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组(正常)的光谱能量带宽与年龄的关系。我们已经证明，年龄与调节心率变异性的低峰(交感)和高峰(副交感)之间存在指数关系。我们已经在我们的卒中患者中发现了神经源性ST段压低，并正在详细阐述其机制。我们在卒中患者的TEE上发现了显著的主动脉动脉粥样硬化分布的近端-远端梯度。有症状性冠状动脉病变与主动脉近端斑块显著相关(P-0.03)，弓部和降主动脉斑块与显著(79%)颈动脉颅外段狭窄显著相关(P&lt；0.01)。在单变量和年龄调整的双变量分析中，多种危险因素和人口统计学因素可以预测动脉粥样硬化的严重程度，并根据主动脉位置的不同显示出一些不同的相关性。然而，在多变量分析中，只有吸烟表现出区域性特异性(对于升主动脉)(p=0.03)；没有其他危险因素与任何节段的动脉粥样硬化相关。晚电位预示着致命性心律失常的发生。我们发现，21%的中风与心肌缺血有关；而且，如果存在的话，他们会持续一年以上的随访，而在中风组，他们在中风发病后1-3个月消失，这表明与脑部疾病有关。到目前为止，已有三名无心脏病的中风患者在TEE上发现了整体心肌收缩异常，这些异常在9个月的随访中消失(神经源性顿抑心肌)；其中67%的患者有晚电位，这些数据表明中风对心脏的交感神经影响异常。无短暂性脑缺血发作患者出现这种现象。

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.