Clinical characteristics and prognosis of brain-heart interaction in patients with acute severe stroke / 中华危重病急救医学

ABSTRACT

To investigate and analyze the clinical characteristics and prognosis of brain-heart interaction (BHI) in patients with acute severe stroke. Methods The patients with acute severe stroke admitted to Neurointensive Care Unit of Xuanwu Hospital, Capital Medical University from January 1st, 2015 to December 31st, 2017 were enrolled. The clinical data, indicators related to BHI and prognosis were collected. Patients were divided into BHI group and non-BHI group according to the presence or absence of BHI. The differences of each index were compared between two groups. The independent risk factors of BHI were analyzed using multivariate Logistic regression analysis. In addition, subgroup analysis was performed for patients in the BHI group based on the presence or absence of Takotsubo syndrome (TTS), and multivariate Logistic regression was used to analyze independent risk factors for TTS. Results 119 patients with acute severe stroke were analyzed, BHI occurred in 91 cases (76.5%), and 17 cases (14.3%) TTS were included in the BHI group. Compared with non-BHI group, BHI group had lower rates of cerebrovascular disease history (20.9% vs. 42.9%, P = 0.020), lower smoking history (25.3% vs. 50.0%, P = 0.013), lower statin use (16.5% vs. 50.0%, P = 0.000), lower total cholesterol [TC (mmol/L) 3.97±1.05 vs. 4.43±0.88, P =0.039], and lower low density lipoprotein [LDL (mmol/L) 2.30±0.76 vs. 3.00±0.84, P = 0.000]. Multivariate Logistic regression showed that the use of statins [odds ratio (OR) = 0.222, 95% confidence interval (95%CI) = 0.075-0.658, P =0.007] and the history of cerebrovascular diseases (OR = 0.321, 95%CI = 0.113-0.912, P = 0.033) were protective factors of BHI. Compared with non-TTS subgroup, TTS subgroup had a lower percentage of diabetes history (0% vs. 37.8%, P = 0.002), lower glycated hemoglobin [HbA1c 0.055 (0.050, 0.056) vs. 0.064 (0.056, 0.075), P = 0.000], higher TC (mmol/L 4.70±1.16 vs. 3.80±0.95, P = 0.001), first day mean arterial pressure [MAP (mmHg, 1 mmHg = 0.133 kPa)114 (98, 122) vs. 103 (94, 108), P = 0.042], third day diastolic blood pressure [DBP (mmHg) 82 (77, 94) vs. 67 (59, 86), P = 0.002], and third day MAP [mmHg 106 (95, 114) vs. 94 (80, 106), P = 0.015]. Multivariate Logistic regression analysis showed that increased MAP on the third day of admission was an independent risk factor for TTS (OR = 11.833, 95%CI = 1.113-125.779, P = 0.040), increased HbA1c was protective factor of TTS (OR = 0.022, 95%CI = 0.001-0.345, P = 0.006). The rate of poor outcome at discharge of all the BHI patients were higher than those of the non-BHI patients (34.1% vs. 14.3%, P = 0.045). Conclusions Acute severe stroke patients with high incidence of acquiring BHI and having BHI is associated with poor outcome after discharge. Using statins, ischemic preconditioning and control blood pressure, the occurrence of BHI can be reduced and might be beneficial to patients.