Ischemic Stroke after Heart Transplantation

被引:33
作者
Acampa, Maurizio [1 ]
Lazzerini, Pietro Enea [2 ]
Guideri, Francesca [1 ]
Tassi, Rossana [1 ]
Martini, Giuseppe [1 ]
机构
[1] Univ Senese, Azienda Osped, Santa Maria Alle Scotte Gen Hosp, Stroke Unit,Dept Neurol & Sensorineural Sci, Viale Bracci, Siena, Italy
[2] Univ Siena, Dept Med Sci Surg & Neurosci, Viale Bracci, Siena, Italy
关键词
Ischemic stroke; Heart transplantation; Inflammation; Cardioembolism; P wave dispersion; Homocysteine; POSTOPERATIVE ATRIAL-FIBRILLATION; P-WAVE DISPERSION; NEUROLOGIC COMPLICATIONS; CARDIAC-SURGERY; CEREBROVASCULAR COMPLICATIONS; LUNG TRANSPLANTATION; RISK-FACTORS; INTERNATIONAL SOCIETY; HOMOCYSTEINE LEVELS; MODERN-ERA;
D O I
10.5853/jos.2015.01599
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Cerebrovascular complications after orthotopic heart transplantation (OHT) are more common in comparison with neurological sequelae subsequent to routine cardiac surgery. Ischemic stroke and transient ischemic attack (TIA) are more common (with an incidence of up to 13%) than intracranial hemorrhage (2.5%). Clinically, ischemic stroke is manifested by the appearance of focal neurologic deficits, although sometimes a stroke may be silent or manifests itself by the appearance of encephalopathy, reflecting a diffuse brain disorder. Ischemic stroke subtypes distribution in perioperative and postoperative period after OHT is very different from classical distribution, with different pathogenic mechanisms. Intact, ischemic stroke may be caused by less common and unusual mechanisms, linked to surgical procedures and to postoperative inflammation, peculiar to this group of patients. However, many strokes (40%) occur without a well-defined etiology (cryptogenic strokes). A silent atrial fibrillation (AF) may play a role in pathogenesis of these strokes and P wave dispersion may represent a predictor of AF. In OHT patients, P wave dispersion correlates with homocysteine plasma levels and hyperhomocysteinemia could play a role in the pathogenesis of these strokes with multiple mechanisms increasing the risk of AF. In conclusion, stroke after heart transplantation represents a complication with considerable impact not only on mortality but also on subsequent poor functional outcome.
引用
收藏
页码:157 / 168
页数:12
相关论文
共 81 条
[1]   P wave dispersion in cryptogenic stroke: A risk factor for cardioembolism? [J].
Acampa, Maurizio ;
Guideri, Francesca ;
Tassi, Rossana ;
Dello Buono, Davide ;
Celli, Lorenzo ;
Mammarella, Lara di Toro ;
Lazzerini, Pietro Enea ;
Marotta, Giovanna ;
Lo Giudice, Giuseppe ;
D'Andrea, Paolo ;
Martini, Giuseppe .
INTERNATIONAL JOURNAL OF CARDIOLOGY, 2015, 190 :202-204
[2]   Homocysteine and P wave dispersion in patients with heart transplantation [J].
Acampa, Maurizio ;
Lazzerini, Pietro Enea ;
Guideri, Francesca ;
Rechichi, Serena ;
Capecchi, Pier Leopoldo ;
Maccherini, Massimo ;
Laghi-Pasini, Franco .
CLINICAL TRANSPLANTATION, 2011, 25 (01) :119-125
[3]   CEREBROVASCULAR SYNDROMES FOLLOWING CARDIAC TRANSPLANTATION [J].
ADAIR, JC ;
CALL, GK ;
OCONNELL, JB ;
BARINGER, JR .
NEUROLOGY, 1992, 42 (04) :819-823
[4]   CLASSIFICATION OF SUBTYPE OF ACUTE ISCHEMIC STROKE - DEFINITIONS FOR USE IN A MULTICENTER CLINICAL-TRIAL [J].
ADAMS, HP ;
BENDIXEN, BH ;
KAPPELLE, LJ ;
BILLER, J ;
LOVE, BB ;
GORDON, DL ;
MARSH, EE ;
KASE, CS ;
WOLF, PA ;
BABIKIAN, VL ;
LICATAGEHR, EE ;
ALLEN, N ;
BRASS, LM ;
FAYAD, PB ;
PAVALKIS, FJ ;
WEINBERGER, JM ;
TUHRIM, S ;
RUDOLPH, SH ;
HOROWITZ, DR ;
BITTON, A ;
MOHR, JP ;
SACCO, RL ;
CLAVIJO, M ;
ROSENBAUM, DM ;
SPARR, SA ;
KATZ, P ;
KLONOWSKI, E ;
CULEBRAS, A ;
CAREY, G ;
MARTIR, NI ;
FICARRA, C ;
HOGAN, EL ;
CARTER, T ;
GURECKI, P ;
MUNTZ, BK ;
RAMIREZLASSEPAS, M ;
TULLOCH, JW ;
QUINONES, MR ;
MENDEZ, M ;
ZHANG, SM ;
ALA, T ;
JOHNSTON, KC ;
ANDERSON, DC ;
TARREL, RM ;
NANCE, MA ;
BUDLIE, SR ;
DIERICH, M ;
HELGASON, CM ;
HIER, DB ;
SHAPIRO, RA .
STROKE, 1993, 24 (01) :35-41
[5]   Prevalence, pathophysiology, and clinical significance of post-heart transplant atrial fibrillation and atrial flutter [J].
Ahmari, SAL ;
Bunch, TJ ;
Chandra, A ;
Chandra, V ;
Ujino, K ;
Daly, RC ;
Kushwaha, SS ;
Edwards, BS ;
Maalouf, YF ;
Seward, J ;
McGregor, CG ;
Chandrasekaran, K .
JOURNAL OF HEART AND LUNG TRANSPLANTATION, 2006, 25 (01) :53-60
[6]   Cerebrovascular Complications After Heart Transplantation [J].
Alejaldre, Aida ;
Delgado-Mederos, Raquel ;
Angel Santos, Miguel ;
Marti-Fabregas, Joan .
CURRENT CARDIOLOGY REVIEWS, 2010, 6 (03) :214-217
[7]   Atrial fibrillation after cardiac surgery - A major morbid event? [J].
Almassi, GH ;
Schowalter, T ;
Nicolosi, AC ;
Aggarwal, A ;
Moritz, TE ;
Henderson, WG ;
Tarazi, R ;
Shroyer, AL ;
Sethi, GK ;
Grover, FL ;
Hammermeister, KE .
ANNALS OF SURGERY, 1997, 226 (04) :501-511
[8]   The ASCOD Phenotyping of Ischemic Stroke (Updated ASCO Phenotyping) [J].
Amarenco, P. ;
Bogousslavsky, J. ;
Caplan, R. ;
Donnan, G. A. ;
Wolf, M. E. ;
Hennerici, M. G. .
CEREBROVASCULAR DISEASES, 2013, 36 (01) :1-5
[9]   Classification of Stroke Subtypes [J].
Amarenco, P. ;
Bogousslavsky, J. ;
Caplan, L. R. ;
Donnan, G. A. ;
Hennerici, M. G. .
CEREBROVASCULAR DISEASES, 2009, 27 (05) :493-501
[10]   Underlying Pathology of Stroke of Unknown Cause (Cryptogenic Stroke) [J].
Amarenco, Pierre .
CEREBROVASCULAR DISEASES, 2009, 27 :97-103