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Heart failure patients have enhanced cerebral autoregulation response in acute ischemic stroke

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Abstract

The cerebrovascular effects of a failing heart-pump are largely unknown. Chronic heart failure (HF) might cause pre-conditioning effect on cerebral hemodynamics but not study so far in acute stroke. We aimed to investigate if HF induces effects in dynamic cerebral autoregulation (CA), within 6 h of symptom-onset through chronic stage of ischemic stroke. We enrolled 50 patients with acute ischemic stroke. Groups with (N = 8) and without HF and 20 heathy controls were compared. Arterial blood pressure (Finometer) and cerebral blood flow velocity (transcranial Doppler) were monitored within 6 and at 24 h from symptom-onset and at 3 months. We assessed dynamic CA by transfer function analysis and cardiac disease markers. HF associated with higher phase (better dynamic CA) at ischemic hemisphere within 6 (p = 0.042) and at 24 h (p = 0.006) but this effect was not evident at 3 months (p > 0.05). Gain and coherence trends were similar between groups. We found a positive correlation between phase and admission troponin I levels (Spearman’s r = 0.348, p = 0.044). Our findings advances on the knowledge of how brain and heart interact in acute ischemic stroke by showing a sustained dynamic cerebral autoregulation response in HF patients mainly with severe aortic valve disease. Understanding the physiological mechanisms that govern this complex interplay can be useful to find novel therapeutic targets which can improve outcome in ischemic stroke.

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Funding

This study received public national grant from Fundação para a Ciência e a Tecnologia (FCT), Portugal, with the number PTDC/SAU-ORG/113329/2009.

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Authors and Affiliations

  1. Cardiovascular Research and Development Center, Faculty of Medicine, University of Porto, Alameda Professor Hernani Monteiro, 4200-319, Porto, Portugal

    Pedro Castro, Paulo Castro Chaves & Elsa Azevedo

  2. Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal

    Pedro Castro & Elsa Azevedo

  3. Veterans Biomedical Institute and War Related Illness and Injury Study Center, Department of Veterans Affairs, New Jersey Healthcare System, East Orange, USA

    Jorge Serrador

  4. New Jersey Medical School, Newark, NJ, USA

    Jorge Serrador

  5. Cardiovascular Autonomic Function Lab, Institute of Physiology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal

    Isabel Rocha

  6. Division of Stroke and Neurocritical, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Farzaneh Sorond

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  1. Pedro Castro
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Correspondence to Pedro Castro.

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11239_2020_2166_MOESM1_ESM.tif

Supplementary file1 (TIF 159 kb). Supplemental Figure 1 Averaged spectral curves of cerebral autoregulation parameters – coherence, gain and phase – of groups patients with chronic Heart failure (HF) and without HF and healthy controls. In stroke patients, these were obtained < 6 hours from symptom onset. Very Low Frequency (VLF, 0.02-0.05 Hz; HF), low frequency (LF, 0.05-0.20 Hz) to high frequency (HF, 0.20-0.5 Hz). Repeated-measures ANOVA showed a significant difference (P<0.05) in VLF phase only when comparing the group of patients with HF versus group without HF or the healthy control group and it is highlighted with bracket with asterisk (*). A detailed statistical analysis and TFA values are presented in Table 2

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Castro, P., Serrador, J., Rocha, I. et al. Heart failure patients have enhanced cerebral autoregulation response in acute ischemic stroke. J Thromb Thrombolysis 50, 753–761 (2020). https://doi.org/10.1007/s11239-020-02166-9

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