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Sembill JA, Sprügel MI, Haupenthal D, Kremer S, Knott M, Mühlen I, Kallmünzer B, Kuramatsu JB. Endovascular thrombectomy in patients with anterior circulation stroke: an emulated real-world comparison. Neurol Res Pract 2024; 6:37. [PMID: 39049127 PMCID: PMC11270839 DOI: 10.1186/s42466-024-00331-6] [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: 04/09/2024] [Accepted: 06/21/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Endovascular thrombectomy (EVT) has been proven effective in anterior circulation stroke due to large vessel occlusion (LVO). However, translation from randomized clinical trials (RCTs) with highly selected patients to real-world requires confirmation, particularly to identify associations outside of strict selection criteria. AIMS This study aims to compare functional outcomes after EVT in real-world with those reported in RCTs, and to identify associations with functional outcome after EVT outside RCT-criteria. METHODS This study analyzed longitudinal German real-world data from the Stroke Research Consortium in Northern Bavaria (STAMINA) cohort from January, 2015 to June, 2019. We conducted a trial emulation, comparing patients with anterior circulation stroke and LVO meeting selection criteria for RCTs investigating EVT (1) predominantly within 6 hours with those from HERMES meta-analysis, and (2) within 6-24 hours with those from AURORA meta-analysis. We (3) analyzed treatment effects of EVT and association with functional outcome in patients treated outside RCT criteria. RESULTS Of 598 patients, 281 (47.0%) met RCT-criteria for treatment within 6 hours (hereinafter STAMINA-HERMES), 74 (12.4%) met RCT-criteria for treatment within 6-24 hours (STAMINA-AURORA), and 277 (46.3%) patients received EVT outside RCT-criteria. We observed no difference in rates of functional independence or mortality, comparing STAMINA-HERMES with HERMES meta-analysis (mRS 0-1: n=120/281 [43%] vs. 291/633 [46%], p=0.36; mortality: n=34/281 [12%] vs. 97/633 [15%], p=0.20), and STAMINA-AURORA with AURORA meta-analysis (mRS 0-1: n=26/74 [35%] vs. 122/266 [46%], p=0.10, mortality: n=10/74 [14%] vs. 45/266 [17%], p=0.48). Patients treated outside RCT-criteria had worse outcome (mRS 0-1: n=38/277 [14%], mortality: n=90/277 [32%], both p<0.001); possibly driven by pre-existing functional dependence (n=172/277 [62%]). Compared to matched controls, EVT outside of RCT-criteria was associated with lower mortality (absolute treatment effect: -14%, 95% Confidence Interval [CI] -23 to -5, p<0.01), but not with recovery to functional independence or premorbid functional status (treatment effect: 4%, CI -4 to 11, p=0.34), which was associated with lower NIHSS (Odds ratio [OR] 0.86, CI 0.80-0.92, p<0.001) and age (OR 0.95, CI 0.93-0.98, p=0.002). CONCLUSIONS Translation of EVT outcomes reported in RCTs into real-world is possible, however, almost half of patients did not meet trial criteria. Identification of patients who functionally benefit from frequently performed EVT outside RCT-criteria requires further investigation. TRIAL REGISTRATION Clinicaltrials.gov, NCT04357899.
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Affiliation(s)
- Jochen A Sembill
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany.
| | - Maximilian I Sprügel
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - David Haupenthal
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Svenja Kremer
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Michael Knott
- Department of Neuroradiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Iris Mühlen
- Department of Neuroradiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Bernd Kallmünzer
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Joji B Kuramatsu
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
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Harky A, Chow VJ, Voller C, Goyal K, Shaw M, Bhawnani A, Kenawy A, Wilson I, Lip GYH, Field M, Kuduvalli M. Stroke outcomes following cardiac and aortic surgery are improved by the involvement of a stroke team. Eur J Clin Invest 2024:e14275. [PMID: 38943528 DOI: 10.1111/eci.14275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 06/10/2024] [Indexed: 07/01/2024]
Abstract
OBJECTIVES Post-cardiac and aortic surgery stroke is often underreported. We detail our single-centre experience the following introduction of comprehensive consultant-led daily stroke service, to demonstrate the efficacy of a stroke team in recovery from stroke following cardiac and aortic surgeries. METHODS This retrospective, single-centre observational cohort study analysed consecutive patients undergoing cardiac and aortic surgery at our institution from August 2014 to December 2020. Main outcomes included stroke rate, predictors of stroke, and neurological deficit resolution or persistence at discharge and clinic follow-up. RESULTS A total of 12,135 procedures were carried out in the reference period. Among these, 436 (3.6%) suffered a stroke. Overall survival to discharge and follow-up were 86.0% and 84.0% respectively. Independent risk factors for post-operative stroke included advanced age (OR 1.033, 95% CI [1.023, 1.044], p < .001), female sex (OR 1.491, 95% [1.212, 1.827], p < .001), history of previous cardiac surgeries (OR 1.670, 95% CI [1.239, 2.218], p < .001), simultaneous coronary artery bypass graft + valve procedures (OR 1.825, 95% CI [1.382, 2.382], p < .001) and CPB time longer than 240 min (OR 3.384, 95% CI [2.413, 4.705], p < .001). Stroke patients managed by the multidisciplinary team demonstrated significantly higher rates of survival at discharge (87.3% vs. 61.9%, p = .001). CONCLUSIONS Perioperative stroke can be debilitating immediately long term. The involvement of specialist stroke teams plays a key role in reducing the long-term burden and mortality of this condition.
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Affiliation(s)
- Amer Harky
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Vanessa Jane Chow
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Calum Voller
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Kartik Goyal
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Matthew Shaw
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Anurodh Bhawnani
- Department of Cardiothoracic Anaesthesia and Intensive Care, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Ayman Kenawy
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Ian Wilson
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Danish Center for Health Services Research, Aalborg University, Aalborg, Denmark
| | - Mark Field
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Manoj Kuduvalli
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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3
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Zeng M, Smith L, Bird A, Trinh VQN, Bacchi S, Harvey J, Jenkinson M, Scroop R, Kleinig T, Jannes J, Palmer LJ. Predictions for functional outcome and mortality in acute ischaemic stroke following successful endovascular thrombectomy. BMJ Neurol Open 2024; 6:e000707. [PMID: 38932996 PMCID: PMC11202712 DOI: 10.1136/bmjno-2024-000707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
Background Accurate outcome predictions for patients who had ischaemic stroke with successful reperfusion after endovascular thrombectomy (EVT) may improve patient treatment and care. Our study developed prediction models for key clinical outcomes in patients with successful reperfusion following EVT in an Australian population. Methods The study included all patients who had ischaemic stroke with occlusion in the proximal anterior cerebral circulation and successful reperfusion post-EVT over a 7-year period. Multivariable logistic regression and Cox regression models, incorporating bootstrap and multiple imputation techniques, were used to identify predictors and develop models for key clinical outcomes: 3-month poor functional status; 30-day, 1-year and 3-year mortality; survival time. Results A total of 978 patients were included in the analyses. Predictors associated with one or more poor outcomes include: older age (ORs for every 5-year increase: 1.22-1.40), higher premorbid functional modified Rankin Scale (ORs: 1.31-1.75), higher baseline National Institutes of Health Stroke Scale (ORs: 1.05-1.07) score, higher blood glucose (ORs: 1.08-1.19), larger core volume (ORs for every 10 mL increase: 1.10-1.22), pre-EVT thrombolytic therapy (ORs: 0.44-0.56), history of heart failure (outcome: 30-day mortality, OR=1.87), interhospital transfer (ORs: 1.42 to 1.53), non-rural/regional stroke onset (outcome: functional dependency, OR=0.64), longer onset-to-groin puncture time (outcome: 3-year mortality, OR=1.08) and atherosclerosis-caused stroke (outcome: functional dependency, OR=1.68). The models using these predictors demonstrated moderate predictive abilities (area under the receiver operating characteristic curve range: 0.752-0.796). Conclusion Our models using real-world predictors assessed at hospital admission showed satisfactory performance in predicting poor functional outcomes and short-term and long-term mortality for patients with successful reperfusion following EVT. These can be used to inform EVT treatment provision and consent.
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Affiliation(s)
- Minyan Zeng
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Australian Institute for Machine Learning, Adelaide, South Australia, Australia
| | - Luke Smith
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Australian Institute for Machine Learning, Adelaide, South Australia, Australia
| | - Alix Bird
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Australian Institute for Machine Learning, Adelaide, South Australia, Australia
| | - Vincent Quoc-Nam Trinh
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Australian Institute for Machine Learning, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jackson Harvey
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Mark Jenkinson
- Australian Institute for Machine Learning, Adelaide, South Australia, Australia
- School of Computer and Mathematical Sciences, Faculty of Sciences, Engineering and Technology, The University of Adelaide, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Rebecca Scroop
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Timothy Kleinig
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jim Jannes
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Lyle J Palmer
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Australian Institute for Machine Learning, Adelaide, South Australia, Australia
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D'Anna L, Abu-Rumeileh S, Merlino G, Ornello R, Foschi M, Diana F, Barba L, Mastrangelo V, Romoli M, Lobotesis K, Bax F, Kuris F, Valente M, Otto M, Korompoki E, Sacco S, Gigli GL, Nguyen TN, Banerjee S. Safety and Outcomes of Mechanical Thrombectomy in Acute Ischemic Stroke Attributable to Cardiological Diseases: A Scoping Review. J Am Heart Assoc 2024:e034783. [PMID: 38874062 DOI: 10.1161/jaha.124.034783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
There is limited evidence on the outcomes and safety of mechanical thrombectomy (MT) among patients with acute ischemic stroke (AIS) in the context of cardiac diseases. Our study reviews MT in AIS within the context of cardiac diseases, aiming to identify existing and emerging needs and gaps. PubMed and Scopus were searched until December 31, 2023, using a combination of cardiological diseases and "mechanical thrombectomy" or "endovascular treatment" as keywords. Study design included case reports/series, observational studies, randomized clinical trials, and meta-analyses/systematic reviews. We identified 943 articles, of which 130 were included in the review. Results were categorized according to the cardiac conditions. MT shows significant benefits in patients with atrial fibrillation (n=139) but lacks data for stroke occurring after percutaneous coronary intervention (n=2) or transcatheter aortic valve implantation (n=5). MT is beneficial in AIS attributable to infective endocarditis (n=34), although functional benefit may be limited. Controversy surrounds the functional outcomes and mortality of patients with AIS with heart failure undergoing MT (n=11). Despite technical challenges, MT appears feasible in aortic dissection cases (n=4), and in patients with left ventricular assist device or total artificial heart (n=10). Data on AIS attributable to congenital heart disease (n=4) primarily focus on pediatric cases requiring technical modifications. Treatment outcomes of MT in patients with cardiac tumors (n=8) vary because of clot consistency differences. After cardiac surgery stroke, MT may improve outcomes with early intervention (n=13). Available data outline the feasibility of MT in patients with AIS attributable to large-vessel occlusion in the context of cardiac diseases.
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Affiliation(s)
- Lucio D'Anna
- Department of Stroke and Neuroscience Charing Cross Hospital, Imperial College London NHS Healthcare Trust London United Kingdom
- Department of Brain Sciences Imperial College London London United Kingdom
| | - Samir Abu-Rumeileh
- Department of Neurology Martin-Luther-University Halle-Wittenberg Halle (Saale) Germany
| | - Giovanni Merlino
- Stroke Unit and Clinical Neurology Udine University Hospital Udine Italy
| | - Raffaele Ornello
- Department of Biotechnological and Applied Clinical Sciences University of L'Aquila L'Aquila Italy
| | - Matteo Foschi
- Department of Biotechnological and Applied Clinical Sciences University of L'Aquila L'Aquila Italy
| | - Francesco Diana
- Interventional Neuroradiology Vall d'Hebron University Hospital Barcelona Catalunya Spain
| | - Lorenzo Barba
- Department of Neurology Martin-Luther-University Halle-Wittenberg Halle (Saale) Germany
| | | | - Michele Romoli
- Neurology and Stroke Unit, Department of Neuroscience Bufalini Hospital, Azienda Unità Sanitaria Locale Romagna Cesena Italy
| | - Kyriakos Lobotesis
- Neuroradiology, Department of Imaging, Charing Cross Hospital, Imperial College London NHS Healthcare Trust London United Kingdom
| | - Francesco Bax
- Philip Kistler Research Center, Department of Neurology Massachusetts General Hospital and Harvard Medical School Boston MA USA
| | - Fedra Kuris
- Stroke Unit and Clinical Neurology Udine University Hospital Udine Italy
| | - Mariarosaria Valente
- Clinical Neurology Udine University Hospital and Dipartmento di Area Medica, University of Udine Udine Italy
| | - Markus Otto
- Department of Neurology Martin-Luther-University Halle-Wittenberg Halle (Saale) Germany
| | - Eleni Korompoki
- Department of Brain Sciences Imperial College London London United Kingdom
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences University of L'Aquila L'Aquila Italy
| | - Gian Luigi Gigli
- Stroke Unit and Clinical Neurology Udine University Hospital Udine Italy
| | - Thanh N Nguyen
- Department of Neurology, Radiology Boston Medical Center Boston MA USA
| | - Soma Banerjee
- Department of Stroke and Neuroscience Charing Cross Hospital, Imperial College London NHS Healthcare Trust London United Kingdom
- Department of Brain Sciences Imperial College London London United Kingdom
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5
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McNamara KF, Merkler AE, Freeman JV, Krumholz HM, Ahmad T, Sharma R. Ischemic Stroke and Reduced Left Ventricular Ejection Fraction: A Multidisciplinary Approach to Optimize Brain and Cardiac Health. Stroke 2024; 55:1720-1727. [PMID: 38660813 DOI: 10.1161/strokeaha.123.045623] [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] [Indexed: 04/26/2024]
Abstract
Reduced left ventricular ejection fraction ≤40%, a known risk factor for adverse cardiac outcomes and recurrent acute ischemic stroke, may be detected during an acute ischemic stroke hospitalization. A multidisciplinary care paradigm informed by neurology and cardiology expertise may facilitate the timely implementation of an array of proven heart failure-specific therapies and procedures in a nuanced manner to optimize brain and cardiac health.
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Affiliation(s)
- Katelyn F McNamara
- Department of Neurology (K.F.M.N., R.S.), Yale School of Medicine, New Haven, CT
| | | | - James V Freeman
- Department of Internal Medicine, Section of Cardiovascular Medicine (J.V.F., H.M.K., T.A.), Yale School of Medicine, New Haven, CT
| | - Harlan M Krumholz
- Department of Internal Medicine, Section of Cardiovascular Medicine (J.V.F., H.M.K., T.A.), Yale School of Medicine, New Haven, CT
| | - Tariq Ahmad
- Department of Internal Medicine, Section of Cardiovascular Medicine (J.V.F., H.M.K., T.A.), Yale School of Medicine, New Haven, CT
| | - Richa Sharma
- Department of Neurology (K.F.M.N., R.S.), Yale School of Medicine, New Haven, CT
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Zhang C, Wu JC, Tan Z, He XL, Li F, Wang L, Wang Y. Left ventricular systolic dysfunction predicts clinical prognosis in patients with acute ischemic stroke after intravenous thrombolysis. Aging (Albany NY) 2024; 16:7845-7855. [PMID: 38700495 PMCID: PMC11132000 DOI: 10.18632/aging.205786] [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: 11/14/2023] [Accepted: 03/09/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Although intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis is the most effective early treatment for acute ischemic stroke (AIS), outcomes vary greatly among patients. Left ventricular systolic dysfunction (LVSD) is prone to distant organ ischemia and may be a predictor for poor prognosis in AIS patients undergoing intravenous thrombolysis (IVT). Our aim was to investigate the predictivity of LVSD diagnosis (as measured by left ventricular ejection fraction (LVEF)) on 90-day clinical outcomes in AIS patients undergoing thrombolysis. METHODS The current prospective cohort study continuously enrolled 273 AIS patients from the National Stroke Prevention and Treatment Engineering Management Special Database who underwent IVT and completed echocardiography within 24 h of admission between 2021 and 2023. LVSD was examined by evaluation of the echocardiographic LVEF values using Simpson's biplane method of discs in line with international guidelines, and defined as a LVEF value < 50%. Multivariable ordinal logistic regression model was performed to analyze the association between LVEF and functional outcome at 3 months. Restricted cubic spline (RCS) was used to examine the shape of the dose-response association between reduced LVEF and poor functional outcomes. Subgroup analysis was also employed to further verify the reliability and practicability of the results. RESULTS Baseline data analysis showed LVSD patients had more comorbidities including on multivariate analyses, LVSD (OR 2.78, 95% CI 1.23 to 6.24, P=0.014), pre-existing diabetes mellitus (OR 2.08, 95% CI 1.11 to 3.90, P=0.023) and NIHSS on arrival (OR 1.31, 95% CI 1.21 to 1.49, P<0.001) were independent predictors of poor functional outcomes (mRS ≥ 3) at 3 months. Multivariable-adjusted spline regression indicated a linear dose-response association between LVEF after IVT and poor functional outcomes (p for linearity < 0.001), with the optimal cutoff values of LVEF being 0.48. CONCLUSIONS Our finding indicated that AIS patients with LVSD after IVT had poorer outcomes, suggesting the need to monitor and optimize LVEF in stroke management.
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Affiliation(s)
- Chi Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei 230011, Anhui, China
- Department of Neurology, Hefei Hospital Affiliated to Anhui Medical University (The Second People’s Hospital of Hefei), Hefei 230011, Anhui, China
| | - Jun-Cang Wu
- Department of Neurology, Hefei Hospital Affiliated to Anhui Medical University (The Second People’s Hospital of Hefei), Hefei 230011, Anhui, China
| | - Zheng Tan
- Department of Neurology, Hefei Hospital Affiliated to Anhui Medical University (The Second People’s Hospital of Hefei), Hefei 230011, Anhui, China
| | - Xiao-Lu He
- Department of Neurology, Hefei Hospital Affiliated to Anhui Medical University (The Second People’s Hospital of Hefei), Hefei 230011, Anhui, China
| | - Fei Li
- Department of Neurology, Hefei Hospital Affiliated to Anhui Medical University (The Second People’s Hospital of Hefei), Hefei 230011, Anhui, China
| | - Long Wang
- Department of Neurology, Hefei Hospital Affiliated to Anhui Medical University (The Second People’s Hospital of Hefei), Hefei 230011, Anhui, China
| | - Yu Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei 230011, Anhui, China
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Chen G, Ding P, Yang L, Liu X, Yu D, Yue W. Left ventricular ejection fraction <60 % is associated with short-term functional disability in patients of acute ischemic stroke. Heliyon 2024; 10:e29352. [PMID: 38644837 PMCID: PMC11031756 DOI: 10.1016/j.heliyon.2024.e29352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 03/28/2024] [Accepted: 04/05/2024] [Indexed: 04/23/2024] Open
Abstract
Background and objective The association between cardiac dysfunction and functional outcome in acute ischemic stroke (AIS) is not clear. We aimed to investigate the relationship between the routinely assessed left ventricular ejection fraction (LVEF) and functional outcomes in patients with AIS. Methods Data came from a prospective, observational, single-center study (Effect of Cardiac Function on Short-term Functional Prognosis in Patients with Acute Ischemic Stroke, SPARK). The LVEF was assessed with transthoracic echocardiography within 7 days of stroke onset. The primary outcome was functional disability, defined as a modified Rankin Scale score of 3-6 at 90 days (range: 0-6, with higher scores indicating greater disability). We also investigated the association of the LVEF with mortality, early neurological deterioration, hospital stay, and costs. Multivariate logistic regression analysis and 2:1 propensity score matching (PSM) were performed to compare the differences in outcomes. Results A total of 1181 patients were included in this analysis, of which 87 (7.4 %) patients were found to have LVEF of <60 %. In the entire study population, LVEF<60 % was significantly associated with functional disability at 90 days (odds ratio [OR]: 1.85, 95 % confidence intervals (CI): 1.01-3.40) after adjusting for all confounders. After PSM, the association was consistently significant (OR: 5.32, 95 % CI: 3.04-9.30). However, associations of the LVEF with mortality, early neurological deterioration, hospital stay, and costs were not consistently significant across all analyses. In the subgroup analysis, the association of LVEF of <60 % with functional disability was statistically significant in patients with non-cardioembolic stroke, but not in patients with cardioembolic stroke (P for interaction = 0.872). Conclusions An LVEF of <60 % will likely increase the risk of functional disability in patients with AIS. Future strategies to prevent cardiac dysfunction in the acute phase are needed.
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Affiliation(s)
- Guojuan Chen
- Department of Neurology, Clinical College of Neurology, Neurosurgery, and Neurorehabilitation, Tianjin Medical University, Tianjin Huanhu Hospital, Tianjin, China
- Department of Neurology, Tangshan Gongren Hospital, Tangshan, China
| | - Peng Ding
- Department of Neurology, Clinical College of Neurology, Neurosurgery, and Neurorehabilitation, Tianjin Medical University, Tianjin Huanhu Hospital, Tianjin, China
| | - Liqin Yang
- Department of Neurology, Clinical College of Neurology, Neurosurgery, and Neurorehabilitation, Tianjin Medical University, Tianjin Huanhu Hospital, Tianjin, China
| | - Xueqing Liu
- Department of Neurology, Clinical College of Neurology, Neurosurgery, and Neurorehabilitation, Tianjin Medical University, Tianjin Huanhu Hospital, Tianjin, China
| | - Delin Yu
- Department of Ultrasonic, Tianjin Huanhu Hospital, Tianjin, China
| | - Wei Yue
- Department of Neurology, Clinical College of Neurology, Neurosurgery, and Neurorehabilitation, Tianjin Medical University, Tianjin Huanhu Hospital, Tianjin, China
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8
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Wu J, Chen M, Wang H, Zhu Y, Chen Y, Zhang S, Wang D. Comparison of Characteristics and Outcomes Between Acute Ischemic Stroke Patients with Different Types of Heart Failure. Int Heart J 2024; 65:94-99. [PMID: 38148008 DOI: 10.1536/ihj.22-717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Acute ischemic stroke (AIS) can be complicated by heart failure involving preserved ejection fraction (HFpEF) or reduced ejection fraction (HFrEF), and whether or not the prognosis differs between the 2 types of patients remains unclear. We compared the clinical characteristics and outcomes of the 2 types of patients at 3 months after the stroke.We retrospectively analyzed patients who, between 1 January 2018 and 1 January 2021, experienced AIS that was complicated by HFrEF or HFpEF. All patients had been prospectively registered in the Chengdu Stroke Registry. Poor outcome was defined as a modified Rankin Scale (mRS) score of 2-6 at 3 months. Univariate and binary logistic regression was used to assess whether HFpEF was associated with a significantly worse prognosis than HFrEF.Among the final sample of 108 patients (60.2% men; mean age, 73.08 ± 10.82 years), 75 (69.4%) had HFpEF. Compared to HFrEF patients, those with HFpEF were older (P = 0.002), were more likely to have chronic kidney disease (P = 0.033), and were more likely to experience a poor outcome (P = 0.022). After adjustments, HFpEF was associated with significantly greater risk of poor outcome than HFrEF (OR 4.13, 95%CI 1.20-15.79, P = 0.029). However, rates of hemorrhagic transformation or mortality at 3 months after AIS did not differ significantly between the 2 types of heart failure (all P > 0.05).Patients with AIS involving HFpEF experience worse outcomes than those with HFrEF and therefore may require special monitoring and management. Our findings need to be verified in large prospective studies.
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Affiliation(s)
- Jiongxing Wu
- Department of Neurology, West China Hospital, Sichuan University
- Center for Cerebrovascular Diseases, West China Hospital, Sichuan University
| | - Mingxi Chen
- Department of Neurology, West China Hospital, Sichuan University
- Center for Cerebrovascular Diseases, West China Hospital, Sichuan University
| | - Huan Wang
- Department of Neurology, West China Hospital, Sichuan University
- Center for Cerebrovascular Diseases, West China Hospital, Sichuan University
| | - Yuyi Zhu
- Department of Neurology, West China Hospital, Sichuan University
- Center for Cerebrovascular Diseases, West China Hospital, Sichuan University
| | - Yaqi Chen
- Department of Neurology, West China Hospital, Sichuan University
- Center for Cerebrovascular Diseases, West China Hospital, Sichuan University
| | - Shihong Zhang
- Department of Neurology, West China Hospital, Sichuan University
- Center for Cerebrovascular Diseases, West China Hospital, Sichuan University
| | - Deren Wang
- Department of Neurology, West China Hospital, Sichuan University
- Center for Cerebrovascular Diseases, West China Hospital, Sichuan University
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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.
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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
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10
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Doehner W, Böhm M, Boriani G, Christersson C, Coats AJS, Haeusler KG, Jones ID, Lip GYH, Metra M, Ntaios G, Savarese G, Shantsila E, Vilahur G, Rosano G. Interaction of heart failure and stroke: A clinical consensus statement of the ESC Council on Stroke, the Heart Failure Association (HFA) and the ESC Working Group on Thrombosis. Eur J Heart Fail 2023; 25:2107-2129. [PMID: 37905380 DOI: 10.1002/ejhf.3071] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 10/06/2023] [Accepted: 10/16/2023] [Indexed: 11/02/2023] Open
Abstract
Heart failure (HF) is a major disease in our society that often presents with multiple comorbidities with mutual interaction and aggravation. The comorbidity of HF and stroke is a high risk condition that requires particular attention to ensure early detection of complications, efficient diagnostic workup, close monitoring, and consequent treatment of the patient. The bi-directional interaction between the heart and the brain is inherent in the pathophysiology of HF where HF may be causal for acute cerebral injury, and - in turn - acute cerebral injury may induce or aggravate HF via imbalanced neural and neurovegetative control of cardiovascular regulation. The present document represents the consensus view of the ESC Council on Stroke, the Heart Failure Association and the ESC Working Group on Thrombosis to summarize current insights on pathophysiological interactions of the heart and the brain in the comorbidity of HF and stroke. Principal aspects of diagnostic workup, pathophysiological mechanisms, complications, clinical management in acute conditions and in long-term care of patients with the comorbidity are presented and state-of-the-art clinical management and current evidence from clinical trials is discussed. Beside the physicians perspective, also the patients values and preferences are taken into account. Interdisciplinary cooperation of cardiologists, stroke specialists, other specialists and primary care physicians is pivotal to ensure optimal treatment in acute events and in continued long-term treatment of these patients. Key consensus statements are presented in a concise overview on mechanistic insights, diagnostic workup, prevention and treatment to inform clinical acute and continued care of patients with the comorbidity of HF and stroke.
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Affiliation(s)
- Wolfram Doehner
- Berlin Institute of Health Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Deutsches Herzzentrum der Charité, Department of Cardiology (Campus Virchow) and German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Böhm
- Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Saarland University (Kardiologie, Angiologie und Internistische Intensivmedizin), Homburg, Germany
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | | | | | - Karl Georg Haeusler
- Department of Neurology, Universitätsklinikum Würzburg (UKW), Würzburg, Germany
| | - Ian D Jones
- Liverpool Centre for Cardiovascular Science, School of Nursing and Allied Health, Liverpool John Moores University, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Marco Metra
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - George Ntaios
- Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Heart and Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Eduard Shantsila
- Department of Primary Care, University of Liverpool, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Gemma Vilahur
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau and CIBERCV, Barcelona, Spain
| | - Giuseppe Rosano
- St George's University Hospital, London, UK, San Raffaele Cassino, Rome, Italy
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11
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Nistor IR, Gherasim L. From Neurocardiology to Stroke-Heart Syndrome. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2023; 61:177-185. [PMID: 37540842 DOI: 10.2478/rjim-2023-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Indexed: 08/06/2023]
Abstract
The Stroke-Heart syndrome is a major chapter in neurocardiology. Both brain-heart and stroke-heart correlations are based on neurophysiological studies that define and describe the relation between the central autonomic system and cardiac function and it will be presented in this narrative review. The Stroke-Heart syndrome groups the entire spectrum of cardiac changes - clinical, ECG, echocardiographic, biological, morphological - that occur in the first 30 days from the onset of stroke, especially in the first days. Their presence significantly marks the evolution and prognosis of stroke. The damage resulted from hypothalamus-pituitary-adrenal axis activation and high catecholamine release (adrenergic storm) targets mainly the myocyte and the microcirculation.The Takotsubo syndrome and Stunned myocardium are distinct forms of neurogenic myocardial ischemia - with changes in ECG, parietal motility, and biological markers - usually reversible although evolution towards cardiac dysfunction is also possible. The concept of Stroke-Heart syndrome and the brain-heart correlation brought new scientific information regarding stress cardiomyopathy or neurogenic myocardial injury.
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Affiliation(s)
- Ileana Raluca Nistor
- 1Neurology Clinic, "Carol Davila" University of Medicine and Farmacy, Bucharest, Romania
| | - Leonida Gherasim
- 2Cardiology Clinic, "Carol Davila" University of Medicine and Farmacy, Bucharest, Romania
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12
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Wei N, Wei Y, Nie X, Liu X, Xiang X, Pan Y, Meng X, Liu L, Wang Y. Effect of left ventricular ejection fraction Spectrum on 1-Year mortality in patients with acute ischemic stroke or transient ischemic attack. CNS Neurosci Ther 2023; 29:3518-3527. [PMID: 37287419 PMCID: PMC10580366 DOI: 10.1111/cns.14285] [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: 12/14/2022] [Revised: 05/05/2023] [Accepted: 05/21/2023] [Indexed: 06/09/2023] Open
Abstract
AIMS We aimed to investigate the association of the left ventricular ejection fraction (LVEF) spectrum with 1-year clinical outcomes in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA). METHODS In a prospective registry for the Third China National Stroke Registry (CNSR-III), AIS or TIA patients with echocardiography records during hospitalization were recruited. All LVEFs were categorized into intervals of 5% in width. The lowest and highest intervals are ≤40% and >70%, respectively. The primary outcome was all-cause death at 1 year. Cox proportional hazards regression analysis was performed to investigate the association between baseline LVEF and clinical outcomes. RESULTS This analysis included a total of 14,053 patients. In total, 418 patients died during 1-year follow-up. Overall, LVEF ≤60% was associated with a higher risk of all-cause death compared to LVEF >60%, independent of demographic and clinical characteristics (aHR 1.29 [95% CI 1.06-1.58]; p = 0.01). The cumulative incidence of all-cause death was significantly different among the eight LVEF groups that survival declined successively with the decrease of LVEF (log-rank p ≤ 0.0001). CONCLUSIONS Patients with AIS or TIA with decreased LVEF (≤60%) had a lower 1-year survival rate after onset. LVEF 50%-60% even within the normal range, may still contribute to poor outcomes in AIS or TIA. Comprehensive evaluation of cardiac function after acute ischemic cerebrovascular disease should be strengthened.
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Affiliation(s)
- Na Wei
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Yufei Wei
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Ximing Nie
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Xiran Liu
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Xianglong Xiang
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Xia Meng
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Liping Liu
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
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13
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Kwak S, Kwak SG, Chang MC. The effect of preexisting heart failure and coronary artery disease on motor function recovery in cerebral infarct patients: A retrospective observational study. Medicine (Baltimore) 2023; 102:e35453. [PMID: 37832132 PMCID: PMC10578708 DOI: 10.1097/md.0000000000035453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/11/2023] [Indexed: 10/15/2023] Open
Abstract
Less is known about the impact of heart failure (HF) and coronary artery disease (CAD) on motor recovery after cerebral infarction although previous studies have reported that preexisting HF and CAD were associated with increased mortality in stroke patients as well as unfavorable functional outcomes. In this study, we aimed to accurately evaluate the impact of HF and CAD on motor recovery after cerebral infarction by including only patients with corona radiata using diffusion tensor tractography. A total of 110 patients were recruited, and diffusion tensor tractography was performed within 7 to 30 days of infarct onset. Motor function on the affected side was evaluated for each patient using the upper myocardial infarction (MI), lower MI, modified Brunnstrom classification, and the functional ambulation category at the onset of stroke and 6 months after the onset of stroke. The influence of preexisting HF and CAD on the recovery of motor function were analyzed, adjusting for critical factors for motor recovery after stroke, namely the corticospinal tract condition, lesion location, age, and upper and lower MIs at the onset of stroke. No significant difference was found in motor outcomes according to the presence of HF, while poorer outcomes in motor function of the lower extremities and gait ability were observed in patients with CAD compared to patients without CAD. Motor function of the lower extremities and gait ability in cerebral infarct patients with CAD is more impaired than those without CAD.
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Affiliation(s)
- Soyoung Kwak
- Department of Physical Medicine & Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Sang Gyu Kwak
- Department of Medical Statistics, College of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | - Min Cheol Chang
- Department of Physical Medicine & Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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14
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Isokuortti H, Virta JJ, Curtze S, Tiainen M. One-Year Survival of Ischemic Stroke Patients Requiring Mechanical Ventilation. Neurocrit Care 2023; 39:348-356. [PMID: 36759419 PMCID: PMC10541824 DOI: 10.1007/s12028-023-01674-9] [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: 06/27/2022] [Accepted: 01/10/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND The outcome of patients with acute ischemic stroke who require mechanical ventilation has been poor. Intubation due to a reversible condition could be associated with better 1-year survival. METHODS All adult patients treated in Helsinki University Hospital in 2016-2020 who were admitted because of an ischemic stroke (either stroke or thrombosis seen on imaging) and needed mechanical ventilation were included in this retrospective cohort study. Data on demographics, medical history, index stroke, and indication for intubation were collected. The primary outcome was 1-year mortality. Secondary outcomes were modified Rankin Scale (mRS) score at 3 months and living arrangements at 1 year. RESULTS The mean age of the cohort (N = 121) was 66 ± 11 (mean ± SD) years, and the mean admission National Institutes of Health Stroke Scale score was 17 ± 10. Forty-four (36%) patients were male. The most common indication for intubation was unconsciousness (51%), followed by respiratory failure or airway compromise (28%). One-year mortality was 55%. Three-month mRS scores were available for 114 (94%) patients, with the following distribution: 0-2, 18%; 3-5, 28%; and 6 (dead), 54%. Of the 1-year survivors, 72% were living at home. In the multivariate analysis, only age over 75 years and intubation due to unconsciousness, respiratory failure, or cardiac arrest remained significantly associated with mortality. CONCLUSIONS The indication for intubation seems to significantly affect outcome. Functional outcome at 3 months is often poor, but a great majority of 1-year survivors are able to live at home.
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Affiliation(s)
- Harri Isokuortti
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
| | - Jyri J Virta
- Division of Intensive Care Medicine, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Sami Curtze
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Marjaana Tiainen
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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15
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Gentile L, Pracucci G, Saia V, Falcou A, Biraschi F, Zini A, Simonetti L, Riva L, Bigliardi G, Vallone S, Nencini P, Limbucci N, Diomedi M, Da Ros V, Longoni M, Ruggiero M, Tassinari T, Allegretti L, Cerrato P, Rubino E, Bergui M, Cavallo R, Naldi A, Comelli C, Cappellari M, Zivelonghi C, Plebani M, De Vito A, Merli N, Saletti A, Musolino RF, Ferraù L, Vinci SL, Sacco S, Orlandi B, De Santis F, Filauri P, Ruiz L, Sepe FN, Gallesio I, Petruzzellis M, Chiumarulo L, Sangalli D, Salmaggi A, Filizzolo M, Moller J, Melis M, Comelli S, Magoni M, Gilberti N, Gasparotti R, Invernizzi P, Pavia M, Pinto V, Laspada S, Marcheselli S, Ajello D, Viaro F, Baracchini C, Causin F, Giannini N, Caselli MC, Mancuso M, Cosottini M, Scoditti U, Menozzi R, Russo M, Amistá P, Napoletano R, Romano DG, Tassi R, Bracco S, Carimati F, Versino M, Giorgianni A, De Boni A, Fasano A, Barbarini L, Paladini A, Franchini E, Dall'Ora E, Comai A, Giovanni F, Pedicelli A, Sallustio F, Casetta I, Fainardi E, Mangiafico S, Toni D. Mechanical thrombectomy in patients with heart failure: the Italian registry of Endovascular Treatment in Acute Stroke. Neurol Sci 2023; 44:3577-3585. [PMID: 37199875 DOI: 10.1007/s10072-023-06830-9] [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: 12/14/2022] [Accepted: 04/26/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Heart failure (HF) is the second most important cardiac risk factor for stroke after atrial fibrillation (AF). Few data are available on mechanical thrombectomy (MT) in acute ischemic stroke (AIS) patients with HF. METHODS The source of data is the multicentre Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS). All AIS patients ≥ 18 years receiving MT were categorised in two groups: HF and no-HF. Baseline clinical and neuroradiological findings on admission were analysed. RESULTS Of 8924 patients, 642 (7.2%) had HF. Compared to the no-HF group, HF patients had higher prevalence of cardiovascular risk factors. Rate of complete recanalisation (TICI 2b-3) was 76.9% in HF vs 78.1% in no-HF group (p = 0.481). Rate of symptomatic intracerebral haemorrhage at 24-h non-contrast computed tomography (NCCT) was 7.6% in HF vs 8.3% in no-HF patients (p = 0.520). At 3 months, 36.4% of HF patients and 48.2% of no-HF patients (p < 0.001) had mRS 0-2, and mortality was, respectively, 30.7% and 18.5% (p < 0.001). In multivariate logistic regression, HF was independently associated with mortality at 3 months (OR 1.53, 1.24-1.88 95% CI, p < 0.001). In multivariate ordinal regression, HF patients had a probability of transitioning to a higher mRS level of 1.23 (1.05-1.44 95% CI, p = 0.012). The propensity score analysis of two groups matched for age, sex, and NIHSS at admission yielded the same results. CONCLUSION MT is safe and effective in HF patients with AIS. Patients with HF and AIS suffered from higher 3-month mortality and unfavourable outcome regardless of acute treatments.
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Affiliation(s)
- Luana Gentile
- Department of Neurology and Metropolitan Stroke Center, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Maggiore Hospital, Bologna, Italy
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Giovanni Pracucci
- Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - Valentina Saia
- Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy
| | - Anne Falcou
- Emergency Department, Stroke Unit, Policlinico Umberto I Hospital, Rome, Italy
| | - Francesco Biraschi
- Department of Human Neurosciences, Interventional Neuroradiology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Andrea Zini
- Department of Neurology and Metropolitan Stroke Center, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Maggiore Hospital, Bologna, Italy
| | - Luigi Simonetti
- Neuroradiology Department, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Maggiore Hospital, Bologna, Italy
| | - Letizia Riva
- Cardiology Unit, Maggiore Hospital, Bologna, Italy
| | - Guido Bigliardi
- Stroke Unit, Neurology Unit, Department of Neuroscience, Azienda Ospedaliera Universitaria Di Modena, Ospedale Civile Baggiovara, Modena, Italy
| | - Stefano Vallone
- Neuroradiology Unit, Ospedale Civile Di Baggiovara, Azienda Ospedaliera Universitaria Di Modena, Modena, Italy
| | - Patrizia Nencini
- Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - Nicola Limbucci
- Department of Interventional Neuroradiology, Careggi University Hospital, Florence, Italy
| | - Marina Diomedi
- Stroke Unit, Department of Systems Medicine, University of Tor Vergata, Rome, Italy
| | - Valerio Da Ros
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Marco Longoni
- Department of Neurology and Stroke Unit Cesena-Forlì, Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Maria Ruggiero
- Neuroradiology Unit, Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Tiziana Tassinari
- Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy
| | - Luca Allegretti
- Department of Interventional Neuroradiology, Santa Corona Hospital, Pietra Ligure, Italy
| | - Paolo Cerrato
- Stroke Unit, AOU Città Della Salute E Della Scienza, Molinette Hospital, Turin, Italy
| | - Elisa Rubino
- Stroke Unit, AOU Città Della Salute E Della Scienza, Molinette Hospital, Turin, Italy
| | - Mauro Bergui
- Neuroscience Department, University of Torino, Turin, Italy
| | | | - Andrea Naldi
- Neurology Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Chiara Comelli
- Interventional Neuroradiology Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Manuel Cappellari
- Stroke Unit, Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Cecilia Zivelonghi
- Stroke Unit, Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Mauro Plebani
- Interventional Neurovascular Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Nicola Merli
- Neurology Unit, University Hospital Arcispedale S. Anna, Ferrara, Italy
| | - Andrea Saletti
- Department of Radiology, Neuroradiology Unit, Azienda Ospedaliera Universitaria, Arcispedale S. Anna, Ferrara, Italy
| | - Rosa Fortunata Musolino
- Department of Clinical and Experimental Medicine, U.O.S.D. Stroke Unit, AOU Policlinico G. Martino, University of Messina, Messina, Italy
| | - Ludovica Ferraù
- Department of Clinical and Experimental Medicine, U.O.S.D. Stroke Unit, AOU Policlinico G. Martino, University of Messina, Messina, Italy
| | - Sergio Lucio Vinci
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, Neuroradiology Unit, University of Messina, Messina, Italy
| | - Simona Sacco
- Stroke Unit and Neurology Unit, S.S. Filippo and Nicola Hospital, Avezzano, Italy
| | - Berardino Orlandi
- Stroke Unit and Neurology Unit, S.S. Filippo and Nicola Hospital, Avezzano, Italy
| | - Federica De Santis
- Stroke Unit and Neurology Unit, S.S. Filippo and Nicola Hospital, Avezzano, Italy
| | - Pietro Filauri
- Neuroradiology Unit, SS. Filippo and Nicola Hospital, Avezzano, Italy
| | - Luigi Ruiz
- Stroke Unit, SS. Antonio E Biagio E Cesare Arrigo Hospital, Alessandria, Italy
| | | | - Ivan Gallesio
- Neuroradiology Unit, SS. Antonio E Biagio E Cesare Arrigo Hospital, Alessandria, Italy
| | - Marco Petruzzellis
- Neurology Unit and Stroke Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | | | | | | | - Marco Filizzolo
- Interventional Neuroradiology Unit, AOOR Villa Sofia-Cervello, Palermo, Italy
| | | | | | - Simone Comelli
- Vascular and Interventional Neuroradiology Department, ARNAS G. Brotzu, Cagliari, Italy
| | - Mauro Magoni
- Stroke Unit, SpedaliCivili, Vascular Neurology, Brescia, Italy
| | - Nicola Gilberti
- Stroke Unit, SpedaliCivili, Vascular Neurology, Brescia, Italy
| | | | - Paolo Invernizzi
- Neurology Unit, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Marco Pavia
- Neuroradiology Unit, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Vincenza Pinto
- Neurology and Stroke Unit, Perrino Hospital, Brindisi, Italy
| | | | | | - Daniele Ajello
- Neuroradiology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Federica Viaro
- Stroke Unit and Neurosonology Laboratory, Padua University Hospital, Padua, Italy
| | - Claudio Baracchini
- Stroke Unit and Neurosonology Laboratory, Padua University Hospital, Padua, Italy
| | - Francesco Causin
- Department of Diagnostic Imaging and Interventional Radiology, Neuroradiology, Padua University Hospital, Padua, Italy
| | - Nicola Giannini
- Department Neurology and Stroke Unit, Azienda Ospedaliera Universitaria Di Pisa, Pisa, Italy
| | - Maria Chiara Caselli
- Department Neurology and Stroke Unit, Azienda Ospedaliera Universitaria Di Pisa, Pisa, Italy
| | - Michelangelo Mancuso
- Department Neurology and Stroke Unit, Azienda Ospedaliera Universitaria Di Pisa, Pisa, Italy
| | - Mirco Cosottini
- Department of Translational Research and New Technology in Medicine and Surgery, Azienda Ospedaliera Universitaria Di Pisa, Pisa, Italy
| | - Umberto Scoditti
- Stroke Unit, Neurology Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Roberto Menozzi
- Neuroradiology Unit, University Hospital of Parma, Parma, Italy
| | - Monia Russo
- Stroke Unit, Ospedale S. Maria Misericordia, Rovigo, Italy
| | - Pietro Amistá
- Neuroradiology Unit, Ospedale S. Maria Misericordia, Rovigo, Italy
| | - Rosa Napoletano
- Stroke Unit, S. Giovanni Di Dio E Ruggi d'Aragona Hospital, Salerno, Italy
| | - Daniele Giuseppe Romano
- Unita Operativa Radiologia Vascolare, S. Giovanni Di Dio E Ruggi d'Aragona Hospital, Salerno, Italy
| | - Rossana Tassi
- Stroke Unit, Department of Emergency and Transplantation, Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria Alle Scotte", Siena, Italy
| | - Sandra Bracco
- UO Neurointerventistica, Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria Alle Scotte", Siena, Italy
| | - Federico Carimati
- Department of Neurology and Stroke Unit, Circolo e Fondazione Macchi Hospital, ASST Settelaghi, Varese, Italy
| | - Maurizio Versino
- Department of Neurology and Stroke Unit, Circolo e Fondazione Macchi Hospital, ASST Settelaghi, Varese, Italy
| | - Andrea Giorgianni
- Neuroradiology Department, Circolo e Fondazione Macchi Hospital, ASST Settelaghi, Varese, Italy
| | | | - Antonio Fasano
- Department of Neurology, Vito Fazzi Hospital, Lecce, Italy
| | | | | | - Enrica Franchini
- Department of Neurology and Stroke Unit, Bolzano Central Hospital, Bolzano, Italy
| | - Elisa Dall'Ora
- Department of Neurology and Stroke Unit, Bolzano Central Hospital, Bolzano, Italy
| | - Alessio Comai
- Neuroradiology Unit, Bolzano Central Hospital, Bolzano, Italy
| | - Frisullo Giovanni
- Department of Neurology and Stroke Unit, Catholic University, Rome, Italy
| | - Alessandro Pedicelli
- Dipartimento Di Diagnostica Per Immagini, UOSA Neuroradiologia Interventistica, RadioterapiaOncologica Ed Ematologia, Fondazione PoliclinicoUniversitarioA.Gemelli Di Roma, Rome, Italy
| | - Fabrizio Sallustio
- Unitá Di Trattamento Neurovascolare, Ospedale Dei Castelli-ASL6, Rome, Italy
| | - Ilaria Casetta
- Neurology Unit, University Hospital Arcispedale S. Anna, Ferrara, Italy
| | - Enrico Fainardi
- Dipartimento Di Scienze Biomediche, Sperimentali E Cliniche, Università Degli Studi Di Firenze, Ospedale Universitario Careggi, NeuroradiologiaFlorence, Italy
| | - Salvatore Mangiafico
- Interventional Neuroradiology Consultant at IRCCS NeuromedPozzilli (IS), and Adjunct Professor of Interventional Neuroradiology at Tor Vergata University, Sapienza University and S. Andrea Hospital, Rome, Italy
| | - Danilo Toni
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy.
- Emergency Department, Stroke Unit, Policlinico Umberto I Hospital, Rome, Italy.
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16
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Robison RD, Singh M, Jiang L, Riester M, Duprey M, McGeary JE, Goyal P, Wu WC, Erqou S, Zullo A, Rudolph JL, Rogus-Pulia N. Acute Antipsychotic Use and Presence of Dysphagia Among Older Veterans with Heart Failure. J Am Med Dir Assoc 2023; 24:1303-1310. [PMID: 37478895 PMCID: PMC10527768 DOI: 10.1016/j.jamda.2023.06.009] [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: 12/29/2022] [Revised: 06/02/2023] [Accepted: 06/12/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVE Examine whether new antipsychotic (AP) exposure is associated with dysphagia in hospitalized patients with heart failure (HF). DESIGN Retrospective cohort. SETTINGS AND PARTICIPANTS AP-naïve Veterans hospitalized with HF and subsequently discharged to a skilled nursing facility (SNF) between October 1, 2010, and November 30, 2019. METHODS We linked Veterans Health Administration (VHA) electronic medical records with Centers for Medicare & Medicaid (CMS) Minimum Data Set (MDS) version 3.0 assessments and CMS claims. The exposure variable was administration of ≥1 dose of a typical or atypical AP during hospitalization. Our main outcome measure was dysphagia presence defined by (1) inpatient dysphagia diagnosis codes and (2) the SNF admission MDS 3.0 swallowing-related items to examine post-acute care dysphagia status. Inverse probability of treatment weighting was used for risk adjustment. RESULTS The analytic cohort consisted of 29,591 Veterans (mean age 78.5 ± 10.0 years; female 2.9%; n = 865). Acute APs were administered to 9.9% (n = 2941). Those receiving APs had differences in prior dementia [37.1%, n = 1091, vs 22.3%, n = 5942; standardized mean difference (SMD) = 0.33] and hospital delirium diagnoses (7.7%, n = 227 vs 2.8%, n = 754; SMD = 0.22). Acute AP exposure was associated with nearly double the risk for hospital dysphagia diagnosis codes [adjusted (adj.) relative risk (RR) 1.9, 95% CI 1.8, 2.1]. At the SNF admission MDS assessment, acute AP administration during hospitalization was associated with an increased dysphagia risk (adj. RR 1.2, 95% CI 1.0, 1.5) both in the oral (adj. RR 1.7, 95% CI 1.2, 2.0) and pharyngeal phases (adj. RR 1.3, 95% CI 1.0, 1.7). CONCLUSIONS AND IMPLICATIONS In this retrospective study, AP medication exposure was associated with increased dysphagia coding and MDS assessment. Considering other adverse effects, acute AP should be cautiously administered during hospitalization, particularly in those with dementia. Swallowing function is critical to hydration, nutrition, and medical management of HF; therefore, when acute APs are initiated, a swallow evaluation should be considered.
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Affiliation(s)
- Raele Donetha Robison
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health (SMPH), Madison, WI, USA
| | - Mriganka Singh
- Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, RI, USA; Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Lan Jiang
- Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, RI, USA
| | - Melissa Riester
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Matthew Duprey
- Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, RI, USA
| | - John E McGeary
- Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, RI, USA; Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Parag Goyal
- Division of Cardiology and Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Wen-Chih Wu
- Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Sebhat Erqou
- Warren Alpert Medical School of Brown University, Providence, RI, USA; Division of Cardiology, Providence VA Medical Center, Providence, RI, USA; Lifespan Cardiovascular Institute, Providence, RI, USA
| | - Andrew Zullo
- Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, RI, USA; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - James L Rudolph
- Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, RI, USA; Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - Nicole Rogus-Pulia
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health (SMPH), Madison, WI, USA; Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.
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17
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Winder K, Villegas Millar C, Siedler G, Knott M, Dörfler A, Engel A, Achenbach S, Hilz MJ, Kallmünzer B, Schwab S, Seifert F, Fröhlich K. Acute right insular ischaemic lesions and poststroke left ventricular dysfunction. Stroke Vasc Neurol 2023; 8:301-306. [PMID: 36653066 PMCID: PMC10512080 DOI: 10.1136/svn-2022-001724] [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: 05/12/2022] [Accepted: 12/15/2022] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Myocardial injury related to acute ischaemic stroke is common even without primary cardiac disease. We intended to determine associations between values of left ventricular ejection fraction (LVEF) and ischaemic stroke lesion sites. METHODS Of a local database, patients with acute first-ever ischaemic stroke confirmed by brain imaging but without pre-existing heart disease were included. The cardiac morphology and LVEF were obtained from transthoracic or transesophageal echocardiography, and impaired LVEF was categorised as mild (35%-50%), moderate (34%-25%) and severe (<25%). Patient age, stroke severity, ischaemic lesion volume, prevalence of troponin I increase (>0.1 ng/mL), atrial fibrillation and cardiac wall motion abnormalities were assessed and compared between patients with and without impaired LVEF after stroke (significance: p<0.05). A multivariate voxelwise lesion analysis correlated LVEF after stroke with sites of ischaemic lesions. RESULTS Of 1209 patients who had a stroke, 231 (mean age 66.3±14.0 years) met the inclusion criteria; 40 patients (17.3%) had an impaired LVEF after stroke. Patients with impaired LVEF had higher infarct volumes (53.8 mL vs 30.0 mL, p=0.042), a higher prevalence of troponin increase (17.5% vs 4.2%, p=0.006), cardiac wall motion abnormalities (42.5% vs 5.2%, p<0.001) and atrial fibrillation (60.0% vs 26.2%, p<0.001) than patients with LVEF of >50%. The multivariate voxelwise lesion analysis yielded associations between decreased LVEF and damaged voxels in the insula, amygdala and operculum of the right hemisphere. CONCLUSION Our imaging analysis unveils a prominent role of the right hemispheric central autonomic network, especially of the insular cortex, in the brain-heart axis. Our results support preliminary evidence that acute ischaemic stroke in distinct brain regions of the central autonomic network may directly impair cardiac function and thus further supports the concept of a distinct stroke-heart syndrome.
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Affiliation(s)
- Klemens Winder
- Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Neurology, University Hospital and University of Zürich, Zürich, Switzerland
| | - Carolina Villegas Millar
- Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Gabriela Siedler
- Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Knott
- Neuroradiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Arnd Dörfler
- Neuroradiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Anna Engel
- Cardiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Stephan Achenbach
- Cardiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Max J Hilz
- Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Bernd Kallmünzer
- Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan Schwab
- Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Frank Seifert
- Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Kilian Fröhlich
- Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
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18
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Chee RCH, Lin NH, Ho JSY, Leow AST, Li TYW, Lee ECY, Chan MY, Kong WKF, Yeo TC, Chai P, Yip JWL, Poh KK, Sharma VK, Yeo LLL, Tan BYQ, Sia CH. Left Ventricular Ejection Fraction Association with Acute Ischemic Stroke Outcomes in Patients Undergoing Thrombolysis. J Cardiovasc Dev Dis 2023; 10:231. [PMID: 37367396 DOI: 10.3390/jcdd10060231] [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: 05/03/2023] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
(1) Background: Little is known about how left ventricular systolic dysfunction (LVSD) affects functional and clinical outcomes in acute ischemic stroke (AIS) patients undergoing thrombolysis; (2) Methods: A retrospective observational study conducted between 2006 and 2018 included 937 consecutive AIS patients undergoing thrombolysis. LVSD was defined as left ventricular ejection fraction (LVEF) < 50%. Univariate and multivariate binary logistic regression analysis was performed for demographic characteristics. Ordinal shift regression was used for functional modified Rankin Scale (mRS) outcome at 3 months. Survival analysis of mortality, heart failure (HF) admission, myocardial infarction (MI) and stroke/transient ischemic attack (TIA) was evaluated with a Cox-proportional hazards model; (3) Results: LVSD patients in comparison with LVEF ≥ 50% patients accounted for 190 and 747 patients, respectively. LVSD patients had more comorbidities including diabetes mellitus (100 (52.6%) vs. 280 (37.5%), p < 0.001), atrial fibrillation (69 (36.3%) vs. 212 (28.4%), p = 0.033), ischemic heart disease (130 (68.4%) vs. 145 (19.4%), p < 0.001) and HF (150 (78.9%) vs. 46 (6.2%), p < 0.001). LVSD was associated with worse functional mRS outcomes at 3 months (adjusted OR 1.41, 95% CI 1.03-1.92, p = 0.030). Survival analysis identified LVSD to significantly predict all-cause mortality (adjusted HR [aHR] 3.38, 95% CI 1.74-6.54, p < 0.001), subsequent HF admission (aHR 4.23, 95% CI 2.17-8.26, p < 0.001) and MI (aHR 2.49, 95% CI 1.44-4.32, p = 0.001). LVSD did not predict recurrent stroke/TIA (aHR 1.15, 95% CI 0.77-1.72, p = 0.496); (4) Conclusions: LVSD in AIS patients undergoing thrombolysis was associated with increased all-cause mortality, subsequent HF admission, subsequent MI and poorer functional outcomes, highlighting a need to optimize LVEF.
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Affiliation(s)
- Ryan C H Chee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Norman H Lin
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore
| | - Jamie S Y Ho
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore
| | - Aloysius S T Leow
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Tony Y W Li
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore
| | - Edward C Y Lee
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore
| | - Mark Y Chan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore
| | - William K F Kong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore
| | - Tiong-Cheng Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore
| | - Ping Chai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore
| | - James W L Yip
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore
| | - Kian-Keong Poh
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore
| | - Vijay K Sharma
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Division of Neurology, Department of Medicine, National University Hospital, Singapore 119074, Singapore
| | - Leonard L L Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Division of Neurology, Department of Medicine, National University Hospital, Singapore 119074, Singapore
| | - Benjamin Y Q Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Division of Neurology, Department of Medicine, National University Hospital, Singapore 119074, Singapore
| | - Ching-Hui Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore
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19
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Edrissi C, Rathfoot C, Knisely K, Sanders CB, Goodwin R, Nathaniel SI, Nathaniel T. Age Stratification in Acute Ischemic Stroke Patients with Heart Failure. J Clin Med 2022; 12:jcm12010038. [PMID: 36614839 PMCID: PMC9821452 DOI: 10.3390/jcm12010038] [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: 10/14/2022] [Revised: 11/28/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Background and Purpose. Heart failure (HF) is considered one of the major risk factors associated with the severity of acute ischemic stroke(AIS). The risk factors associated with stroke severity in AIS with a history of HF is not fully understood. Methods. A prospectively maintained database from comprehensive stroke centers in PRISMA Health Upstate Sc, was analyzed for patients with AIS and a history of HF from January 2010 to 30 June 2016. The primary outcome was risk factors associated with a National Institute of Health Stroke Scale score (NIHSS) < 7 indicating lower severity and a score ≥ 7 indicating high severity for 65−74 age category and ≥75 years age category for AIS-HF patients. Univariate analysis was used to determine risk factors based on age categories and stroke severities, while multivariable analysis was used to adjust for the effect of confounding variables. Results: A total 367 AIS-HF patients were identified in this study, 113 patients were between 65−74 years old, while 254 patients were in the ≥75 years old age category. In the adjusted analysis for 65−74 age category, history of smoking (OR = 0.105, 95% Confidence interval (CI): 0.018−0.614, p = 0.012), triglycerides (Odd ratio(OR) = 0.993, 95% (CI): 0.987−0.999, p = 0.019), and International Normalized Ratio (INR) (OR = 0.454, 95% CI: 0.196−1.050, p = 0.045), and direct admission treatment (OR = 0.355, 95% CI: 0.137−0.920, p = 0.033) were associated with a lower stroke severity, elevated heart rate (OR = 1.032, 95% CI: 1.009−1.057, p = 0.007) was associated with a higher stroke severity. For the ≥75 years old age category, previous stroke (OR = 2.297, 95% CI: 1.171−9.852, p = 0.024), peripheral vascular disease (OR = 6.784, 95% CI: 1.242−37.065, p = 0.027), heart rate (OR = 1.035, 95% CI: 1.008−1.063, p = 0.012), and systolic blood pressure (OR = 1.023, 95% CI: 1.005−1.041, p = 0.012) were associated with a higher severe stroke severity. Conclusions: After adjusting for the effect of potential confounders, more risk factors were associated with a high severity of stroke among ≥75 years old compared with 65−74 years old AIS-HF patients. Elevated heart rate was an independent risk factor associated with stroke severity in 65−74 and ≥75 years old AIS-HF patients. Elevated heart rate and other identified risk factors should be managed to reduce stroke severity among elderly AIS-HF patients.
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Affiliation(s)
- Camron Edrissi
- School of Medicine-Greenville, University of South Carolina, Greenville, SC 29605, USA
| | - Chase Rathfoot
- School of Medicine-Greenville, University of South Carolina, Greenville, SC 29605, USA
| | - Krista Knisely
- School of Medicine-Greenville, University of South Carolina, Greenville, SC 29605, USA
| | | | - Richard Goodwin
- School of Medicine-Greenville, University of South Carolina, Greenville, SC 29605, USA
| | - Samuel I. Nathaniel
- Department of Biology, North Greenville University, Tigerville, SC 29688, USA
| | - Thomas Nathaniel
- School of Medicine-Greenville, University of South Carolina, Greenville, SC 29605, USA
- Correspondence: ; Tel.: +1-86-44559846; Fax: +1-86-44558404
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20
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Wang M, Peng Y. Advances in brain-heart syndrome: Attention to cardiac complications after ischemic stroke. Front Mol Neurosci 2022; 15:1053478. [PMID: 36504682 PMCID: PMC9729265 DOI: 10.3389/fnmol.2022.1053478] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/02/2022] [Indexed: 11/25/2022] Open
Abstract
Neurocardiology is an emerging field that studies the interaction between the brain and the heart, namely the effects of heart injury on the brain and the effects of brain damage on the heart. Acute ischemic stroke has long been known to induce heart damage. Most post-stroke deaths are attributed to nerve damage, and cardiac complications are the second leading cause of death after stroke. In clinical practice, the proper interpretation and optimal treatment for the patients with heart injury complicated by acute ischemic stroke, recently described as stroke-heart syndrome (SHS), are still unclear. Here, We describe a wide range of clinical features and potential mechanisms of cardiac complications after ischemic stroke. Autonomic dysfunction, microvascular dysfunction and coronary ischemia process are interdependent and play an important role in the process of cardiac complications caused by stroke. As a unique comprehensive view, SHS can provide theoretical basis for research and clinical diagnosis and treatment.
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Affiliation(s)
- Min Wang
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Ya Peng
- Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China,*Correspondence: Ya Peng,
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21
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From cerebrovascular diseases to neuro-co-cardiological diseases: a challenge in the new epoch. Sci Bull (Beijing) 2022; 67:1830-1832. [PMID: 36546292 DOI: 10.1016/j.scib.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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22
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Scheitz JF, Sposato LA, Schulz-Menger J, Nolte CH, Backs J, Endres M. Stroke-Heart Syndrome: Recent Advances and Challenges. J Am Heart Assoc 2022; 11:e026528. [PMID: 36056731 PMCID: PMC9496419 DOI: 10.1161/jaha.122.026528] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
After ischemic stroke, there is a significant burden of cardiovascular complications, both in the acute and chronic phase. Severe adverse cardiac events occur in 10% to 20% of patients within the first few days after stroke and comprise a continuum of cardiac changes ranging from acute myocardial injury and coronary syndromes to heart failure or arrhythmia. Recently, the term stroke–heart syndrome was introduced to provide an integrated conceptual framework that summarizes neurocardiogenic mechanisms that lead to these cardiac events after stroke. New findings from experimental and clinical studies have further refined our understanding of the clinical manifestations, pathophysiology, and potential long‐term consequences of the stroke–heart syndrome. Local cerebral and systemic mediators, which mainly involve autonomic dysfunction and increased inflammation, may lead to altered cardiomyocyte metabolism, dysregulation of (tissue‐resident) leukocyte populations, and (micro‐) vascular changes. However, at the individual patient level, it remains challenging to differentiate between comorbid cardiovascular conditions and stroke‐induced heart injury. Therefore, further research activities led by joint teams of basic and clinical researchers with backgrounds in both cardiology and neurology are needed to identify the most relevant therapeutic targets that can be tested in clinical trials.
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Affiliation(s)
- Jan F Scheitz
- Department of Neurology With Experimental Neurology Charité-Universitätsmedizin Berlin Berlin Germany.,Center for Stroke Research Berlin Charité-Universitätsmedizin Berlin Berlin Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin Berlin Germany.,Berlin Institute of Health (BIH) Berlin Germany.,World Stroke Organization Brain & Heart Task Force
| | - Luciano A Sposato
- World Stroke Organization Brain & Heart Task Force.,Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry Western University London Ontario Canada.,Heart & Brain Laboratory Western University London Ontario Canada
| | - Jeanette Schulz-Menger
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a Joint Cooperation Between the Charité-Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology and the Max-Delbrueck Center for Molecular Medicine DZHK (German Centre for Cardiovascular Research), Partner Site Berlin Berlin Germany.,Department of Cardiology and Nephrology HELIOS Klinikum Berlin Buch Berlin Germany
| | - Christian H Nolte
- Department of Neurology With Experimental Neurology Charité-Universitätsmedizin Berlin Berlin Germany.,Center for Stroke Research Berlin Charité-Universitätsmedizin Berlin Berlin Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin Berlin Germany.,Berlin Institute of Health (BIH) Berlin Germany
| | - Johannes Backs
- Institute of Experimental Cardiology Heidelberg University Heidelberg Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim Heidelberg Germany
| | - Matthias Endres
- Department of Neurology With Experimental Neurology Charité-Universitätsmedizin Berlin Berlin Germany.,Center for Stroke Research Berlin Charité-Universitätsmedizin Berlin Berlin Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin Berlin Germany.,Berlin Institute of Health (BIH) Berlin Germany.,DZNE (German Center for Neurodegenerative Disease), Partner Site Berlin Berlin Germany.,ExcellenceCluster NeuroCure Berlin Germany
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23
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Heart Failure Status among Acute Ischemic Stroke Patients: A Hospital-Based Study. Neurol Res Int 2022; 2022:7348505. [PMID: 36059928 PMCID: PMC9433237 DOI: 10.1155/2022/7348505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 08/07/2022] [Indexed: 11/24/2022] Open
Abstract
Background Since heart failure (HF) and ischemic stroke have common risk factors, their concurrent occurrence is likely. Strokes in HF patients could be life-threatening and lead to severe disabilities, longer hospitalization time, and mortality. The present study aims to investigate the prevalence of HF and its severity based on ejection fraction (EF) in patients with acute ischemic stroke. Methods The present cross-sectional study included acute ischemic stroke patients admitted to Shahid Rajaei hospital in Karaj in 2020–2021. The diagnosis of HF was based on transthoracic echocardiography within 48 hours of symptom onset, and HF was classified into two groups: 41–49% as mildly reduced EF (HFmrEF) and ≤40% as reduced EF (HFrEF). Patients who did not complete cardiac studies were excluded. Results 257 acute ischemic stroke patients (62.6% male) were included. Among stroke patients, the prevalence of HF, including HFrEF and HFmrEF, was 30.0% (95% CI: 21.4–38.6). HFmrEF and HFrEF was diagnosed in 32 (12.5%) and 45 (17.5%) patients, respectively. HF was significantly associated with older age, hypertension, past myocardial infarction (MI), and arrhythmia. A history of previous MI significantly increased the odds of heart failure (OR: 3.25, 95% CI: 1.82–5.81). Conclusion There is a high prevalence of HF among acute ischemic stroke patients. Older patients with a history of hypertension and previous MI are at higher risk. Since patients with HF have a higher mortality and morbidity rate after experiencing an ischemic stroke, close cooperation between the neurology and cardiology specialists for providing advanced care for survivors is required.
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Sprügel MI, Sembill JA, Kremer S, Gerner ST, Knott M, Hock S, Engelhorn T, Dörfler A, Huttner HB, Schwab S. Evaluation of Functional Recovery Following Thrombectomy in Patients With Large Vessel Occlusion and Prestroke Disability. JAMA Netw Open 2022; 5:e2227139. [PMID: 35972737 PMCID: PMC9382438 DOI: 10.1001/jamanetworkopen.2022.27139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE It is uncertain whether thrombectomy is associated with benefits in patients with prestroke disability. OBJECTIVE To evaluate the use of thrombectomy for patients with large vessel occlusion and prestroke disability. DESIGN, SETTING, AND PARTICIPANTS This cohort study included patients with large vessel occlusion stroke and prestroke disability (modified Rankin Scale score, 3 or 4) admitted to a single tertiary care center between January 1, 2006, and June 30, 2019 (controls: 2006-2015; thrombectomy: 2015-2019). Follow-up was conducted at 90 days. Data analysis was performed from November 1 to December 31, 2021. EXPOSURES Use of thrombectomy vs no thrombectomy. MAIN OUTCOMES AND MEASURES The primary outcome was functional recovery at 90 days defined as clinical recovery to the functional status before stroke onset. Secondary outcomes included functional dependency, mortality, early neurologic improvement, and recanalization. RESULTS Among 205 patients (149 women [72.7%]; median age, 82 years [IQR, 75-87 years]), 102 individuals (49.8%) received thrombectomy and 103 (50.2%) were controls. Thrombectomy was significantly associated with functional recovery (thrombectomy, 20 [19.6%]; controls, 8 [7.8%]; adjusted difference, 9.4%; 95% CI, 2.2% to 16.7%; P = .005). Secondary outcomes showed differences in mortality, early neurologic improvement, and recanalization in favor of thrombectomy treatment. The rate of functional dependency did not differ significantly between the 2 groups (adjusted difference, 8.9%; 95% CI, -2.5% to 20.2%; P = .13). The rate of functional recovery after thrombectomy was 44.0% for patients with early neurologic improvement, 29.4% for patients with small infarct volume (<50 mL), and 7.0% for patients with neither of these parameters. CONCLUSIONS AND RELEVANCE Findings of this study suggest that selected patients with prestroke disability may benefit from thrombectomy. However, the thrombectomy-associated increase in functional recovery was small. Therefore, routine use of thrombectomy may not be beneficial among patients with a large ischemic core and infarct volumes less than 50 mL may be necessary to obtain functional recovery. Patients with higher chances of functional recovery are also at an increased risk of survival with substantial disability, indicating potential harms from the intervention; further studies are needed.
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Affiliation(s)
- Maximilian I. Sprügel
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Jochen A. Sembill
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Svenja Kremer
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan T. Gerner
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Knott
- Department of Neuroradiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan Hock
- Department of Neuroradiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Tobias Engelhorn
- Department of Neuroradiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Arnd Dörfler
- Department of Neuroradiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Hagen B. Huttner
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan Schwab
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Krieger P, Zhao A, Croll L, Irvine H, Torres J, Melmed KR, Lord A, Ishida K, Frontera J, Lewis A. Tachycardia is associated with mortality and functional outcome after thrombectomy for acute ischemic stroke. J Stroke Cerebrovasc Dis 2022; 31:106450. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/02/2022] [Accepted: 03/12/2022] [Indexed: 10/18/2022] Open
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Rühl L, Kuramatsu JB, Sembill JA, Kallmünzer B, Madzar D, Gerner ST, Giede-Jeppe A, Balk S, Mueller T, Jäger J, Schwab S, Huttner HB, Sprügel MI. Amantadine treatment is associated with improved consciousness in patients with non-traumatic brain injury. J Neurol Neurosurg Psychiatry 2022; 93:582-587. [PMID: 35086939 PMCID: PMC9148986 DOI: 10.1136/jnnp-2021-327408] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 12/29/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This study determined the effect of amantadine treatment on consciousness in patients with non-traumatic brain injury. METHODS We pooled individual patient data of five single-centre observational studies to determine the effect of amantadine treatment among patients with ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, community-acquired bacterial meningitis and status epilepticus, admitted between January 2012 and December 2015 and ventilated ≥7 days. Patient selection and multivariable regression modelling were used to adjust for differences in intergroup comparison and for parameters associated with consciousness. Improvement of consciousness 5 days after treatment initiation was defined as primary outcome. Secondary outcomes included Glasgow Coma Scale (GCS) at day 5 and GCS at day 10, rate of ICU delirium, epileptic seizures and all-cause mortality at 90 days. RESULTS Overall, 84 of 294 (28.6%) eligible patients received amantadine. Amantadine treatment was associated with improvement of consciousness at day 5 (amantadine: 86.9% vs control: 54.0%; absolute difference: 32.9 (20.0-44.2); adjusted OR (aOR): 5.71 (2.50-13.05), p<0.001). Secondary outcomes showed differences in GCS 5 days (9 (8-11) vs 6 (3-9), p<0.001) and GCS 10 days (10(8-11) vs 9(6-11),p=0.003) after treatment initiation. There were no significant differences regarding all-cause mortality (aOR: 0.89 (0.44-1.82), p=0.758) and ICU delirium (aOR: 1.39 (0.58-3.31), p=0.462). Rate of epileptic seizures after initiation of amantadine treatment was numerically higher in the amantadine group (amantadine: 10.7% vs control: 3.0%; absolute difference: 7.7 (0.3-16.4); aOR: 3.68 (0.86-15.71), p=0.079). CONCLUSIONS Amantadine treatment is associated with improved consciousness among patients with different types of non-traumatic brain injury in this observational cohort analysis. Epileptic seizures should be considered as potential side effects and randomised controlled trials are needed to confirm these findings.
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Affiliation(s)
- Lena Rühl
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Joji B Kuramatsu
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Jochen A Sembill
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Bernd Kallmünzer
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Dominik Madzar
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan T Gerner
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Antje Giede-Jeppe
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stefanie Balk
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Tamara Mueller
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Jakob Jäger
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan Schwab
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Hagen B Huttner
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Maximilian I Sprügel
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Association between dihydropyridine calcium channel blockers and ischemic strokes in patients with nonvalvular atrial fibrillation. Hypertens Res 2022; 45:1028-1036. [PMID: 35173285 DOI: 10.1038/s41440-022-00855-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 12/14/2021] [Accepted: 01/04/2022] [Indexed: 12/15/2022]
Abstract
Outside of clinical trials, the prophylactic effect of dihydropyridine calcium channel blockers (CCBs) on ischemic events in patients with nonvalvular atrial fibrillation (NVAF) has not been confirmed. We compared the effect of dihydropyridine CCBs on ischemic events in anticoagulated NVAF patients. We conducted a multicenter historical cohort study at 71 centers in Japan. The inclusion criterion was taking vitamin K antagonists for NVAF. The exclusion criteria were mechanical heart valves and a history of pulmonary thrombosis or deep vein thrombosis. Consecutive patients (N = 7826) were registered in February 2013 and were followed until February 2017. The primary outcomes were ischemic events and ischemic strokes; the secondary outcomes were all-cause mortality, major bleeding, and hemorrhagic strokes. The mean patient age was 73 years old, and 67% of the patients were male. Seventy-eight percent of the patients had hypertension, and dihydropyridine CCBs were used by 2693 (34%) patients (CCB group). The cumulative incidences of ischemic events and ischemic strokes at 4 years in the CCB and No-CCB groups were 5.9% vs. 5.2% and 5.6% vs. 4.8%, respectively. The adjusted hazard ratios (HRs) (95% confidence intervals [CIs]) of the CCB group for ischemic events and ischemic strokes were 1.22 (0.95-1.57) and 1.32 (1.02-1.71), respectively; the adjusted HRs (95% CIs) of the CCB group for all-cause mortality, major bleeding, and hemorrhagic strokes were 0.85 (0.69-1.04), 1.12 (0.92-1.35), and 1.08 (0.62-1.88), respectively. Dihydropyridine CCB use by anticoagulated NVAF patients significantly increased ischemic strokes in a real-world setting.
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Sanders CB, Knisely K, Rathfoot C, Edrissi C, Nathaniel T. Acute Ischemic Stroke and Heart Failure: Stroke Risk Factors Associated with Exclusion from Thrombolytic Therapy. Clin Appl Thromb Hemost 2022; 28:10760296221116347. [PMID: 36278505 PMCID: PMC9596934 DOI: 10.1177/10760296221116347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/22/2022] [Accepted: 07/11/2022] [Indexed: 11/05/2022] Open
Abstract
Objective: Acute ischemic stroke (AIS) patients with congestive heart failure (HF) that present with various risk factors are less likely to receive recombinant tissue plasminogen activator (rtPA). The risk factors associated with excluding AIS patients with congestive heart failure (AIS-HF) from rtPA therapy have not been fully established. Methods: Retrospective data for 5469 AIS patients comprised of 590 AIS patients with HF and 4879 AIS patients without HF were collected from a regional stroke registry between January 2010 and June 2016. Baseline risk factors were analyzed using logistic regression analysis to determine the risk factors associated with rtPA exclusion in AIS-HF patients. Results: In the adjusted analysis, AIS-HF patients that that did not receive rtPA were more likely to be older (OR = 0.982, 95% CI, 0.966-1, P = .020), presented with coronary artery disease (OR = 0.618, 95% CI, 0.391-0.98, P = .040), and with an elevated INR (OR = 0.326, 95% CI, 0.129-0.82, P = .018). AIS-HF patients that were included for rtPA therapy were more likely to show improvement in ambulatory status (OR = 1.69, 95% CI, 1.058-2.7, P = .028). The discriminating power of the model was strong with an area under the curve (AUROC) = 0.668 (95% CI, 0.611-0.724, P < .001). Conclusion: Our study establishes the associations between stroke risk factors and exclusion from rtPA therapy. This finding suggests the need to develop management strategies for older HF patients with carotid artery disease and an elevated INR to improve their eligibility for rtPA treatment following an acute ischemic stroke.
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Affiliation(s)
| | - Krista Knisely
- School of Medicine Greenville, University of South Carolina, Greenville, SC, USA
| | - Chase Rathfoot
- School of Medicine Greenville, University of South Carolina, Greenville, SC, USA
| | - Camron Edrissi
- School of Medicine Greenville, University of South Carolina, Greenville, SC, USA
| | - Thomas Nathaniel
- School of Medicine Greenville, University of South Carolina, Greenville, SC, USA
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29
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Chen BJ, Daneshvari NO, Johansen MC. Bleeding risk in patients with cardiac disease from ischaemic stroke reperfusion therapy: an update. BMJ Neurol Open 2021; 3:e000156. [PMID: 34485911 PMCID: PMC8372809 DOI: 10.1136/bmjno-2021-000156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 08/01/2021] [Indexed: 11/29/2022] Open
Abstract
Background Intravenous tissue plasminogen activator (rtPA) and arterial endovascular therapy (ET) rapidly restore cerebral perfusion in eligible patients who had an acute ischaemic stroke (AIS). It is unknown whether patients who had an AIS with premorbid cardiac disease respond differently to reperfusion therapies than those without. These patients may have risk factors that worsen outcomes or may represent those who would most benefit from reperfusion therapy. Objective To determine whether patients who had an AIS with the most frequently encountered pre-existing cardiac conditions, atrial fibrillation (AF), heart failure (HF), left ventricular assist devices (LVADs), or taking anticoagulation for cardiac indications, are at increased risk for poor outcome, such as symptomatic intracranial haemorrhage (sICH), after reperfusion therapy. Results Although AF is an independent risk factor for poor poststroke outcomes, intravenous rtPA is not associated with increased risk of sICH for those not on anticoagulants. Likewise, HF is independently associated with mortality post stroke, yet these patients benefit from reperfusion therapies without increased rates of sICH. Patients with LVADs or who are on anticoagulation should not be given IV rtPA; however, ET remains a viable option in those who meet criteria, even patients with LVAD. Conclusion There is no evidence of an increased risk for sICH after intravenous rtPA or ET for those with AF or HF. Intravenous rtPA should not be given to patients on anticoagulation or with LVADs, but ET should be offered to them when eligible. Whenever possible, future AIS reperfusion research should include patients with premorbid cardiac disease as they are frequently excluded, representing a gap in evidence.
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Affiliation(s)
- Bridget J Chen
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nicholas O Daneshvari
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michelle C Johansen
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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30
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Barkhudaryan A, Doehner W, Scherbakov N. Ischemic Stroke and Heart Failure: Facts and Numbers. An Update. J Clin Med 2021; 10:jcm10051146. [PMID: 33803423 PMCID: PMC7967189 DOI: 10.3390/jcm10051146] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/26/2021] [Accepted: 02/27/2021] [Indexed: 12/22/2022] Open
Abstract
Heart failure (HF) is a severe clinical syndrome accompanied by a number of comorbidities. Ischemic stroke occurs frequently in patients with HF as a complication of the disease. In the present review, we aimed to summarize the current state of research on the role of cardio–cerebral interactions in the prevalence, etiology, and prognosis of both diseases. The main pathophysiological mechanisms underlying the development of stroke in HF and vice versa are discussed. In addition, we reviewed the results of recent clinical trials investigating the prevalence and prevention of stroke in patients with HF.
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Affiliation(s)
- Anush Barkhudaryan
- Department of Cardiology, Clinic of General and Invasive Cardiology, University Hospital No 1, Yerevan State Medical University, Yerevan 0025, Armenia;
- Cardiovascular Research Institute Basel, University Hospital Basel, 4056 Basel, Switzerland
| | - Wolfram Doehner
- BIH Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany;
- Department of Cardiology, Campus Virchow, Charité-Universitätsmedizin Berlin, DZHK (German Center for Cardiovascular Research), Partner Site Berlin, 13353 Berlin, Germany
- Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Nadja Scherbakov
- BIH Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany;
- Department of Cardiology, Campus Virchow, Charité-Universitätsmedizin Berlin, DZHK (German Center for Cardiovascular Research), Partner Site Berlin, 13353 Berlin, Germany
- Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- Correspondence:
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Jimenez-Ruiz A, Racosta JM, Kimpinski K, Hilz MJ, Sposato LA. Cardiovascular autonomic dysfunction after stroke. Neurol Sci 2021; 42:1751-1758. [PMID: 33687612 DOI: 10.1007/s10072-021-05128-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/20/2021] [Indexed: 12/19/2022]
Abstract
Strokes are the paradigmatic example of the sudden impairment of the cerebral regulation of cardiac autonomic regulation. Although several aspects of dysautonomic cardiovascular regulation post stroke remain unanswered, there has been a wealth of research in this area in the last decade. In this article, we present a state-of-the-art review on the anatomical and functional organization of cardiovascular autonomic regulation, and the pathophysiology, incidence, time course, diagnosis, clinical aspects, prognosis, and management of post-stroke cardiovascular autonomic dysfunction.
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Affiliation(s)
| | - Juan M Racosta
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Kurt Kimpinski
- Department of Medicine, Queen Elizabeth Hospital, Charlottetown, PE, Canada
| | - Max J Hilz
- University of Erlangen-Nuremberg, Erlangen, Germany.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Luciano A Sposato
- Heart & Brain Laboratory, Western University, London, ON, Canada. .,Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. .,Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. .,Robarts Research Institute, Western University, London, ON, Canada. .,Lawson Research Institute, London, ON, Canada. .,Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
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32
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Sposato LA, Hilz MJ, Aspberg S, Murthy SB, Bahit MC, Hsieh CY, Sheppard MN, Scheitz JF. Post-Stroke Cardiovascular Complications and Neurogenic Cardiac Injury: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 76:2768-2785. [PMID: 33272372 DOI: 10.1016/j.jacc.2020.10.009] [Citation(s) in RCA: 109] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/25/2020] [Accepted: 10/12/2020] [Indexed: 02/07/2023]
Abstract
Over 1.5 million deaths worldwide are caused by neurocardiogenic syndromes. Furthermore, the consequences of deleterious brain-heart interactions are not limited to fatal complications. Cardiac arrhythmias, heart failure, and nonfatal coronary syndromes are also common. The brain-heart axis is implicated in post-stroke cardiovascular complications known as the stroke-heart syndrome, sudden cardiac death, and Takotsubo syndrome, among other neurocardiogenic syndromes. Multiple pathophysiological mechanisms with the potential to be targeted with novel therapies have been identified in the last decade. In the present state-of-the-art review, we describe recent advances in the understanding of anatomical and functional aspects of the brain-heart axis, cardiovascular complications after stroke, and a comprehensive pathophysiological model of stroke-induced cardiac injury.
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Affiliation(s)
- Luciano A Sposato
- Heart & Brain Laboratory, Western University, London, Ontario, Canada; Departments of Clinical Neurological Sciences, Epidemiology and Biostatistics, and Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada; Robarts Research Institute, London, Ontario, Canada.
| | - Max J Hilz
- University of Erlangen-Nuremberg, Erlangen, Germany; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sara Aspberg
- Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Santosh B Murthy
- Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York. https://twitter.com/san_murthy
| | - M Cecilia Bahit
- INECO Neurociencias Oroño, Rosario, Santa Fe, Argentina. https://twitter.com/ceciliabahit
| | - Cheng-Yang Hsieh
- Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan; School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan. https://twitter.com/chengyanghsieh
| | - Mary N Sheppard
- Molecular and Clinical Sciences Research Institute, St George's, University of London, London, United Kingdom
| | - Jan F Scheitz
- Klinik für Neurologie mit Experimenteller Neurologie and Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Germany; German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislaufforschung), partner site Berlin, Charité-Universitätsmedizin Berlin, Germany; Berlin Institute of Health, Berlin, Germany. https://twitter.com/Jan_FriSch
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Massaro AR. Neurological complications of heart failure. HANDBOOK OF CLINICAL NEUROLOGY 2021; 177:77-89. [PMID: 33632459 DOI: 10.1016/b978-0-12-819814-8.00005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Heart failure (HF) is a major global cause of death with increasing absolute worldwide numbers of HF patients. HF results from the interaction between cardiovascular aging with specific risk factors, comorbidities, and disease modifiers. The failing heart and neuronal injury have a bidirectional interaction requiring specific management strategies. Decreased cardiac output has been associated with lower brain volumes. Cerebral blood flow (CBF) may normalize following heart transplantation among severe HF patients. Stroke and cognitive impairment remain the main neurologic conditions associated with HF. However, HF patients may also suffer from chronic cerebral hypoperfusion. It seems likely that HF-related ischemic strokes are primarily the result of cardiac embolism. Atrial fibrillation (AF) is present in half of stroke patient with HF. The increased risk of hemorrhagic strokes is less well characterized and likely multifactorial, but may in part reflect a higher use of long-term antithrombotic therapy. The steady improvement of neuroimaging techniques has demonstrated an increased prevalence of silent ischemic lesions among HF patients. The populations most likely to benefit from long-term anticoagulant therapy are HF patients with AF. Cognitive impairment in HF can have a variety of clinical manifestations from mild memory problems to dementia.
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Li KHC, Jesuthasan A, Kui C, Davies R, Tse G, Lip GYH. Acute ischemic stroke management: concepts and controversies.A narrative review. Expert Rev Neurother 2020; 21:65-79. [PMID: 33047640 DOI: 10.1080/14737175.2021.1836963] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Amongst the 25.7 million survivors and 6.5 million deaths from stroke between 1990 and 2013, ischemic strokes accounted for approximately 70% and 50% of the cases, respectively. With patients still suffering from complications and stroke recurrence, more questions have been raised as to how we can better improve patient management. AREAS COVERED The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Newcastle-Ottawa Scale (NOS) were adopted to ensure a comprehensive inclusion of quality literature from various sources. PubMed and Embase were searched for evidence on thrombolysis, mechanical thrombectomy, artificial intelligence (AI), antiplatelet therapy, anticoagulation and hypertension management. EXPERT OPINION The directions of future research in these areas are dependent on the current level of validation. Endovascular therapy and applications of AI are relatively new compared to the other areas discussed in this review. As such, future studies need to focus on validating their efficacy. As for thrombolysis, antiplatelet and anticoagulation therapy, their efficacy has been well-established and future research efforts should be directed toward adjusting its use according to patient-specific factors, starting with factors with the most clinical relevance and prevalence.
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Affiliation(s)
- Ka Hou Christien Li
- Medicine, Newcastle University , Newcastle, UK.,Arrowe Park Acute Stroke Unit, Wirral University Teaching Hospital NHS Foundation Trust , Wirral, UK
| | | | | | - Ruth Davies
- Arrowe Park Acute Stroke Unit, Wirral University Teaching Hospital NHS Foundation Trust , Wirral, UK
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University , Tianjin, China
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital , Liverpool, UK.,Department of Clinical Medicine, Aalborg University , Aalborg, Denmark
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35
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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.
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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
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36
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Lin HB, Wei GS, Li FX, Guo WJ, Hong P, Weng YQ, Zhang QQ, Xu SY, Liang WB, You ZJ, Zhang HF. Macrophage-NLRP3 Inflammasome Activation Exacerbates Cardiac Dysfunction after Ischemic Stroke in a Mouse Model of Diabetes. Neurosci Bull 2020; 36:1035-1045. [PMID: 32683554 PMCID: PMC7475163 DOI: 10.1007/s12264-020-00544-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 03/17/2020] [Indexed: 02/05/2023] Open
Abstract
Ischemic stroke is one of the leading causes of death worldwide. In the post-stroke stage, cardiac dysfunction is common and is known as the brain-heart interaction. Diabetes mellitus worsens the post-stroke outcome. Stroke-induced systemic inflammation is the major causative factor for the sequential complications, but the mechanism underlying the brain-heart interaction in diabetes has not been clarified. The NLRP3 (NLR pyrin domain-containing 3) inflammasome, an important component of the inflammation after stroke, is mainly activated in M1-polarized macrophages. In this study, we found that the cardiac dysfunction induced by ischemic stroke is more severe in a mouse model of type 2 diabetes. Meanwhile, M1-polarized macrophage infiltration and NLRP3 inflammasome activation increased in the cardiac ventricle after diabetic stroke. Importantly, the NLRP3 inflammasome inhibitor CY-09 restored cardiac function, indicating that the M1-polarized macrophage-NLRP3 inflammasome activation is a pathway underlying the brain-heart interaction after diabetic stroke.
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Affiliation(s)
- Hong-Bin Lin
- Department of Anesthesiology, Zhujiang Hospital of Southern Medical University, Guangzhou, 510220 China
- Department of Anesthesiology, Shenzhen SAMII Medical Center, Shenzhen, 518118 China
- Department of Anesthesiology, The Second Affiliated Hospital, Shantou University Medical College, Shantou, 515041 China
| | - Guan-Shan Wei
- Department of Anesthesiology, Zhujiang Hospital of Southern Medical University, Guangzhou, 510220 China
| | - Feng-Xian Li
- Department of Anesthesiology, Zhujiang Hospital of Southern Medical University, Guangzhou, 510220 China
| | - Wen-Jing Guo
- Department of Anesthesiology, Zhujiang Hospital of Southern Medical University, Guangzhou, 510220 China
| | - Pu Hong
- Department of Anesthesiology, Zhujiang Hospital of Southern Medical University, Guangzhou, 510220 China
| | - Ya-Qian Weng
- Department of Anesthesiology, Zhujiang Hospital of Southern Medical University, Guangzhou, 510220 China
| | - Qian-Qian Zhang
- Department of Anesthesiology, Zhujiang Hospital of Southern Medical University, Guangzhou, 510220 China
| | - Shi-Yuan Xu
- Department of Anesthesiology, Zhujiang Hospital of Southern Medical University, Guangzhou, 510220 China
| | - Wen-Bin Liang
- University of Ottawa Heart Institute and Department of Cellular and Molecular Medicine, University of Ottawa, Ontario, K1N Canada
| | - Zhi-Jian You
- Department of Anesthesiology, Shenzhen SAMII Medical Center, Shenzhen, 518118 China
| | - Hong-Fei Zhang
- Department of Anesthesiology, Zhujiang Hospital of Southern Medical University, Guangzhou, 510220 China
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37
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Tate MJ, Shugart RM, Moraney RA, Brechtel LE, Blum B, Thomas I Nathaniel. Gender and functional outcomes in prestroke depressive patients treated with thrombolytic therapy. FUTURE NEUROLOGY 2020. [DOI: 10.2217/fnl-2019-0030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Aim: This study investigated the clinical factors associated with functional ambulatory outcomes and gender differences in prestroke depressive patients. Materials & methods: Clinical risk factors associated with improved functional outcomes with recombinant tissue plasminogen activator-treated cohorts were determined using binary logistic regression. Results: In the adjusted analysis, improvement in ambulation was associated with male patients that had higher National Institute of Health stroke scale score (p = 0.04), a stroke history (p = 0.026), lower serum creatinine levels (p = 0.049) and were taking cholesterol reducing medication (p = 0.014). Improvement in females was associated with taking antidepressants (p = 0.027) and having lower National Institute of Health stroke scale score (p = 0.002). Conclusion: Our findings indicate gender disparities between male and female prestroke depressive patients.
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Affiliation(s)
- Mandy J Tate
- University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC 29605, USA
| | - Rachel M Shugart
- University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC 29605, USA
| | - Robyn A Moraney
- University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC 29605, USA
| | - Leanne E Brechtel
- University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC 29605, USA
| | - Brice Blum
- University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC 29605, USA
| | - Thomas I Nathaniel
- University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC 29605, USA
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