Abstract Details

Title Neurogenic Cardiac Outcome in Patients with Acute Ischemic Stroke: The Brain-Heart Connection

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S35 - Cerebrovascular Disease: Meta-analyses and Outcomes Research (1:48 PM-2:00 PM)

Poster/Presentation
Number 005

Background Neurogenic cardiac impairment can occur after acute ischemic stroke (AIS), but the mapping of the neuroanatomic correlation of stroke-related myocardial injury remains uncertain.

Objective

This study aims to identify the association between cardiac outcomes and middle cerebral artery (MCA) ischemic stroke, with or without insular cortex involvement, as well as the impact of new-onset atrial fibrillation (AF) after AIS on recurrent stroke.

Design/Methods Serial measurements of cTnI, BNP, cardiac monitoring, and echocardiography were performed on 415 patients with MRI-confirmed MCA stroke, with or without insular involvement. Patients with renal failure, recent cardiovascular events, or congestive heart failure were excluded.

Results

115 patients (28%) had left MCA infarcts with insular involvement, 122 (29%) had right MCA infarcts involving insular cortex, and 178 (43%) had no insular involvement. Patients with left MCA stroke with insular involvement tended to exhibit higher BNP and cTnI, and transient cardiac dysfunction, which mimicked Takotsubo cardiomyopathy in 10 patients with left ventricular ejection fraction of 20-40%. Incidence of new-onset AF was higher in right MCA stroke involving insula (77%) than left MCA involving insula (23%). 9/51 patients with new-onset AF were not on anticoagulant therapy due to various reasons; none of them experienced cardiovascular events, recurrent AF, or stroke during 3-year follow-up period. Statistically significant correlations between BNP or cTnI elevation and the severity of left insular damage, and the incidence of AF and right insular infarcts, were revealed using linear regression analysis.

Conclusions The present study shows that the incidence of new-onset AF is significantly higher in patients with right MCA stroke involving insula, while patients with left MCA AIS with insular involvement demonstrated more cardiac dysfunction. There was no increased risk of recurrent ischemic stroke in 9 patients with new-onset AF not on anticoagulant therapy, which indicated a need for further research on presumed neurogenic AF and its management.

Authors/Disclosures
Jiangyong Min, MD (Corewell Health West) PRESENTER	Dr. Min has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbott . Dr. Min has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic .
Grant J. Young, MD (Vanderbilt University Medical Center)	Dr. Young has nothing to disclose.
	No disclosure on file
	No disclosure on file
Nabil Wees, MD (Augusta University)	Dr. Wees has nothing to disclose.
Nadeem I. Khan, MD (Spectrum Health)	Dr. Khan has nothing to disclose.
Malgorzata Miller, MD (Corewell Health)	Dr. Miller has nothing to disclose.
Muhib Khan, MD, FAAN (Mayo Clinic)	The institution of Dr. Khan has received research support from NINDS. The institution of Dr. Khan has received research support from Genentech. The institution of Dr. Khan has received research support from Spectrum Health-MSU alliance. Dr. Khan has received research support from NIH.