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Abstract Details

Neurogenic Cardiac Outcome in Patients with Acute Ischemic Stroke: The Brain-Heart Connection
Cerebrovascular Disease and Interventional Neurology
S35 - Cerebrovascular Disease: Meta-analyses and Outcomes Research (1:48 PM-2:00 PM)
005

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. 
Neurogenic cardiac impairment can occur after acute ischemic stroke (AIS), but the mapping of the neuroanatomic correlation of stroke-related myocardial injury remains uncertain.
Serial measurements of cTnI, BNP, cardiac monitoring, and echocardiography were performed on 415 patients with MRI-confirmed MCA stroke, with or without insular involvement. Patients with renal failure, recent cardiovascular events, or congestive heart failure were excluded. 

115 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 cTnI, and transient cardiac dysfunction, which mimicked Takotsubo cardiomyopathy in 10 patients with left ventricular ejection fraction of 20-40%. Incidence of new-onset AF was higher in right MCA stroke involving insula (77%) than left MCA  involving insula (23%). 9/51 patients with new-onset AF were not on anticoagulant therapy due to various reasons; none of them experienced cardiovascular events, recurrent AF, or  stroke during 3-year follow-up period. Statistically significant correlations between BNP or cTnI elevation and the severity of left insular damage, and the incidence of AF and right insular infarcts, were revealed using linear regression analysis. 
The present study shows that the incidence of new-onset AF is significantly higher in patients with right MCA stroke involving insula, while patients with left MCA AIS with insular involvement demonstrated more cardiac dysfunction. There was no increased risk of recurrent ischemic stroke in 9 patients with new-onset AF not on anticoagulant therapy, which indicated a need for further research on presumed neurogenic AF and its management. 
Authors/Disclosures
Jiangyong Min, MD (Corewell Health West)
PRESENTER 		Dr. Min has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic . Dr. Min has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for CredentialMed, LLC. The institution of Dr. Min has received research support from Corerwell Health Foundation .
Grant J. Young, MD Dr. Young has nothing to disclose.
No disclosure on file
No disclosure on file
Nabil Wees, MD (Augusta University) Dr. Wees has nothing to disclose.
Nadeem I. Khan, MD (Spectrum Health) Dr. Khan has nothing to disclose.
Malgorzata Miller, MD (Corewell Health) The institution of Dr. Miller has received research support from NIH StrokeNet VERIFY trial.
Muhib Khan, MD, FAAN (Mayo Clinic) The institution of Dr. Khan has received research support from Mayo Clinic 好色先生 Grant . The institution of Dr. Khan has received research support from Mayo Clinic Small Grants .