Cardiovascular autonomic dysfunction after stroke

Jiménez‐Ruiz, Amado; Racosta, Juan Manuel; Kimpinski, Kurt; Hilz, Max J.; Sposato, Luciano A.

doi:10.1007/s10072-021-05128-y

Cited by 28 publications

(19 citation statements)

References 75 publications

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“…Yet, RRI-CV values and RRI-total powers again did not differ from control values suggesting that the decrease in the overall CAM was only minor after 6 months. The finding of lower baroreflex sensitivity, higher sympathetic modulation, and slightly lower overall cardiac autonomic modulation in the patients 6 months after stroke than in controls is in line with previous studies, which showed cardiovascular autonomic dysfunction even in the chronic phase after stroke [ 4 , 9 , 10 , 38 ].…”

Section: Discussionsupporting

confidence: 92%

Cardiovascular medication seems to promote recovery of autonomic dysfunction after stroke

et al. 2022

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Background Stroke may compromise cardiovascular–autonomic modulation (CAM). The longitudinal post-stroke CAM alterations remain unclear as previous studies excluded patients with cardiovascular medication. This study evaluated whether CAM dysfunction improves after several months in patients under typical clinical conditions, i.e., without excluding patients with cardiovascular medication. Methods In 82 ischemic stroke patients [33 women, 64.9 ± 8.9 years, NIHSS-scores 2 (interquartile range 1–5)], we evaluated the applications of cardiovascular medication before stroke, during autonomic tests performed within 1 week, 3 and 6 months after stroke onset. We determined resting RR intervals (RRI), systolic, diastolic blood pressures (BPsys), respiration, parameters reflecting total CAM [RRI-standard deviation (RRI-SD), RRI-total powers], sympathetic [RRI-low-frequency powers (RRI-LF), BPsys-LF powers] and parasympathetic CAM [RMSSD, RRI-high-frequency powers (RRI-HF powers)], and baroreflex sensitivity. ANOVA or Friedman tests with post hoc analyses compared patient data with data of 30 healthy controls, significance was assumed for P < 0.05. Results More patients had antihypertensive medication after than before stroke. First-week CAM testing showed lower RRIs, RMSSD, RRI-SDs, RRI-total powers, RRI-HF powers, and baroreflex sensitivity, but higher BPsys-LF powers in patients than controls. After 3 and 6 months, patients had significantly higher RRIs, RRI-SDs, RRI-total powers, RMSSDs, RRI-HF powers, and baroreflex sensitivity, but lower BPsys-LF powers than in the 1st week; RMSSDs and RRI-HF powers no longer differed between patients and controls. However, 6-month values of RRIs, RRI-SDs, and baroreflex sensitivity were again lower in patients than controls. Conclusions Even mild strokes compromised cardiovagal modulation and baroreflex sensitivity. After 3 months, CAM had almost completely recovered. Recovery might be related to the mild stroke severity. Presumably, CAM recovery was also promoted by the increased application of cardiovascular medication. Yet, slight CAM dysfunction after 6 months suggests continuing autonomic vulnerability.

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Section: Discussionsupporting

confidence: 92%

Cardiovascular medication seems to promote recovery of autonomic dysfunction after stroke

et al. 2022

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“…The respiratory rate subcriterion was often met in all 3 groups (60.2 to 81.2%), indicating that tachypnea occurred not only due to infection, but also due to the stroke itself, as disturbances of respiratory patterns with tachypnea are frequently observed in stroke patients ( 27 , 28 ). Accordingly, tachycardia was frequently observed in all patients, which may rather reflect stroke-associated cardiovascular autonomic dysfunction than a clinical sign of infection or sepsis in these patients ( 29 ). Thus, our data confirm that the qSOFA score may be a helpful screening tool that should not be used without confirmatory tests, such as the regular SOFA score ( 6 ).…”

Section: Discussionmentioning

confidence: 99%

Sepsis in Patients With Large Vessel Occlusion Stroke–Clinical Characteristics and Outcome

et al. 2022

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BackgroundInfections are an important complication after stroke and negatively affect clinical outcome. While pneumonia and urinary tract infections are well recognized after stroke, the incidence and consequences of sepsis remain unclear. The aim of this study was to evaluate the frequency and characteristics of sepsis in patients undergoing endovascular therapy for large vessel occlusion stroke, and its association with clinical outcome.MethodsWe analyzed a cohort of patients who underwent endovascular therapy at a single center between 2016 and 2020. The diagnosis and timing of infections and Sequential Organ Failure Assessment scores were evaluated retrospectively to identify patients with sepsis. Patients with sepsis were compared to controls regarding clinical characteristics and outcome.ResultsFifty-four of 406 patients (13.3%) were found to have sepsis. The median onset of sepsis was 2 days after admission. The majority of cases (85.2%) was caused by pneumonia. At 3 months, 72.5% of patients with sepsis were bedridden or dead compared to 25.7 and 42.7% of controls and patients with an infection without sepsis, respectively. The adjusted odds ratio (95% confidence interval) for a poor outcome was 5.4 (1.6–17.6) for patients with sepsis vs. controls, and 2.0 (0.8–5.2) for patients with sepsis vs. patients with an infection without sepsis.ConclusionsSepsis is a frequent complication after large vessel occlusion stroke, and may be associated with a poor clinical outcome. More studies are needed to determine specific risk factors and measures to early recognize and reduce the possibly negative impact of sepsis on outcome after stroke.

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“…Cardiovascular complications are common after ischaemic stroke even without primary cardiac disease and comprise troponin increase, 1 2 cardiac arrhythmia, 3 4 left ventricular (LV) dysfunction [4][5][6] and sudden cardiac death. [4][5][6][7] Cardiovascular complications following an ischaemic stroke are associated with significantly worse prognosis in terms of major adverse cardiovascular events. 8 Particularly impaired LV function (ie, ejection fraction (EF) <50%) after acute ischaemic stroke is a well-recognised poststroke cardiovascular complication occurring in up to 31% of patients and contributes to poor outcome.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Acute right insular ischaemic lesions and poststroke left ventricular dysfunction

et al. 2023

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IntroductionMyocardial 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.MethodsOf 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.ResultsOf 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.ConclusionOur 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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Cardiovascular autonomic dysfunction after stroke

Cited by 28 publications

References 75 publications

Cardiovascular medication seems to promote recovery of autonomic dysfunction after stroke

Cardiovascular medication seems to promote recovery of autonomic dysfunction after stroke

Sepsis in Patients With Large Vessel Occlusion Stroke–Clinical Characteristics and Outcome

Acute right insular ischaemic lesions and poststroke left ventricular dysfunction

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