SHR)=1.51, 95% CI: 1.37 to 1.66) and AMI (SHR=3.40, 95% CI: 2.71 to 4.28). Additionally, according to the Kaplan-Meier analysis, patients with HF were at a significantly higher risk of cumulative incidence of IS and AMI than did patients with non-HF (p value of log-rank test <0.001).ConclusionThis study indicated that HF is a strong independent risk factor for IS, even in the absence of AF or AFL. Clinical physicians should investigate IS through routine screening and careful monitoring of patients with HF.
Collapse
|
9
|
Arterial Stiffness and Indices of Left Ventricular Diastolic Dysfunction in Patients with Embolic Stroke of Undetermined Etiology. DISEASE MARKERS 2019; 2019:9636197. [PMID: 31612072 PMCID: PMC6757252 DOI: 10.1155/2019/9636197] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/04/2019] [Accepted: 07/27/2019] [Indexed: 12/31/2022]
Abstract
Purpose The study is aimed at identifying echocardiographic and circulating biomarkers as well as hemodynamic indices of embolic stroke of undetermined etiology (ESUS) in patients aged <65. Methods We prospectively investigated 520 patients with confirmed ischemic stroke and selected those 65 patients who were diagnosed with ESUS (age 54 (47-58) years, 42% male). An additional 36 without stroke but with a similar risk profile were included as a control group (age 53 (47-58) years, 61% male). All patients underwent echocardiography, noninvasive assessment of hemodynamic parameters using a SphygmoCor tonometer (AtCor Med., Australia), and measurements of selected biomarkers. Results ESUS patients and controls were well matched for baseline characteristics including blood pressure and left ventricular ejection fraction (LVEF). Compared to controls, patients with ESUS had lower mean early diastolic (E') and systolic (S') mitral annular velocities and a higher ratio of the peak velocity of early diastolic transmitral flow to the peak velocity of early diastolic mitral annular motion (all p < 0.01). The peak velocity flow in the late diastole (A wave) value and LV mass indexed to the body surface area (LVMI) (g/m2) were higher in the ESUS group than in the control group (both p < 0.01). The isovolumetric relaxation time (IVRT) was longer and the mean left atrial volume index (LAVI) was higher in ESUS patients compared to the control group. Parameters of arterial stiffness such as augmentation pressure, augmentation index, and augmentation index adjusted to a heart rate of 75 bpm (AIx75) were higher in ESUS patients compared to controls (p < 0.05). Patients in the ESUS group had higher levels of asymmetric dimethylarginine, interleukin 6, and N-terminal probrain natriuretic peptide (NT-proBNP, all p < 0.05) than those in the control group. In multivariate analysis, the following factors were significantly associated with the presence of ESUS: AIx75 (odds ratio (OR) 1.095, 95% confidence interval (CI) 1.004-1.194; p = 0.04), IVRT (OR 1.045, 95% CI: 1.009-1.082; p = 0.014), LAVI (OR 1.3, 95% CI: 1.099-1.537; p = 0.002), and NT-proBNP (OR 1.003, 95% CI: 1.001-1.005; p = 0.005). Conclusions Increased arterial stiffness and indices of diastolic dysfunction as well as a higher NT-proBNP level are significantly associated with ESUS. These parameters require further scrutiny over time to understand their impact on the development of symptomatic heart failure. The ClinicalTrials.gov identifier is NCT03377465.
Collapse
|
10
|
Kalesan B, Andersson C, Torp-Pedersen C, Gislason GH, Vasan RS. ASSOCIATIONS OF OCCUPANT MOTOR VEHICLE CRASH WITH FUTURE HEART FAILURE AND ISCHEMIC STROKE IN OLDER ADULTS. Am J Epidemiol 2019; 188:1400-1403. [PMID: 31111859 DOI: 10.1093/aje/kwz077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 03/18/2019] [Accepted: 03/18/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Bindu Kalesan
- Section of Preventive Medicine, Department of Medicine, School of Medicine, Boston University, Boston, MA.,Department of Community Health Sciences, School of Public Health, Boston University, Boston, MA
| | | | - Christian Torp-Pedersen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Ramachandran S Vasan
- Section of Preventive Medicine, Department of Medicine, School of Medicine, Boston University, Boston, MA.,Department of Epidemiology, School of Public Health, Boston University, Boston, MA
| |
Collapse
|
11
|
Li Y, Fitzgibbons TP, McManus DD, Goddeau RP, Silver B, Henninger N. Left Ventricular Ejection Fraction and Clinically Defined Heart Failure to Predict 90-Day Functional Outcome After Ischemic Stroke. J Stroke Cerebrovasc Dis 2018; 28:371-380. [PMID: 30396839 DOI: 10.1016/j.jstrokecerebrovasdis.2018.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/01/2018] [Accepted: 10/06/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Heart failure (HF) is a risk factor for atrial fibrillation (AF), stroke, and post-stroke disability. However, differing definitions and application of HF-criteria may impact model prediction. We compared the predictive ability of left ventricular ejection fraction (LVEF), a readily available objective echocardiographic index, with clinical HF definitions for functional disability and AF in stroke patients. METHODS We retrospectively analyzed ischemic stroke patients evaluated between January 2013 and May 2015. Outcomes of interest were: (a) 90-day functional disability (modified Rankin score 3-6) and (b) AF. We compared: (1) LVEF (continuous variable), (2) left ventricular systolic dysfunction (LVSD)-categories (absent to severe), (3) clinical history of HF, and (4) HF/LVSD-categories: (i) HF absent without LVSD, (ii) HF absent with LVSD, (iii) HF with preserved ejection fraction (HFpEF), and (iv) HF with reduced ejection fraction (HFrEF). Multivariable logistic regression was used to determine the predictive ability for 90-day disability and AF, respectively. RESULTS Six hundred eighty five consecutive patients (44.5% female) fulfilled the study criteria and were included. After adjustment, the LVEF was independently associated with 90-day disability (OR .98, 95% CI .96-.99, P = .011) with similar predictive ability (area under the curve [AUC] = .85) to models including the LVSD-categories (AUC = .85), clinically define HF (AUC = .86), and HF/LVSD-categories (AUC = .86). The LVEF, HF, LVSD-, and HF/LVSD-categories were independently associated with AF (P < .01, each) with similar predictive ability (AUC = .74, .74, .73, and .75, respectively). CONCLUSIONS Compared to commonly defined HF definitions, the objectively determined LVEF possesses comparable predictive ability for 90-day disability and AF in stroke patients.
Collapse
Affiliation(s)
- Yi Li
- Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts.
| | - Timothy P Fitzgibbons
- Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
| | - David D McManus
- Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
| | - Richard P Goddeau
- Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts.
| | - Brian Silver
- Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts.
| | - Nils Henninger
- Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts.
| |
Collapse
|
12
|
Oliveira MMC, Sampaio EES, Kawaoka JR, Hatem MAB, Câmara EJN, Fernandes AMS, Oliveira-Filho J, Aras R. Silent Cerebral Infarctions with Reduced, Mid-Range and Preserved Ejection Fraction in Patients with Heart Failure. Arq Bras Cardiol 2018; 111:419-422. [PMID: 30379259 PMCID: PMC6173340 DOI: 10.5935/abc.20180140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/12/2018] [Indexed: 12/28/2022] Open
Abstract
Heart failure predisposes to an increased risk of silent cerebral infarction, and
data related to left ventricular ejection fraction are still limited. Our
objective was to describe the clinical and echocardiographic characteristics and
factors associated with silent cerebral infarction in patients with heart
failure, according to the left ventricular ejection fraction groups. A
prospective cohort was performed at a referral hospital in Cardiology between
December 2015 and July 2017. The left ventricular ejection fraction groups were:
reduced (≤ 40%), mid-range (41-49%) and preserved (≥ 50%). All
patients underwent cranial tomography, transthoracic and transesophageal
echocardiography. Seventy-five patients were studied. Silent cerebral infarction
was observed in 14.7% of the study population (45.5% lacunar and 54.5%
territorial) and was more frequent in patients in the reduced left ventricular
ejection fraction group (29%) compared with the mid-range one (15.4%, p =
0.005). There were no cases of silent cerebral infarction in the group of
preserved left ventricular ejection fraction. In the univariate analysis, an
association was identified between silent cerebral infarction and reduced (OR =
8.59; 95%CI: 1.71 - 43.27; p = 0.009) and preserved (OR = 0.05; 95%CI:
0.003-0.817, p = 0.003) left ventricular ejection fraction and diabetes mellitus
(OR = 4.28, 95%CI: 1.14-16.15, p = 0.031). In patients with heart failure and
without a clinical diagnosis of stroke, reduced and mid-range left ventricular
ejection fractions contributed to the occurrence of territorial and lacunar
silent cerebral infarction, respectively. The lower the left ventricular
ejection fraction, the higher the prevalence of silent cerebral infarction.
Collapse
Affiliation(s)
| | | | | | - Maria Amélia Bulhões Hatem
- Hospital Universitário Professor Edgard Santos (HUPES) - Universidade Federal da Bahia, Salvador, BA - Brazil
| | | | | | - Jamary Oliveira-Filho
- Hospital Universitário Professor Edgard Santos (HUPES) - Universidade Federal da Bahia, Salvador, BA - Brazil
| | - Roque Aras
- Ambulatório de Cardiomiopatias e Insuficiência Cardíaca - Universidade Federal da Bahia, Salvador, BA - Brazil
| |
Collapse
|
13
|
Gainey J, Blum B, Bowie B, Cooley K, Madeline L, Ervin EL, Nathaniel TI. Stroke and dyslipidemia: clinical risk factors in the telestroke versus non-telestroke. Lipids Health Dis 2018; 17:226. [PMID: 30261884 PMCID: PMC6161368 DOI: 10.1186/s12944-018-0870-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/21/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Clinical risk factors related to not administering thrombolysis to acute ischemic stroke patients with incidence dyslipidemia is not clear. This issue was investigated in telestroke and non-telestroke settings. METHODS We analyzed retrospective data collected from a stroke registry to compare exclusion risk factors in the telestroke and non-telestroke. We performed multivariate analysis was performed to identify risk factors that may result in exclusion from rtPA. Variance inflation factors were used to examine multicollinearity and significant interactions between independent variables in the model, while Hosmer-Lemeshow test, Cox & Snell were used to determine the fitness of the regression models. RESULTS A greater number of patients with acute ischemic stroke with incidence dyslipidemia were treated in the non-telestroke (285) when compared with the telestroke network (187). Although non-telestroke admitted more patients than the telestroke, the telestroke treated more patients with rtPA (89.30%) and excluded less (10.70%), while the non-telestroke excluded from rtPA (61.40%). In the non-telestroke, age (adjusted OR, 0.965; 95% CI, 0.942-0.99), blood glucose level (adjusted OR, 0.995; 95% CI, 0.99-0.999), international normalized ratio (adjusted OR, 0.154; 95% CI, 0.031-0.78),congestive heart failure(CHF) (adjusted OR, 0.318; 95% CI, 0.109-0.928), previous stroke (adjusted OR, 0.405; 95% CI, 0.2-0.821) and renal insufficiency (adjusted OR, 0.179; 95% CI, 0.035-0.908) were all directly linked to exclusion from rtPA. In the telestroke, only body mass index (adjusted OR, 0.911; 95% CI, 0.832-0.997) significantly excluded acute ischemic stroke patients with incidence dyslipidemia from thrombolysis therapy. CONCLUSION Despite having more patients with acute ischemic stroke that present incidence dyslipidemia, the non-telestroke patients had more clinical risk factors that excluded more patients from rtPA when compared with telestroke. Future studies should focus on how identified clinical risk factors can be managed to improve the use of rtPA in the non-telestroke setting. Moreover, the optimization of the risk-benefit ratio of rtPA by the telestroke technology can be advanced to the non-telestroke setting to improve the use of thrombolysis therapy.
Collapse
Affiliation(s)
- Jordan Gainey
- School of Medicine-Greenville, University of South Carolina, 607 Grove Road, Greenville, SC, 29605, USA
| | - Brice Blum
- School of Medicine-Greenville, University of South Carolina, 607 Grove Road, Greenville, SC, 29605, USA
| | - Bekah Bowie
- School of Medicine-Greenville, University of South Carolina, 607 Grove Road, Greenville, SC, 29605, USA
| | - Keiko Cooley
- School of Medicine-Greenville, University of South Carolina, 607 Grove Road, Greenville, SC, 29605, USA
| | - Lee Madeline
- Greenville Health System, 701 Grove Road, Greenville, 29605, SC, USA
| | | | - Thomas I Nathaniel
- School of Medicine-Greenville, University of South Carolina, 607 Grove Road, Greenville, SC, 29605, USA.
| |
Collapse
|
14
|
Siller-Matula JM, Pecen L, Patti G, Lucerna M, Kirchhof P, Lesiak M, Huber K, Verheugt FW, Lang IM, Renda G, Schnabel RB, Wachter R, Kotecha D, Sellal JM, Rohla M, Ricci F, De Caterina R. Heart failure subtypes and thromboembolic risk in patients with atrial fibrillation: The PREFER in AF - HF substudy. Int J Cardiol 2018; 265:141-147. [DOI: 10.1016/j.ijcard.2018.04.093] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/16/2018] [Accepted: 04/20/2018] [Indexed: 01/28/2023]
|
15
|
Doehner W. Comorbidities of chronic heart failure – a systemic syndrome requiring cross-specialty efforts. J Cardiovasc Med (Hagerstown) 2018; 19:79-82. [DOI: 10.2459/jcm.0000000000000606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
16
|
Doehner W, Ural D, Haeusler KG, Čelutkienė J, Bestetti R, Cavusoglu Y, Peña-Duque MA, Glavas D, Iacoviello M, Laufs U, Alvear RM, Mbakwem A, Piepoli MF, Rosen SD, Tsivgoulis G, Vitale C, Yilmaz MB, Anker SD, Filippatos G, Seferovic P, Coats AJS, Ruschitzka F. Heart and brain interaction in patients with heart failure: overview and proposal for a taxonomy. A position paper from the Study Group on Heart and Brain Interaction of the Heart Failure Association. Eur J Heart Fail 2017; 20:199-215. [PMID: 29280256 DOI: 10.1002/ejhf.1100] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 10/23/2017] [Accepted: 11/08/2017] [Indexed: 12/16/2022] Open
Abstract
Heart failure (HF) is a complex clinical syndrome with multiple interactions between the failing myocardium and cerebral (dys-)functions. Bi-directional feedback interactions between the heart and the brain are inherent in the pathophysiology of HF: (i) the impaired cardiac function affects cerebral structure and functional capacity, and (ii) neuronal signals impact on the cardiovascular continuum. These interactions contribute to the symptomatic presentation of HF patients and affect many co-morbidities of HF. Moreover, neuro-cardiac feedback signals significantly promote aggravation and further progression of HF and are causal in the poor prognosis of HF. The diversity and complexity of heart and brain interactions make it difficult to develop a comprehensive overview. In this paper a systematic approach is proposed to develop a comprehensive atlas of related conditions, signals and disease mechanisms of the interactions between the heart and the brain in HF. The proposed taxonomy is based on pathophysiological principles. Impaired perfusion of the brain may represent one major category, with acute (cardio-embolic) or chronic (haemodynamic failure) low perfusion being sub-categories with mostly different consequences (i.e. ischaemic stroke or cognitive impairment, respectively). Further categories include impairment of higher cortical function (mood, cognition), of brain stem function (sympathetic over-activation, neuro-cardiac reflexes). Treatment-related interactions could be categorized as medical, interventional and device-related interactions. Also interactions due to specific diseases are categorized. A methodical approach to categorize the interdependency of heart and brain may help to integrate individual research areas into an overall picture.
Collapse
Affiliation(s)
- Wolfram Doehner
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Germany.,Division of Cardiology and Metabolism, Department of Cardiology (CVK), Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Charité - Universitätsmedizin Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Germany
| | - Dilek Ural
- Department of Cardiology, Koc University School of Medicine, Istanbul, Turkey
| | - Karl Georg Haeusler
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin, Germany
| | - Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Centre of Cardiology, Vilnius University, Lithuania
| | - Reinaldo Bestetti
- Department of Medicine, University of Ribeirão Preto, Ribeirão Preto, Brazil
| | - Yuksel Cavusoglu
- Cardiology Department, Eskisehir Osmangazi University, Eskisehir, Turkey
| | | | - Duska Glavas
- Cardiology Department, University Hospital Split, Croatia
| | - Massimo Iacoviello
- University Cardiology Unit, Cardiothoracic Department, University Hospital, Bari, Italy
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | | | - Amam Mbakwem
- College of Medicine, University of Lagos, Lagos, Nigeria
| | - Massimo F Piepoli
- Heart Failure Unit, Cardiology, G. da Saliceto Hospital, Piacenza, Italy
| | - Stuart D Rosen
- Ealing and Royal Brompton Hospitals and NHLI, Imperial College, London, UK
| | | | - Cristiana Vitale
- Department of Medical Science, IRCCS San Raffaele Pisana, Rome, Italy
| | - M Birhan Yilmaz
- Department of Cardiology, Faculty of Medicine Cumhuriyet University, Sivas, Turkey
| | - Stefan D Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK), Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Charité - Universitätsmedizin Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Germany.,Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Gerasimos Filippatos
- Attikon University Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Petar Seferovic
- University of Belgrade, Faculty of Medicine, Clinical Center of Serbia, Belgrade, Serbia
| | - Andrew J S Coats
- Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - Frank Ruschitzka
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
17
|
Wu Y, Zhu L, Luo Y. Design and Hemocompatibility Analysis of a Double-Suction Injection Suspension Blood Pump Using Computational Fluid Dynamics Methods. Artif Organs 2017; 41:979-987. [DOI: 10.1111/aor.12888] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/12/2016] [Accepted: 10/04/2016] [Indexed: 01/22/2023]
Affiliation(s)
- Yue Wu
- Institute of Biomedical Manufacturing and Life Quality Engineering, School of Mechanical Engineering Shanghai Jiao Tong University; Shanghai China
| | - Liangfan Zhu
- Institute of Biomedical Manufacturing and Life Quality Engineering, School of Mechanical Engineering Shanghai Jiao Tong University; Shanghai China
| | - Yun Luo
- Institute of Biomedical Manufacturing and Life Quality Engineering, School of Mechanical Engineering Shanghai Jiao Tong University; Shanghai China
| |
Collapse
|
18
|
Scherbakov N, Haeusler KG, Doehner W. Ischemic stroke and heart failure: facts and numbers. ESC Heart Fail 2015; 2:1-4. [PMID: 28834645 PMCID: PMC5746959 DOI: 10.1002/ehf2.12026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 03/03/2015] [Indexed: 01/16/2023] Open
Abstract
Heart failure (HF) is pandemic in the modern society. Comorbidities of HF come increasingly to the fore in today's patient presentation and demand multidisciplinary treatment concepts. Ischemic stroke is a major comorbidity in HF patients and frequently contributes to the adverse outcome and functional dependency. Patients with HF are two‐fold to three‐fold more likely to suffer an ischemic stroke, have more than two times higher mortality and show worse functional outcome after stroke compared with non‐HF subjects. The risk of recurrent stroke is about two‐fold elevated in patients with HF. The risk of stroke increased with time duration of HF from 18 per 100 cases in the first year of HF to 47 per 1000 patients within the next 4‐5 years. Moreover, so called ‘silent’ strokes (clinically asymptomatic brain lesions) are two to four times more likely in HF patients. In turn, 10–24% of stroke patients have HF. Specific characteristics of the interaction between ischemic stroke and HF have been uncovered in recent years. However, gaps in present knowledge need to be addressed in future studies. What are the detailed pathophysiologic links beyond atrial fibrillation, stroke patterns, and time courses in the interaction? What implication has HF with preserved versus reduced ejection fraction? Does treatment of HF prevents ischemic stroke or reduces stroke‐related sequelae? This editorial provides a condensed overview on current insights and presents facts and numbers on the interaction between heart failure and ischemic stroke.
Collapse
Affiliation(s)
- Nadja Scherbakov
- Center for Stroke Research Berlin (CSB), Charite Universitätsmedizin Berlin, Berlin, Germany.,German Center for Cardiovascular Diseases (DZHK), Berlin, Germany
| | - Karl Georg Haeusler
- Center for Stroke Research Berlin (CSB), Charite Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Wolfram Doehner
- Center for Stroke Research Berlin (CSB), Charite Universitätsmedizin Berlin, Berlin, Germany.,German Center for Cardiovascular Diseases (DZHK), Berlin, Germany.,Department of Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|