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Rezk A, Liu W, Nijs K, Lee JW, Rajaleelan W, Nakatani R, Al Azazi E, Englesakis M, Chowdhury T. Brain and Heart Interactions Delineating Cardiac Dysfunction in Four Common Neurological Disorders: A Systematic Review and Meta-analysis. J Neurosurg Anesthesiol 2024:00008506-990000000-00125. [PMID: 39171885 DOI: 10.1097/ana.0000000000000987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 07/25/2024] [Indexed: 08/23/2024]
Abstract
Neurological and cardiovascular disorders are the leading causes of morbidity and mortality worldwide. While the effects of cardiovascular disease (CD) on the nervous system are well understood, understanding of the reciprocal relationship has only recently become clearer. Based on disability-adjusted life years, this systematic review and meta-analysis present the pooled incidence and association of CD in 4 selected common, noncommunicable neurological disorders: (1) migraine, (2) Alzheimer disease and other dementias, (3) epilepsy, and (4) head injury. Sixty-five studies, including over 4 and a half million patients, were identified for inclusion in this review. Among the 4 neurological disorders, the majority of patients (89.4%) had epilepsy, 9.6% had migraine, and 0.97% had head injury. Alzheimer disease and other dementias were reported in only 0.02% of patients. The pooled effect estimates (incidence and association) of CD in the 4 neurological disorders was 10% (95% CI: 5.8%-16.9%; I2 = 99.94%). When stratified by the neurological disorder, head injury was associated with the highest incidence of CD (28%). The 4 neurological disorders were associated with a 2-fold increased odds for developing CD in comparison to patients without neurological disorders. Epilepsy was associated with the greatest increased odds of developing CD (odds ratio: 2.25; 95% CI: 1.82-2.79; P = 0.04). In studies that reported this variable, the pooled hazard ratio was 1.64 (95% CI: 1.38-1.94), with head injury having the highest hazard ratio (2.17; 95% CI: 1.30-3.61). Large prospective database studies are required to understand the long-term consequences of CD in patients with neurological disorders.
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Affiliation(s)
- Amal Rezk
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Winnie Liu
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Kristof Nijs
- Department of Anaesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
| | - Jun Won Lee
- University of Saskatchewan School of Medicine, Saskatoon, Canada
| | - Wesley Rajaleelan
- Department of Anesthesia and Pain Medicine, University of Ottawa, Ottawa, Canada
| | - Rodrigo Nakatani
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Emad Al Azazi
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Marina Englesakis
- Library and Information Services, University Health Network, Toronto, Canada
| | - Tumul Chowdhury
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
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Lele AV, Liu J, Kunapaisal T, Chaikittisilpa N, Kiatchai T, Meno MK, Assad OR, Pham J, Fong CT, Walters AM, Nandate K, Chowdhury T, Krishnamoorthy V, Vavilala MS, Kwon Y. Early Cardiac Evaluation, Abnormal Test Results, and Associations with Outcomes in Patients with Acute Brain Injury Admitted to a Neurocritical Care Unit. J Clin Med 2024; 13:2526. [PMID: 38731055 PMCID: PMC11084203 DOI: 10.3390/jcm13092526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/17/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Background: to examine factors associated with cardiac evaluation and associations between cardiac test abnormalities and clinical outcomes in patients with acute brain injury (ABI) due to acute ischemic stroke (AIS), spontaneous subarachnoid hemorrhage (SAH), spontaneous intracerebral hemorrhage (sICH), and traumatic brain injury (TBI) requiring neurocritical care. Methods: In a cohort of patients ≥18 years, we examined the utilization of electrocardiography (ECG), beta-natriuretic peptide (BNP), cardiac troponin (cTnI), and transthoracic echocardiography (TTE). We investigated the association between cTnI, BNP, sex-adjusted prolonged QTc interval, low ejection fraction (EF < 40%), all-cause mortality, death by neurologic criteria (DNC), transition to comfort measures only (CMO), and hospital discharge to home using univariable and multivariable analysis (adjusted for age, sex, race/ethnicity, insurance carrier, pre-admission cardiac disorder, ABI type, admission Glasgow Coma Scale Score, mechanical ventilation, and intracranial pressure [ICP] monitoring). Results: The final sample comprised 11,822 patients: AIS (46.7%), sICH (18.5%), SAH (14.8%), and TBI (20.0%). A total of 63% (n = 7472) received cardiac workup, which increased over nine years (p < 0.001). A cardiac investigation was associated with increased age, male sex (aOR 1.16 [1.07, 1.27]), non-white ethnicity (aOR), non-commercial insurance (aOR 1.21 [1.09, 1.33]), pre-admission cardiac disorder (aOR 1.21 [1.09, 1.34]), mechanical ventilation (aOR1.78 [1.57, 2.02]) and ICP monitoring (aOR1.68 [1.49, 1.89]). Compared to AIS, sICH (aOR 0.25 [0.22, 0.29]), SAH (aOR 0.36 [0.30, 0.43]), and TBI (aOR 0.19 [0.17, 0.24]) patients were less likely to receive cardiac investigation. Patients with troponin 25th-50th quartile (aOR 1.65 [1.10-2.47]), troponin 50th-75th quartile (aOR 1.79 [1.22-2.63]), troponin >75th quartile (aOR 2.18 [1.49-3.17]), BNP 50th-75th quartile (aOR 2.86 [1.28-6.40]), BNP >75th quartile (aOR 4.54 [2.09-9.85]), prolonged QTc (aOR 3.41 [2.28; 5.30]), and EF < 40% (aOR 2.47 [1.07; 5.14]) were more likely to be DNC. Patients with troponin 50th-75th quartile (aOR 1.77 [1.14-2.73]), troponin >75th quartile (aOR 1.81 [1.18-2.78]), and prolonged QTc (aOR 1.71 [1.39; 2.12]) were more likely to be associated with a transition to CMO. Patients with prolonged QTc (aOR 0.66 [0.58; 0.76]) were less likely to be discharged home. Conclusions: This large, single-center study demonstrates low rates of cardiac evaluations in TBI, SAH, and sICH compared to AIS. However, there are strong associations between electrocardiography, biomarkers of cardiac injury and heart failure, and echocardiography findings on clinical outcomes in patients with ABI. Findings need validation in a multicenter cohort.
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Affiliation(s)
- Abhijit V. Lele
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA 98104, USA; (C.T.F.); (A.M.W.); (K.N.); (M.S.V.)
| | - Jeffery Liu
- Department of Biosciences, Wiess School of Natural Sciences, Rice University, Houston, TX 77005, USA;
| | - Thitikan Kunapaisal
- Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat-Yai 90110, Thailand;
| | - Nophanan Chaikittisilpa
- Department of Anesthesiology, Siriraj Hospital, Mahidol University, Bangkok 73170, Thailand; (N.C.); (T.K.)
| | - Taniga Kiatchai
- Department of Anesthesiology, Siriraj Hospital, Mahidol University, Bangkok 73170, Thailand; (N.C.); (T.K.)
| | - Michael K. Meno
- Department of Medicine, University of Washington, Seattle, WA 98104, USA; (M.K.M.); (O.R.A.); (J.P.)
| | - Osayd R. Assad
- Department of Medicine, University of Washington, Seattle, WA 98104, USA; (M.K.M.); (O.R.A.); (J.P.)
| | - Julie Pham
- Department of Medicine, University of Washington, Seattle, WA 98104, USA; (M.K.M.); (O.R.A.); (J.P.)
| | - Christine T. Fong
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA 98104, USA; (C.T.F.); (A.M.W.); (K.N.); (M.S.V.)
| | - Andrew M. Walters
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA 98104, USA; (C.T.F.); (A.M.W.); (K.N.); (M.S.V.)
| | - Koichiro Nandate
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA 98104, USA; (C.T.F.); (A.M.W.); (K.N.); (M.S.V.)
| | - Tumul Chowdhury
- Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University of Toronto, Toronto, ON M5S 1A1, Canada;
| | | | - Monica S. Vavilala
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA 98104, USA; (C.T.F.); (A.M.W.); (K.N.); (M.S.V.)
| | - Younghoon Kwon
- Department of Cardiology, Harborview Medical Center, University of Washington, Seattle, WA 98104, USA;
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