THE CARDIAC CONSEQUENCES OF HEMISPHERIC STROKE

我们研究了没有明显心脏病、糖尿病和高血压的对照（正常）个体的光谱能量带宽与年龄之间的关系。我们已经证明，年龄与调节心率变异性的低（交感）和高（副交感）峰值之间存在指数关系。我们已经在中风患者中确定了神经源性ST段抑制，并详细说明了其机制。我们已经显示了近端-远端梯度分布的显著主动脉粥样硬化发现在我们的中风患者TEE。症状性冠状动脉疾病与近端主动脉斑块之间有很强的相关性（p< 0.03），弓和降主动脉斑块与显著的颈动脉颅外狭窄之间有很强的相关性（p<0.01）。在单变量和年龄调整双变量分析中，多种危险因素和人口统计学因素可预测主动脉粥样硬化的严重程度，并根据主动脉位置显示出一些差异相关性。然而，在多变量分析中，只有吸烟表现出区域特异性（对于升主动脉）（p=0.03）；没有其他危险因素与任何节段主动脉粥样硬化相关。晚电位预测致死性心律失常的发生。我们发现21%的中风与心脏缺血有关；此外，当出现时，它们会持续超过1年的随访，而在中风组中，它们在中风发作后1-3个月消失，这表明它们与大脑疾病有关。3例无心脏疾病的脑卒中患者TEE全局性心肌收缩异常，随访9个月消失（神经源性休克心肌）；67%的患者有晚电位，这些数据暗示继发于中风的心脏交感神经异常影响。没有TIA患者有这种现象。

We have investigated the relationship between spectral energy bandwidths and age in control (normal) individuals, without significant cardiac disease, diabetes and hypertension. We have shown that there is an exponential relationship between age and both low (sympathetic) and high (parasympathetic) peaks regulating heart rate variability. We have identified neurogenic ST segment depression in our stroke patients and are detailing the mechanisms. We have shown a proximo-distal gradient in the distribution of significant aortic atheroma found on TEE in our stroke patients. A strong association was found between symptomatic coronary artery disease and plaque in the proximal aorta (p-0.03) and between plaque in the arch and descending aorta and significant (>79%) extracranial carotid stenosis (p<0.01). On univariable and age-adjusted bivariate analysis, multiple risk and demographic factors were predictive of aortic atheroma severity and showed some differential associations according to aorta location. However, on multivariable analysis only smoking showed regional specifity (for the ascending aorta) (p=0.03); no other risk factors were associated with aortic atheroma in any segment. Late potentials predict onset of lethal cardiac arrhythmias. We showed that 21% of strokes are associated with cardiac ischemia; moreover when present they persist over 1 year of follow-up whereas in the stroke group they disappear 1-3 months after stroke onset indicating an association with the cerebral disease. Three stroke patients without cardiac disease have so far been found to have global myocardial contraction abnormalities on TEE, which disappear at 9 months follow-up (neurogenic stunned myocardium); 67% of these patients have late potentials and these data imply abnormal sympathetic influences on the heart secondary to the stroke. No TIA patients have this phenomenon.