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Прогностические факторы сердечно-сосудистой смерти у больных с ишемическим инсультом в отдаленные сроки наблюдения
Фонякин А.В., Гераскина Л.А., Шандалин В.А. Прогностические факторы сердечно-сосудистой смерти у больных с ишемическим инсультом в отдаленные сроки наблюдения. КардиоСоматика. 2016; 7 (3): 97–103.
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Fonyakin A.V., Geraskina L.A., Shandalin V.A. Prognostic factors of cardiovascular death in patients with ischemic stroke in the long-term follow up. Cardiosomatics. 2016; 7 (3): 97–103.
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Аннотация
В проспективное наблюдательное неинтервенционное исследование включены 148 пациентов, перенесших ишемический инсульт, в возрасте 60 (52; 68) лет, с синусовым ритмом. По окончании острого периода инсульта (21–22-е сутки) проводили холтеровское мониторирование с оценкой аритмий и вариабельности сердечного ритма (ВСР). Длительность проспективного наблюдения составила 35 (28; 40) мес. Регистрировали все случаи сердечно-сосудистой смерти (ССС), включая смерть вследствие повторного инсульта, инфаркта миокарда (ИМ), внезапной сердечной смерти (ВСС), острой сердечной недостаточности (ОСН), тромбоэмболии легочной артерии. За время наблюдения ССС была зарегистрирована у 15 (10%) пациентов: у 7 – вследствие повторного инсульта, у 2 – вследствие острого ИМ, у 3 – вследствие ОСН, у 3 – в результате ВСС. По данным многофакторного регрессионного анализа, при синусовом ритме выявлена достоверная ассоциация с развитием ССС следующих факторов: возраст старше 67 лет, мужской пол, вовлечение в зону ишемического повреждения островка, наджелудочковые экстрасистолы (более 54 экстрасистол в сутки), желудочковые аритмии, брадиаритмии, снижение мощности спектра высоких частот (ВЧ) менее 39 мс2 и низких частот менее 180 мс2 ВСР. По отдельности из числа указанных факторов с повышенным риском развития летальных осложнений статистически значимо ассоциировались только два параметра: вовлечение в зону инфаркта мозга островка (р<0,02) и мощность спектра ВЧ<39 мс2 (р<0,04).
Ключевые слова: ишемический инсульт, сердечно-сосудистая смерть, прогностические факторы, проспективное наблюдение.
Ключевые слова: ишемический инсульт, сердечно-сосудистая смерть, прогностические факторы, проспективное наблюдение.
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In a prospective observational non-interventional study included 148 patients with ischemic stroke at the age of 60 (52; 68) years, with sinus rhythm. At the end of the acute stroke period (21–22 days) was performed Holter monitoring with the assessment of arrhythmias and heart rate variability (HRV). Duration of prospective follow-up was 35 (28; 40) months. We register all cases of cardiovascular death (СD), including death due to recurrent stroke, myocardial infarction (MI), sudden СD (SCD), acute heart failure (AHF), pulmonary embolism. During follow up CD was registered in 15 (10%) patients: in 7 patients – due to recurrent stroke, 2 patients – due to acute MI, in 3 – due to AHF, 3 patients – due to SCD. On multivariate regression analysis in sinus rhythm revealed significant association with the development of CD following factors: age over 67 years, male gender, involvement insula in the area of ischemic damage, supraventricular extrasystoles (more than 54 extrasystoles per day), ventricular arrhythmias, bradyarrhythmias, reduced power range of high-frequency (HF) less than 39 ms2 and low frequency less than 180 ms2 HRV. Separately from the number of these factors with increased risk of fatal complications was significantly associated only two parameters: the involvement insula in the cerebral infarct area (p<0.02) and the power spectrum of the HF<39 ms2 (p<0.04).
Key words: ischemic stroke, cardiovascular death, prognostic factors, prospective study.
Полный текст
Список литературы
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9. Pendlebury ST, Rothwell PM. Risk of recurrent stroke, other vascular events and dementia after transient ischemic attack and stroke. Cerebrovasc Dis 2009; 27 (Suppl. 3): 1–11.
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17. Kiyohara Y, Kubo M, Kato I et al. Ten-year prognosis of stroke and risk factors for death in a Japanese Community. The Hisayama Study. Stroke 2003; 34: 2343–8.
18. Harmsen P, Lappas G, Rosengren A, Wilhelmsen L. Long-Term Risk Factors for Stroke Twenty-Eight Years of Follow-Up of 7457 Middle-Aged Men in Göteborg, Sweden. Stroke 2006; 37: 1663–7.
19. Zhou M, Offer A, Yang G et al. Body Mass Index, Blood Pressure, and Mortality From Stroke. A Nationally Representative Prospective Study of 212 000 Chinese Men. Stroke 2008; 39: 753–9.
20. Kochhauser S, Dechering DG, Dittrich R et al. Supraventricular premature beats and short atrial runs predict atrial fibrillation in continuously monitored patients with cryptogenic stroke. Stroke 2014; 45: 884–6.
21. Голухова Е.З. Неинвазивая аритмология. М.: Изд-во НЦССХ им. А.Н.Бакулева РАМН, 2002. / Golukhova E.Z. Neinvazivaia aritmologiia. M.: Izd-vo NTsSSKh im. A.N.Bakuleva RAMN, 2002. [in Russian]
22. Bigger JT, Fleiss JL, Kleiger RE, Rolnitzky LM. The Multicenter Postinfarction Research Group: The relationship among ventricular arrhythmias, left ventricular dysfunction, and mortality in 2 years after myocardial infarction. Circulation 1984; 69: 250–6.
23. Davis AM, Natelson AM. Brain-heart interaction. The neurocardiology of arrhythmia and sudden cardiac death. Tex Heart Inst J 1993; 20: 158–69.
24. Colivicchi F, Bassi A, Santini M et al. Prognostic implications of right-sided insular damage, cardiac autonomic derangement, and arrhythmias after acute ischemic stroke. Stroke 2005; 36 (8): 1710–5.
25. Tokgozoglu SL, Batur MK, Topcuoglu MA et al. Effects of stroke localization on cardiac autonomic balance and sudden death. Stroke 1999; 30 (7): 1307–11.
26. Meyer S, Strittmatter M, Fischer C et al. Lateralization in autonomic dysfunction in ischemic stroke involving the insular cortex. Neuroreport 2004; 15 (2): 357–61.
27. Cheung RT, Hachinski V. The insula and cerebrogenic sudden death. Arch Neurol 2000; 57 (12): 1685–8.
28. Colivicchi F, Bassi A, Santini M et al. Cardiac autonomic derangement and arrhythmias in right-sided stroke with insular involvement. Stroke 2004; 35 (9): 2094–8.
29. Oppenheimer SM, Kedem G, Martin WM. Left-insular cortex lesions perturb cardiac autonomic tone in humans. Clin Auton Res 1996; 6 (3): 131–40.
30. Robinson TG, James M, Youde J et al. Cardiac baroreceptor sensitivity predicts long-term outcome after acute ischemic stroke. Stroke 2003; 34: 705–12.
31. Широков Е.А. Инсульт, инфаркт, внезапная смерть: теория сосудистых катастроф. М.: КВОРУМ, 2010. / Shirokov E.A. Insul't, infarkt, vnezapnaia smert': teoriia sosudistykh katastrof. M.: KVORUM, 2010. [in Russian]
2. Суслина З.А. Сосудистая патология головного мозга: итоги и перспективы. Анналы клин. и эксперим. неврологии. 2007; 1: 10–6. / Suslina Z.A Sosudistaia patologiia golovnogo mozga: itogi i perspektivy. Annaly klin. i eksperim. nevrologii. 2007; 1: 10–6. [in Russian]
3. Hardie K, Hankey GJ, Jamrozik K et al. Ten-year survival after first-ever stroke and related prognostic factors in the Perth Community stroke study. Stroke 2003; 34: 1842–6.
4. Dhamoon MS, Tai W, Boden-Albala B et al. Risk of myocardial infarction or vascular death after first ischemic stroke. Stroke 2007; 38: 1752–8.
5. Sacco RL, Shi T, Zamanillo MC, Kargman DE. Predictors of mortality and recurrence after hospitalized cerebral infarction in an urban community: the Northern Manhattan Stroke Study. Neurology 1994; 44: 626–34.
6. Kernan WN, Ovbiagele B, Black HR et al. Guidelines for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack. A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45: 2160–236.
7. Верещагин Н.В., Суслина З.А., Гераскина Л.А., Фонякин А.В. Антигипертензивная терапия при сосудистой патологии мозга: успехи, спорные и нерешенные вопросы. Кремлевская медицина. Клин. вестн. 2003; 2: 7–10. / Vereshchagin N.V., Suslina Z.A., Geraskina L.A., Fonyakin A.V. Antigipertenzivnaia terapiia pri sosudistoi patologii mozga: uspekhi, spornye i nereshennye voprosy. Kremlevskaia meditsina. Klin. vestn. 2003; 2: 7–10. [in Russian]
8. Кулеш С.Д., Лихачев С.А., Филина Н.А. и др. Пятилетняя выживаемость после мозгового инсульта. Анналы клин. и эксперим. неврологии. 2012; 1: 14–9. / Kulesh S.D., Likhachev S.A., Filina N.A. et al. Piatiletniaia vyzhivaemost' posle mozgovogo insul'ta. Annaly klin. i eksperim. nevrologii. 2012; 1: 14–9. [in Russian]
9. Pendlebury ST, Rothwell PM. Risk of recurrent stroke, other vascular events and dementia after transient ischemic attack and stroke. Cerebrovasc Dis 2009; 27 (Suppl. 3): 1–11.
10. Рябова В.С. Отдаленные последствия мозгового инсульта (по материалам регистра). Журн. невропатол. и психиатр. им. С.С.Корсакова 1986; LXXXVI (Вып. 4): 532–6. / Ryabova V.S. Otdalennye posledstviia mozgovogo insul'ta (po materialam registra). Zhurn. nevropatol. i psikhiatr. im. S.S.Korsakova 1986; LXXXVI (Vyp. 4): 532–6. [in Russian]
11. Broderick JP, Phillips SJ, O`Fallon WM et al. Relationship of cardiac disease to stroke occurrence, recurrence, and mortality. Stroke 1992; 23: 1250–6.
12. Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. (Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology). Eur Heart J 1996; 17: 354–81.
13. Национальные рекомендации ВНОК И ОССН по диагностике и лечению ХСН (третий пересмотр). Сердечная недостаточность. 2010; 1 (57): 3–62. / Natsional'nye rekomendatsii VNOK I OSSN po diagnostike i lecheniiu KhSN (tretii peresmotr). Serdechnaia nedostatochnost'. 2010; 1 (57): 3–62. [in Russian]
14. Sacco RL, Wolf PA, Kannel WB, McNamara PM. Survival and recurrence following stroke: the Framingham study. Stroke 1982; 13: 290–5.
15. Dennis MS, Burn JPS, Sandercock PAG et al. Long-term survival after first-ever stroke: The Oxfordshire Community Stroke Project. Stroke 1993; 24: 796–800.
16. Hankey GJ, Jamrozik K, Broadhurst RJ et al. Five-year survival after first-ever stroke and related prognostic factors in the Perth Community stroke study. Stroke 2000; 31: 2080–6.
17. Kiyohara Y, Kubo M, Kato I et al. Ten-year prognosis of stroke and risk factors for death in a Japanese Community. The Hisayama Study. Stroke 2003; 34: 2343–8.
18. Harmsen P, Lappas G, Rosengren A, Wilhelmsen L. Long-Term Risk Factors for Stroke Twenty-Eight Years of Follow-Up of 7457 Middle-Aged Men in Göteborg, Sweden. Stroke 2006; 37: 1663–7.
19. Zhou M, Offer A, Yang G et al. Body Mass Index, Blood Pressure, and Mortality From Stroke. A Nationally Representative Prospective Study of 212 000 Chinese Men. Stroke 2008; 39: 753–9.
20. Kochhauser S, Dechering DG, Dittrich R et al. Supraventricular premature beats and short atrial runs predict atrial fibrillation in continuously monitored patients with cryptogenic stroke. Stroke 2014; 45: 884–6.
21. Голухова Е.З. Неинвазивая аритмология. М.: Изд-во НЦССХ им. А.Н.Бакулева РАМН, 2002. / Golukhova E.Z. Neinvazivaia aritmologiia. M.: Izd-vo NTsSSKh im. A.N.Bakuleva RAMN, 2002. [in Russian]
22. Bigger JT, Fleiss JL, Kleiger RE, Rolnitzky LM. The Multicenter Postinfarction Research Group: The relationship among ventricular arrhythmias, left ventricular dysfunction, and mortality in 2 years after myocardial infarction. Circulation 1984; 69: 250–6.
23. Davis AM, Natelson AM. Brain-heart interaction. The neurocardiology of arrhythmia and sudden cardiac death. Tex Heart Inst J 1993; 20: 158–69.
24. Colivicchi F, Bassi A, Santini M et al. Prognostic implications of right-sided insular damage, cardiac autonomic derangement, and arrhythmias after acute ischemic stroke. Stroke 2005; 36 (8): 1710–5.
25. Tokgozoglu SL, Batur MK, Topcuoglu MA et al. Effects of stroke localization on cardiac autonomic balance and sudden death. Stroke 1999; 30 (7): 1307–11.
26. Meyer S, Strittmatter M, Fischer C et al. Lateralization in autonomic dysfunction in ischemic stroke involving the insular cortex. Neuroreport 2004; 15 (2): 357–61.
27. Cheung RT, Hachinski V. The insula and cerebrogenic sudden death. Arch Neurol 2000; 57 (12): 1685–8.
28. Colivicchi F, Bassi A, Santini M et al. Cardiac autonomic derangement and arrhythmias in right-sided stroke with insular involvement. Stroke 2004; 35 (9): 2094–8.
29. Oppenheimer SM, Kedem G, Martin WM. Left-insular cortex lesions perturb cardiac autonomic tone in humans. Clin Auton Res 1996; 6 (3): 131–40.
30. Robinson TG, James M, Youde J et al. Cardiac baroreceptor sensitivity predicts long-term outcome after acute ischemic stroke. Stroke 2003; 34: 705–12.
31. Широков Е.А. Инсульт, инфаркт, внезапная смерть: теория сосудистых катастроф. М.: КВОРУМ, 2010. / Shirokov E.A. Insul't, infarkt, vnezapnaia smert': teoriia sosudistykh katastrof. M.: KVORUM, 2010. [in Russian]
________________________________________________
1. Murray CJ, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet 1997; 349: 1436–42.
2. Suslina Z.A Sosudistaia patologiia golovnogo mozga: itogi i perspektivy. Annaly klin. i eksperim. nevrologii. 2007; 1: 10–6. [in Russian]
3. Hardie K, Hankey GJ, Jamrozik K et al. Ten-year survival after first-ever stroke and related prognostic factors in the Perth Community stroke study. Stroke 2003; 34: 1842–6.
4. Dhamoon MS, Tai W, Boden-Albala B et al. Risk of myocardial infarction or vascular death after first ischemic stroke. Stroke 2007; 38: 1752–8.
5. Sacco RL, Shi T, Zamanillo MC, Kargman DE. Predictors of mortality and recurrence after hospitalized cerebral infarction in an urban community: the Northern Manhattan Stroke Study. Neurology 1994; 44: 626–34.
6. Kernan WN, Ovbiagele B, Black HR et al. Guidelines for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack. A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45: 2160–236.
7. Vereshchagin N.V., Suslina Z.A., Geraskina L.A., Fonyakin A.V. Antigipertenzivnaia terapiia pri sosudistoi patologii mozga: uspekhi, spornye i nereshennye voprosy. Kremlevskaia meditsina. Klin. vestn. 2003; 2: 7–10. [in Russian]
8. Kulesh S.D., Likhachev S.A., Filina N.A. et al. Piatiletniaia vyzhivaemost' posle mozgovogo insul'ta. Annaly klin. i eksperim. nevrologii. 2012; 1: 14–9. [in Russian]
9. Pendlebury ST, Rothwell PM. Risk of recurrent stroke, other vascular events and dementia after transient ischemic attack and stroke. Cerebrovasc Dis 2009; 27 (Suppl. 3): 1–11.
10. Ryabova V.S. Otdalennye posledstviia mozgovogo insul'ta (po materialam registra). Zhurn. nevropatol. i psikhiatr. im. S.S.Korsakova 1986; LXXXVI (Vyp. 4): 532–6. [in Russian]
11. Broderick JP, Phillips SJ, O`Fallon WM et al. Relationship of cardiac disease to stroke occurrence, recurrence, and mortality. Stroke 1992; 23: 1250–6.
12. Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. (Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology). Eur Heart J 1996; 17: 354–81.
13. Natsional'nye rekomendatsii VNOK I OSSN po diagnostike i lecheniiu KhSN (tretii peresmotr). Serdechnaia nedostatochnost'. 2010; 1 (57): 3–62. [in Russian]
14. Sacco RL, Wolf PA, Kannel WB, McNamara PM. Survival and recurrence following stroke: the Framingham study. Stroke 1982; 13: 290–5.
15. Dennis MS, Burn JPS, Sandercock PAG et al. Long-term survival after first-ever stroke: The Oxfordshire Community Stroke Project. Stroke 1993; 24: 796–800.
16. Hankey GJ, Jamrozik K, Broadhurst RJ et al. Five-year survival after first-ever stroke and related prognostic factors in the Perth Community stroke study. Stroke 2000; 31: 2080–6.
17. Kiyohara Y, Kubo M, Kato I et al. Ten-year prognosis of stroke and risk factors for death in a Japanese Community. The Hisayama Study. Stroke 2003; 34: 2343–8.
18. Harmsen P, Lappas G, Rosengren A, Wilhelmsen L. Long-Term Risk Factors for Stroke Twenty-Eight Years of Follow-Up of 7457 Middle-Aged Men in Göteborg, Sweden. Stroke 2006; 37: 1663–7.
19. Zhou M, Offer A, Yang G et al. Body Mass Index, Blood Pressure, and Mortality From Stroke. A Nationally Representative Prospective Study of 212 000 Chinese Men. Stroke 2008; 39: 753–9.
20. Kochhauser S, Dechering DG, Dittrich R et al. Supraventricular premature beats and short atrial runs predict atrial fibrillation in continuously monitored patients with cryptogenic stroke. Stroke 2014; 45: 884–6.
21. Golukhova E.Z. Neinvazivaia aritmologiia. M.: Izd-vo NTsSSKh im. A.N.Bakuleva RAMN, 2002. [in Russian]
22. Bigger JT, Fleiss JL, Kleiger RE, Rolnitzky LM. The Multicenter Postinfarction Research Group: The relationship among ventricular arrhythmias, left ventricular dysfunction, and mortality in 2 years after myocardial infarction. Circulation 1984; 69: 250–6.
23. Davis AM, Natelson AM. Brain-heart interaction. The neurocardiology of arrhythmia and sudden cardiac death. Tex Heart Inst J 1993; 20: 158–69.
24. Colivicchi F, Bassi A, Santini M et al. Prognostic implications of right-sided insular damage, cardiac autonomic derangement, and arrhythmias after acute ischemic stroke. Stroke 2005; 36 (8): 1710–5.
25. Tokgozoglu SL, Batur MK, Topcuoglu MA et al. Effects of stroke localization on cardiac autonomic balance and sudden death. Stroke 1999; 30 (7): 1307–11.
26. Meyer S, Strittmatter M, Fischer C et al. Lateralization in autonomic dysfunction in ischemic stroke involving the insular cortex. Neuroreport 2004; 15 (2): 357–61.
27. Cheung RT, Hachinski V. The insula and cerebrogenic sudden death. Arch Neurol 2000; 57 (12): 1685–8.
28. Colivicchi F, Bassi A, Santini M et al. Cardiac autonomic derangement and arrhythmias in right-sided stroke with insular involvement. Stroke 2004; 35 (9): 2094–8.
29. Oppenheimer SM, Kedem G, Martin WM. Left-insular cortex lesions perturb cardiac autonomic tone in humans. Clin Auton Res 1996; 6 (3): 131–40.
30. Robinson TG, James M, Youde J et al. Cardiac baroreceptor sensitivity predicts long-term outcome after acute ischemic stroke. Stroke 2003; 34: 705–12.
31. Shirokov E.A. Insul't, infarkt, vnezapnaia smert': teoriia sosudistykh katastrof. M.: KVORUM, 2010. [in Russian]
Авторы
А.В.Фонякин*, Л.А.Гераскина, В.А.Шандалин
ФГБНУ Научный центр неврологии. 125367, Россия, Москва, Волоколамское ш., д. 80
*Fonyakin@mail.ru
ФГБНУ Научный центр неврологии. 125367, Россия, Москва, Волоколамское ш., д. 80
*Fonyakin@mail.ru
________________________________________________
A.V.Fonyakin*, L.A.Geraskina, V.A.Shandalin
Research Center of Neurology. 125367, Russian Federation, Moscow, Volokolamskoe sh., d. 80
*Fonyakin@mail.ru
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