Atrial Failure as a Clinical Entity: JACC Review Topic of the Week

Atrial dysfunction has been widely considered a marker or consequence of other cardiac conditions rather than the cause itself. Here, we propose the term atrial failure as a clinically relevant entity, defined as any atrial dysfunction causing impaired heart performance, symptoms, and worsening quality of life or life expectancy. Aspects of the etiology, mechanisms, and consequences of atrial failure are discussed. Recent advances in cardiac electrophysiology and imaging have improved our understanding of the highly complex atrial anatomy and function, underlying the paramount importance of the atria in optimal heart performance. It is time to reappraise the concept of the failing atrium as a primary cause or aggravating factor of the symptoms in many of our patients. The concept of atrial failure may foster basic and translational research to gain a better understanding of how to identify and manage atrial dysfunction.     

Five-Session Dual-Transcranial Direct Current Stimulation With Task-Specific Training Does Not Improve Gait and Lower Limb Performance Over Training Alone in Subacute Stroke: A Pilot Randomized Controlled Trial

ObjectiveTo determine the effect of five-session dual-transcranial direct current stimulation (dual-tDCS) combined with task-specific training on gait and lower limb motor performance in individuals with subacute stroke.Materials and MethodsTwenty-five participants who had a stroke in the subacute phase with mild motor impairment were recruited, randomized, and allocated into two groups. The active group (n = 13) received dual-tDCS with anodal over the lesioned hemisphere M1 and cathodal over the nonlesioned hemisphere, at 2 mA for 20 min before training for five consecutive days, while the sham group (n = 12) received sham mode before training. Gait speed as a primary outcome, temporospatial gait variables, lower-limb functional tasks (sit-to-stand and walking mobility), and muscle strength as secondary outcomes were collected at preintervention and postintervention (day 5), one-week follow-up, and one-month follow-up.ResultsThe primary outcome and most of the secondary outcomes were improved in both groups, with no significant difference between the two groups, and most of the results indicated small to moderate effect sizes of active tDCS compared to sham tDCS.ConclusionThe combined intervention showed no benefit over training alone in improving gait variables and lower-limb performance. However, some performances were saturated at some point, as moderate to high function participants were recruited in the present study. Future studies should consider recruiting participants with more varied motor impairment levels and may need to determine the optimal stimulation protocols and parameters to improve gait and lower-limb performance.     

Reduced cortical arousability to nocturnal apneic episodes in patients with wake-up ischemic stroke

Study objectivesSleep breathing disorders (SBD) have been linked to wake-up stroke (WUS). Respiratory arousals have an important role in responding to danger during sleep, yet currently no studies have investigated respiratory arousability in WUS. In this study, we used a clinical tool to predict low respiratory arousal threshold (ArTH), and then compared respiratory arousability in patients with WUS and non-WUS.MethodsWe enrolled 119 patients with acute ischemic stroke and assigned them into WUS (n = 34) and non-WUS (n = 85) groups. All participants underwent polysomnography (PSG) during the acute phase of stroke. The respiratory ArTH predictive tool assigns one point for each of the following: apnea-hypopnea index (AHI) < 30/h, nadir oxygen saturation (SaO₂) > 82.5%, and fraction of hypopneas > 58.3%. An ArTH score ≥2 represents low respiratory ArTH.ResultsOur results reconfirmed the association between moderate-to-severe sleep apnea syndrome and WUS (OR 2.879, 95% CI 1.17–7.089, p = 0.021). Significantly fewer participants with obstructive sleep apnea (AHI ≥ 5/h) had low respiratory ArTH in the WUS group than in the non-WUS group (34.8% vs. 68.1%, respectively, p = 0.008). High respiratory ArTH was independently associated with WUS (OR 5.556, 95% CI 1.959–15.761, p = 0.001).ConclusionsThe correlation between SBD and WUS suggests that sleep apnea might induce acute physiological changes that trigger the onset of stroke. We show that reduced respiratory arousability is associated with WUS, and hypothesize that reduced cortical capability to generate respiratory arousal may have a role in triggering stroke during sleep.     

RNF213基因相关脑血管病研究进展

颅内大动脉狭窄/闭塞(intracranial major artery stenosis/occlusion,ICASO)是我国缺血性卒中最常见病因之一。既往研究提示其与烟雾病在受累血管分布、种族差异性等方面具有相似性。环指蛋白213(ring finger protein 213,RNF213)基因是烟雾病的易感基因。研究发现该基因与ICASO、大动脉粥样硬化性缺血性卒中、颅内动脉瘤同样具有相关性,提示RNF213基因可能与脑血管病发生、发展存在密切的联系。本文旨在通过回顾国内外相关文献,就RNF213结构、功能、基因多态性及与脑血管病相关性等问题进行概述。     

阿司匹林联合氯吡格雷治疗进行性脑卒中的效果评价

目的观察进行性脑卒中患者使用阿司匹林联合氯吡格雷治疗的临床效果。方法选取2015年6月—2016年6月某医院收治的进行性脑卒中患者108例作为研究对象,依据随机数表法分为对照组和观察组,每组各54例。对照组使用阿司匹林药物进行治疗,观察组则使用阿司匹林联合氯吡格雷药物进行治疗,经过2周治疗后,对比两组患者临床疗效、神经功能缺损程度、日常自理能力以及不良反应。结果治疗后,观察组患者治疗总有效率(96.30%)高于对照组(83.33%),神经功能缺损程度评分(4.91±1.01)低于对照组(7.69±1.97),生活自理能力评分(86.52±4.36)高于对照组(74.69±4.83),不良反应发生率(7.41%)低于对照组(25.93%,P<0.05)。结论进行性脑卒中患者在接受氯吡格雷联合治疗后,临床效果显著提高,神经功能缺损程度降低,日常自理能力提高,不良反应较少。