Autonomic Nervous System and Stress to Predict Secondary Ischemic Events after Transient Ischemic Attack or Minor Stroke: Possible Implications of Heart Rate Variability

Guan, Lina; Collet, Jean‐Paul; Mazowita, Garey; Claydon, Victoria E.

doi:10.3389/fneur.2018.00090

Cited by 45 publications

(41 citation statements)

References 151 publications

(191 reference statements)

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“…The main mechanisms involved in the so-called strokeheart crosstalk include the hypothalamic-pituitary-adrenal axis (HPA) [12], the immune and inflammatory responses [13], and the gut dysbiosis [14], as well as the risk factors (age, sex, race, hypertension, smoking, diet, and physical inactivity) primarily involved in the pathogenesis of AIS [15]. Regardless of the mechanisms, cardiac complications increase the risk of developing AIS, and vice-versa; AIS causes dysautonomia and hyperinflammation, thus predisposing patients to heart dysfunction [16].…”

Section: Pathophysiological Mechanisms Involved In Stroke-heart Intermentioning

confidence: 99%

Brain–heart interaction after acute ischemic stroke

et al. 2020

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Early detection of cardiovascular dysfunctions directly caused by acute ischemic stroke (AIS) has become paramount. Researchers now generally agree on the existence of a bidirectional interaction between the brain and the heart. In support of this theory, AIS patients are extremely vulnerable to severe cardiac complications. Sympathetic hyperactivity, hypothalamic-pituitary-adrenal axis, the immune and inflammatory responses, and gut dysbiosis have been identified as the main pathological mechanisms involved in brain-heart axis dysregulation after AIS. Moreover, evidence has confirmed that the main causes of mortality after AIS include heart attack, congestive heart failure, hemodynamic instability, left ventricular systolic dysfunction, diastolic dysfunction, arrhythmias, electrocardiographic anomalies, and cardiac arrest, all of which are more or less associated with poor outcomes and death. Therefore, intensive care unit admission with continuous hemodynamic monitoring has been proposed as the standard of care for AIS patients at high risk for developing cardiovascular complications. Recent trials have also investigated possible therapies to prevent secondary cardiovascular accidents after AIS. Labetalol, nicardipine, and nitroprusside have been recommended for the control of hypertension during AIS, while beta blockers have been suggested both for preventing chronic remodeling and for treating arrhythmias. Additionally, electrolytic imbalances should be considered, and abnormal rhythms must be treated. Nevertheless, therapeutic targets remain challenging, and further investigations might be essential to complete this complex multi-disciplinary puzzle. This review aims to highlight the pathophysiological mechanisms implicated in the interaction between the brain and the heart and their clinical consequences in AIS patients, as well as to provide specific recommendations for cardiovascular management after AIS.

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Section: Pathophysiological Mechanisms Involved In Stroke-heart Intermentioning

confidence: 99%

Brain–heart interaction after acute ischemic stroke

et al. 2020

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“…Despite these developments, the molecular triggers that are associated with the disease development and eventually with the elevated plasma, TRL accumulation remain largely unexplored. There is a strong evidence that both, central and peripheral nervous systems, may be involved in this regulation .…”

Section: Discussionmentioning

confidence: 99%

“…There is a strong evidence that both, central and peripheral nervous systems, may be involved in this regulation [4,[36][37][38].…”

Section: Discussionmentioning

confidence: 99%

Adrenoceptor‐related decrease in serum triglycerides is independent of PPARα activation

et al. 2019

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Adrenoceptor (AR)‐linked pathways belong to the major components of the stress response system and are associated with the pathophysiology of diseases within the spectrum of metabolic syndrome. In this study, the role of adrenoceptor stimulation in serum triglyceride (TG) regulation in mice was investigated. For this purpose, α1‐ARs were activated with phenylephrine (PH) and β1/2‐ARs with isoprenaline (ISOP). Both AR agonists markedly reduced serum TG levels independently of PPARα activation. These drugs also significantly activated the hormone‐sensitive lipase in the white adipose tissue indicating increased mobilization of TGs in this tissue. In addition, PH and ISOP up‐regulated Lpl, Nr4A, Dgat1, Mttp, Aadac and Cd36 genes, critical in TG regulation, whereas the observed decrease in serum TG levels was independent of the hepatic very low‐density lipoprotein (VLDL)‐TG secretion. Interestingly, PH and ISOP also inactivated the hepatic insulin/PI3k/AKT/FoxO1 signaling pathway, holding a critical role in the regulation of genes involved in TG synthesis. Taken together, the findings of the present study indicate that stimulation of α1‐ and β1/2‐ARs markedly reduced serum TG steady‐state levels as a result of alterations in TG synthesis, uptake, transport, hydrolysis, metabolism and clearance, an effect induced by PPARα independent mechanisms.

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“…Heart rate variability (HRV) is thought to reflect the overall stresses acting on the body, as it is a precise and valid measurement of ANS. Importantly, impaired ANS with decreased HRV is associated with known risk factors for stroke, which likely results in development of severe ischemic events (7,8) and a worse prognosis (9,10).…”

Section: Introductionmentioning

confidence: 99%

The Association of Autonomic Nervous System Function With Ischemic Stroke, and Treatment Strategies

2020

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Acute ischemic stroke, especially minor stroke, and transient ischemic attack have high risks of recurrence and exacerbation into severe ischemic strokes. It remains challenging to perform risk stratification and screen high-risk groups for initiation of early treatment in these patients. Moreover, with the growing population of patients with chronic small vessel disease, the mechanisms and clinical implications require further investigation. Traditional tools such as the ABCD2 score (age, blood pressure, clinical features, duration of symptoms, diabetes) have only moderate predictive value in patients with transient ischemic attack or minor stroke. By contrast, measurement of changes in heart rate variability (HRV) is an important and novel tool for risk stratification and outcome prediction in patients with cardiovascular diseases, as it reflects the overall level of autonomic nervous system dysfunction. Thus, abnormal HRV may be useful for prognosis and improve stratification of stroke patients with diverse risks. HRV may also partially explain autonomic nervous dysfunction and other manifestations during the process of chronic cerebral small vessel disease. In summary, measurement of HRV may contribute to early initiation of interventions in acute or chronic stroke patients using novel treatments involving rebalancing of autonomic nervous system function.

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Autonomic Nervous System and Stress to Predict Secondary Ischemic Events after Transient Ischemic Attack or Minor Stroke: Possible Implications of Heart Rate Variability

Cited by 45 publications

References 151 publications

Brain–heart interaction after acute ischemic stroke

Brain–heart interaction after acute ischemic stroke

Adrenoceptor‐related decrease in serum triglycerides is independent of PPARα activation

The Association of Autonomic Nervous System Function With Ischemic Stroke, and Treatment Strategies

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