Clinical 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.
J Neurol. 2024 Sep;271(9):5969-5975. doi: 10.1007/s00415-024-12531-w. Epub 2024 Jul 15.
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).
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.
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.
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.
急性中风（中风心脏综合征-SHS）后心脏受累是一种已确定的并发症，与交感神经激活、炎症和神经内分泌反应有关。肌钙蛋白“上升和下降模式”>30%是 SHS 的一个标志物。本研究旨在评估不同大小和位置的中风（OCSP 分类）再灌注治疗在 SHS 预防/发病机制中的作用。
我们回顾性分析了 2018 年至 2020 年期间在的里雅斯特（意大利）卒中单元收治的 890 例患者的数据。其中，411 例符合纳入标准（急性缺血性非腔隙性卒中）。为每位患者收集临床数据、影像学特征和心脏损伤标志物[肌钙蛋白 I（TnI）、NT-proBNP、“上升和下降模式”>30%]。我们根据 OCSP 比较了不同的中风亚型，同时评估了有和无 SHS 患者之间的差异。
在接受治疗的全前循环梗死（TACI）患者中，SHS 的发生率低于未接受治疗的 TACI 患者。部分前循环（PACI）和后循环（POCI）以及接受治疗和未接受治疗的患者之间的 SHS 发生率相似。在 TACI 组中，我们比较了 SHS-TACI 和非 SHS-TACI，进行了单变量和多变量分析；治疗（OR 0.408 CI95% 0.185-0.900；p=0.026）和糖尿病（OR 2.618 CI95% 1.181-5.803；p=0.018）与 SHS 显著相关。在 SHS 的发展中没有发现明显的岛叶效应。
在严重的前循环中风（TACI）中，再灌注治疗可能有效预防 SHS。相反，糖尿病是 SHS 的独立危险因素。PACI 和 POCI 具有相似的肌钙蛋白升高率。
