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Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...
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Ischemic Stroke after Heart Transplantation.

Maurizio Acampa1, Pietro Enea Lazzerini2, Francesca Guideri1

  • 1Stroke Unit, Department of Neurological and Sensorineural Sciences, Azienda Ospedaliera Universitaria Senese, "Santa Maria alle Scotte" General Hospital, viale Bracci, Siena, Italy.

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Summary

Cerebrovascular complications, including ischemic stroke, are more frequent after heart transplantation than other heart surgeries. Hyperhomocysteinemia and silent atrial fibrillation may contribute to stroke risk in these patients.

Keywords:
CardioembolismHeart transplantationHomocysteineInflammationIschemic strokeP wave dispersion

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Area of Science:

  • Cardiology
  • Neurology
  • Transplantation Medicine

Background:

  • Cerebrovascular complications are more common after orthotopic heart transplantation (OHT) compared to routine cardiac surgery.
  • Ischemic stroke and transient ischemic attack (TIA) occur in up to 13% of OHT patients, significantly more than intracranial hemorrhage (2.5%).

Purpose of the Study:

  • To investigate the distinct mechanisms and risk factors for cerebrovascular complications, particularly ischemic stroke, following OHT.
  • To explore the role of silent atrial fibrillation and hyperhomocysteinemia in cryptogenic strokes post-OHT.

Main Methods:

  • Review of clinical data and neurological sequelae in OHT patients.
  • Analysis of stroke subtypes, incidence, and potential pathogenic mechanisms specific to the perioperative and postoperative periods.
  • Correlation of P wave dispersion with homocysteine levels and atrial fibrillation in OHT patients.

Main Results:

  • Ischemic stroke is the predominant cerebrovascular complication, with atypical distribution and pathogenic mechanisms compared to general populations.
  • A significant proportion (40%) of strokes are cryptogenic, suggesting unidentified underlying causes.
  • Silent atrial fibrillation and hyperhomocysteinemia are implicated as potential contributors to stroke pathogenesis, with P wave dispersion as a possible predictor of AF.

Conclusions:

  • Stroke is a significant complication of OHT, impacting both mortality and long-term functional outcomes.
  • Understanding the unique mechanisms of stroke post-OHT is crucial for risk mitigation.
  • Further research into the roles of AF and hyperhomocysteinemia may reveal novel therapeutic targets.