scholarly journals Randomized Sham-Controlled Pilot Study of Neurocardiac Function in Patients With Acute Ischaemic Stroke Undergoing Heart Rate Variability Biofeedback

2021 ◽  
Vol 12 ◽  
Author(s):  
Timo Siepmann ◽  
Paulin Ohle ◽  
Annahita Sedghi ◽  
Erik Simon ◽  
Martin Arndt ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Stroke Unit ◽  
Clinical Trial Registration ◽  
Autonomic Symptoms ◽  
Sudomotor Function ◽  
Stroke Unit Care ◽  
Sham Biofeedback

Background: Neurocardiac dysfunction worsens clinical outcome and increases mortality in stroke survivors. We hypothesized that heart rate variability (HRV) biofeedback improves neurocardiac function by modulating autonomic nervous system activity after acute ischaemic stroke (AIS).Methods: We randomly allocated (1:1) 48 acute ischaemic stroke patients to receive nine sessions of HRV- or sham biofeedback over 3 days in addition to comprehensive stroke unit care. Before and after the intervention patients were evaluated for HRV via standard deviation of normal-to-normal intervals (SDNN, primary outcome), root mean square of successive differences between normal heartbeats (RMSSD), a predominantly parasympathetic measure, and for sympathetic vasomotor and sudomotor function. Severity of autonomic symptoms was assessed via survey of autonomic symptom scale total impact score (TIS) at baseline and after 3 months.Results: We included 48 patients with acute ischaemic stroke [19 females, ages 65 (4.4), median (interquartile range)]. Treatment with HRV biofeedback increased HRV post intervention [SDNN: 43.5 (79.0) ms vs. 34.1 (45.0) ms baseline, p = 0.015; RMSSD: 46.0 (140.6) ms vs. 29.1 (52.2) ms baseline, p = 0.015] and alleviated autonomic symptoms after 3 months [TIS 3.5 (8.0) vs. 7.5 (7.0) baseline, p = 0.029], which was not seen after sham biofeedback (SDNN: p = 0.63, RMSSD: p = 0.65, TIS: 0.06). There were no changes in sympathetic vasomotor and sudomotor function (p = ns).Conclusions: Adding HRV biofeedback to standard stroke unit care led to improved neurocardiac function and sustained alleviation of autonomic symptoms after acute ischaemic stroke, which was likely mediated by a predominantly parasympathetic mechanism.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03865225.

Abstract WP377: Heart Rate Variability Biofeedback Improves Cardiac Autonomic Function in Patients With Acute Ischaemic Stroke: A Randomized Controlled Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Timo Siepmann ◽  
Paulin Ohle ◽  
Erik Simon ◽  
Annahita Sedghi ◽  
Lars P Pallesen ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Spectral Analysis ◽  
Cardiac Function ◽  
Functional Outcomes ◽  
Stroke Unit ◽  
Autonomic Function ◽  
Cardiac Autonomic Function ◽  
Autonomic Symptoms ◽  
Stroke Unit Care

Introduction: In patients with acute ischaemic stroke (AIS) dysregulation of cardiac function with decreased heart rate variability (HRV) due to impaired integrity of the autonomic nervous system is a frequent complication which is associated with increased mortality and worsening of clinical outcome. HRV biofeedback has previously been suggested to improve cardiac autonomic function by increasing parasympathetic tone. Hypothesis: We hypothesized that HRV biofeedback can be used to complement stroke unit care and alleviate autonomic cardiac dysfunction following AIS. Methods: We randomly allocated patients with AIS to either receive 9 sessions of HRV (n=24) or sham (n=24) biofeedback in addition to standard stroke unit care. These patients underwent detailed assessment of autonomic cardiac function including analysis of HRV via standard deviation of NN intervals (SDNN) and spectral analysis. Furthermore, we assessed vasomotor and sudomotor autonomic function, severity of autonomic symptoms and neurological and functional outcomes. Results: We included 48 patients (19 females, ages 65±14 years, baseline NIHSS 2.2 ± 2.2, mean ± standard deviation). Patients who had undergone HRV biofeedback displayed improved cardiac function compared to baseline (SDNN 72.6 ± 52.4 ms vs. 45.5 ± 34.7 ms, p<0.01) which was not seen in those who received sham biofeedback (p=ns). Similar changes were seen on spectral analysis measures of parasympathetic function (p<0.01). Improvement of autonomic cardiac function following HRV biofeedback was paralleled by decreased severity of autonomic symptoms (p<0.05). Contrasting our observation of an increase in predominantly parasympathetic parameters such as CVNN, sympathetic measures of sudomotor and vasomotor function remained unchanged in both groups (p=ns). Neurological and functional outcomes were unchanged immediately post intervention, however 3-month follow up is yet to be completed. Discussion: HRV biofeedback can modulate autonomic cardiac function post AIS to increase HRV and alleviate autonomic symptoms which might be beneficial in facilitating recovery from functional impairment. This seems to be mediated by a predominantly parasympathetic mechanism of action.

scholarly journals Impact of heart rate on admission on mortality and morbidity in acute ischaemic stroke patients - results from VISTA

2016 ◽  
Vol 23 (12) ◽  
pp. 1750-1756 ◽  
Author(s):  
C. H. Nolte ◽  
H. Erdur ◽  
U. Grittner ◽  
A. Schneider ◽  
S. K. Piper ◽  
...  
Keyword(s):  
Heart Rate ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Stroke Patients ◽  
Mortality And Morbidity

scholarly journals Role of transoesophageal echocardiography in detecting patent foramen ovale in stroke patients aged ≤60 years: A retrospective study

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242885
Author(s):  
Reabal Najjar ◽  
Andrew Hughes
Keyword(s):  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Patent Foramen Ovale ◽  
Stroke Unit ◽  
Transoesophageal Echocardiography ◽  
Inverse Association ◽  
Foramen Ovale ◽  
Stroke Patients ◽  
Venous Thromboembolic Events ◽  
Pfo Closure

Background The underlying aetiology of ischaemic strokes is unknown in as many as 50% of cases. Patent foramen ovale (PFO) has become an increasingly recognised cause of ischaemic strokes in young patients. The present study aimed (1) to assess the frequency of transoesophageal echocardiography (TOE) performed and the proportion of PFOs detected in patients aged ≤60 years and (2) examine the effect of PFO closure on reducing stroke reoccurrence. Methods This was a retrospective clinical audit based on de-identified, secure medical records of the Canberra Hospital, Australia. A review of records was conducted on discharged patients aged 18–60 years admitted to the stroke unit following an ischaemic stroke episode between January 1, 2015, and December 31, 2018. Results A total of 214 acute ischaemic stroke patients were admitted to the stroke unit (mean age, 49.2 ± 9.7 years). Concerning aetiology, 47.2% were cryptogenic in origin, whereas 52.8% had a stroke of a determined cause. 12 patients were diagnosed with a PFO and 7 venous thromboembolic events were identified, 1 in the cryptogenic group and 6 in the determined cause group. 91.7% of PFOs were diagnosed in patients with a cryptogenic stroke. Trans-thoracic echocardiography (TTE) was performed in 37.3% of patients and had detected 4 PFOs (sensitivity 27.3%, specificity 92.5%). TOE was performed in 26.2% of patients and had detected 11 PFOs (sensitivity 90.0%, specificity 100%). The number needed to treat to prevent the occurrence of an ischaemic stroke through PFO closure was estimated at 30. Conclusions An inverse association between age and PFO presence was found in patients aged 18–60 years. Additionally, TOE was superior to TTE for detecting PFO, particularly in those with stroke of an undetermined cause. Our results suggest an increased need for TOE as a routine imaging procedure for acute ischaemic stroke patients aged ≤60.

Acute stroke treatment

2017 ◽  
Author(s):  
Hugh Markus ◽  
Anthony Pereira ◽  
Geoffrey Cloud
Keyword(s):  
Acute Stroke ◽  
Acute Ischaemic Stroke ◽  
Stroke Unit ◽  
Recurrent Stroke ◽  
Stroke Care ◽  
Recent Application ◽  
Acute Stroke Care ◽  
Stroke Treatment ◽  
Acute Stroke Treatment ◽  
Stroke Unit Care

In this chapter the use of thrombolysis and the more recent application of thrombectomy in acute ischaemic stroke are covered. Organized stroke unit care has a major impact on both reducing mortality and improving outcome, and the chapter describes the evidence for this. It also covers other components of supportive acute stroke care, including the importance of instituting measures to avoid complications and to prevent early recurrent stroke.

Cardiology cathlab-based management of thrombotic carotid stenoses in acute ischaemic stroke en route to full interventional stroke service: tools, techniques, challenges and patient outcomes

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Musialek ◽  
A Mazurek ◽  
T Tomaszewski ◽  
A Borratynska ◽  
M Urbanczyk ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Carotid Artery ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Stroke Unit ◽  
High Pressures ◽  
Public Institution ◽  
External Carotid ◽  
Funding Source ◽  
Stroke Service

Abstract Background Shortage of endovascular operators able to deliver manual thrombectomy in acute ischemic stroke (AIS) on a 24/7/365 basis is a main challenge in many health care settings around the world. Another fundamental barrier is getting multispecialy teams to work collaboratively with each other in AIS as is already done (albeit on an elective rather than acute basis and in absence of “territorial” issues) in managing stroke mechanistic pathologies such as atrial fibrillation (pharmacology/ablation) or PFO (diagnosis/closure). Purpose To establish a practical path towards a clinically and orranizationally effective cardiology cathlab-based acute ischaemic stroke service, including intracranial manual thrombectomy, in a large multi-specialty hospital with a high-volume stroke unit but absence of neuroradiology service. Methods Withn a symptomatic and increased-stroke-risk asymptomatic carotid stenosis all-comer endovascular revascularization study (NeuroVascular Team decision-making) we have treated, on an emergent basis, 17 patients (13 men, age 58–75 years, median 67 years) with AIS caused by severe thrombotic carotid artery stenoses. All cases were performed as part of our pathway towards a full 24/7 thrombectomy stroke service. Results All lesions (100%) were thrombotic (mobile thrombus - 29%). Proximal neuroprotection (flow reversal using a common carotid artery±external carotid artery occlusive balloon/s) was used in 15/17 patients (88%). In 2 patients (12%) filter protection was applied as proximal system use was unfeasible for anatomic or clinical reasons. All cases were done under activated clotting time control and using a micronet-covered embolic prevention stent system that was routinely optimized -under an effective neuroprotection- with large balloons/high pressures. There were no procedure- or device-related complications. TIMI/TICI-3 was achieved in all cases. Vascular access closure device use was 76%. A 30-day good clinical outcome (mRS of 0–2) rate was 94%. One patient had a haemorrhagic stroke transformation that finally led to death. By 30 days no new stroke, stent thrombosis, myocardial infarction or other SAE occurred Conclusions Cardiologists skilled in carotid interventions are naturally positioned to deliver AIS treatment. 24/7 interventional services and networks for acute myocardial infarction have long been established and, as demonstrated in our centre, the services and skills can be translated -in collaboration with a local stroke unit/neurology- to AIS. Breaking away from traditionally-perceived “territories” towards working as a multispecialy AIS team is a logical concept that provides an effective healthcare solution for large numbers of stroke patients currently needing -and not receving- thrombectomy. Working hand in hand with neurology and radiology in managing acute carotid syndromes is thus part of a natural evolution towards full interventional stroke services including thrombectomy. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Jagiellonian University Medical College

scholarly journals Access to and delivery of acute ischaemic stroke treatments: A survey of national scientific societies and stroke experts in 44 European countries

2018 ◽  
Vol 4 (1) ◽  
pp. 13-28 ◽  
Author(s):  
Diana Aguiar de Sousa ◽  
Rascha von Martial ◽  
Sònia Abilleira ◽  
Thomas Gattringer ◽  
Adam Kobayashi ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Endovascular Treatment ◽  
Acute Stroke ◽  
Stroke Unit ◽  
Intravenous Thrombolysis ◽  
European Countries ◽  
Annual Number ◽  
National Data ◽  
Acute Stroke Unit ◽  
Stroke Unit Care

Introduction Acute stroke unit care, intravenous thrombolysis and endovascular treatment significantly improve the outcome for patients with ischaemic stroke, but data on access and delivery throughout Europe are lacking. We assessed best available data on access and delivery of acute stroke unit care, intravenous thrombolysis and endovascular treatment throughout Europe. Methods A survey, drafted by stroke professionals (ESO, ESMINT, EAN) and a patient organisation (SAFE), was sent to national stroke societies and experts in 51 European countries (World Health Organization definition) requesting experts to provide national data on stroke unit, intravenous thrombolysis and endovascular treatment rates. We compared both pooled and individual national data per one million inhabitants and per 1000 annual incident ischaemic strokes with highest country rates. Population estimates were based on United Nations data, stroke incidences on the Global Burden of Disease Report. Results We obtained data from 44 European countries. The estimated mean number of stroke units was 2.9 per million inhabitants (95% CI 2.3–3.6) and 1.5 per 1000 annual incident strokes (95% CI 1.1–1.9), highest country rates were 9.2 and 5.8. Intravenous thrombolysis was provided in 42/44 countries. The estimated mean annual number of intravenous thrombolysis was 142.0 per million inhabitants (95% CI 107.4–176.7) and 72.7 per 1000 annual incident strokes (95% CI 54.2–91.2), highest country rates were 412.2 and 205.5. Endovascular treatment was provided in 40/44 countries. The estimated mean annual number of endovascular treatments was 37.1 per million inhabitants (95% CI 26.7–47.5) and 19.3 per 1000 annual incident strokes (95% CI 13.5–25.1), highest country rates were 111.5 and 55.9. Overall, 7.3% of incident ischaemic stroke patients received intravenous thrombolysis (95% CI 5.4–9.1) and 1.9% received endovascular treatment (95% CI 1.3–2.5), highest country rates were 20.6% and 5.6%. Conclusion We observed major inequalities in acute stroke treatment between and within 44 European countries. Our data will assist decision makers implementing tailored stroke care programmes for reducing stroke-related morbidity and mortality in Europe.

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