Neurogenic cardiac outcome in patients after acute ischemic stroke: The brain and heart connection |
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| Institution: | 1. Department of Neurosciences and Comprehensive Stroke Center, Spectrum Health and Michigan State University College of Human Medicine, 25 Michigan Street NE, Suite 6100, Grand Rapids, MI 49503, United States;2. Department of Neurology, Vanderbilt University School of Medicine, Nashville, TN, United States;3. Stephen M. Ross School of Business, University of Michigan, Ann Arbor, MI, United States;4. Offices of Research and Education, Spectrum Health, Grand Rapids, MI, United States;5. Department of Cardiovascular Medicine, Frederik Meijer Heart and Vascular Institute, Spectrum Health and Michigan State University College of Human Medicine, Grand Rapids, MI, United States;1. Department of Neurosurgery, Matsuyama Shimin Hospital, Matsuyama City, Ehime, Japan;2. Department of Neurology, Matsuyama Shimin Hospital, Matsuyama City, Ehime, Japan;3. Department of Neurosurgery, Ehime University Graduate School of Medicine, Tōon City, Ehime, Japan;4. Department of Radiology, Matsuyama Shimin Hospital, Matsuyama City, Ehime, Japan;1. Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, 170, Jomaru-ro, Bucheon, Gyeonggi-Do 14584, Republic of Korea;2. Department of Neurosurgery, College of Medicine, St. Vincent''s Hospital, The Catholic University of Korea, Seoul, Republic of Korea;3. Department of Neurosurgery, Hangang Sacred Heart Hospital, Hallym University, Seoul, Republic of Korea;1. Division of Neurocritical Care, Montefiore Medical Center, Albert Einstein College of Medicine, NY, USA;2. Department of Neurology, Brigham and Women''s Hospital, Boston, MA, USA;3. Department of Neurology, Massachusetts General Hospital, Boston, MA, USA;4. Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA;5. Department of Pharmacy, Brigham and Women''s Hospital, Boston, MA, USA;6. Renal Division, Brigham and Women''s Hospital, Boston, MA, USA;7. Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand;8. Department of Neurosurgery, Brigham and Women''s Hospital, Boston, MA, USA;1. Department of Neurology, Aizawa Hospital, 2-5-1 Honjo, Matsumoto, Nagano 390-8510, Japan;2. Department of General Internal Medicine, Aizawa Hospital, Japan |
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| Abstract: | BackgroundNeurogenic cardiac impairment can occur after acute ischemic stroke (AIS), but the mapping of the neuroanatomic correlation of stroke-related myocardial injury remains uncertain. This study aims to identify the association between cardiac outcomes and middle cerebral artery (MCA) ischemic stroke, with or without insular cortex involvement, as well as the impact of new-onset atrial fibrillation (AF) after AIS on recurrent stroke.MethodsSerial measurements of high sensitivity troponin T (TnT), brain natriuretic peptide (BNP), electrocardiography (ECG), echocardiogram, and cardiac monitoring were performed on 415 patients with imaging confirmed MCA stroke, with or without insular involvement. Patients with renal failure, recent cardiovascular events, or congestive heart failure were excluded.ResultsOne hundred fifteen patients (28%) had left MCA infarcts with insular involvement, 122 (29%) had right MCA infarcts involving insular cortex, and 178 (43%) had no insular involvement. Patients with left MCA stroke with insular involvement tended to exhibit higher BNP and TnI, and transient cardiac dysfunction, which mimicked Takotsubo cardiomyopathy in 10 patients with left ventricular ejection fraction (LVEF) of 20-40%. Incidence of new-onset AF was higher in right MCA stroke involving insula (39%) than left MCA involving insula (4%). Nine out of fifty-three patients with new-onset AF were not on anticoagulant therapy due to various reasons; none of them experienced recurrent AF or stroke during up to a 3-year follow-up period. Statistically significant correlations between BNP or TnT elevation and left insular infarcts, as well as the incidence of AF and right insular infarcts, were revealed using linear regression analysis.ConclusionsThe present study demonstrated that acute left MCA stroke with insular involvement could cause transient cardiac dysfunction and elevated cardiac enzymes without persistent negative outcomes in the setting of health baseline cardiac condition. The incidence of new-onset AF was significantly higher in patients with right MCA stroke involving the insula. There was no increased risk of recurrent ischemic stroke in nine patients with newly developed AF who were not on anticoagulant therapy, which indicated a need for further research on presumed neurogenic AF and its management. |
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