Skip to main content

Advertisement

SpringerLink
Log in

Thrombolysis in Stroke-Heart Syndrome: a useful tool for neurocardiac wellness?

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Introduction

Stroke-heart syndrome is a physiopathological condition of cardiac suffering due to cerebral injury secondary to major vessel occlusion in anterior circulation. It can be detected by increase in cardiac blood biomarkers. Our aim was to investigate a possible ancillary effect of thrombolysis in mitigating Stroke-Heart Syndrome after acute ischaemic stroke.

Patients and methods

We retrospectively collected ischaemic stroke patients admitted to our Stroke Unit between August 1, 2017 and December 31, 2020 and acutely treated for an intracranial anterior circulation occlusion, without anamnestic ischaemic cardiopathy. We divided patients into Group B (“Bridge”) including patients treated with both thrombolysis and thrombectomy and Group D (“Direct”) including primary thrombectomies.

Results

120 patients were included in the study. Group B consisted of 92 patients, Group D of 28 patients, without significant differences in age, baseline and discharge NIHSS, cardiovascular risk factors or TOAST aetiology. Whilst admission, troponin levels were similar in both groups, significant differences in troponin peak (median 16 ng/L in Group B vs 45 ng/L in Group D, p = 0.022) and BNP values (median 455 pg/mL in Group B vs 784 pg/mL in Group D, p = 0.031) were found in the first 72 h since admission. Functional independence at discharge was significantly higher in Group B than Group D (mRS 0–2 36% vs 10%, p = 0.011).

Discussion and conclusion

Significant differences in troponin peak and BNP values suggest a reduced stroke-related heart impairment in patients treated with bridge therapeutic approach: thrombolysis prior to thrombectomy could have a complementary effect on reducing Stroke-Heart Syndrome, improving overall neurological outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

Data are available in anonymous form upon reasonable request after ethics clearance and approval from the corresponding author.

References

  1. Sposato LA, Hilz MJ, Aspberg S, Murthy SB, Bahit MC, Hsieh CY, Sheppard MN, Scheitz JF, World Stroke Organisation Brain & Heart Task Force (2020) Post-stroke cardiovascular complications and neurogenic cardiac injury: JACC state-of-the-art review. J Am Coll Cardiol 76(23):2768–2785. https://doi.org/10.1016/j.jacc.2020.10.009

    Article  PubMed  Google Scholar 

  2. Ghadri JR, Wittstein IS, Prasad A, Sharkey S, Dote K, Akashi YJ, Cammann VL, Crea F, Galiuto L, Desmet W et al (2018) International Expert Consensus Document on Takotsubo Syndrome (Part I): clinical characteristics, diagnostic criteria, and pathophysiology. Eur Heart J 39(22):2032–2046. https://doi.org/10.1093/eurheartj/ehy076

    Article  PubMed  PubMed Central  Google Scholar 

  3. Thom M, Boldrini M, Bundock E, Sheppard MN, Devinsky O (2018) Review: the past, present and future challenges in epilepsy-related and sudden deaths and biobanking. Neuropathol Appl Neurobiol 44(1):32–55. https://doi.org/10.1111/nan.12453

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Scheitz JF, Nolte CH, Doehner W, Hachinski V, Endres M (2018) Stroke-heart syndrome: clinical presentation and underlying mechanisms. Lancet Neurol 17(12):1109–1120. https://doi.org/10.1016/S1474-4422(18)30336-3

    Article  PubMed  Google Scholar 

  5. Scheitz JF, Sposato LA, Schulz-Menger J, Nolte CH, Backs J, Endres M (2022) Stroke-heart syndrome: recent advances and challenges. J Am Heart Assoc 11(17):e026528. https://doi.org/10.1161/JAHA.122.026528

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Wrigley P, Khoury J, Eckerle B, Alwell K, Moomaw CJ, Woo D, Flaherty ML, De Los Rios la Rosa F, Mackey J, Adeoye O et al (2017) Prevalence of positive troponin and echocardiogram findings and association with mortality in acute ischemic stroke. Stroke 48(5):1226–1232. https://doi.org/10.1161/STROKEAHA.116.014561

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Scheitz JF, Stengl H, Nolte CH, Landmesser U, Endres M (2021) Neurological update: use of cardiac troponin in patients with stroke. J Neurol 268(6):2284–2292. https://doi.org/10.1007/s00415-020-10349-w

    Article  PubMed  Google Scholar 

  8. García-Berrocoso T, Giralt D, Bustamante A, Etgen T, Jensen JK, Sharma JC, Shibazaki K, Saritas A, Chen X, Whiteley WN, Montaner J (2013) B-type natriuretic peptides and mortality after stroke: a systematic review and meta-analysis. Neurology 81(23):1976–1985. https://doi.org/10.1212/01.wnl.0000436937.32410.32

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B et al (2019) Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 50(12):e344–e418. https://doi.org/10.1161/STR.0000000000000211

    Article  PubMed  Google Scholar 

  10. Chen J, Wan TF, Xu TC, Chang GC, Chen HS, Liu L (2021) Direct endovascular thrombectomy or with prior intravenous thrombolysis for acute ischemic stroke: a meta-analysis. Front Neurol 12:752698. https://doi.org/10.3389/fneur.2021.752698

    Article  PubMed  PubMed Central  Google Scholar 

  11. Bhatt DL, Lopes RD, Harrington RA (2022) Diagnosis and treatment of acute coronary syndromes: a review. JAMA 327(7):662–675. https://doi.org/10.1001/jama.2022.0358

    Article  PubMed  Google Scholar 

  12. Kaddoura R, Mohamed Ibrahim MI, Arabi AR (2022) Has low-dose intracoronary thrombolysis gained ground in primary percutaneous intervention? Angiology. https://doi.org/10.1177/00033197221138725

    Article  PubMed  Google Scholar 

  13. Barber PA, Demchuk AM, Zhang J, Buchan AM (2000) Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke Programme Early CT Score. Lancet 355(9216):1670–1674. https://doi.org/10.1016/s0140-6736(00)02237-6

    Article  CAS  PubMed  Google Scholar 

  14. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE 3rd (1993) Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 24(1):35–41. https://doi.org/10.1161/01.str.24.1.35

    Article  PubMed  Google Scholar 

  15. Bamford J, Sandercock P, Dennis M, Burn J, Warlow C (1991) Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet 337(8756):1521–1526. https://doi.org/10.1016/0140-6736(91)93206-o

    Article  CAS  PubMed  Google Scholar 

  16. Kume T, Akasaka T, Kawamoto T, Yoshitani H, Watanabe N, Neishi Y, Wada N, Yoshida K (2005) Assessment of coronary microcirculation in patients with takotsubo-like left ventricular dysfunction. Circ J 69(8):934–939. https://doi.org/10.1253/circj.69.934

    Article  PubMed  Google Scholar 

  17. Welsh P, Preiss D, Hayward C, Shah ASV, McAllister D, Briggs A, Boachie C, McConnachie A, Padmanabhan S, Welsh C, Woodward M, Campbell A, Porteous D, Mills NL, Sattar N (2019) Cardiac troponin T and troponin I in the general population. Circulation 139(24):2754–2764. https://doi.org/10.1161/CIRCULATIONAHA.118.038529

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Clerico A, Padoan A, Zaninotto M, Passino C, Plebani M (2020) Clinical relevance of biological variation of cardiac troponins. Clin Chem Lab Med 59(4):641–652. https://doi.org/10.1515/cclm-2020-1433

    Article  CAS  PubMed  Google Scholar 

  19. Mukoyama M, Nakao K, Obata K, Jougasaki M, Yoshimura M, Morita E, Hosoda K, Suga S, Ogawa Y, Yasue H et al (1991) Augmented secretion of brain natriuretic peptide in acute myocardial infarction. Biochem Biophys Res Commun 180(1):431–436. https://doi.org/10.1016/s0006-291x(05)81311-7

    Article  CAS  PubMed  Google Scholar 

  20. Akashi YJ, Musha H, Nakazawa K, Miyake F (2004) Plasma brain natriuretic peptide in takotsubo cardiomyopathy. QJM 97(9):599–607. https://doi.org/10.1093/qjmed/hch094

    Article  CAS  PubMed  Google Scholar 

  21. Del Buono MG, Montone RA, Camilli M, Carbone S, Narula J, Lavie CJ, Niccoli G, Crea F (2021) Coronary microvascular dysfunction across the spectrum of cardiovascular diseases: JACC state-of-the-art review. J Am Coll Cardiol 78(13):1352–1371. https://doi.org/10.1016/j.jacc.2021.07.042

    Article  PubMed  PubMed Central  Google Scholar 

  22. Niccoli G, Scalone G, Lerman A, Crea F (2016) Coronary microvascular obstruction in acute myocardial infarction. Eur Heart J 37(13):1024–1033. https://doi.org/10.1093/eurheartj/ehv484

    Article  PubMed  Google Scholar 

  23. El-Maraghi N, Genton E (1980) The relevance of platelet and fibrin thromboembolism of the coronary microcirculation, with special reference to sudden cardiac death. Circulation 62(5):936–944. https://doi.org/10.1161/01.cir.62.5.936

    Article  CAS  PubMed  Google Scholar 

  24. Kleinbongard P, Heusch G (2022) A fresh look at coronary microembolization. Nat Rev Cardiol 19(4):265–280. https://doi.org/10.1038/s41569-021-00632-2

    Article  PubMed  Google Scholar 

  25. Bracard S, Ducrocq X, Mas JL, Soudant M, Oppenheim C, Moulin T, Guillemin F, THRACE investigators (2016) Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial. Lancet Neurol 15(11):1138–1147. https://doi.org/10.1016/S1474-4422(16)30177-6

    Article  CAS  PubMed  Google Scholar 

  26. Sarraj A, Grotta J, Albers GW, Hassan AE, Blackburn S, Day A, Sitton C, Abraham M, Cai C, Dannenbaum M, SELECT Investigators et al (2021) Clinical and neuroimaging outcomes of direct thrombectomy vs bridging therapy in large vessel occlusion: analysis of the SELECT Cohort Study. Neurology 96(23):e2839–e2853. https://doi.org/10.1212/WNL.0000000000012063

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Vidale S, Romoli M, Clemente AE (2021) Mechanical thrombectomy with or without thrombolysis: a meta-analysis of RCTs. Acta Neurol Scand 143(5):554–557. https://doi.org/10.1111/ane.13390

    Article  CAS  PubMed  Google Scholar 

  28. Siow I, Tan BYQ, Lee KS, Ong N, Toh E, Gopinathan A, Yang C, Bhogal P, Lam E, Spooner O et al (2022) Bridging thrombolysis versus direct mechanical thrombectomy in stroke due to basilar artery occlusion. J Stroke 24(1):128–137. https://doi.org/10.5853/jos.2021.02082

    Article  PubMed  PubMed Central  Google Scholar 

  29. Desilles JP, Loyau S, Syvannarath V, Gonzalez-Valcarcel J, Cantier M, Louedec L, Lapergue B, Amarenco P, Ajzenberg N, Jandrot-Perrus M et al (2015) Alteplase reduces downstream microvascular thrombosis and improves the benefit of large artery recanalization in stroke. Stroke 46(11):3241–3248. https://doi.org/10.1161/STROKEAHA.115.010721

    Article  PubMed  Google Scholar 

  30. Fischer U, Kaesmacher J, Mendes Pereira V, Chapot R, Siddiqui AH, Froehler MT, Cognard C, Furlan AJ, Saver JL, Gralla J (2017) Direct mechanical thrombectomy versus combined intravenous and mechanical thrombectomy in large-artery anterior circulation stroke: a topical review. Stroke 48(10):2912–2918. https://doi.org/10.1161/STROKEAHA.117.017208

    Article  PubMed  Google Scholar 

  31. Fischer U, Kaesmacher J, Strbian D, Eker O, Cognard C, Plattner PS, Bütikofer L, Mordasini P, Deppeler S, Pereira VM, SWIFT DIRECT Collaborators et al (2022) Thrombectomy alone versus intravenous alteplase plus thrombectomy in patients with stroke: an open-label, blinded-outcome, randomised non-inferiority trial. Lancet 400(10346):104–115. https://doi.org/10.1016/S0140-6736(22)00537-2

    Article  CAS  PubMed  Google Scholar 

  32. Mitchell PJ, Yan B, Churilov L, Dowling RJ, Bush SJ, Bivard A, Huo XC, Wang G, Zhang SY, Ton MD, DIRECT-SAFE Investigators et al (2022) Endovascular thrombectomy versus standard bridging thrombolytic with endovascular thrombectomy within 4·5 h of stroke onset: an open-label, blinded-endpoint, randomised non-inferiority trial. Lancet 400(10346):116–125. https://doi.org/10.1016/S0140-6736(22)00564-5

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Clinical University Hospital of Trieste (ASUGI), University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy

    Ilario Scali, Marcello Naccarato, Gabriele Prandin, Federica Palacino, Carlo Lugnan, Laura Mancinelli, Emanuele Vincis, Giovanni Furlanis, Paola Caruso & Paolo Manganotti

Authors
  1. Ilario Scali
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marcello Naccarato
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gabriele Prandin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Federica Palacino
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carlo Lugnan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Laura Mancinelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Emanuele Vincis
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Giovanni Furlanis
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Paola Caruso
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Paolo Manganotti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ilario Scali.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical standards

All procedures performed in the study were approved by the local ethics committee (EC approval number 3482) in accordance with the ethical standards of the institutional research committee and with the Helsinki declaration and its later amendments or comparable ethical standards.

Disclosures

The authors have no relevant financial or non-financial interests to disclose.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Scali, I., Naccarato, M., Prandin, G. et al. Thrombolysis in Stroke-Heart Syndrome: a useful tool for neurocardiac wellness?. J Neurol 271, 2405–2411 (2024). https://doi.org/10.1007/s00415-023-12167-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-023-12167-2

Keywords

Search

Navigation