Heart rate variability of acute ischemic stroke patients according to troponin levels

Yıl 2023, Cilt: 36 Sayı: 3, 279 - 283, 29.09.2023

Cigdem Ilerı Zekeriya Dogan Ipek Mıdı

https://doi.org/10.5472/marumj.1367390

Öz

Objective: Neurogenic myocardial stunning is a type of stress-induced cardiomyopathy thought to be a result of dysregulation of the
autonomic nervous system. Heart rate variability (HRV) analysis is a potential method for understanding the underlying mechanisms
of autonomic dysfunction in ischemic stroke. The aim of the study was to investigate HRV in stroke patients in accordance with
troponin levels.
Patients and Methods: Sixty-six patients (mean age 65 ± 13 years; 39 male) presenting with acute ischemic stroke were consecutively
included. High-sensitive cardiac troponin I (hs-cTnI) levels were accepted as elevated when> 0.04 ng/mL. All patients underwent
ambulatory electrocardiographic (ECG) monitoring within the first seven days to obtain time-domain and frequency-domain
measures of HRV.
Results: Twenty patients (30.3 %) had elevated hs-cTnI. Patients with high troponin levels had significantly lower left ventricular
ejection fraction (LVEF), higher ST-segment-T wave changes, and higher N terminal pro-brain natriuretic peptide (NT-proBNP)
levels. Low-frequency/high-frequency (LF/HF) value was significantly higher in the troponin-positive group, but other ambulatory
ECG monitoring parameters such as SDNN, SDANN, RMSSD, and pNN50 were similar among patients.
Conclusion: Neurogenic myocardial damage presenting with high troponin levels can be seen in ischemic stroke patients and may be
associated with sympathetic overactivity.

Anahtar Kelimeler

Myocardial stunning, Neurogenic cardiac injury, Troponin

Kaynakça

• Biso S, Wongrakpanich S, Agrawal A, Yadlapati S, Kishlyansky M, Figueredo V. A review of neurogenic stunned myocardium. Cardiovasc Psychiatry Neurol 2017;2017:5842182. doi: 10.1155/2017/5842182
• Kono T, Morita H, Kuroiwa T, Onaka H, Takatsuka H, Fujiwara A. Left ventricular wall motion abnormalities in patients with subarachnoid hemorrhage: Neurogenic stunned myocardium. J Am Coll Cardiol 1994;24:636-40. doi: 10.1016/0735- 1097(94)90008-6
• Nguyen H, Zaroff JG. Neurogenic stunned myocardium. Curr Neurol Neurosci Rep 2009;9:486-91. doi: 10.1007/ s11910.009.0071-0
• Gherasim L, Nistor R. Neurogenic stunned myocardium as part of stress cardiomyopathy. Maedica (Bucur) 2022;17:902- 10. doi: 10.26574/maedica.2022.17.4.902
• Kenigsberg BB, Barnett CF, Mai JC, Chang JJ. Neurogenic stunned myocardium in severe neurological ınjury. Curr Neurol Neurosci Rep 2019;19:90. doi: 10.1007/ s11910.019.0999-7
• Mierzewska-Schmidt M, Gawecka A. Neurogenic stunned myocardium – do we consider this diagnosis in patients with acute central nervous system injury and acute heart failure? Anaesthesiol Intensive Ther 2015;47:175-80. doi: 10.5603/ AIT.2015.0017
• Buitrago-Ricaurte N, Cintra F, Silva GS. Heart rate variability as an autonomic biomarker in ischemic stroke. Arq Neuropsiquiatr 2020;78:724-32. doi: 10.1590/0004- 282X20200087
• Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J 1996;17:354-81
• Qu Y, Sun YY, Abuduxukuer R, et al. Heart rate variability parameter changes in patients with acute ischemic stroke undergoing intravenous thrombolysis. J Am Heart Assoc 2023;12:e028778. doi: 10.1161/JAHA.122.028778
• Lees T, Shad-Kaneez F, Simpson AM, Nassif NT, Lin Y, Lal S. Heart rate variability as a biomarker for predicting stroke, post-stroke complications and functionality. Biomark Insights 2018;13:117.727.1918786931. doi: 10.1177/117.727.1918786931
• Mo J, Huang L, Peng J, Ocak U, Zhang J, Zhang JH. Autonomic disturbances in acute cerebrovascular disease. Neurosci Bull 2019;35:133-44. doi: 10.1007/s12264.018.0299-2
• Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015;28:1-39.e14. doi: 10.1016/j. echo.2014.10.003
• Megjhani M, Kaffashi F, Terilli K, et al. Heart rate variability as a biomarker of neurocardiogenic injury after subarachnoid hemorrhage. Neurocrit Care 2020;32:162-71. doi: 10.1007/ s12028.019.00734-3
• Sörös P, Hachinski V. Cardiovascular and neurological causes of sudden death after ischaemic stroke. Lancet Neurol 2012;11:179-88. doi: 10.1016/S1474-4422(11)70291-5
• Chidambaram H, Gnanamoorthy K, Suthakaran PK, Rajendran K, Pavadai C. Assessment of autonomic dysfunction in acute stroke patients at a tertiary care hospital. J Clin Diagn Res 2017;11:OC28-OC31. doi: 10.7860/JCDR/2017/24740.9431
• Constantinescu V, Matei D, Costache V, Cuciureanu D, Arsenescu-Georgescu C. Linear and nonlinear parameters of heart rate variability in ischemic stroke patients. Neurol Neurochir Pol 2018;52:194-206. doi: 10.1016/j. pjnns.2017.10.002
• Aftyka J, Staszewski J, Dębiec A, et al. The hemisphere of the brain in which a stroke has occurred visible in the heart rate variability. Life (Basel) 2022;12:1659. doi: 10.3390/ life12101659
• Bybee KA, Prasad A. Stress-related cardiomyopathy syndromes. Circulation 2008;118:397-409. doi: 10.1161/ CIRCULATIONAHA.106.677625
• Krishnamoorthy V, Mackensen GB, Gibbons EF, Vavilala MS. Cardiac dysfunction after neurologic injury: What do we know and where are we going? Chest 2016;149:1325-31. doi: 10.1016/j.chest.2015.12.014
• Hinson HE, Sheth KN. Manifestations of the hyperadrenergic state after acute brain injury. Curr Opin Crit Care 2012;18:139- 45. doi: 10.1097/MCC.0b013e328.351.3290
• Gherasim L. Takotsubo syndrome versus neurogenic stunned myocardium. Maedica (Bucur) 2020;15:288-96. doi: 10.26574/ maedica.2020.15.3.288
• Wittstein IS. The sympathetic nervous system in the pathogenesis of Takotsubo syndrome. Heart Fail Clin 2016;12:485-98. doi: 10.1016/j.hfc.2016.06.012
• Kallmünzer B, Breuer L, Kahl N, et al. Serious cardiac arrhythmias after stroke: Incidence, time course, and predictors—a systematic, prospective analysis. Stroke 2012;43:2892-7. doi: 10.1161/STROKEAHA.112.664318
• Yperzeele L, van Hooff RJ, Nagels G, De Smedt A, De Keyser J, Brouns R. Heart rate variability and baroreceptor sensitivity in acute stroke: a systematic review. Int J Stroke 2015;10:796-800. doi: 10.1111/ijs.12573
• Grilletti JVF, Scapini KB, Bernardes N, et al. Impaired baroreflex sensitivity and increased systolic blood pressure variability in chronic post-ischemic stroke. Clinics (Sao Paulo) 2018;73:e253. doi: 10.6061/clinics/2018/e253.