Resting Heart Rate and Ischemic Stroke in Patients with Heart Failure

Nakanishi, Koki; Tullio, Marco R. Di; Qian, Min; Thompson, John L.P.; Labovitz, Arthur J.; Mann, Douglas L.; Sacco, Ralph L.; Pullicino, Patrick; Freudenberger, Ronald S; Teerlink, John R.; Graham, Susan; Lip, Gregory Y. H.; Levin, Bruce; Mohr, J. P.; Buchsbaum, Richard; Estol, Conrado J.; Lok, Dirk J.; Ponikowski, Piotr; Anker, Stefan D.; Homma, Shunichi

doi:10.1159/000474958

Cited by 4 publications

(4 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In agreement with previous evidence [ 39 ], our data show that peak velocities are stable over time, but we showed for the first time that a reduction in HR is associated with increased LA stasis in SR. If confirmed in larger cohorts, this finding could provide novel insight into the finding that ivabradine (a negatively chronotropic agent) has been associated with an increased risk of incident AF [ 40 ] and ischemic stroke in patients with systolic heart failure in SR, in contrast to its beneficial effect on mortality and hospital re-admissions [ 41 ]. Nevertheless, HR changes are likely to only partially explain the temporal variability observed in LA stasis, given the mild correlation observed, and other factors are likely to also be involved.…”

Section: Discussionmentioning

confidence: 94%

Left atrial 4D flow cardiovascular magnetic resonance: a reproducibility study in sinus rhythm and atrial fibrillation

Spartera

Pessoa-Amorim

Stracquadanio

et al. 2021

Journal of Cardiovascular Magnetic Resonance

View full text Add to dashboard Cite

Background Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) allows sophisticated quantification of left atrial (LA) blood flow, and could yield novel biomarkers of propensity for intra-cardiac thrombus formation and embolic stroke. As reproducibility is critically important to diagnostic performance, we systematically investigated technical and temporal variation of LA 4D flow in atrial fibrillation (AF) and sinus rhythm (SR). Methods Eighty-six subjects (SR, n = 64; AF, n = 22) with wide-ranging stroke risk (CHA2DS2VASc 0–6) underwent LA 4D flow assessment of peak and mean velocity, vorticity, vortex volume, and stasis. Eighty-five (99%) underwent a second acquisition within the same session, and 74 (86%) also returned at 30 (27–35) days for an interval scan. We assessed variability attributable to manual contouring (intra- and inter-observer), and subject repositioning and reacquisition of data, both within the same session (same-day scan–rescan), and over time (interval scan). Within-subject coefficients of variation (CV) and bootstrapped 95% CIs were calculated and compared. Results Same-day scan–rescan CVs were 6% for peak velocity, 5% for mean velocity, 7% for vorticity, 9% for vortex volume, and 10% for stasis, and were similar between SR and AF subjects (all p > 0.05). Interval-scan variability was similar to same-day scan–rescan variability for peak velocity, vorticity, and vortex volume (all p > 0.05), and higher for stasis and mean velocity (interval scan CVs of 14% and 8%, respectively, both p < 0.05). Longitudinal changes in heart rate and blood pressure at the interval scan in the same subjects were associated with significantly higher variability for LA stasis (p = 0.024), but not for the remaining flow parameters (all p > 0.05). SR subjects showed significantly greater interval-scan variability than AF patients for mean velocity, vortex volume, and stasis (all p < 0.05), but not peak velocity or vorticity (both p > 0.05). Conclusions LA peak velocity and vorticity are the most reproducible and temporally stable novel LA 4D flow biomarkers, and are robust to changes in heart rate, blood pressure, and differences in heart rhythm.

show abstract

Section: Discussionmentioning

confidence: 94%

Left atrial 4D flow cardiovascular magnetic resonance: a reproducibility study in sinus rhythm and atrial fibrillation

Spartera

Pessoa-Amorim

Stracquadanio

et al. 2021

Journal of Cardiovascular Magnetic Resonance

View full text Add to dashboard Cite

show abstract

“…On the same track, considering patients with heart failure with reduced left ventricular ejection fraction (HFrEF) in sinus rhythm who are treated with the current recommended medical regimen, which includes beta-blockers, Nakanishi et al [ 74 ], suggested a higher risk of ischemic stroke in those patients when they show low RHR. A high RHR is associated with increased mortality and hospital re-admissions in patients with HFrEF who are in sinus rhythm, and beta-blockers significantly improve the outcome.…”

Section: Discussionmentioning

confidence: 99%

Exploring the Utility of Autonomic Nervous System Evaluation for Stroke Prognosis

Orgianelis,

Merkouris,

Kitmeridou

et al. 2023

Neurology International

View full text Add to dashboard Cite

Stroke is a major cause of functional disability and is increasing in frequency. Therefore, stroke prognosis must be both accurate and timely. Among other biomarkers, heart rate variability (HRV) is investigated in terms of prognostic accuracy within stroke patients. The literature research of two databases (MEDLINE and Scopus) is performed to trace all relevant studies published within the last decade addressing the potential utility of HRV for stroke prognosis. Only the full-text articles published in English are included. In total, forty-five articles have been traced and are included in the present review. The prognostic value of biomarkers of autonomic dysfunction (AD) in terms of mortality, neurological deterioration, and functional outcome appears to be within the range of known clinical variables, highlighting their utility as prognostic tools. Moreover, they may provide additional information regarding poststroke infections, depression, and cardiac adverse events. AD biomarkers have demonstrated their utility not only in the setting of acute ischemic stroke but also in transient ischemic attack, intracerebral hemorrhage, and traumatic brain injury, thus representing a promising prognostic tool whose clinical application may greatly facilitate individualized stroke care.

show abstract

“…This finding was also observed in the adjusted analysis for the total AIS-HF population and the 65-74 age category of AIS-HF patients. Lower heart rates are associated with reduced hospitalizations and decreased mortality among HF patients [19,20]. Among older patients, optimal heart rate is reported to be between 70-76, and for every 10-point increase in heart rate, the risk of poor outcomes increases by 10% [19,21].…”

Section: Discussionmentioning

confidence: 99%

“…Lower heart rates are associated with reduced hospitalizations and decreased mortality among HF patients [19,20]. Among older patients, optimal heart rate is reported to be between 70-76, and for every 10-point increase in heart rate, the risk of poor outcomes increases by 10% [19,21]. This increase is reported to be independent of β-blocker use [22] and associated with a decrease in cardiac perfusion to myocardium exacerbating dysfunction [23].…”

Section: Discussionmentioning

confidence: 99%

Age Stratification in Acute Ischemic Stroke Patients with Heart Failure

Edrissi

Rathfoot

Knisely

et al. 2022

JCM

View full text Add to dashboard Cite

Background and Purpose. Heart failure (HF) is considered one of the major risk factors associated with the severity of acute ischemic stroke(AIS). The risk factors associated with stroke severity in AIS with a history of HF is not fully understood. Methods. A prospectively maintained database from comprehensive stroke centers in PRISMA Health Upstate Sc, was analyzed for patients with AIS and a history of HF from January 2010 to 30 June 2016. The primary outcome was risk factors associated with a National Institute of Health Stroke Scale score (NIHSS) < 7 indicating lower severity and a score ≥ 7 indicating high severity for 65–74 age category and ≥75 years age category for AIS-HF patients. Univariate analysis was used to determine risk factors based on age categories and stroke severities, while multivariable analysis was used to adjust for the effect of confounding variables. Results: A total 367 AIS-HF patients were identified in this study, 113 patients were between 65–74 years old, while 254 patients were in the ≥75 years old age category. In the adjusted analysis for 65–74 age category, history of smoking (OR = 0.105, 95% Confidence interval (CI): 0.018–0.614, p = 0.012), triglycerides (Odd ratio(OR) = 0.993, 95% (CI): 0.987–0.999, p = 0.019), and International Normalized Ratio (INR) (OR = 0.454, 95% CI: 0.196–1.050, p = 0.045), and direct admission treatment (OR = 0.355, 95% CI: 0.137–0.920, p = 0.033) were associated with a lower stroke severity, elevated heart rate (OR = 1.032, 95% CI: 1.009–1.057, p = 0.007) was associated with a higher stroke severity. For the ≥75 years old age category, previous stroke (OR = 2.297, 95% CI: 1.171–9.852, p = 0.024), peripheral vascular disease (OR = 6.784, 95% CI: 1.242–37.065, p = 0.027), heart rate (OR = 1.035, 95% CI: 1.008–1.063, p = 0.012), and systolic blood pressure (OR = 1.023, 95% CI: 1.005–1.041, p = 0.012) were associated with a higher severe stroke severity. Conclusions: After adjusting for the effect of potential confounders, more risk factors were associated with a high severity of stroke among ≥75 years old compared with 65–74 years old AIS-HF patients. Elevated heart rate was an independent risk factor associated with stroke severity in 65–74 and ≥75 years old AIS-HF patients. Elevated heart rate and other identified risk factors should be managed to reduce stroke severity among elderly AIS-HF patients.

show abstract

Resting Heart Rate and Ischemic Stroke in Patients with Heart Failure

Cited by 4 publications

References 30 publications

Left atrial 4D flow cardiovascular magnetic resonance: a reproducibility study in sinus rhythm and atrial fibrillation

Left atrial 4D flow cardiovascular magnetic resonance: a reproducibility study in sinus rhythm and atrial fibrillation

Exploring the Utility of Autonomic Nervous System Evaluation for Stroke Prognosis

Age Stratification in Acute Ischemic Stroke Patients with Heart Failure

Contact Info

Product

Resources

About