Abstract
Background
Neurogenic cardiac impairment can occur after acute ischemic stroke (AIS), but the
mapping of the neuroanatomic correlation of stroke-related myocardial injury remains
uncertain. This study aims to identify the association between cardiac outcomes and
middle cerebral artery (MCA) ischemic stroke, with or without insular cortex involvement,
as well as the impact of new-onset atrial fibrillation (AF) after AIS on recurrent
stroke.
Methods
Serial measurements of high sensitivity troponin T (TnT), brain natriuretic peptide
(BNP), electrocardiography (ECG), echocardiogram, and cardiac monitoring were performed
on 415 patients with imaging confirmed MCA stroke, with or without insular involvement.
Patients with renal failure, recent cardiovascular events, or congestive heart failure
were excluded.
Results
One hundred fifteen patients (28%) had left MCA infarcts with insular involvement,
122 (29%) had right MCA infarcts involving insular cortex, and 178 (43%) had no insular
involvement. Patients with left MCA stroke with insular involvement tended to exhibit
higher BNP and TnI, and transient cardiac dysfunction, which mimicked Takotsubo cardiomyopathy
in 10 patients with left ventricular ejection fraction (LVEF) of 20-40%. Incidence
of new-onset AF was higher in right MCA stroke involving insula (39%) than left MCA
involving insula (4%). Nine out of fifty-three patients with new-onset AF were not
on anticoagulant therapy due to various reasons; none of them experienced recurrent
AF or stroke during up to a 3-year follow-up period. Statistically significant correlations
between BNP or TnT elevation and left insular infarcts, as well as the incidence of
AF and right insular infarcts, were revealed using linear regression analysis.
Conclusions
The present study demonstrated that acute left MCA stroke with insular involvement
could cause transient cardiac dysfunction and elevated cardiac enzymes without persistent
negative outcomes in the setting of health baseline cardiac condition. The incidence
of new-onset AF was significantly higher in patients with right MCA stroke involving
the insula. There was no increased risk of recurrent ischemic stroke in nine patients
with newly developed AF who were not on anticoagulant therapy, which indicated a need
for further research on presumed neurogenic AF and its management.
Key Words
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Article info
Publication history
Published online: October 28, 2022
Accepted:
October 20,
2022
Received in revised form:
October 14,
2022
Received:
August 31,
2022
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106859
Copyright
© 2022 Elsevier Inc. All rights reserved.