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Прогностические факторы сердечно-сосудистой смерти у больных с ишемическим инсультом в отдаленные сроки наблюдения
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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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.
Key words: ischemic stroke, cardiovascular death, prognostic factors, prospective study.
Ключевые слова: ишемический инсульт, сердечно-сосудистая смерть, прогностические факторы, проспективное наблюдение.
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Key words: ischemic stroke, cardiovascular death, prognostic factors, prospective study.
Полный текст
Список литературы
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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. 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]
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]
________________________________________________
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.
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Авторы
А.В.Фонякин*, Л.А.Гераскина, В.А.Шандалин
ФГБНУ Научный центр неврологии. 125367, Россия, Москва, Волоколамское ш., д. 80
*Fonyakin@mail.ru
Research Center of Neurology. 125367, Russian Federation, Moscow, Volokolamskoe sh., d. 80
*Fonyakin@mail.ru
ФГБНУ Научный центр неврологии. 125367, Россия, Москва, Волоколамское ш., д. 80
*Fonyakin@mail.ru
________________________________________________
Research Center of Neurology. 125367, Russian Federation, Moscow, Volokolamskoe sh., d. 80
*Fonyakin@mail.ru
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