Science and Innovations in MedicineScience and Innovations in Medicine2500-13882618-754XFSBEI of Higher Education SamSMU of Ministry of Health of the Russian Federation10571510.35693/2500-1388-2022-7-2-89-94Research ArticleExtrasystolic arrhythmia: is it an additional risk factor of cryptogenic stroke?GermanovaOlga A.<p>PhD, Organ function test doctor, Functional Diagnostics Department, Clinics of SamSMU</p>olga_germ@mail.ruhttps://orcid.org/0000-0003-4833-4563GermanovAndrei V.<p>PhD, Associate professor, Chair of Introduction to internal medicine</p>a.v.germanov@samsmu.ruhttps://orcid.org/0000-0002-0367-7776ShchukinYurii V.<p>PhD, Professor, Head of the Chair of Introduction to internal medicine</p>samgmu_pt@mail.ruhttps://orcid.org/0000-0003-0387-8356GalatiGiuseppe<p>Cardiologist</p>giuseppe.galati5@gmail.comhttps://orcid.org/0000-0002-8001-1249Samara State Medical UniversityHospital San Raffaele290420227289943103202209042022Copyright © 2022, Germanova O.A., Germanov A.V., Shchukin Y.V., Galati G.2022<p><strong>Aim </strong> to study the development of ischemic stroke (IS) or transient ischemic attack (TIA) in patients with extrasystoles (ES), depending on the moment of ES ventricular systole occurrence in cardiocycle.</p>
<p><strong>Material and methods.</strong> The study group included 440 patients with ES 700 per day; the control group consisted of 88 patients with ES 700 per day. The following instrumental and laboratory methods were used: echocardiography, Doppler ultrasound of brachiocephalic arteries, 24-hours ECG monitoring, digital sphygmography of common carotid arteries; CT or MRI of the brain; lipid spectrum. The study group was divided into two subgroups according to the moment of ES ventricular systole occurrence in cardiocycle, regardless of ectopia: subgroup 1 120 patients with ES before the transmitral blood flow peak; subgroup 2 320 patients with ES after the transmitral blood flow peak. We analyzed the development of stroke or TIA during 1 year.</p>
<p><strong>Results.</strong> For most parameters, subgroups 1, 2 and the control group were identical. The important differences were registered in the hemodynamic and kinetic parameters of common carotid arteries. The earlier the ES ventricular systole occurred in cardiocycle, the higher increase of the parameters was observed. During one year of follow-up, stroke and TIA occurred more frequently in subgroup 1.</p>
<p><strong>Conclusion.</strong> ES is an additional risk factor for stroke. The most dangerous is ES with ventricular systole occurrence before transmitral blood flow peak. The wave of the 1st post-extrasystolic contraction causes additional trauma of arterial wall and can become a key factor for instability of atherosclerotic plaques with their defragmentation, embolism and stroke.</p>cryptogenic strokeextrasystolestroke riskкриптогенный инсультэкстрасистолияриск развития инсульта[Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association. Stroke. 2021;52(7):364-467. doi: 10.1161/STR.0000000000000375][Virani SS, Alonso A, Benjamin EJ, et al; on behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics–2020 update: a report from the American Heart Association. Circulation. 2020;141:139-596. doi: 10.1161/CIR.0000000000000757][James SL, Abate D, Abate KH, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1789-1858. doi: 10.1016/S0140-6736(18)32279-7][Wilkins E, Wilson L, Wickramasinghe K, et al. European Cardiovascular Disease Statistics 2017. Brussels: European Heart Network, 2017.][Bennett DA, Krishnamurthi RV, Barker-Collo S, et al.; Global Burden of Diseases, Injuries, and Risk Factors 2010 Study Stroke Expert Group. The global burden of ischemic stroke: findings of the GBD 2010 study. Glob Heart. 2014; 9:107-112. doi: 10.1016/j.gheart.2014.01.001][Kunst AE, Amiri M, Janssen F. The decline in stroke mortality: exploration of future trends in 7 Western European countries. Stroke. 2011;42:2126-2130. doi: 10.1161/STROKEAHA.110.599712][Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012; 380:2197-2223. doi: 10.1016/S0140-6736(12)61689-4][Zahra A, Lee EW, Sun LY, Park JH. Cardiovascular disease and diabetes mortality, and their relation to socio-economical, environmental, and health behavioural factors in worldwide view. Public Health. 2015;129:385-395. doi: 10.1016/j.puhe.2015.01.013][Béjot Y, Bailly H, Durier J, Giroud M. Epidemiology of stroke in Europe and trends for the 21st century. Presse Med. 2016; 45(12 pt 2):e391-e398. doi: 10.1016/j.lpm.2016.10.003][Strong K, Mathers C, Bonita R. Preventing stroke: saving lives around the world. Lancet Neurol. 2007;6:182-187. doi: 10.1016/S1474-4422(07)70031-5][Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006; 3:e442. doi: 10.1371/journal.pmed.0030442][Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet. 1997;349:1498-1504. doi: 10.1016/S0140-6736(96)07492-2][United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects: The 2017 Revision, Methodology of the United Nations Population Estimates and Projections, Working Paper No. ESA/P/WP.250. New York: United Nations; 2017.][Asplund K. What MONICA told us about stroke. Lancet Neurol. 2005;4:64-68. doi: 10.1016/S1474-4422(04)00967-6][Truelsen T, Piechowski-Jóźwiak B, Bonita R, et al. Stroke incidence and prevalence in Europe: a review of available data. Eur J Neurol. 2006;13:581-598. doi: 10.1111/j.1468-1331.2006.01138.x][Gardener H, Sacco RL, Rundek T, et al. Race and ethnic disparities in stroke incidence in the Northern Manhattan Study. Stroke. 2020;51:1064-1069. doi: 10.1161/STROKEAHA.119.028806][Hart RG, Diener HC, Coutts SB, et al; Cryptogenic Stroke/ESUS International Working Group. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol. 2014;13:429-438. doi: 10.1016/S1474-4422(13)70310-7][Benjamin EJ, Muntner P, Alonso A, et al. American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics – 2019 update: a report from the American Heart Association. Circulation. 2019;139:56-528.][Messas E, Goudot G, Halliday A, et al. On behalf the ESC WG of Aorta & Peripheral Vascular Diseases, Management of carotid stenosis for primary and secondary prevention of stroke: state-of-the-art 2020: a critical review. European Heart Journal. 2020;22:35-42. doi: 10.1093/eurheartj/suaa162][Schermerhorn ML, Liang P, Dakour-Aridi H, et al. In-hospital outcomes of transcarotid artery revascularization and carotid endarterectomy in the Society for Vascular Surgery Vascular Quality Initiative. J Vasc Surg. 2020;71(1):87-95.][Germanova O, Shchukin Yu, Germanov V, et al. Extrasystolic arrhythmia: is it an additional risk factor of atherosclerosis? Minerva Cardioangiol. 2021;11:32-39. doi: 10.23736/S0026-4725.20.05490-0][Germanova OA, Germanov VA, Shchukin YuV, et al. Extrasystoles: adverse effects of the first postextrasystolic contraction. Bulletin of the Medical Institute "REAVIZ" (Rehabilitation, Doctor and Health). 2020;(6):89-97. (In Russ.). [Германова О.А., Германов В.А., Щукин Ю.В., и др. Экстрасистолия: неблагоприятные эффекты первого постэкстрасистолического сокращения. Вестник медицинского института «Реавиз». Реабилитация, Врач и Здоровье. 2020;(6):89-97.]. https://doi.org/10.20340/vmi-rvz.2020.6.11]