Published Online
on July 14, 2005

A more recent version of this article appeared on August 1, 2005

This Article Full Text (PDF) All Versions of this Article: 36/8/1710    most recent 01.STR.0000173400.19346.bdv1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Colivicchi, F. Articles by Caltagirone, C. Search for Related Content PubMed PubMed Citation Articles by Colivicchi, F. Articles by Caltagirone, C. Related Collections Acute Stroke Syndromes Autonomic, reflex, and neurohumoral control of circulation

Submitted on March 11, 2005
Revised on May 6, 2005
Accepted on May 25, 2005

Prognostic Implications of Right-Sided Insular Damage, Cardiac Autonomic Derangement, and Arrhythmias After Acute Ischemic Stroke

Furio Colivicchi MD, FESC; Andrea Bassi MD; Massimo Santini MD, FESC, FACC; and Carlo Caltagirone MD^*

From the Cardiovascular Department (F.C., M.S.), San Filippo Neri Hospital; Istituto Di Ricovero E Cuea A Carattere Scientifico (IRCCS) Santa Lucia Foundation (A.B., C.C.); and the Department of Neurology (C.C.), University of Rome "Tor Vergata," Rome, Italy.

^* To whom correspondence should be addressed. E-mail: c.caltagirone{at}hsantalucia.it.

Background and Purpose--Acute stroke is associated with impairment of cardiac autonomic balance and increased incidence of arrhythmias. These abnormalities appear more relevant in the case of involvement of the right insula in the infarct area. The aim of this study was to assess the impact of right-sided insular damage, cardiac autonomic derangement, and arrhythmias on clinical outcome after acute ischemic stroke.

Methods--Holter monitoring for 24 hours was performed in 208 consecutive patients with first-ever acute ischemic stroke. Time- and frequency-domain measures of heart rate variability and arrhythmias were considered in all cases. All patients were followed for a 12-month period after the initial event.

Results--During the 12-month follow-up period, 48 patients died (1-year probability of death, 0.23; 95% CI, 0.17 to 0.30). Multivariate analysis demonstrated that age (hazard ratio [HR], 1.06; 95% CI, 1.01 to 1.10; P=0.0087), stroke severity on admission (HR, 1.25; 95% CI, 1.13 to 1.39; P=0.0001), presence of right-sided insular damage (HR, 2.01; 95% CI, 1.13 to 1.39; P=0.0187), as well as lower values of the SD of all normal-to-normal RR intervals (HR, 3.32; 95% CI, 1.67 to 6.24; P=0.002), and presence of nonsustained ventricular tachycardia during Holter monitoring (HR, 2.99; 95% CI, 1.58 to 5.67; P=0.0007) were independent predictors of 1-year mortality.

Conclusions--The integration of traditional risk stratifiers with autonomic and arrhythmic markers, and the careful search for right-sided insular involvement, may represent an effective approach for identification of stroke patients at risk for early mortality.

Key words: heart rate • outcome • stroke

This article has been cited by other articles:

				H. Sarikaya, R. W. Baumgartner, and M. Arnold Letter by Sarikaya et al Regarding Article, "A Sensitive Dissection: Profound Bradycardia Complicating Carotid Dissection" Circulation, June 2, 2009; 119(21): e545 - e545. [Full Text] [PDF]

				A. Diedrich, A. Porta, F. Barbic, R. J. Brychta, P. Bonizzi, L. Diedrich, S. Cerutti, D. Robertson, and R. Furlan Lateralization of expression of neural sympathetic activity to the vessels and effects of carotid baroreceptor stimulation Am J Physiol Heart Circ Physiol, June 1, 2009; 296(6): H1758 - H1765. [Abstract] [Full Text] [PDF]

				H. Ay, E. M. Arsava, W. J. Koroshetz, and A. G. Sorensen Middle Cerebral Artery Infarcts Encompassing the Insula Are More Prone to Growth Stroke, February 1, 2008; 39(2): 373 - 378. [Abstract] [Full Text] [PDF]

				A. K. Mistri, T. G. Robinson, and J. F. Potter Pressor Therapy in Acute Ischemic Stroke: Systematic Review Stroke, June 1, 2006; 37(6): 1565 - 1571. [Abstract] [Full Text] [PDF]