Heart failure patients have enhanced cerebral autoregulation response in acute ischemic stroke

Area of Science:

• Neurology
• Cardiology
• Intensive Care Medicine

Background:

• The impact of heart failure (HF) on cerebrovascular dynamics during acute ischemic stroke is not well understood.
• While chronic HF may precondition the brain, its effects on cerebral autoregulation (CA) in acute stroke remain unstudied.

Purpose of the Study:

• To investigate the influence of HF on dynamic CA in patients with acute ischemic stroke.
• To compare CA between patients with and without HF, and healthy controls, from symptom onset through the chronic stage.

Main Methods:

• Fifty acute ischemic stroke patients were enrolled, categorized with (N=8) and without HF, alongside 20 healthy controls.
• Dynamic CA was assessed using transfer function analysis of arterial blood pressure (Finometer) and cerebral blood flow velocity (transcranial Doppler) at 6h, 24h, and 3 months post-stroke.
• Cardiac disease markers, including troponin I, were measured.

Main Results:

• HF patients exhibited significantly better dynamic CA (higher phase) in the ischemic hemisphere at 6h (p=0.042) and 24h (p=0.006) post-stroke.
• This enhanced CA was not observed at the 3-month follow-up (p>0.05).
• A positive correlation was found between CA phase and admission troponin I levels (r=0.348, p=0.044).

Conclusions:

• Heart failure is associated with a transiently improved dynamic cerebral autoregulation in the acute phase of ischemic stroke, particularly in patients with severe aortic valve disease.
• Understanding this brain-heart interaction may reveal new therapeutic targets for improving stroke outcomes.
• The findings highlight a complex interplay between cardiac function and cerebral hemodynamics in stroke patients.