Impact of Arrhythmia in Hospital Mortality in Acute Ischemic Stroke Patients: A Retrospective Cohort Study in Northern Mexico.

BACKGROUND: Atrial fibrillation has been associated with higher morbidity and mortality rates in acute ischemic stroke patients (AIS). However, there is scarce information regarding the clinical outcomes and strokes' characteristics among AIS patients with other type of arrhythmias. OBJECTIVE: Our study aims to analyze the hospital mortality rate, stroke characteristics, and clinical and demographical data of patients with any post-stroke arrhythmia. METHODS: Retrospective cohort study of AIS patients with 24h-Holter monitoring during hospital admission recruited between 2015-2020, outcomes were measured using the modified Rankin scale. RESULTS: 597 patients (61.13±13.61 years; 352 men) were included. Arrhythmias were diagnosed in 33 (5.5%), with atrial fibrillation as the most common finding (82%). Age was related to a higher rate of arrhythmia (P = 0.014). A larger prevalence of cardioembolic strokes (69.7% vs 16.6%, P < 0.05) and AIS in the middle cerebral artery's vascular territory (78.8% vs 58.7%, P < 0.05) were found amongst patients with an arrhythmia. No significant association was found between NIHSS at admission with neither incidence of arrhythmia nor mortality. Within the arrhythmia group, three in-hospital deaths were reported: one AF, one ventricular arrhythmia and one second-degree atrioventricular block. In a logistic regression analysis, patients with any kind of arrhythmia had a higher mortality rate (9.1% vs 1.2%, P = 0.011; OR 6.766, 95% CI 1.552 - 29.500). CONCLUSION: Arrhythmia detection after an AIS was associated with increased in-hospital mortality. Risk factors related to arrhythmia detection were a higher mean age, cardioembolic strokes and AIS affecting the middle cerebral artery.

[Obstructive sleep apnea syndrome and its relationship with ischaemic stroke]. / Sindrome de apnea obstructiva del sueño y su relacion con el ictus isquemico.

AIM: To describe the main physiopathological mechanisms of obstructive sleep apnea syndrome (OSAS) associated with the development of stroke. DEVELOPMENT: Sleep breathing disorders have a high prevalence in the healthy population, among them, the OSAS is the most recognized. This syndrome has been associated with vascular diseases such as stroke, hypertension, atrial fibrillation, among others. Stroke has a high global prevalence and is considered a catastrophic disease. The physiopathological mechanisms are of great importance to understand the relationship that exists between OSAS and stroke. Both diseases are associated with molecular, cellular, and autonomic nervous system changes, with systemic cardiovascular repercussions and in particular with the vascular health of the brain. CONCLUSIONS: The relationship between OSAS and ischaemic stroke is evident. The advance in the identification of molecular markers and low-cost studies for the identification of OSAS will allow implementing strategies to reduce their consequences in cardiovascular diseases, mainly in ischaemic stroke.

TITLE: Sindrome de apnea obstructiva del sueño y su relacion con el ictus isquemico.Objetivo. Describir los principales mecanismos fisiopatologicos del sindrome de apnea obstructiva del sueño (SAOS) asociados con el desarrollo de ictus. Desarrollo. Los trastornos de la respiracion del sueño tienen alta prevalencia en la poblacion sana, entre los que el SAOS es el mas reconocido. Este sindrome se ha asociado con enfermedades vasculares como el ictus, la hipertension arterial y la fibrilacion auricular, entre otras. El ictus posee una alta prevalencia mundial y se considera una enfermedad catastrofica. Los mecanismos fisiopatologicos son de gran importancia para comprender la relacion que existe entre SAOS e ictus. Ambos trastornos se asocian con cambios moleculares, celulares y del sistema nervioso autonomo, con repercusiones cardiovasculares sistemicas y, en particular, con la salud vascular del cerebro. Conclusiones. La relacion del SAOS y el ictus isquemico es evidente. El avance en la identificacion de marcadores moleculares y en estudios de bajo coste para la identificacion de SAOS permitira implementar estrategias para reducir sus consecuencias en las enfermedades cardiovasculares, principalmente en el ictus isquemico.