Stroke-associated damage to brain structure may lead to heart attack

of the paper. "Animal studies have suggested this could be caused by damage in the insula, which is known to be a controller of the autonomic nervous system. But evidence regarding what part of the insula is involved with that effect has been contradictory."

The current study led by first author Hakan Ay, MD, analyzed data from 50 MGH patients with ischemic (caused by arterial blockage) strokes who also had myocardial damage as measured by elevated levels of troponins, enzymes released by damaged heart muscle that are considered definitive indicators of such damage. Information from 50 other stroke patients, randomly selected from those who did not have increased troponins, was used for control comparison.

To determine exactly what area of the brain might cause myocardial damage when injured by a stroke, the researchers used a sophisticated way of analyzing brain images from the patients' original evaluation. MR imaging data from all the patients was combined to create brain maps highlighting areas where brain tissue was more likely to be injured in patients with elevated troponins than in those with no evidence of cardiac damage. The results showed that patients whose stroke affected the right insular area had a 15 times greater risk for subsequent heart muscle injury than did patients with damage in other areas. The right insula is known to be involved with the sympathetic nervous system, the portion of the autonomic system that sets off stress-related responses.

"This image analysis technique is a more sophisticated way of understanding how the brain is organized and what are the effects of damage to specific structures," says Sorensen, an associate professor of Radiology at Harvard Medical School. "Future studies may help us determine which stroke patients are more likely to have complications like pneumonia or disruptions in heart rhythm."

Koroshetz adds, "In treating stroke patients, we often raise their blood pressure

Contact: Sue McGreevey
Massachusetts General Hospital

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