Heart failure patients have enhanced cerebral autoregulation response in acute ischemic stroke
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Heart failure patients have enhanced cerebral autoregulation response in acute ischemic stroke Pedro Castro1,2 · Jorge Serrador3,4 · Isabel Rocha5 · Paulo Castro Chaves1 · Farzaneh Sorond6 · Elsa Azevedo1,2
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The cerebrovascular effects of a failing heart-pump are largely unknown. Chronic heart failure (HF) might cause pre-conditioning effect on cerebral hemodynamics but not study so far in acute stroke. We aimed to investigate if HF induces effects in dynamic cerebral autoregulation (CA), within 6 h of symptom-onset through chronic stage of ischemic stroke. We enrolled 50 patients with acute ischemic stroke. Groups with (N = 8) and without HF and 20 heathy controls were compared. Arterial blood pressure (Finometer) and cerebral blood flow velocity (transcranial Doppler) were monitored within 6 and at 24 h from symptom-onset and at 3 months. We assessed dynamic CA by transfer function analysis and cardiac disease markers. HF associated with higher phase (better dynamic CA) at ischemic hemisphere within 6 (p = 0.042) and at 24 h (p = 0.006) but this effect was not evident at 3 months (p > 0.05). Gain and coherence trends were similar between groups. We found a positive correlation between phase and admission troponin I levels (Spearman’s r = 0.348, p = 0.044). Our findings advances on the knowledge of how brain and heart interact in acute ischemic stroke by showing a sustained dynamic cerebral autoregulation response in HF patients mainly with severe aortic valve disease. Understanding the physiological mechanisms that govern this complex interplay can be useful to find novel therapeutic targets which can improve outcome in ischemic stroke. Keywords Autoregulation · Heart failure · Stroke · Cerebral infarction · Ultrasound
Highlights
• We measured dynamic cerebral autoregulation (CA) with
• Chronic heart failure might cause pre-conditioning effect
transcranial Doppler in ischemic stroke patients with and without heart failure. • Heart failure patients had with higher phase (better dynamic CA) at ischemic hemisphere within 6 and at 24 h but this effect was not evident at 3 months.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11239-020-02166-9) contains supplementary material, which is available to authorized users.
1
* Pedro Castro [email protected]
Cardiovascular Research and Development Center, Faculty of Medicine, University of Porto, Alameda Professor Hernani Monteiro, 4200‑319 Porto, Portugal
2
Jorge Serrador [email protected]
Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal
3
Veterans Biomedical Institute and War Related Illness and Injury Study Center, Department of Veterans Affairs, New Jersey Healthcare System, East Orange, USA
4
New Jersey Medical School, Newark, NJ, USA
5
Cardiovascular Autonomic Function Lab, Institute of Physiology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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