Heart-Brain Relationship in Stroke

Exploration of the shared gene signatures and molecular mechanisms between cardioembolic stroke and ischemic stroke

Introduction

This study aimed to investigate the shared molecular mechanisms underlying cardioembolic stroke (CS) and ischemic stroke (IS) using integrated bioinformatics analysis.

Methods

Microarray datasets for the CS (GSE58294, blood samples from CS and controls) and IS (GSE16561, blood from IS and controls; GSE22255, peripheral blood mononuclear cells from IS and matched controls) were acquired from the Gene Expression Omnibus database. Differential expression analysis and weighted gene co-expression network analysis were utilized to identify shared genes between the two diseases. Protein-protein interaction (PPI) network and topology analyses were conducted to identify the core shared genes. Three machine learning algorithms were employed to detect biomarkers from the core shared genes, and the diagnostic value of the hub genes was evaluated by establishing a predictive nomogram. Immune infiltration was evaluated using single-sample gene set enrichment analysis (ssGSEA), and pathways were analyzed with gene set enrichment analysis.

Results

There were 125 shared up-regulated genes and 2 shared down-regulated between CS and IS, which were mainly involved in immune inflammatory response-related biological functions. The Maximum Clique Centrality algorithm identified 25 core shared genes in the PPI network constructed using the shared genes. ABCA1, CLEC4E, and IRS2 were identified as biomarkers for both CS and IS and performed well in predicting the onset risk of CS and IS. All three biomarkers were highly expressed in both CS and IS compared to their corresponding controls. These biomarkers significantly correlated with neutrophil infiltration and autophagy activation in both CS and IS. Particularly, all three biomarkers were associated with the activation of neutrophil extracellular trap formation, but only in the IS.

Conclusion

ABCA1, CLEC4E, and IRS2 were identified as potential key biomarkers and therapeutic targets for CS and IS. Autophagy and neutrophil infiltration may represent the common mechanisms linking these two diseases.

Clinical applications of artificial intelligence and machine learning in neurocardiology: a comprehensive review

Neurocardiology is an evolving field focusing on the interplay between the nervous system and cardiovascular system that can be used to describe and understand many pathologies. Acute ischemic stroke can be understood through this framework of an interconnected, reciprocal relationship such that ischemic stroke occurs secondary to cardiac pathology (the Heart-Brain axis), and cardiac injury secondary to various neurological disease processes (the Brain-Heart axis). The timely assessment, diagnosis, and subsequent management of cerebrovascular and cardiac diseases is an essential part of bettering patient outcomes and the progression of medicine. Artificial intelligence (AI) and machine learning (ML) are robust areas of research that can aid diagnostic accuracy and clinical decision making to better understand and manage the disease of neurocardiology. In this review, we identify some of the widely utilized and upcoming AI/ML algorithms for some of the most common cardiac sources of stroke, strokes of undetermined etiology, and cardiac disease secondary to stroke. We found numerous highly accurate and efficient AI/ML products that, when integrated, provided improved efficacy for disease prediction, identification, prognosis, and management within the sphere of stroke and neurocardiology. In the focus of cryptogenic strokes, there is promising research elucidating likely underlying cardiac causes and thus, improved treatment options and secondary stroke prevention. While many algorithms still require a larger knowledge base or manual algorithmic training, AI/ML in neurocardiology has the potential to provide more comprehensive healthcare treatment, increase access to equitable healthcare, and improve patient outcomes. Our review shows an evident interest and exciting new frontier for neurocardiology with artificial intelligence and machine learning.

Association Between Diurnal Temperature Range and Risk of Cardiomyopathy-Induced Hospitalisation in Henan, China: A Time-Series Study

Purpose

The effect of the diurnal temperature range (DTR) on human health in diverse geographic areas and the potential confounding factors are not fully understood. Additionally, while a robust association has been reported between temperature and cardiomyopathy (CM), evidence of the impact of DTR is relatively limited. Here, we determined whether an association exists between DTR and CM hospitalisations in vulnerable populations.

Methods

CM admission data (2016-2021) were collected from seven tertiary hospitals in Henan.We used a GAM combined with a distributed lag non-linear model (DLNM) to investigate the delayed effects of DTR on daily hospitalisations for CM.Stratified analysis was performed in subgroups according to sex, age, and season. Attributable fractions (AF) and attributable numbers (AN) were employed to illustrate the disease burden and investigate the association between temperature and DTR.

Results

Overall, 5,757 CM cases were identified. DTR and CM admissions exhibited a non-linear correlation. High DTR (P95: 15.5 °C) and low DTR (P05: 3 °C) increased CM admission risk, with low DTR having a stronger effect. Males and warm seasons were significantly more susceptible to DTR, and low DTR affected youth and adults more than older adults. AF and AN of low DTR on CM admissions were 51% and 2,936, respectively.

Conclusion

Our results revealed a significant association between DTR and CM hospitalisations, providing valuable insights for the development targeted prevention and control measures.

Cognitive Impairment and Synaptic Dysfunction in Cardiovascular Disorders: The New Frontiers of the Heart-Brain Axis

Within the central nervous system, synaptic plasticity, fundamental to processes like learning and memory, is largely driven by activity-dependent changes in synaptic strength. This plasticity often manifests as long-term potentiation (LTP) and long-term depression (LTD), which are bidirectional modulations of synaptic efficacy. Strong epidemiological and experimental evidence show that the heart-brain axis could be severely compromised by both neurological and cardiovascular disorders. Particularly, cardiovascular disorders, such as heart failure, hypertension, obesity, diabetes and insulin resistance, and arrhythmias, may lead to cognitive impairment, a condition known as cardiogenic dementia. Herein, we review the available knowledge on the synaptic and molecular mechanisms by which cardiogenic dementia may arise and describe how LTP and/or LTD induction and maintenance may be compromised in the CA1 region of the hippocampus by heart failure, metabolic syndrome, and arrhythmias. We also discuss the emerging evidence that endothelial dysfunction may contribute to directly altering hippocampal LTP by impairing the synaptically induced activation of the endothelial nitric oxide synthase. A better understanding of how CV disorders impact on the proper function of central synapses will shed novel light on the molecular underpinnings of cardiogenic dementia, thereby providing a new perspective for more specific pharmacological treatments.

A Bidirectional Mendelian Randomization Study of the Causal Association Between Ischemic Stroke, Coronary Heart Disease, and Hydrocephalus

BACKGROUND

The association among coronary heart disease, ischemic stroke, and hydrocephalus remains ambiguous.

OBJECTIVES

There is a need for a Mendelian randomization study to evaluate the underlying causality between coronary heart disease, ischemic stroke, and hydrocephalus.

METHODS

The data source utilized genome-wide association studies, employing a threshold of p < 5 × 10-8 to identify single nucleotide polymorphisms strongly linked to ischemic stroke and coronary heart disease as instrumental variables (IVs). Five methods-inverse variance weighted (IVW), Mendelian randomization (MR) Egger, Weighted Median, Weighted mode, and Simple mode-utilized the selected IVs to estimate the causality between ischemic stroke, coronary heart disease, and hydrocephalus.

RESULTS

The IVW demonstrated that ischemic stroke and coronary heart disease serve as risk factors for hydrocephalus (odds ratio [OR] = 1.650, 95% CI: 1.066-2.554, p = 0.025; OR = 1.307, 95% CI: 1.023-1.668, p = 0.032). Both the MR-Egger intercept test and Cochran's Q test affirmed the relative reliability of the IVW analysis results. However, no evidence of a reverse causation was observed between hydrocephalus and coronary heart disease or ischemic stroke.

CONCLUSIONS

Coronary heart disease and Ischemic stroke may increase the risk of hydrocephalus.

Safety and Outcomes of Mechanical Thrombectomy in Acute Ischemic Stroke Attributable to Cardiological Diseases: A Scoping Review

There is limited evidence on the outcomes and safety of mechanical thrombectomy (MT) among patients with acute ischemic stroke (AIS) in the context of cardiac diseases. Our study reviews MT in AIS within the context of cardiac diseases, aiming to identify existing and emerging needs and gaps. PubMed and Scopus were searched until December 31, 2023, using a combination of cardiological diseases and "mechanical thrombectomy" or "endovascular treatment" as keywords. Study design included case reports/series, observational studies, randomized clinical trials, and meta-analyses/systematic reviews. We identified 943 articles, of which 130 were included in the review. Results were categorized according to the cardiac conditions. MT shows significant benefits in patients with atrial fibrillation (n=139) but lacks data for stroke occurring after percutaneous coronary intervention (n=2) or transcatheter aortic valve implantation (n=5). MT is beneficial in AIS attributable to infective endocarditis (n=34), although functional benefit may be limited. Controversy surrounds the functional outcomes and mortality of patients with AIS with heart failure undergoing MT (n=11). Despite technical challenges, MT appears feasible in aortic dissection cases (n=4), and in patients with left ventricular assist device or total artificial heart (n=10). Data on AIS attributable to congenital heart disease (n=4) primarily focus on pediatric cases requiring technical modifications. Treatment outcomes of MT in patients with cardiac tumors (n=8) vary because of clot consistency differences. After cardiac surgery stroke, MT may improve outcomes with early intervention (n=13). Available data outline the feasibility of MT in patients with AIS attributable to large-vessel occlusion in the context of cardiac diseases.

Atrial fibrillation and preexisting cognitive impairment in ischemic stroke patients: Dijon Stroke Registry

BACKGROUND

Atrial Fibrillation (AF) is a common cause of ischemic stroke (IS), and is associated with cognitive impairment in the general population. We aimed to compare the prevalence of preexisting cognitive impairment between IS patients with and without AF, and to assess whether prior brain damage could contribute to the observed differences.

METHODS

Patients with acute IS were prospectively identified from the population-based Dijon Stroke Registry, France. Patients who had a CT-scan as brain imaging modality were included in this analysis to assess the presence of preexisting leukoaraiosis, old vascular brain lesions, and cerebral atrophy. Characteristics of patients including prior-to-stroke cognitive status (normal cognition, mild cognitive impairment (MCI), or dementia) were compared between those with and without AF.

RESULTS

Among 916 IS patients, 288 (31.4 %) had AF, of whom 88 had newly diagnosed AF. AF patients had more frequent prior MCI (17.8 % versus 10.2 %) or dementia (22.4 % versus 13.1 %) (p = 0.001), vascular risk factors, and preexisting brain damage. In unadjusted model, preexisting cognitive impairment was associated with AF (OR=2.24; 95 % CI: 1.49-3.37, p < 0.001 for MCI; OR=2.20; 95 % CI: 1.52-3.18, p < 0.001 for dementia). After adjustment for clinical and imaging variables, preexisting mild cognitive impairment (OR=1.87; 95 % CI: 1.06-3.32, p = 0.032) and dementia (OR=1.98; 95 % CI: 1.15-3.40, p = 0.013) were independently associated with AF.

CONCLUSION

AF is a common condition in IS patients and is associated with preexisting cognitive impairment. Brain lesions visible on imaging did not seem to fully account for this association that may involve other mechanisms yet to be elucidated.

Analysis of Clinical Symptoms and Risk Factors Related to Functional Prognosis in Patients With Cardiogenic Stroke

Background

Cardiogenic stroke is associated with substantial morbidity and mortality, necessitating a better understanding of its clinical characteristics for improved patient outcomes. This study aimed to identify clinical characteristics influencing short-term functional prognosis in patients with cardiogenic stroke.

Methods

The study prospectively enrolled 212 patients with cardiogenic stroke, collecting their clinical data and laboratory results. The modified Rankin Scale score at 90 days was used to define functional prognosis, with patients having a good prognosis (modified Rankin Scale ≤2; n = 164) or poor prognosis (modified Rankin Scale ≥3; n = 48).

Results

The poor prognosis group had higher rates of total anterior circulation infarcts (12.5% vs 0.0%; P < .001) and posterior circulation infarction (50.0% vs 38.4%; P < .001) compared with the good prognosis group. Lesion characteristics differed significantly, with the poor prognosis group exhibiting more large-area lesions (39.6% vs 18.9%; P < .001) and multiple confluent lesions (56.3% vs 24.4%; P < .001). Admission-based National Institute of Health Stroke Scale scores were higher in the poor prognosis group (median [IQR], 12 [8-18] vs 5 [4-7]; P <.001), correlating with worse outcomes. The admission National Institute of Health Stroke Scale score predicted patients' 90-day prognosis with good accuracy (area under the curve, 0.937 [95% CI, 0.895-0.965]; P < .001), with a threshold of 7 yielding 85.42% sensitivity and 85.37% specificity.

Conclusion

Higher admission National Institute of Health Stroke Scale scores were significantly associated with poor functional prognosis at 90 days, highlighting the importance of early National Institute of Health Stroke Scale-based assessment for improved outcomes.

Impact of Concurrent Ischaemic Stroke on Unfavourable Outcomes in Men and Women with Dilated Cardiomyopathy

Background

Growing evidence suggests that concurrent ischaemic stroke (IS) exacerbates the prognosis of patients with dilated cardiomyopathy (DCM) and that this effect may be further influenced by sex. However, the exact effect of sex remains unclear. This study aimed to explore the effects of the relevant risk factors on the prognosis of patients with DCM and concurrent IS. Considering the sex differences in DCM, this study further investigated the impact of concurrent IS on the prognosis of men and women with DCM.

Methods

A total of 632 patients with DCM enrolled between 2016 and 2021 were included in this study. Clinical data were obtained from medical records, and all participants were followed up in the outpatient clinic or by telephone for at least 1 year. A Cox proportional hazards model and Kaplan-Meier curves were used to evaluate the effects of concurrent IS on the prognosis of patients with DCM.

Results

Patients with DCM complicated with IS (DCM-IS) had significantly lower cumulative survival rates than patients with DCM without IS (non-IS) (74.6% vs. 84.2%, χ 2 = 6.85, p = 0.009). Additionally, IS was associated with greater risks of death and heart transplantation (HTx) in men (75.8% vs. 85.1%, χ 2 = 5.02, p = 0.025), but not in women (71.0% vs. 81.5%, χ 2 = 1.91, p = 0.167).

Conclusions

This large-scale multicentre prospective cohort study demonstrated a poorer prognosis in patients with concurrent DCM and IS, particularly among men. Patients with DCM should not be overlooked in IS screening, emphasis should be placed on the occurrence of IS in patients with DCM. Early and proactive secondary prevention of cerebrovascular diseases might improve the prognosis of DCM patients. More intervention studies focusing on men with DCM complicated with IS should be prioritised.

Neurological Consequences of Cardiac Arrhythmias: Relationship Between Stroke, Cognitive Decline, and Heart Rhythm Disorders

Cardiac arrhythmias are one of the most common disorders with high morbidity and mortality. The effect of cardiac arrhythmias on the brain is very pronounced due to the high sensitivity of the brain to oxygen and blood supply. This mortality is preventable by early diagnosis and treatment which improves the patient's quality of life. Intervening at the right time, post arrhythmia is significant in preventing deaths and improving patient outcomes. Multiple pathophysiological mechanisms are studied for the brain-axis implications, that have the potential to be targeted by novel therapies. In this review, we describe the pathophysiological mechanisms and recent advances in detail to understand the functional aspects of the brain-heart axis and neurological implications post-stroke, caused by cardiac disorders.  This paper aims to discuss the current literature on the neurological consequences of cardiac arrhythmias and delve into a deeper understanding of the brain-heart axis, imbalances, and decline, with the aim of summarizing everything and all about the neurological consequences of cardiac arrhythmias.

Case Report: Acute cerebral infarction caused by left atrial and right ventricular myxoma received emergency operation

Cardiac myxoma is a rare etiology of ischemic stroke, especially in young people. We report a case of multiple myxomas in left atrium and right ventricle inducing acute cerebral infarction. No significant abnormalities were detected in the patient's preoperative laboratory examination. Following emergency surgery, the patient's prognosis was satisfactory, providing valuable empirical insight for the surgical management of acute cerebral infarction in individuals diagnosed with cardiac myxoma. Our objective is to heighten awareness regarding the evaluation and treatment of patients with acute cerebral infarction subsequent to early diagnosis of cardiac myxoma.

Visual analysis based on CiteSpace software: a bibliometric study of atrial myxoma

Objective

To use CiteSpace and VOSviewer visual metrology to analyze the research status, frontier hotspots, and trends in research on atrial myxoma.

Methods

The Web of Science core collection database was used to retrieve relevant literature on atrial myxoma from 2001 to 2022. CiteSpace software was used to analyze keywords with a co-occurrence network, co-polymerization class, and burst terms, and a corresponding visual atlas was drawn for analysis.

Results

A total of 893 valid articles were included. The country with the highest number of articles was the United States (n = 186). The organization with the highest number of articles was the Mayo Clinic (n = 15). The author with the highest number of articles was Yuan SM (n = 12). The highest cited author was Reynen K (n = 312). The highest cited journal was Annals of Thoracic Surgery (n = 1,067). The most frequently cited literature was published in the New England Journal of Medicine in 1995, which was cited 233 times. The keywords co-occurrence, copolymerization analysis, and Burst analysis revealed that the main research focuses were surgical methods, case reports, and genetic and molecular level studies on the pathogenesis of myxoma.

Conclusions

This bibliometric analysis revealed that the main research topics and hotspots in atrial myxoma included surgical methods, case reports, genetic and molecular studies.

Combination of platelet-to-lymphocyte ratio and D-dimer for the identification of cardiogenic cerebral embolism in non-valvular atrial fibrillation

Background

Non-valvular atrial fibrillation (NVAF) is the most common cause of cardiogenic cerebral embolism (CCE). However, the underlying mechanism between cerebral embolism and NVAF is indefinite, and there is no effective and convenient biomarker to identify potential risk of CCE in patients with NVAF in clinic. The present study aims to identify risk factors for interpreting the potential association of CCE with NVAF and providing valuable biomarkers to predict the risk of CCE for NVAF patients.

Methods

641 NVAF patients diagnosed with CCE and 284 NVAF patients without any history of stroke were recruited in the present study. Clinical data including demographic characteristics, medical history, and clinical assessments, were recorded. Meanwhile, Blood cell counts, lipid profiles, high-sensitivity C-reactive protein, and coagulation function-related indicators were measured. Least absolute shrinkage and selection operator (LASSO) regression analysis was utilized to build a composite indicator model based on the blood risk factors.

Results

(1) CCE patients had significantly increased neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio (PLR), and D-dimer levels as compared with patients in the NVAF group, and these three indicators can distinguish CCE patients from ones in the NVAF group with an area under the curve (AUC) value of over 0.750, respectively. (2) Using the LASSO model, a composite indicator, i.e., the risk score, was determined based on PLR and D-dimer and displayed differential power for distinguishing CCE patients from NVAF patients with an AUC value of over 0.934. (3) The risk score was positively correlated with the National Institutes of Health Stroke Scale and CHADS2 scores in CCE patients. (4) There was a significant association between the change value of the risk score and the recurrence time of stroke in initial CCE patients.

Conclusions

The PLR and D-dimer represent an aggravated process of inflammation and thrombosis in the occurrence of CCE after NVAF. The combination of these two risk factors can contribute to identifying the risk of CCE for patients with NVAF with an accuracy of 93.4%, and the greater in change of composite indicator, the shorter in the recurrence of CCE for NVAF patients.

Development and refinement of diagnostic and therapeutic strategies for managing patients with cardiogenic stroke: An arduous journey

Cardioembolic stroke, referred to as cardiogenic stroke, is a clinical syndrome in which emboli from the heart pass through the circulatory system and cause cerebral artery embolism and corresponding brain dysfunction. Compared to other subtypes of ischemic stroke, cardiogenic stroke presents with more etiologies, greater severity, worse prognosis, and a higher recurrence rate. In this minireview, we provide new insights into the etiological classification, diagnostic methods, and interventions of cardiogenic stroke.

The Octopus Trap of Takotsubo and Stroke: Genetics, Biomarkers and Clinical Management

Takotsubo cardiomyopathy (TC) is a reversible cardiomyopathy mimicking an acute coronary syndrome, usually observed in response to acute stress situations. The association between acute ischemic stroke and TC is already known, since it has been previously reported that ischemic stroke can be both a consequence and a potential cause of TC. However, the precise pathophysiological mechanism linking the two conditions is still poorly understood. The aim of our review is to expand insights regarding the genetic susceptibility and available specific biomarkers of TC and to investigate the clinical profile and outcomes of patients with TC and stroke. Since evidence and trials on TC and stroke are currently lacking, this paper aims to fill a substantial gap in the literature about the relationship between these pathologies.

Dynamics of Cognitive Function in Patients with Heart Failure Following Transcatheter Mitral Valve Repair

Aims: Interventional transcatheter edge-to-edge mitral valve repair (TMVR) is an established treatment option for patients with severe mitral regurgitation (MR) and high operative risk. Cognitive impairment is one of the most common conditions among often extensive comorbidities in these patients. The specific patterns of cognitive decline and particularly the effect of TMVR are not well described. Thus, this study aimed to investigate into the impact of TMVR on cognitive impairment, exercise capacity, and quality of life. Methods: Cognitive function (executive, naming, memory, attention, language, abstraction, and orientation) was assessed with the standardized Montreal Cognitive Assessment test (MoCA; range between 0 and 30 points) before and 3 months after TMVR in 72 consecutive patients alongside echocardiographic examination and assessment of exercise capacity (six-minute walk test) as well as quality-of-life questionnaires (Minnesota living with heart failure questionnaire, MLHF-Q). Results: Patients’ median age was 81 [76.0; 84.5] years, 39.7% were female with a median EuroScore II of 4.4% [2.9; 7.7]. The assessment of cognitive function showed a significant improvement of the cumulative MoCA-Test result (from 22.0 [19.0; 24.5] to 24 [22.0; 26.0]; p < 0.001) with significant changes in the subcategories executive (p < 0.001), attention (p < 0.001), abstraction (p < 0.001), and memory (p < 0.001). In addition, quality of life (from 47.5 [25.0; 69.3] to 24.0 [12.0; 40.0]; p < 0.001) and exercise capacity (from 220.0 m [160.0; 320.0] to 280.0 m [200.0; 380.0]; p = 0.003) increased significantly 3 months after the TMVR procedure. Conclusions: TMVR leads to a significant improvement of cognitive function, exercise capacity, and quality of life in patients with chronic heart failure in 3 months follow up and again highlights the benefit of the evermore established TMVR procedure for patients with high operative risk.