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Treatment of Stroke, Dementia and Atrial Fibrillation

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A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Emergency Medicine".

Deadline for manuscript submissions: closed (30 April 2023) | Viewed by 17871

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Special Issue Editors

Prof. Dr. Vincenzo Russo

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Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli” – Monaldi Hospital, Via Leonardo Bianchi, 80131 Naples, Italy
Interests: atrial fibrillation; cardiovascular pharmacology; arrhythmic disorders; cardiac pacing; non-vitamin K oral anticoagulants; neuromuscular disorders; muscular dystrophies
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Dr. Riccardo Proietti

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Department of Cardiac, Thoracic, and Vascular Sciences – University of Padua, Via Giustiniani 2, 35121 Padua, Italy
Interests: stroke; cerebrovascular events; silent stroke; dementia; mild cognitive impairment; anticoagulation; non vitamin k oral anticoagulants; atrial fibrillation; cardiac pacing

Special Issue Information

Dear Colleagues,

Stroke and dementia are among the top ten causes of death worldwide as estimated by the World Health Organization. Atrial fibrillation (AF) is estimated to cause of about 15 percent of all ischemic strokes and as many as 30 percent of strokes occurring in people in their 80s. The reduction of burden of stroke related to AF is a difficult goal to achieve because of a few clinical characteristics of AF itself: 1) episodes of arrhythmias may be asymptomatic and misdiagnosed, 2) stroke related to AF tends to be recurrent if an appropriate treatment is not promptly initiated, 3) the occurrence during AF of silent ischemic stroke that may not clinically manifest but may impact cognitive function. Indeed, silent ischemic cerebrovascular events have been recently proposed as the main pathophysiologic mechanisms linking AF with cognitive decline and dementia. 4) Finally, in AF the disjunction between the risks of cerebrovascular events (CVE) and the burden of arrhythmias is held as a dominant concept. Accordingly, the risk of CVE is not directly related to the presence of the arrhythmia but persists even during arrhythmia-free intervals. In other words, the two forms of AF classified according to duration (paroxysmal vs persistent) of arrhythmias hold the same risk of stroke.

Given the complexity of this topic and its impact on clinical practice and public health, Medicina is launching a Special Issue entitled “Stroke, Dementia and Atrial Fibrillation” with the aim of gathering together accurate and up-to-date scientific information on all aspects of association between cerebrovascular events, cognitive impairment and AF. We are pleased to invite you and your co-workers to submit your original research articles reporting on the pathophysiological mechanisms underpinning this association. We also encourage the submission of original manuscripts spanning basic to clinical research and focusing on stroke prevention in AF. We would also like to invite you to submit review articles aimed at providing a comprehensive overview of the recent advances in understanding pharmacological interventions to prevent CVE.

Prof. Dr. Vincenzo Russo
Prof. Dr. Riccardo Proietti
Guest Editors

Keywords

Atrial Fibrillation
Stroke
Cognitive Impairment
Dementia
Oral anticoagulation
Non vitamin K oral anticoagulants
Cardiac implanted devices
Cardiomyopahty
Neuromuscular Disorders

Published Papers (6 papers)

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Research

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11 pages, 1563 KiB

Open AccessArticle

Atrial Fibrillation and Dementia: Epidemiological Insights on an Undervalued Association

by Andrea Saglietto, Andrea Ballatore, Henri Xhakupi, Gaetano Maria De Ferrari and Matteo Anselmino

Medicina 2022, 58(3), 361; https://doi.org/10.3390/medicina58030361 - 1 Mar 2022

Cited by 4 | Viewed by 2917

Abstract

Background and objectives: Atrial fibrillation (AF) and dementia are growing causes of morbidity and mortality, representing relevant medical and socioeconomic burdens. In this study, based on data from the Global Burden of Disease Injuries and Risk Factors Study (GBD) 2019, we focused on AF and dementia distribution and investigated the potential correlation between the two epidemiological trends. Materials and Methods: Crude and age-standardized incidence, prevalence, mortality rate, and disability-adjusted life years (DALYs) lost, derived from GBD 2019, were reported for AF and dementia. Global features were also stratified by high and low sociodemographic-index (SDI) countries. Granger test analysis was performed to investigate the correlation between AF and dementia incidence time trends. Results: From 1990 to 2019 crude worldwide incidence and prevalence showed a dramatic increase for both conditions (from 43.24 to 61.01 and from 528.72 to 771.51 per 100,000 individuals for AF, respectively; from 54.60 to 93.52 and from 369.88 to 667.2 per 100,000 individuals for dementia, respectively). In the same timeframe, crude mortality rate doubled for AF and dementia (from 2.19 to 4.08, and from 10.49 to 20.98 per 100,000 individuals, respectively). Age-standardized estimate showed a substantial stability over the years, highlighting the key role of the progressively aging population. Crude estimates of all of the investigated metrics are greater in high SDI countries for both conditions. This association was still valid for age-standardized metrics, albeit by a reduced magnitude, suggesting the presence of higher risk factor burden in these countries. Finally, according to Granger test, we found a significant association between the historical trends of AF and dementia incidence (p = 0.004). Conclusions: AF and dementia burden progressively increased in the last three decades. Given the potential association between these two conditions, further clinical data assessing this relationship is needed. Full article

(This article belongs to the Special Issue Treatment of Stroke, Dementia and Atrial Fibrillation)

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13 pages, 1272 KiB

Open AccessArticle

Effects of Acupuncture on Cardiac Remodeling in Patients with Persistent Atrial Fibrillation: Results of a Randomized, Placebo-Controlled, Patient- and Assessor-Blinded Pilot Trial and Its Implications for Future Research

by Jung Myung Lee, Seung Min Kathy Lee, Jungtae Leem, Jin-Bae Kim, Jimin Park, Jun Hyeong Park, Suji Lee, Hyung Oh Kim, Hyemoon Chung, Jong Shin Woo, Woo-Shik Kim, Sanghoon Lee and Weon Kim

Medicina 2022, 58(1), 41; https://doi.org/10.3390/medicina58010041 - 27 Dec 2021

Cited by 5 | Viewed by 3653

Abstract

Background and Objectives: In this study, we attempted to determine the effects of acupuncture on cardiac remodeling and atrial fibrillation (AF) recurrence rates in patients with AF after electrical cardioversion (EC). Materials and Methods: We randomly assigned 44 patients with persistent AF to an acupuncture group or a sham acupuncture group. An electroacupuncture treatment session was administered once weekly for 12 weeks at four acupuncture points (left PC5, PC6, ST36, and ST37). Results: Among the 44 recruited participants, 16 (treatment group) and 15 (control group) completed the trial. The three-month AF recurrence rate (primary outcome) was not significantly different between the two groups. Following the completion of treatment, patients who had been treated with acupuncture had a significant reduction in left atrial volume index (42.2 ± 13.9 to 36.1 ± 9.7 mL/m²; p = 0.028), whereas no change in atrial size was observed in the sham acupuncture group. No serious adverse events were observed. The AF recurrence rate and cardiac function did not differ significantly between the two groups. At three months, the acupuncture treatment group showed more favorable atrial structural remodeling compared to the sham acupuncture group. Conclusion: In future research on acupuncture in AF management, it is recommended that the inclusion criteria be amended to include only symptomatic AF, that an appropriate control group is designed, and that the acupuncture treatment frequency is increased to several times per week. Full article

(This article belongs to the Special Issue Treatment of Stroke, Dementia and Atrial Fibrillation)

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8 pages, 569 KiB

Open AccessArticle

Immediate Effects of Diaphragmatic Breathing with Cervical Spine Mobilization on the Pulmonary Function and Craniovertebral Angle in Patients with Chronic Stroke

by Ho Jung An, A Yeon Kim and Shin Jun Park

Medicina 2021, 57(8), 826; https://doi.org/10.3390/medicina57080826 - 16 Aug 2021

Cited by 3 | Viewed by 2748

Abstract

Background and Objectives: Patients with stroke have a forward neck posture due to neurological damage and often have impaired pulmonary function. This study investigated the effect of diaphragmatic breathing with cervical mobilization to improve pulmonary function cervical alignments. Materials and Methods: This study used a one-group pre-test–post-test design including 20 patients with stroke. Two types of cervical joint mobilization techniques, consisting of left and right lateral glide mobilization and posterior–anterior mobilization, were utilized. During joint mobilization, the patients performed diaphragmatic breathing. The measurements were performed immediately after the intervention. Pulmonary function was evaluated using a spirometer to measure the forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and peak expiratory flow (PEF). The craniovertebral angle (CVA) was measured using lateral photographs. Results: After diaphragm breathing with cervical joint mobilization, subjects had significantly increased FEV1, FVC, PEF and CVA. Conclusion: Diaphragm breathing with cervical joint mobilization are possible interventions to increase pulmonary function and improve the craniovertebral angle in patients with stroke. However, a complete conclusion can be reached only after a follow-up study has been conducted with a comparison of more subjects and controls. Full article

(This article belongs to the Special Issue Treatment of Stroke, Dementia and Atrial Fibrillation)

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14 pages, 359 KiB

Open AccessArticle

Cognition, Statins, and Cholesterol in Elderly Ischemic Stroke Patients: A Neurologist’s Perspective

by Anamaria Jurcau and Aurel Simion

Medicina 2021, 57(6), 616; https://doi.org/10.3390/medicina57060616 - 13 Jun 2021

Cited by 9 | Viewed by 2768

Abstract

Background and Objectives: The efficacy of hydroxy methyl glutaryl-coenzyme A reductase inhibitors (statins) in reducing the incidence of cardiovascular events pushed the target LDL-cholesterol (LDL-C) levels lower and lower in successive guidelines despite signals regarding potential cognitive side effects. We evaluated the relationship between cognitive impairment and LDL-C levels in elderly ischemic stroke patients. Materials and Methods: 29 ischemic stroke patients aged 65 and above with LDL-C levels ≤70 mg/dL, classified according to the TOAST criteria, underwent detailed neuropsychological testing comprising the MMSE test, Montreal Cognitive Assessment (MoCA) and Addenbrooke’s Cognitive Evaluation (ACE-III) test. Their performances were compared to those of 29 age-matched ischemic stroke patients with LDL-Cl levels >71 mg/dL. Results: The MMSE test failed to detect significant cognitive differences between the two groups. The MoCA and ACE-III tests detected impairments in visuo-spatial/executive function, attention, and recall/memory in patients with low LDL-C. A stepwise linear regression model of the ACE-III total scores revealed that LDL-cholesterol levels could contribute to 13.8% of the detected cognitive dysfunction, second in importance only to age, which contributed to 38.8% of the detected impairment. Conclusions: Physicians should be cautious when prescribing statins to elderly people. Hydrophilic ones may be preferred in cognitively impaired patients. Full article

(This article belongs to the Special Issue Treatment of Stroke, Dementia and Atrial Fibrillation)

Review

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16 pages, 429 KiB

Open AccessReview

Gender Differences in Atrial Fibrillation: From the Thromboembolic Risk to the Anticoagulant Treatment Response

by Anna Rago, Ciro Pirozzi, Antonello D’Andrea, Pierpaolo Di Micco, Andrea Antonio Papa, Antonio D’Onofrio, Paolo Golino, Gerardo Nigro and Vincenzo Russo

Medicina 2023, 59(2), 254; https://doi.org/10.3390/medicina59020254 - 28 Jan 2023

Cited by 3 | Viewed by 2056

Abstract

Atrial fibrillation (AF) is the most common cardiac arrhythmia associated with an increased thromboembolic risk. The impact of the female sex as an independent risk factor for thromboembolic events in AF is still debated. Background and Objectives: The aim of this review is to evaluate the gender-related differences in cardioembolic risk and response to anticoagulants among AF patients. Materials and Methods: The PubMed database is used to review the reports about gender differences and thromboembolic risk in atrial fibrillation. Results: Non-vitamin K oral anticoagulants (NOACs) represent the gold standard for thromboembolic risk prevention in patients with non-valvular atrial fibrillation (NVAF). Despite a similar rate of stroke and systemic embolism (SE) among men and women in NOACs or vitamin K antagonists (VKAs) treatment, the use of NOACs in AF women is associated with a lower risk of intracranial bleeding, major bleeding, and all-cause mortality than in men. Conclusions: The female sex can be defined as a stroke risk modifier rather than a stroke risk factor since it mainly increases the thromboembolic risk in the presence of other risk factors. Further studies about the efficacy and safety profile of NOACs according to sex are needed to support clinicians in performing the most appropriate and tailored anticoagulant therapy, either in male or female AF patients. Full article

(This article belongs to the Special Issue Treatment of Stroke, Dementia and Atrial Fibrillation)

14 pages, 702 KiB

Open AccessReview

Asymptomatic Stroke in the Setting of Percutaneous Non-Coronary Intervention Procedures

by Giovanni Ciccarelli, Francesca Renon, Renato Bianchi, Donato Tartaglione, Maurizio Cappelli Bigazzi, Francesco Loffredo, Paolo Golino and Giovanni Cimmino

Medicina 2022, 58(1), 45; https://doi.org/10.3390/medicina58010045 - 28 Dec 2021

Cited by 1 | Viewed by 2433

Abstract

Advancements in clinical management, pharmacological therapy and interventional procedures have strongly improved the survival rate for cardiovascular diseases (CVDs). Nevertheless, the patients affected by CVDs are more often elderly and present several comorbidities such as atrial fibrillation, valvular heart disease, heart failure, and chronic coronary syndrome. Standard treatments are frequently not available for “frail patients”, in particular due to high surgical risk or drug interaction. In the past decades, novel less-invasive procedures such as transcatheter aortic valve implantation (TAVI), MitraClip or left atrial appendage occlusion have been proposed to treat CVD patients who are not candidates for standard procedures. These procedures have been confirmed to be effective and safe compared to conventional surgery, and symptomatic thromboembolic stroke represents a rare complication. However, while the peri-procedural risk of symptomatic stroke is low, several studies highlight the presence of a high number of silent ischemic brain lesions occurring mainly in areas with a low clinical impact. The silent brain damage could cause neuropsychological deficits or worse, a preexisting dementia, suggesting the need to systematically evaluate the impact of these procedures on neurological function. Full article

(This article belongs to the Special Issue Treatment of Stroke, Dementia and Atrial Fibrillation)

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