Cardiac Stroke Volume Index Is Associated With Early Neurological Improvement in Acute Ischemic Stroke Patients

Early neurological improvement as assessed with the NIH stroke scale (NIHSS) at 24 h has been associated with improved long-term functional outcomes following acute ischemic stroke (AIS). Cardiac dysfunction is often present in AIS, but its association with outcomes is incompletely defined. We perfo...

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Autores principales:	Joseph Miller, Farhan Chaudhry, Sam Tirgari, Sean Calo, Ariel P. Walker, Richard Thompson, Bashar Nahab, Christopher Lewandowski, Phillip Levy
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	ischemic stroke (IS) cardiac function heart brain interaction autonomic dysfunction stroke outcome and recovery Physiology QP1-981
Acceso en línea:	https://doaj.org/article/e2666523e74d4fffbd9f7fed220e143e
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spelling	oai:doaj.org-article:e2666523e74d4fffbd9f7fed220e143e2021-11-18T09:36:03ZCardiac Stroke Volume Index Is Associated With Early Neurological Improvement in Acute Ischemic Stroke Patients1664-042X10.3389/fphys.2021.689278https://doaj.org/article/e2666523e74d4fffbd9f7fed220e143e2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fphys.2021.689278/fullhttps://doaj.org/toc/1664-042XEarly neurological improvement as assessed with the NIH stroke scale (NIHSS) at 24 h has been associated with improved long-term functional outcomes following acute ischemic stroke (AIS). Cardiac dysfunction is often present in AIS, but its association with outcomes is incompletely defined. We performed a pilot study to evaluate the association between non-invasively measured cardiac parameters and 24-h neurological improvement in prospectively enrolled patients with suspected AIS who presented within 12 h of symptom-onset and had an initial systolic blood pressure>140 mm Hg. Patients receiving thrombolytic therapy or mechanical thrombectomy were excluded. Non-invasive pulse contour analysis was used to measure mean arterial blood pressure (MAP), cardiac stroke volume index (cSVI), cardiac output (CO) and cardiac index (CI). Transcranial Doppler recorded mean middle cerebral artery flow velocity (MFV). We defined a decrease of 4 NIHSS points or NIHSS ≤ 1 at 24-h as neurological improvement. Of 75 suspected, 38 had confirmed AIS and did not receive reperfusion therapy. Of these, 7/38 (18.4%) had neurological improvement over 24 h. MAP was greater in those without improvement (108, IQR 96–123 mm Hg) vs. those with (89, IQR 73–104 mm Hg). cSVI, CO, and MFV were similar between those without and with improvement: 37.4 (IQR 30.9–47.7) vs. 44.7 (IQR 42.3–55.3) ml/m2; 5.2 (IQR 4.2–6.6) vs. 5.3 (IQR 4.7–6.7) mL/min; and 39.9 (IQR 32.1–45.7) vs. 34.4 (IQR 27.1–49.2) cm/s, respectively. Multivariate analysis found MAP and cSVI as predictors for improvement (OR 0.93, 95%CI 0.85–0.98 and 1.14, 95%CI 1.03–1.31). In this pilot study, cSVI and MAP were associated with 24-h neurological improvement in AIS.Joseph MillerFarhan ChaudhrySam TirgariSean CaloAriel P. WalkerRichard ThompsonBashar NahabChristopher LewandowskiPhillip LevyFrontiers Media S.A.articleischemic stroke (IS)cardiac functionheart brain interactionautonomic dysfunctionstroke outcome and recoveryPhysiologyQP1-981ENFrontiers in Physiology, Vol 12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	ischemic stroke (IS) cardiac function heart brain interaction autonomic dysfunction stroke outcome and recovery Physiology QP1-981
spellingShingle	ischemic stroke (IS) cardiac function heart brain interaction autonomic dysfunction stroke outcome and recovery Physiology QP1-981 Joseph Miller Farhan Chaudhry Sam Tirgari Sean Calo Ariel P. Walker Richard Thompson Bashar Nahab Christopher Lewandowski Phillip Levy Cardiac Stroke Volume Index Is Associated With Early Neurological Improvement in Acute Ischemic Stroke Patients
description	Early neurological improvement as assessed with the NIH stroke scale (NIHSS) at 24 h has been associated with improved long-term functional outcomes following acute ischemic stroke (AIS). Cardiac dysfunction is often present in AIS, but its association with outcomes is incompletely defined. We performed a pilot study to evaluate the association between non-invasively measured cardiac parameters and 24-h neurological improvement in prospectively enrolled patients with suspected AIS who presented within 12 h of symptom-onset and had an initial systolic blood pressure>140 mm Hg. Patients receiving thrombolytic therapy or mechanical thrombectomy were excluded. Non-invasive pulse contour analysis was used to measure mean arterial blood pressure (MAP), cardiac stroke volume index (cSVI), cardiac output (CO) and cardiac index (CI). Transcranial Doppler recorded mean middle cerebral artery flow velocity (MFV). We defined a decrease of 4 NIHSS points or NIHSS ≤ 1 at 24-h as neurological improvement. Of 75 suspected, 38 had confirmed AIS and did not receive reperfusion therapy. Of these, 7/38 (18.4%) had neurological improvement over 24 h. MAP was greater in those without improvement (108, IQR 96–123 mm Hg) vs. those with (89, IQR 73–104 mm Hg). cSVI, CO, and MFV were similar between those without and with improvement: 37.4 (IQR 30.9–47.7) vs. 44.7 (IQR 42.3–55.3) ml/m2; 5.2 (IQR 4.2–6.6) vs. 5.3 (IQR 4.7–6.7) mL/min; and 39.9 (IQR 32.1–45.7) vs. 34.4 (IQR 27.1–49.2) cm/s, respectively. Multivariate analysis found MAP and cSVI as predictors for improvement (OR 0.93, 95%CI 0.85–0.98 and 1.14, 95%CI 1.03–1.31). In this pilot study, cSVI and MAP were associated with 24-h neurological improvement in AIS.
format	article
author	Joseph Miller Farhan Chaudhry Sam Tirgari Sean Calo Ariel P. Walker Richard Thompson Bashar Nahab Christopher Lewandowski Phillip Levy
author_facet	Joseph Miller Farhan Chaudhry Sam Tirgari Sean Calo Ariel P. Walker Richard Thompson Bashar Nahab Christopher Lewandowski Phillip Levy
author_sort	Joseph Miller
title	Cardiac Stroke Volume Index Is Associated With Early Neurological Improvement in Acute Ischemic Stroke Patients
title_short	Cardiac Stroke Volume Index Is Associated With Early Neurological Improvement in Acute Ischemic Stroke Patients
title_full	Cardiac Stroke Volume Index Is Associated With Early Neurological Improvement in Acute Ischemic Stroke Patients
title_fullStr	Cardiac Stroke Volume Index Is Associated With Early Neurological Improvement in Acute Ischemic Stroke Patients
title_full_unstemmed	Cardiac Stroke Volume Index Is Associated With Early Neurological Improvement in Acute Ischemic Stroke Patients
title_sort	cardiac stroke volume index is associated with early neurological improvement in acute ischemic stroke patients
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/e2666523e74d4fffbd9f7fed220e143e
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Cardiac Stroke Volume Index Is Associated With Early Neurological Improvement in Acute Ischemic Stroke Patients

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