CARDIAC AUTONOMIC CONSEQUENCES OF HEMISPHERE STROKE

半球中风对心脏自主神经的影响

• 批准号: 2685708
• 负责人: STEPHEN M OPPENHEIMER
• 金额: $ 70.51万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1995
• 资助国家: 美国
• 起止时间: 1995-05-10 至 2000-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2685708
• 关键词: arrhythmia; autonomic nervous system; brain mapping; cardiography; cardiovascular disorder epidemiology; coronary disorder; human subject; medical complication; prognosis; stroke

Victims of stroke most commonly die from cardiac causes. Although they have a high incidence of ischemic heart disease, autopsy and experimental studies in acute stroke indicate that cardiac ischemia is not the cause of death. Instead, increased sympathetic tone causing cardiac damage and arrhythmias is implicated. As a result of previous studies it is suggested that left middle cerebral artery (MCA) stroke involving the insula or right MCA stroke sparing the insula shifts cardiac autonomic balance towards sympathetic predominance which can cause cardiac arrhythmias. No prospective clinical studies have yet compared stroke location and cardiac outcome. Our overall goal is to reduce the prime cause of stroke-related mortality by determining whether cardiac outcomes after acute stroke differ according to: stroke location (AIM 1); in relation to cardiac autonomic tone (AIM 2); and whether patients at longterm risk for adverse cardiac outcome can be predicted by clinical neurological, cardiac and autonomic status using multivariate analysis (AIM3). The overall study design involves selection of patients within 1 week of hemisphere or brainstem stroke. Daily cardiac and neurological examinations will be performed for a further week. Pre-existing coronary artery disease (CAD) will be ascertained by examination, history, ECG, thallium scan and echocardiography; contribution of CAD to cardiac outcome will be treated by multivariate analysis. Cardiac outcomes include: new onset ECG changes, cardiac arrhythmias and changes in cardiac contractility and cardiac enzymes; myocardial infarction, angina and sudden cardiac death. These will be assessed during the first week after inclusion in the study and regularly for 1 year thereafter. Incidence of cardiac events will be related to stroke location and cardiac autonomic tone, and compared to the incidence in TIA patients as a control group. Cardiovascular autonomic tone will be assessed by spectral analysis of heart rate and blood pressure variability using a specially designed cardiac autonomic platform and by urinary catecholamine excretion. Control groups for comparison will include TIA patients and age-matched normal individuals. Accomplishment of these aims should indicate prevention strategies for the most common cause of post-stroke death.

中风患者大多死于心脏原因。尽管他们 有较高的缺血性心脏病发病率，尸检和实验 对急性中风的研究表明，心脏缺血不是中风的原因 死亡。相反，交感神经张力增加会导致心脏损伤和 心律失常也有牵连。根据先前的研究结果，有人建议 左侧大脑中动脉(MCA)卒中累及脑岛或右侧 保留脑岛的MCA卒中将心脏自主神经平衡转移到 交感神经占优势，可导致心律失常。不是 前瞻性临床研究已经比较了卒中部位和心脏 结果。我们的总体目标是减少与中风相关的主要原因 通过确定急性卒中后心脏结局是否不同来确定死亡率 根据：卒中部位(AIM 1)；与心脏自主神经相关 音调(AIM 2)；以及长期存在心脏不良风险的患者 通过临床神经、心脏和自主神经可以预测结果 状态采用多因素分析(AIM3)。总体研究设计 涉及在大脑半球或脑干后1周内选择患者 卒中。每日的心脏和神经检查将用于 再过一周。既往存在的冠状动脉疾病(CAD)将 通过检查，病史，心电图，铊扫描和 超声心动图；冠心病对心脏结局的贡献将通过以下方式进行治疗 多变量分析。心脏转归包括：新发的心电图改变， 心律失常与心脏收缩功能和心脏功能的变化 酶；心肌梗塞、心绞痛和心脏性猝死。这些 将在纳入研究后的第一周进行评估，并 在此之后的1年内定期进行。心脏事件的发生率将是 与卒中位置和心脏自主神经张力相关，并与 以短暂性脑缺血发作患者为对照组。心血管自主神经 音调将通过心率和血压的频谱分析进行评估 变异性使用专门设计的心脏自主神经平台和 尿儿茶酚胺排泄量。用于比较的对照组将 包括短暂性脑缺血发作患者和年龄匹配的正常人。成就 这些目标应该表明针对最常见原因的预防战略。 中风后死亡。