Cardiac output in patients with acute stroke

It is well known that blood pressure is elevated during acute stroke. Despite its importance for cerebral haemodynamics, cardiac output (CO) has been determined only in individual cases during acute stroke. We measured CO and blood pressure in patients with no history of heart disease who suffered from acute stroke (n = 30) and in a control group comparable with regard to age, gender and cardiac health (n = 30). CO, blood pressure and heart rate were significantly (P < 0.01) higher in the group of stroke patients than in the control group. There was a tendency for more time to have elapsed between the onset of symptoms and measurements, the higher the CO [b = 0.08 l/min per hour (–0.01; 0.17)]. Adjusted for age in a multiple regression model, the regression coefficient was significant (CO = 10.35 + 0.094 × time – 0.077 × age). The present study shows for the first time that patients with a healthy cardiovascular system who suffer from acute stroke have a higher CO than a group of comparable controls.     

Cardiac abnormalities in stroke patients with negative arteriograms

Sixty-five consecutive patients with recent unequivocal TIA (33) or stroke (32), but nondiagnostic arteriograms, had two-dimensional echocardiograms (2DE) and electrocardiograms (ECG) to determine the incidence of cardiac abnormalities which could cause embolic stroke. Abnormalities were classified according to increasing probability of causing an embolic event: non-specific, possible emboligenic abnormality (PEA) or definite emboligenic abnormality (EA). Although 2DE was abnormal in 33 patients (51%), and ECG in 38 (59%), many abnormalities were nonspecific. Only four patients (6%) had EA on ECG and two (3%) on 2DE. Since one patient had EA on both tests, 2DE identified only one patient (mitral valve prolapse) not already identified by ECG. All patients with EA had a prior history of cardiac disease. PEA was present on ECG in 11 patients (17%), and on 2DE in 25 (38%). There was no correlation between age, CT results, or neurologic symptoms commonly associated with embolic stroke and the presence of EA or PEA on ECG or 2DE. Although TIA and stroke patients with negative arteriograms have a high incidence of abnormalities on ECG and 2DE, the percentage of patients with EA is low, and cardiac history and ECG identify most patients. 2DE provides little additional information.     

Autologous mesenchymal stem cell transplantation in stroke patients

Mesenchymal stem cell (MSC) transplantation improves recovery from ischemic stroke in animals. We examined the feasibility, efficacy, and safety of cell therapy using culture-expanded autologous MSCs in patients with ischemic stroke. We prospectively and randomly allocated 30 patients with cerebral infarcts within the middle cerebral arterial territory and with severe neurological deficits into one of two treatment groups: the MSC group (n = 5) received intravenous infusion of 1 x 10(8) autologous MSCs, whereas the control group (n = 25) did not receive MSCs. Changes in neurological deficits and improvements in function were compared between the groups for 1 year after symptom onset. Neuroimaging was performed serially in five patients from each group. Outcomes improved in MSC-treated patients compared with the control patients: the Barthel index (p = 0.011, 0.017, and 0.115 at 3, 6, and 12 months, respectively) and modified Rankin score (p = 0.076, 0.171, and 0.286 at 3, 6, and 12 months, respectively) of the MSC group improved consistently during the follow-up period. Serial evaluations showed no adverse cell-related, serological, or imaging-defined effects. In patients with severe cerebral infarcts, the intravenous infusion of autologous MSCs appears to be a feasible and safe therapy that may improve functional recovery.     

Cardiac arrhythmias in acute stroke

Cardiac arrhythmias were more frequent (p less than 0.001) in 312 stroke patients admitted to an intensive care stroke unit, than in 92 patients admitted to the unit and subsequently found not to have strokes. This significant difference remained when a stroke subgroup and the non-stroke group were matched for age, sex and duration of stay in the unit (P less than 0.005). Hypertension and hypertensive cardiac disease were more common in the stroke than in the non-stroke patients (P less than 0.001). Ectopic beats and atrial fibrillation, as well as other arrhythmias, were most frequent in patients with cerebral hemisphere infarction, and patients with hemispheric lesions had significantly more arrhythmias than those with brain stem lesions (P less than 0.05). The arrhythmias were rarely (2%) responsible for hemodynamic ischemic cerebrovascular lesions, but may have been associated with cerebral embolism in up to 17% of cases. The cardiac arrhythmias appeared to have little influence on the course of the subsequent recovery from stroke. Although these arrhythmias frequently reflect the high incidence of cardiac disease in stroke patients, in some cases they are secondary to the acute cerebrovascular lesion itself.     

Cardiac disease and stroke

1074 patients with valvular heart diseases (VHD), non-valvular atrial fibrillation (NVAF) and acute myocardial infarction (AMI) in the last ten years were surveyed. 12.1% of patients (130/1074) were associated with stroke. The incidence in VHD was 27.2% (73/268), in NVAF 19.1% (42/220) and in AMI 2.3% (13/569), the former two are significantly higher than the last one (P less than 0.005).     

Cardiac transplantation in Friedreich ataxia

In this article, we describe a 14-year-old boy with a confirmed diagnosis of Friedreich ataxia who underwent cardiac transplantation for left ventricular failure secondary to dilated cardiomyopathy with restrictive physiology. His neurological status prior to transplantation reflected early signs of neurological disease, with evidence of dysarthria, weakness, mild gait impairment, and limb ataxia. We review the ethical issues considered during the process leading to the decision to offer cardiac transplantation.     

Cardiac transplantation in becker muscular dystrophy

Summary A 23-year-old man with X-linked Becker type muscular dystrophy underwent cardiac transplantation because of dilated cardiomyopathy which was complicated by terminal heart failure. Impairment of muscle function was mild and slowly progressive, whereas the cardiac disease was severe and rapidly progressive. All four chambers of the removed heart were grossly dilated; microscopically, the myocardial fibres were hypertrophic and pale; the nuclei exhibited pleomorphism with variability in nuclear size, shape, and depth of staining.     

Cell transplantation for stroke

Cell transplantation has emerged as an experimental approach to restore brain function after stroke. Various cell types including porcine fetal cells, stem cells, immortalized cell lines, and marrow stromal cells are under investigation in experimental and clinical stroke trials. This review discusses the unique advantages and limitations of the different graft sources and emphasizes the current, limited knowledge about their biology. The survival, integration, and efficacy of neural transplants in stroke patients will depend on the type, severity, chronicity, adequacy of circulation, and location of the stroke lesion.     

Cardiac transplantation in female Emery-Dreifuss muscular dystrophy

Summary A young woman with humeroperoneal muscular dystrophy and contractures received a heart transplant for a severe dilated cardiomyopathy. Cardiac histopathology consisted of myocyte hypertrophy, interstitial fibrosis, and nuclear hyperchromaticity without mitochondrial abnormalities. Myopathy and heart disease were not clinically evident in her family, although three relatives had unexplained shortened Achilles tendons without weakness. Tendon contractures may be a partial expression of this myopathic disorder, suggesting an autosomal dominant inheritance with variable penetrance. A muscular dystrophy clinically similar to that of the Emery-Dreifuss (EDMD) type can thus occur in women. Rather than the cardiac arrhythmias typical of EDMD, a dilated cardiomyopathy may occur and present with severe congestive heart failure. This is the first report of cardiac transplantation in such a case.     

Cardiac transplantation in Becker muscular dystrophy.

Becker muscular dystrophy is associated with abnormal cardiac features in about 75% of cases; up to one-third will develop ventricular dilatation leading to congestive cardiac failure. As this form of muscular dystrophy is relatively benign, failure to respond to medical treatment warrants assessment for cardiac transplantation.     

Cell transplantation for ischemic stroke

Cell replacement therapy has been evaluated as a regenerative strategy for patients with fixed neurologic deficits after ischemic stroke. Animal models have identified specific cell lines which lead to regeneration and improvement in behavior and motor function after implantation into areas of ischemic injury. This has led to the development of pilot studies in humans, which have mainly investigated the safety and pilot efficacy of such approaches with promising early results. As research in this area progresses, further prospective trials are necessary not only to demonstrate clinical efficacy but also to understand the mechanisms underlying the early positive experiences, to select appropriate patients for cell replacement therapy, and to elucidate the optimal timing and mode of cell delivery.     

Neural transplantation for stroke.

Tremendous achievements in neuroscience over the past three decades have provided a solid foundation for basic and clinical research in neurotransplantation. Restorative neurosurgical procedures will develop from different directions, and it is likely that a combination of approaches will be necessary to maximise patient outcomes. We believe that cerebral infarction and selected neurodegenerative disorders are appropriate initial candidates for this research.     

自体干细胞原位移植治疗青中年缺血性脑卒中

背景：如能提高患者内源性干细胞水平,使之归巢到损伤部位,从而增强损伤后自我修复能力,这样既符合机体自身损伤的反应性修复机制,又可以避免异基因移植引起的免疫排斥反应。 目的：通过观察粒细胞集落刺激因子动员自体干细胞原位移植治疗青中年急性缺血性脑卒中患者功能恢复及梗死面积变化,探讨原位移植治疗青中年缺血性脑卒中的安全性和有效性。 方法：40例青中年大脑中动脉区急性缺血性脑卒中患者,随机分为原位移植组20例和对照组20例。原位移植组在发病7~10 d内开始给予粒细胞集落刺激因子15 μg/kg皮下注射连用5 d,动员自体干细胞原位移植,其他治疗同对照组;对照组予以常规治疗。取发病10 d内及发病3个月后CT片进行阿尔伯特CT评分(ASPCTS)及国立卫生研究院卒中评分 (NIHSS)。 结果与结论：治疗过程中患者未出现严重不良反应。随访3个月,原位移植组ASPCTS评分明显增加,NIHSS评分减小明显,与对照组比较差异有显著性意义(P < 0.05)。结果表明粒细胞集落刺激因子动员自体干细胞原位移植治疗青中年急性脑梗死安全可行,能显著减小脑梗死体积和促进神经功能恢复。     

Cardiac evaluation of the patient with stroke

Coronary artery disease and ischemic cerebrovascular disease are leading causes of morbidity and mortality in the United States. Coronary artery disease often coexists with asymptomatic carotid artery atherosclerosis, transient ischemic attacks, or ischemic stroke. Numerous studies have shown that mortality from all forms of ischemic cerebrovascular disease is primarily due to coronary artery disease. Thus, there is increasing interest in identifying coronary artery disease in patients with cerebrovascular disease, including those without clinical manifestations of heart disease. We review the use of current noninvasive techniques to detect coronary artery disease and present practical approaches to screen for ischemic heart disease. Current diagnostic imaging methods for potential cardioembolic sources of cerebral infarction are also discussed.     

Cardiac transplantation in a Duchenne muscular dystrophy carrier

We report here for the first time the case of a symptomatic DMD carrier, who had a heart transplant for a severe dilated cardiomyopathy. Dystrophin immunohistochemistry, western blot and analysis of X-chromosome inactivation on leucocytes, and skeletal and cardiac muscle biopsies on the explanted heart were performed. The patient was a heterozygote for exons 50–52 deletion in the dystrophin gene. The number of dystrophin-deficient fibres in the heart was much higher than in skeletal muscle. On the other hand, the explanted heart showed a non-skewed pattern of X-chromosome inactivation, as in leukocytes and skeletal muscle. The adverse cardiac course may be explained by the absence of regeneration among cardiomyocytes.     

干细胞移植治疗缺血性脑卒中

学术背景：缺血性脑卒中发病后的神经损伤一旦形成,则没有有效的促进神经功能恢复的治疗方法。大量的实验研究证实，干细胞移植不仅具有功能保护作用，也为细胞替代和功能恢复提供了可能。 目的：综述干细胞移植治疗缺血性脑卒中的实验研究及应用特点。 检索策略：应用计算机检索Pubmed1997-01/2007-10期间相关文章，检索词为“stem cells transplant，stroke，ischemia”，并限定文章语言种类为English。同时计算机检索万方数据库2001-01/2006-12期间相关文章，检索词为“干细胞、移植、缺血性脑卒中”，并限定文章语言种类为中文。对资料进行初审，并查看每篇文献后的引文。纳入标准：文章所述内容应与移植后巨细胞病毒感染的诊断和防治等研究进展中的应用相关。排除标准：重复研究或Meta分析类文章。共收集到60篇相关文献，26篇文献符合纳入标准，排除的34篇为内容陈旧或重复文献。 文献评价：符合纳入标准的26篇文献中，1篇涉及缺血性脑卒中进行细胞移植治疗的特殊性，10篇涉及用于治疗缺血性脑卒中的干细胞介绍，4篇涉及干细胞移植治疗缺血性脑卒中的机制，7篇涉及干细胞植入的时机，4篇涉及干细胞移植的部位。 资料综合：①脑卒中发病后影响的是多个不同的种（系）的神经细胞。目前应用于治疗缺血性脑卒中的干细胞来源于骨髓、脐血、成熟动物脂肪组织或脑组织。②干细胞移植治疗缺血性脑卒中的作用机制主要可以归纳为两方面的机制：重建损伤组织结构包括血管、神经环路、恢复损伤部位组织结构的完整性；分泌各种营养因子减少内源性细胞凋亡、促进内源性血管再生和神经再生。③目前关于干细胞移植治疗缺血性脑卒中的最佳时机还未明确。④不同部位的脑组织环境有利于不同类型的干细胞生存和增殖，不同类型的干细胞所植入的部位也不同。 结论：尽管干细胞移植治疗缺血性脑卒中实验证实，干细胞移植能促进缺血性脑卒中损伤部位神经功能的恢复，但尚缺乏长期观察的研究数据。干细胞移植治疗缺血性脑卒中的机制还有待于进一步明确。