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Fan X, Cao J, Li M, Zhang D, El‐Battrawy I, Chen G, Zhou X, Yang G, Akin I. Stroke Related Brain-Heart Crosstalk: Pathophysiology, Clinical Implications, and Underlying Mechanisms. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2307698. [PMID: 38308187 PMCID: PMC11005719 DOI: 10.1002/advs.202307698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/09/2024] [Indexed: 02/04/2024]
Abstract
The emergence of acute ischemic stroke (AIS) induced cardiovascular dysfunctions as a bidirectional interaction has gained paramount importance in understanding the intricate relationship between the brain and heart. Post AIS, the ensuing cardiovascular dysfunctions encompass a spectrum of complications, including heart attack, congestive heart failure, systolic or diastolic dysfunction, arrhythmias, electrocardiographic anomalies, hemodynamic instability, cardiac arrest, among others, all of which are correlated with adverse outcomes and mortality. Mounting evidence underscores the intimate crosstalk between the heart and the brain, facilitated by intricate physiological and neurohumoral complex networks. The primary pathophysiological mechanisms contributing to these severe cardiac complications involve the hypothalamic-pituitary-adrenal (HPA) axis, sympathetic and parasympathetic hyperactivity, immune and inflammatory responses, and gut dysbiosis, collectively shaping the stroke-related brain-heart axis. Ongoing research endeavors are concentrated on devising strategies to prevent AIS-induced cardiovascular dysfunctions. Notably, labetalol, nicardipine, and nitroprusside are recommended for hypertension control, while β-blockers are employed to avert chronic remodeling and address arrhythmias. However, despite these therapeutic interventions, therapeutic targets remain elusive, necessitating further investigations into this complex challenge. This review aims to delineate the state-of-the-art pathophysiological mechanisms in AIS through preclinical and clinical research, unraveling their intricate interplay within the brain-heart axis, and offering pragmatic suggestions for managing AIS-induced cardiovascular dysfunctions.
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Affiliation(s)
- Xuehui Fan
- Key Laboratory of Medical ElectrophysiologyMinistry of Education and Medical Electrophysiological Key Laboratory of Sichuan ProvinceCollaborative Innovation Center for Prevention of Cardiovascular DiseasesInstitute of Cardiovascular ResearchSouthwest Medical UniversityLuzhou646000China
- CardiologyAngiologyHaemostaseologyand Medical Intensive CareMedical Centre MannheimMedical Faculty MannheimHeidelberg University68167HeidelbergGermany
- European Center for AngioScience (ECAS)German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheimand Centre for Cardiovascular Acute Medicine Mannheim (ZKAM)Medical Centre MannheimHeidelberg University68167HeidelbergGermany
| | - Jianyang Cao
- School of Physical EducationSouthwest Medical UniversityLuzhouSichuan Province646000China
- Acupuncture and Rehabilitation DepartmentThe Affiliated Traditional Chinese Medicine Hospital of Southwest Medical UniversityLuzhou646000China
| | - Mingxia Li
- School of Physical EducationSouthwest Medical UniversityLuzhouSichuan Province646000China
- Acupuncture and Rehabilitation DepartmentThe Affiliated Traditional Chinese Medicine Hospital of Southwest Medical UniversityLuzhou646000China
| | - Dechou Zhang
- Department of NeurologyThe Affiliated Traditional Chinese Medicine Hospital of Southwest Medical UniversityLuzhou646000China
| | - Ibrahim El‐Battrawy
- Department of Cardiology and AngiologyRuhr University44780BochumGermany
- Institut für Forschung und Lehre (IFL)Department of Molecular and Experimental CardiologyRuhr‐University Bochum44780BochumGermany
| | - Guiquan Chen
- Acupuncture and Rehabilitation DepartmentThe Affiliated Traditional Chinese Medicine Hospital of Southwest Medical UniversityLuzhou646000China
| | - Xiaobo Zhou
- Key Laboratory of Medical ElectrophysiologyMinistry of Education and Medical Electrophysiological Key Laboratory of Sichuan ProvinceCollaborative Innovation Center for Prevention of Cardiovascular DiseasesInstitute of Cardiovascular ResearchSouthwest Medical UniversityLuzhou646000China
- CardiologyAngiologyHaemostaseologyand Medical Intensive CareMedical Centre MannheimMedical Faculty MannheimHeidelberg University68167HeidelbergGermany
- European Center for AngioScience (ECAS)German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheimand Centre for Cardiovascular Acute Medicine Mannheim (ZKAM)Medical Centre MannheimHeidelberg University68167HeidelbergGermany
| | - Guoqiang Yang
- CardiologyAngiologyHaemostaseologyand Medical Intensive CareMedical Centre MannheimMedical Faculty MannheimHeidelberg University68167HeidelbergGermany
- European Center for AngioScience (ECAS)German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheimand Centre for Cardiovascular Acute Medicine Mannheim (ZKAM)Medical Centre MannheimHeidelberg University68167HeidelbergGermany
- Acupuncture and Rehabilitation DepartmentThe Affiliated Traditional Chinese Medicine Hospital of Southwest Medical UniversityLuzhou646000China
| | - Ibrahim Akin
- CardiologyAngiologyHaemostaseologyand Medical Intensive CareMedical Centre MannheimMedical Faculty MannheimHeidelberg University68167HeidelbergGermany
- European Center for AngioScience (ECAS)German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheimand Centre for Cardiovascular Acute Medicine Mannheim (ZKAM)Medical Centre MannheimHeidelberg University68167HeidelbergGermany
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Muthalaly RG, Abrahams TB, Nerlekar N, Nelson AJ, Tan S, Chan J, Phan T, Ma H, Nicholls SJ. Asymptomatic coronary artery disease in ischaemic stroke survivors: A systematic review and meta-analysis. Eur Stroke J 2024:23969873241231702. [PMID: 38357886 DOI: 10.1177/23969873241231702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Ischaemic stroke and coronary artery disease share risk factors and stroke survivors experience a high rate of cardiac events. Recent work suggests a high burden of asymptomatic coronary artery disease (CAD) in ischaemic stroke survivors. Thus, we performed this systematic review and meta-analysis to A) estimate the prevalence of CAD in ischaemic stroke survivors without known CAD and B) evaluate the association between coronary atherosclerosis and future major adverse cardiovascular events (MACE) in stroke survivors. PATIENTS AND METHODS We conducted a systematic review and meta-analysis according to the PRISMA statement. We included studies investigating acute ischaemic stroke or transient ischaemic attack where participants underwent anatomical assessment of all coronary arteries. For objective B) we included studies that reported an association between coronary atherosclerosis and MACE. Two reviewers used the Newcastle-Ottawa Scale to assess risk of bias. We used random-effects modelling for our analyses. RESULTS We identified 2983 studies of which 17 were included. These studies had a total of 6862 participants between 2008 and 2022. The pooled prevalence of any coronary atherosclerosis was 66.8% (95% CI 57.2%-75.1%) with substantial heterogeneity (I2 = 95.2%). The pooled prevalence of obstructive (>50%) stenosis was 29.3% with substantial heterogeneity (I2 = 91%). High-risk coronary anatomy (triple vessel disease or left main stenosis) was found in 7.0% (95% CI 4%-12%) with high heterogeneity I2 = 72%. One study examined high-risk plaques and found a prevalence of 5.9%. Five studies reported the association of coronary atherosclerosis with future MACE. The presence of obstructive CAD confers a HR of 8.0 (95% CI 1.7-37.1, p = 0.007) for future MACE. DISCUSSION AND CONCLUSIONS Asymptomatic CAD is common in ischaemic stroke survivors. The presence and severity of asymptomatic CAD strongly associates with the risk of future MACE. Further evaluation of the benefits of routine coronary assessment in ischaemic stroke is warranted.
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Affiliation(s)
- Rahul G Muthalaly
- Victorian Heart Institute, Monash University, Clayton, VIC, Australia
| | | | - Nitesh Nerlekar
- Victorian Heart Institute, Monash University, Clayton, VIC, Australia
| | - Adam J Nelson
- Victorian Heart Institute, Monash University, Clayton, VIC, Australia
| | - Sean Tan
- Victorian Heart Institute, Monash University, Clayton, VIC, Australia
| | - Jasmine Chan
- Victorian Heart Institute, Monash University, Clayton, VIC, Australia
| | - Thanh Phan
- Victorian Heart Institute, Monash University, Clayton, VIC, Australia
| | - Henry Ma
- Victorian Heart Institute, Monash University, Clayton, VIC, Australia
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Grachev VG, Vedenskaya SS, Smolenskaya OG. Features of Antithrombotic Therapy in Patients with Multifocal Arterial Disease. ACTA ACUST UNITED AC 2021; 61:87-95. [PMID: 33849424 DOI: 10.18087/cardio.2021.3.n1498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/26/2021] [Accepted: 02/25/2021] [Indexed: 12/24/2022]
Abstract
Multifocal arterial injury is common in patients with atherosclerotic cardiovascular diseases and is associated with increased risk of cardiovascular complications and death. Administration of more intensive antithrombotic therapy, particularly combinations of acetylsalicylic acid and a "vascular" dose of rivaroxaban, in patients with multifocal arterial injury is characterized by a beneficial ratio of efficiency and safety due to a pronounced decrease in the risk of cardiovascular complications. Detection of peripheral artery diseases in patients with ischemic heart disease and atherosclerotic cerebrovascular pathology makes it possible to improve the risk stratification, optimize the diagnostic tactics and clarify indications for more intensive antithrombotic therapy.
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Affiliation(s)
- V G Grachev
- Urals State Medical University of Ministry Healthcare of Russian Federation, Yekaterinburg
| | - S S Vedenskaya
- Urals State Medical University of Ministry Healthcare of Russian Federation, Yekaterinburg
| | - O G Smolenskaya
- Urals State Medical University of Ministry Healthcare of Russian Federation, Yekaterinburg
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Grachev VG, Vedenskaya SS, Smolenskaya OG. Features of Risk Stratification, Diagnosis and Secondary Prevention in Patients with Multifocal Arterial Disease. Part 1: Risk Stratification and Diagnosis. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2021. [DOI: 10.20996/1819-6446-2021-02-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Multifocal arterial disease is common in patients with atherosclerotic cardiovascular disease and is associated with an increased risk of cardiovascular complications and death. The possibility of improving the prognosis of patients with multifocal arterial disease is associated with a more efficient diagnosis of both the underlying disease and obstructive atherosclerotic lesions of other localizations and with a more intensive secondary prevention. According to observational studies, the presence of significant stenoses of the carotid arteries and, especially, lower extremities arterial disease can be predictorы of similar lesions in other vascular beds and their detection with screening methods available in clinical practice allows improvement of the diagnosis in patients with suspected coronary artery disease. On the other hand, screening of lower extremities artery diseases in patients with acute coronary syndrome can clarify indications for the use of invasive diagnostic and treatment strategy, in patients with chronic coronary artery disease it can justify more aggressive approaches to secondary prevention.
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Gong J, Asher SB, Cucchiara B, Cuchel M, Soffer D. Case report: 68 yo Chinese-American woman with high HDL-C and ischemic stroke attributed to intracranial atherosclerotic stenosis. J Clin Lipidol 2021; 15:248-254. [PMID: 33573892 DOI: 10.1016/j.jacl.2021.01.006] [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: 07/03/2020] [Revised: 01/05/2021] [Accepted: 01/19/2021] [Indexed: 11/30/2022]
Abstract
Atherosclerotic cardiovascular disease (ASCVD) events are the most common cause of death in the United States and for most individuals who experience these events, may be predicted by risk identification tools. ASCVD risk calculators enable a clinician-patient discussion and the presence of risk-enhancing factors may further inform decision-making with respect to preventive pharmacotherapy, especially statin prescription. In cases where the decision of whether to treat with medicine is unclear, coronary artery calcium scoring by computed tomography offers enhanced risk stratification and may allow both clinicians and patients to feel more at ease with the decision to withhold statin therapy. Despite this thoughtful approach, individual risk may still be underestimated. We present a case of a woman whose family history suggested increased short- and long-term ASCVD risk due to intracranial atherosclerosis, but whose tests suggested a more equivocal indication for treatment. Neither she nor her clinician appreciated the presence of significant enough risk to persevere through minor statin side effects for primary prevention, but she was lucky to have survived without appreciable harm from an acute cerebrovascular event and is now able to pursue an appropriate secondary preventive strategy. We discuss how exceptional characteristics may mislead clinicians, including misperception about lower risk due to gender, East Asian predisposition to intracranial more than coronary atherosclerosis, high levels of high density lipoprotein cholesterol (HDL-C), and CACS = 0.
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Affiliation(s)
- Jan Gong
- Perelman School of Medicine at the University of Pennsylvania
| | | | - Brett Cucchiara
- Perelman School of Medicine at the University of Pennsylvania
| | - Marina Cuchel
- Perelman School of Medicine at the University of Pennsylvania
| | - Daniel Soffer
- Perelman School of Medicine at the University of Pennsylvania.
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Bhatia R, Sharma G, Patel C, Garg A, Roy A, Bali P, Singh N, Sisodia P, Sreenivas V, Srivastava MVP, Prasad K. Coronary Artery Disease in Patients with Ischemic Stroke and TIA. J Stroke Cerebrovasc Dis 2019; 28:104400. [PMID: 31606321 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104400] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/02/2019] [Accepted: 09/07/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Ischemic stroke (IS) and coronary artery disease (CAD) share common risk factors and one may be the harbinger of the other. We aimed to study prevalence of symptomatic and asymptomatic CAD in a cohort of consecutive patients with IS and assess its relationship with intracranial and extracranial large artery cerebrovascular disease (LAD). METHODS All consecutive eligible IS and Transient Ischemic Attack (TIA) patients were recruited into the study. Both clinically suspected and asymptomatic patients (N = 259) underwent myocardial Stress-rest Gated Technetium-99m (Tc99m) MIBI Myocardial Perfusion SPECT scan performed on a dual head SPECT-CT to estimate evidence of myocardial ischemia. RESULTS Three hundred patients completed the study. Forty one patients were previously diagnosed cases of definitive CAD. Twelve patients were clinically suspected to have CAD and 247 patients were asymptomatic. Among these, 12 patients (4.81%) had a positive SPECT. The overall prevalence of CAD was 17.67% (n = 53). Presence of diabetes was an independent predictor of CAD (OR 1.98, 95% CI 1.07-3.67. P .02). No significant association was found between the presence of LAD and CAD in all subgroup comparisons. However, there was a suggestion of higher LAD among patients with known CAD compared with others. CONCLUSIONS CAD is prevalent in patients with ischemic stroke. No definitive relationship was found between CAD and intracranial or extracranial LAD. Population based stratification tools are needed to further assess the need to detect subclinical CAD in patients with stroke.
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Affiliation(s)
- Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
| | - Gautam Sharma
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Chetan Patel
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Prerna Bali
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Nishita Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Pranjal Sisodia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Kameshwar Prasad
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Gunnoo T, Hasan N, Khan MS, Slark J, Bentley P, Sharma P. Quantifying the risk of heart disease following acute ischaemic stroke: a meta-analysis of over 50,000 participants. BMJ Open 2016; 6:e009535. [PMID: 26792217 PMCID: PMC4735313 DOI: 10.1136/bmjopen-2015-009535] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Following an acute stroke, there is a high risk of recurrence. However, the leading cause of mortality following a stroke is due to coronary artery disease (CAD) and myocardial infarction (MI) but that risk has not been robustly quantified. We sought to reliably quantify the risk of ischaemic heart disease (IHD) in patients presenting with acute ischaemic stroke (AIS) in the absence of a known cardiac history. SETTING A meta-analysis study. PubMed, MEDLINE, EMBASE and Google Scholar were searched for potential studies up to October 2015. Included studies reported an acute cerebral ischaemic event and followed for CAD or MI within 1 year in patients without known IHD. Using arcsine transformed proportions for meta-analysis, studies were combined using a generic inverse variance random-effects model to calculate the pooled standardised mean difference and 95% CIs. These were interpreted as the percentage prevalence of CAD or incidence of MI following AIS. RESULTS 17 studies with 4869 patients with AIS demonstrated a mean average of asymptomatic CAD in 52%. Anatomical methods of CAD detection revealed a prevalence of asymptomatic ≥ 50% coronary stenosis in 32% (95% CI 19% to 47%; p<0.00001). 8 studies with 47229 patients with ischaemic stroke revealed an overall risk of MI in the year following stroke of 3% (95% CI 1% to 5%; p<0.00001) despite the absence of any cardiac history. CONCLUSIONS One-third of patients with ischaemic stroke with no cardiac history have more than 50% coronary stenosis and 3% are at risk of developing MI within a year. Our findings provide a reliable quantitative measure of the risk of IHD following AIS in patients with no cardiac history.
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Affiliation(s)
- Trishna Gunnoo
- Department of Medicine, Imperial College London, London, UK
| | - Nazeeha Hasan
- Department of Medicine, Imperial College London, London, UK
| | | | - Julia Slark
- Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
| | - Paul Bentley
- Department of Medicine, Imperial College London, London, UK
| | - Pankaj Sharma
- Ashford & St Peters Hospital, Surrey, UK
- Institute of Cardiovascular Research Royal Holloway University of London (ICR2UL), London, UK
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Iwasaki K, Matsumoto T, Kawada S. Potential Utility of Multidetector Computed Tomography to Identify both Cardiac Embolic Sources and Coronary Artery Disease in Patients with Embolic Stroke. Cardiology 2015; 133:205-10. [PMID: 26618934 DOI: 10.1159/000441277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 09/23/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Our objective was to study the potential utility of multidetector computed tomography (MDCT) to identify both cardiac embolic sources and coronary artery disease (CAD) in embolic-stroke patients. METHODS We performed MDCT for 184 patients with embolic stroke but without known CAD. Twenty-six patients had atrial fibrillation. We investigated the prevalence of the potential source of the embolism and the coronary characteristics. RESULTS Overall, 64 potential embolic sources were detected in 59 patients (32.1%). Left atrial appendage thrombus, left ventricular thrombus and aortic atheroma were detected in 3.3, 0.5 and 15.8% of patients, respectively. Circulatory stasis and patent foramen ovale were detected in 8.7 and 6.5%, respectively. As for coronary calcium score, only 47 patients (25.5%) had a score of zero and 51 (27.7%) had a score of ≥ 400. Significant CAD was detected in 18 patients (9.8%). One hundred and thirty-seven (74.5%) had coronary plaques. The prevalence of positive remodeling, low-attenuation plaque, spotty calcification and a napkin-ring sign was 7.1, 1.6, 5.4 and 2.7%, respectively. Importantly, only 34 patients (13.0%) had no abnormalities detected by MDCT. CONCLUSIONS Our results suggest that MDCT has potential to identify both cardiac embolic sources and CAD in patients with embolic stroke but without known CAD.
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Acute ischemic stroke imaging: a practical approach for diagnosis and triage. Int J Cardiovasc Imaging 2015; 32:19-33. [DOI: 10.1007/s10554-015-0757-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 08/26/2015] [Indexed: 11/30/2022]
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Carmona-Rubio AE, Lee AM, Puchner S, Ghoshhajra B, Sharma UC. A review of adherence to the guidelines for coronary CT angiography quantitative stenosis grading thresholds in published research. Postgrad Med 2014; 127:194-201. [PMID: 25540988 DOI: 10.1080/00325481.2015.995065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The degree of coronary stenosis of potential hemodynamic significance is central to the interpretation of coronary computed tomography angiography (CCTA), but has been variably defined in the literature. Societal guidelines have attempted to address this issue via recommended thresholds. OBJECTIVES We surveyed the various thresholds for defining significant coronary stenosis reported in research published since the introduction of the Society for Cardiovascular Computed Tomography guidelines regarding the interpretation and reporting of CCTA. METHODS We systematically reviewed the results of bibliographic searches of all original research articles on CCTA, focusing on studies reporting > 25 subjects, to assess the definitions of severity of coronary lesions as found on CCTA. To enable comparisons, we stratified the methods of reporting lesion severity into ≥ 50%, 50% to 69%, and "others" (including infrequent reporting methods). RESULTS Fifty-nine11 published studies were identified and met inclusion criteria. Eighteen studies reported the severity of coronary stenosis using a definition of 50% to 69% as moderate stenosis; 35 studies defined ≥ 50% coronary stenosis as "stenosis," "significant stenosis," or "obstructive lesion" without distinguishing a threshold for moderate versus severe stenosis. Six studies utilized other thresholds, such as 20% to 75%, 40% to 69%, 40% to 70%, 40% to 79%, and 50% to 75% to define moderate coronary stenosis. CONCLUSIONS Fifty-three of 59 studies were graded in accordance with the recommended threshold of ≥ 50% defining potentially significant stenosis, with 18 studies reporting precisely in accordance with the guidelines-recommended thresholds of ≥ 50% narrowing as defining moderate stenosis and ≥ 70% narrowing as defining severe stenosis. Six studies were reported using alternative thresholds for significant stenosis. However, a majority of research studies published since 2009 do not follow the societal guidelines for stenosis grading, since these studies do not clearly describe the degree of coronary stenosis.
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Affiliation(s)
- Andres E Carmona-Rubio
- Department of Medicine, University at Buffalo, State University of New York, School of Medicine , Buffalo, NY
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11
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Iwasaki K, Haraoka K, Hamaguchi T, Imamura T, Kawada S, Ohno M, Kashihara K. Prevalence of subclinical coronary artery disease in ischemic stroke patients. J Cardiol 2014; 65:71-5. [PMID: 24861913 DOI: 10.1016/j.jjcc.2014.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 04/04/2014] [Accepted: 04/09/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recently, ischemic stroke has emerged as a new coronary artery disease (CAD) risk equivalent. Our purpose is to study the prevalence of CAD in ischemic stroke patients compared with that in non-stroke patients. METHODS AND RESULTS We measured coronary calcium score (CCS) in 151 ischemic stroke patients without known CAD (stroke group) and compared it with 151 age- and sex-matched non-stroke patients (control group). CCS was significantly higher in the stroke group than in the control group (stroke group, median: 64, interquartile range: 3-382 vs. control group, median: 3, interquartile range: 0-65, p<0.0001). High-risk CAD, defined as a CCS≥400, was detected in 24.5% of the stroke group compared with 9.3% of the control group (p<0.0001). Agreement between the Framingham risk score and CCS was found in only 62 patients (41.1%). In a multiple logistic regression analysis, age [hazard ratio (HR) 1.09, 95% confidence interval (CI) 1.03-1.14], diabetes (HR 2.97, 95%CI 1.52-5.78), stroke (HR 3.85, 95%CI 1.89-7.81), and male sex (HR 4.41, 95%CI 1.82-0.75) were significantly associated with high-risk CAD (p<0.001). CONCLUSIONS Our results show that the prevalence of subclinical CAD in ischemic stroke patients was high, and that a quarter of them had high-risk CAD. Age, diabetes, stroke, and male sex were independent predictors of high-risk CAD.
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Affiliation(s)
| | - Kayo Haraoka
- Department of Cardiology, Okayama Kyokuto Hospital, Okayama, Japan
| | | | - Takaki Imamura
- Department of Neurology, Okayama Kyokuto Hospital, Okayama, Japan
| | - Sanami Kawada
- Department of Neurology, Okayama Kyokuto Hospital, Okayama, Japan
| | - Manabu Ohno
- Department of Neurology, Okayama Kyokuto Hospital, Okayama, Japan
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Mechtouff L, Boussel L, Cakmak S, Lamboley JL, Bourhis M, Boublay N, Schott AM, Derex L, Cho TH, Nighoghossian N, Douek PC. Multilevel assessment of atherosclerotic extent using a 40-section multidetector scanner after transient ischemic attack or ischemic stroke. AJNR Am J Neuroradiol 2013; 35:568-72. [PMID: 24136645 DOI: 10.3174/ajnr.a3760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The first part of this study assessed the potential of MDCT with a CTA examination of the aorta and the coronary, cervical, and intracranial vessels in the etiologic work-up of TIA or ischemic stroke compared with established imaging methods. The objective of the second part of this study was to assess the atherosclerotic extent by use of MDCT in these patients. MATERIALS AND METHODS From August 2007 to August 2011, a total of 96 patients with ischemic stroke or TIA without an evident cardioembolic source were enrolled. All patients underwent MDCT. Atherosclerotic extent was classified in 0, 1, 2, 3, and 4 atherosclerotic levels according to the number of arterial territories (aortic arch, coronary, cervical, intracranial) affected by atherosclerosis defined as ≥ 50% cervical, intracranial, or coronary stenosis or ≥ 4-mm aortic arch plaque. RESULTS There were 91 patients who had an interpretable MDCT. Mean age was 67.4 years (± 11 years), and 75 patients (83.3%) were men. The prevalence of 0, 1, 2, 3, and 4 atherosclerotic levels was 48.3%, 35.2%, 12.1%, 4.4%, and 0%, respectively. Aortic arch atheroma was found in 47.6% of patients with 1 atherosclerotic level. The combination of aortic arch atheroma and cervical stenosis was found in 63.6% of patients with ≥ 2 atherosclerotic levels. Patients with ≥ 2 atherosclerotic levels were older than patients with < 2 atherosclerotic levels (P = .04) in univariate analysis. CONCLUSIONS MDCT might be useful to assess the extent of atherosclerosis. It could help to screen for high-risk patients who could benefit from a more aggressive preventive strategy.
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Affiliation(s)
- L Mechtouff
- From the Stroke Unit (L.M., L.D., T.-H.C., N.N.), Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
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Park HE, Chun EJ, Choi SI, Lee SP, Yoon CH, Kim HK, Youn TJ, Kim YJ, Choi DJ, Sohn DW, Cho GY. Clinical and imaging parameters to predict cardiovascular outcome in asymptomatic subjects. Int J Cardiovasc Imaging 2013; 29:1595-602. [DOI: 10.1007/s10554-013-0235-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 05/02/2013] [Indexed: 01/07/2023]
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Conforto AB, Leite CDC, Nomura CH, Bor-Seng-Shu E, Santos RD. Is there a consistent association between coronary heart disease and ischemic stroke caused by intracranial atherosclerosis? ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 71:320-6. [DOI: 10.1590/0004-282x20130028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 10/17/2012] [Indexed: 11/21/2022]
Abstract
Coronary heart disease and ischemic stroke are frequent coexistent conditions that share risk factors and pose major burdens to global health. Even though a clear relation has been established between extracranial internal carotid artery atherosclerosis and symptomatic or asymptomatic coronary heart disease, there is a gap in knowledge about the association between intracranial atherosclerosis and coronary heart disease. Intracranial atherosclerosis is associated with high risks of stroke recurrence and vascular death. More research and clinical trials are needed to answer whether early diagnosis of asymptomatic coronary heart disease and aggressive treatment can decrease the risk of vascular death in patients with ischemic stroke caused by intracranial atherosclerosis.
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Affiliation(s)
- Adriana B. Conforto
- São Paulo University, Brazil; São Paulo University, Brazil; São Paulo University, Brazil
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Jensen JK, Medina HM, Nørgaard BL, Øvrehus KA, Jensen JM, Nielsen LH, Maurovich-Horvat P, Engel LC, Januzzi JL, Hoffmann U, Truong QA. Association of ischemic stroke to coronary artery disease using computed tomography coronary angiography. Int J Cardiol 2012; 160:171-4. [DOI: 10.1016/j.ijcard.2011.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 03/11/2011] [Accepted: 04/14/2011] [Indexed: 11/25/2022]
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