N‐Terminal Pro–Brain Natriuretic Peptide (NT‐proBNP) Levels are Increased in Patients With Transient Ischemic Attack Accompanied by Nonfocal Symptoms

Plas, Gerben J. J.; Jurg, Susanne D.; Brusse‐Keizer, Marjolein; Dippel, Diederik W.J.; Koudstaal, Peter J.; Hertog, Heleen M. den

doi:10.1161/jaha.115.002072

Cited by 7 publications

(6 citation statements)

References 15 publications

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“…Nevertheless, in our study sample, patients with TNAs were not more likely to have vascular risk factors, such as hypertension, lipid-lowering medication or diabetes mellitus than participants without TNAs. Second, cognitive impairment could be the result of cerebral hypoperfusion, which has long been suggested a potential cause of TNAs [1, 2, 29]. This concurs with the results of a large, population-based study in which cerebral hypoperfusion is associated with accelerated cognitive decline [30].…”

Section: Discussionsupporting

confidence: 76%

Nonfocal transient neurological attacks are related to cognitive impairment in patients with heart failure

et al. 2019

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Introduction Nonfocal transient neurological attacks (TNAs) are associated with an increased risk of future dementia, but it is unclear whether TNAs are also associated with concurrent cognitive impairment. We hypothesized that recent TNAs are related to worse cognitive functioning. We tested our hypothesis in patients with heart failure, as these patients are at risk of cerebral hypoperfusion, which might play a role in the etiology of TNAs. Methods We performed neuropsychological testing in all patients with heart failure enrolled in the Heart Brain Connection study. We assessed global cognition, attention-psychomotor speed, executive functioning, memory and language. All patients were interviewed with a standardized questionnaire on the occurrence of TNAs in the preceding 6 months. We studied associations between TNAs and cognitive functioning with linear and logistic regression analyses, adjusted for age, sex and education. We performed additional analyses in patients without previous stroke or TIA and in patients without brain infarction on MRI. Results Thirty-seven (23%) of 158 patients (mean age 70 years, 67% men) experienced one or more TNAs. Patients with a recent TNA were more likely to be impaired on ≥ 1 cognitive domains than patients without TNAs [41% vs. 18%, adjusted odds ratio 4.6, 95% confidence interval (CI) 1.8–11.8]. Patients with TNAs performed worse than patients without TNAs on global cognition (mean difference in z scores − 0.36, 95% CI − 0.54 to − 0.18), and on the cognitive domains attention-psychomotor speed (mean difference − 0.40, 95% CI − 0.66 to − 0.14), memory (mean difference − 0.57, 95% CI − 0.98 to − 0.15) and language (mean difference − 0.47, 95% CI − 0.79 to − 0.16). These associations were independent of cardiac output and volume of white matter hyperintensities. Subgroup analyses in patients without previous stroke or TIA or brain infarction on MRI ( n = 78) yielded comparable results, with the exception of the cognitive domain language, which was no longer different between patients with and without TNAs. Conclusion Among patients with heart failure, TNAs are associated with cognitive impairment, which warrants the need for more clinical awareness of this problem. Electronic supplementary material The online version of this article (10.1007/s00415-019-09376-z) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 76%

Nonfocal transient neurological attacks are related to cognitive impairment in patients with heart failure

et al. 2019

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“…Two previous studies have found indirect evidence for a cardiac origin, as patients with nonfocal symptoms had a high risk of major cardiac events during follow-up [1,6] . A recent study showed increased NT-proBNP levels in patients with TIA accompanied by nonfocal symptoms [9] . Another study found brady arrhythmias in a subgroup of patients aged under 30 [8] .…”

Section: Discussionmentioning

confidence: 99%

“…Positive nonfocal symptoms might by caused by an epileptic or migraine-like phenomena, whereas negative nonfocal symptoms are due to cardiac rhythm and conduction disorders, heart failure, or ischemic heart disease, which may directly lead to nonfocal symptoms by causing a sudden reduction in cerebral blood flow or indirectly by anxiety-induced hyperventilation. In a recent study, we found that NT-proBNP levels are increased in patients with TIA accompanied by nonfocal symptoms, suggesting that temporary nonfocal symptoms serve as markers of cardiac dysfunction [9] . Furthermore, a recent study showed that patients with attacks with nonfocal symptoms were associated with frontoparietal cortical ischemia on either side [10] .…”

Section: Introductionmentioning

confidence: 89%

Nonfocal Symptoms in Patients with Transient Ischemic Attack or Ischemic Stroke: Occurrence, Clinical Determinants, and Association with Cardiac History

Plas

Booij²,

Brouwers³

et al. 2016

Cerebrovasc Dis

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Background: Transient ischemic attacks (TIAs) accompanied by nonfocal symptoms are associated with a higher risk of cardiovascular events, in particular cardiac events. Reported frequencies of TIAs accompanied by nonfocal symptoms range from 18 to 53%. We assessed the occurrence of nonfocal symptoms in patients with TIA or minor ischemic stroke in a neurological outpatient clinic in terms of clinical determinants, cardiac history, and atrial fibrillation (AF). Methods: We included 1,265 consecutive patients with TIA or minor stroke who visited the outpatient clinic. During these visits, we systematically asked for nonfocal symptoms. Nonfocal symptoms included decreased consciousness, amnesia, positive visual phenomena, non-rotatory dizziness, and paresthesias. Relative risks for the presence of nonfocal symptoms in relation to clinical determinants, AF, and cardiac history were calculated. Results: In 243 (19%) of 1,265 patients, TIA or minor ischemic stroke was accompanied by one or more nonfocal symptoms. Non-rotatory dizziness, paresthesia, and amnesia were the most common nonfocal symptoms. In patients with an event of the posterior circulation or obesity, the qualifying TIA or minor stroke was more frequently accompanied by nonfocal symptoms, and in patients with significant carotid stenosis, nonfocal symptoms occurred less frequently. AF was related only with amnesia. Conclusion: Nonfocal symptoms are present in one out of 5 patients with TIA or ischemic stroke, in particular when located in the posterior circulation. A cardiac history or AF was not directly related to nonfocal symptoms. A heterogeneous etiology is suggested.

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“…Consensus on the etiology of TNAs and its pathogenesis is still lacking. Both transient and chronic global cerebral hypoperfusion have been suggested to be an important causal factor [3,6]. However, as there is no clear evidence to support this hypothesis, debate remains [3,6].…”

Section: Introductionmentioning

confidence: 99%

Cerebral Perfusion and the Occurrence of Nonfocal Transient Neurological Attacks

Oudeman

Bron

Berg-Vos³

et al. 2019

Cerebrovasc Dis

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Introduction: Nonfocal transient neurological attacks (TNAs) are associated with an increased risk of cardiac events, stroke and dementia. Their etiology is still unknown. Global cerebral hypoperfusion has been suggested to play a role in their etiology, but this has not been investigated. We assessed whether lower total brain perfusion is associated with a higher occurrence of TNAs. Methods: Between 2015 and 2018, patients with heart failure were included in the Heart Brain Connection study. Patients underwent brain magnetic resonance imaging, including quantitative magnetic resonance angiography (QMRA) to measure cerebral blood flow (CBF). We calculated total brain perfusion of each participant by dividing total CBF by brain volume. Patients were interviewed with a standardized questionnaire on the occurrence of TNAs by physicians who were blinded to QMRA flow status. We assessed the relation between total brain perfusion and the occurrence of TNAs with Poisson regression analysis. Results: Of 136 patients (mean age 70 years, 68% men), 29 (21%) experienced ≥1 TNAs. Nonrotatory dizziness was the most common subtype of TNA. Patients with TNAs were more often female and more often had angina pectoris than patients without TNAs, but total CBF and total brain perfusion were not different between both groups. Total brain perfusion was not associated with the occurrence of TNAs (adjusted risk ratio 1.12, 95% CI 0.88–1.42). Conclusion: We found no association between total brain perfusion and the occurrence of TNAs in patients with heart failure.

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N‐Terminal Pro–Brain Natriuretic Peptide (NT‐proBNP) Levels are Increased in Patients With Transient Ischemic Attack Accompanied by Nonfocal Symptoms

Cited by 7 publications

References 15 publications

Nonfocal transient neurological attacks are related to cognitive impairment in patients with heart failure

Nonfocal transient neurological attacks are related to cognitive impairment in patients with heart failure

Nonfocal Symptoms in Patients with Transient Ischemic Attack or Ischemic Stroke: Occurrence, Clinical Determinants, and Association with Cardiac History

Cerebral Perfusion and the Occurrence of Nonfocal Transient Neurological Attacks

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