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Published on: February 2, 2017
Stroke heart injury: the effect of cerebral reperfusion treatment. A 3-year retrospective study
Gabriele Prandin1, Giovanni Furlanis2, Laura Mancinelli2
1Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, ASUGI, University of Trieste, Strada di fiume, 447, 34149, Trieste, Italy. prandingabriele@gmail.com.
Insights
Reperfusion treatment may prevent Stroke Heart Syndrome (SHS) in severe anterior strokes (TACI). Diabetes is an independent risk factor for SHS, while other stroke types show similar rates regardless of treatment.
Area of Science:
- Cardiology
- Neurology
- Stroke Medicine
Background:
- Stroke Heart Syndrome (SHS) is a known complication of acute stroke.
- SHS involves sympathetic activation, inflammation, and neuro-endocrine responses.
- Troponin elevation patterns can indicate SHS.
Purpose of the Study:
- To evaluate the role of reperfusion treatments in preventing or causing SHS.
- To analyze SHS in relation to stroke size and location using the OCSP classification.
Main Methods:
- Retrospective analysis of 411 acute ischemic non-lacunar stroke patients.
- Collected clinical and imaging data, including cardiac injury markers (TnI, NT-proBNP).
- Compared SHS rates across different OCSP stroke subtypes and between treated and non-treated patients.
Main Results:
- Treated Total Anterior Circulation Infarct (TACI) patients had a lower SHS rate than non-treated TACI patients.
- Partial Anterior Circulation Infarct (PACI) and Posterior Circulation Infarct (POCI) showed similar SHS rates, irrespective of treatment.
- Diabetes was a significant independent risk factor for SHS (OR 2.618).
Conclusions:
- Reperfusion treatment may prevent SHS in severe anterior strokes (TACI).
- Diabetes is an independent risk factor for developing SHS.
- PACI and POCI exhibit similar troponin elevation rates, with no clear insular effect on SHS.
Background:
Cardiac involvement following an acute stroke (Stroke Heart Syndrome-SHS) is an established complication and it is linked to the involvement of sympathetic activation, inflammation, and neuro-endocrine response. Troponin "rise and fall pattern" > 30% is one marker of SHS. The aim of this study was to evaluate the role of reperfusion treatments in the prevention/pathogenesis of SHS with different stroke sizes and locations (OCSP classification).
Methods:
We retrospectively analyzed data of 890 patients admitted to the Stroke Unit of Trieste (Italy) between 2018 and 2020. Out of them, 411 met the inclusion criteria (acute ischemic non-lacunar stroke). Clinical data were collected for each patient, imaging characteristics, and markers of cardiac injury [troponin I (TnI), NT-proBNP, "rise and fall pattern" > 30%]. We compared different stroke subtypes according to OCSP, while evaluating any differences in patients with and without SHS.
Results:
In treated total anterior circulation infarct (TACI) patients, the rate of SHS is lower than in non-treated TACI. Similar SHS rate was found in partial anterior (PACI) and posterior stroke (POCI), and between treated and non-treated patients. Focusing on TACI group, we compared SHS-TACI and non-SHS-TACI, we performed a univariate and multivariate analysis; treatment (OR 0.408 CI95% 0.185-0.900; p = 0.026) and diabetes (OR 2.618 CI95% 1.181-5.803; p = 0.018) were significantly associated to SHS. No clear insular effect was found in SHS development.
Conclusions:
In severe anterior stroke (TACI), reperfusion treatment may be effective in preventing SHS. Conversely, diabetes is an independent risk factor for SHS. PACI and POCI have similar troponin elevation rate.
