Brain-heart axis--Review Article.

UNLABELLED: There has been a large confirmation over the last decades that stroke may produce cardiac changes (echocardiographic, electrocardiographic, enzymatic). In ischemic stroke, systolic dysfunction is associated with a high risk of mortality during hospitalization. A recent study demonstrated that cardiac diastolic dysfunction could also accompany acute stroke besides the systolic dysfunction already pointed out by previous studies, being a predictive marker of acute cerebrovascular events. Increased sympathetic activity is contributory, inducing a reversible cardiac myocyte damage and cardiac enzyme surges. Some of the most frequent electrocardiographic abnormalities in stroke are ST segment abnormalities and various tachyarrhythmias (especially atrial fibrillation) and bradyarrhythmias. One can infer the importance of careful and continuous electrocardiographic monitoring of the stroke patient in order to identify these quite frequent electrocardiographic alterations, as it is well known that death due to cardiac arrhythmias is common among acute stroke patients. In order to increase the diagnostic yield, a high level of NTproBNP (N-terminal of the prohormone brain natriuretic peptide) may be used as a discriminant for the patients with a higher probability of cardiac arrhythmias and mortality at presentation, during hospitalization and on the long term. In such patients, cardiac monitoring techniques are more likely to reveal abnormalities. A high BNP level may have potentially important management implications as it may signal a worse prognosis and may prompt the undertaking of certain therapeutic measures. This review summarizes the possible pathological mechanisms of heart-brain connections and their clinical and therapeutical implications. ABBREVIATIONS: AF = atrial fibrillation, ECG = electrocardiography, HRV = heart rate variability, cTn = cardiac troponin, SAH = subarachnoid hemorrhage, CK-MB = creatine kinase-MB, BNP = brain natriuretic peptide, NT-proBNP = N-terminal of the prohormone brain natriuretic peptide, ANP = atrial natriuretic peptide, mRS = modified Rankin Scale, NIHSS = the National Institutes of Health Stroke Scale.

Romanian subjects entered in the hypertension in the very elderly trial (HYVET).

The baseline characteristics, possibly related to cardiovascular outcome, in 94 Romanian hypertensive men and 168 women over the age of 80 entered into the Hypertension in the Very Elderly Trial (HYVET) were compared with those in 725 men and 1128 women entered into the trial in the rest of Western and Eastern Europe (mainly Russia and Bulgaria). There was a tendency for more women in the Romanian subjects (66.7% versus 60.9% (P = 0.08)) and therefore all comparisons were adjusted for this non significant difference. The Romanian subjects were slightly younger, had more previous hypertension, but more previous strokes than the rest of Europe, and consumed a similar amount of alcohol. The Romanian subjects were, on average, lighter and shorter. Romanians had higher mean concentrations of blood urea and glucose and higher concentrations of HDL cholesterol. Total cholesterol was, on average, lower in Romanian subjects than was serum creatinine. Serum sodium, blood hematocrit and hemoglobin were all, on average, lower in Romanian subjects. The Romanian subjects were recruited from predominantly rural areas and it is hypothesised that their diet may have contained less salt, iron and other haematinics. Calorie restriction, compared to the rest of Europe, may have resulted in lower stature and weight but recent increases in calorie intake may have resulted in the increasing average blood glucose in both sexes. DDT is known to block the uptake of HDL cholesterol by the liver and may explain the increased HDL concentrations in Romania. Some of these biochemical differences may reflect different methodologies employed in Romanian laboratories, but we could not confirm this possibility.