Login Register Cart 0
Generic placeholder image

Current Neurovascular Research

Editor-in-Chief

ISSN (Print): 1567-2026
ISSN (Online): 1875-5739

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

Synergistic Effect of Hypokalemia and Atrial Fibrillation on Prognosis in Patients with Stroke after Intravenous Thrombolysis

Author(s): Li-Min Wei , Wan-Qian Ge, Jia-Sheng Huang and Cheng-Ye Zhou*

Volume 18, Issue 3, 2021

Published on: 06 September, 2021

Page: [287 - 294] Pages: 8

DOI: 10.2174/1567202618666210906142522

Price: $65

conference banner
Abstract

Background: The association between atrial fibrillation (AF) and the prognosis of intravenous thrombolysis (IVT) in patients with Acute Ischemic Stroke (AIS) is debated. Hypokalemia is highly prevalent in patients with AF. We aimed to investigate the effect of hypokalemia and AF on the prognosis of AIS patients following IVT.

Methods: AIS patients undergoing IVT were enrolled and divided into four groups: normokalemia and non-AF, normokalemia and AF, hypokalemia and non-AF, hypokalemia and AF. Logistic regression was applied to analyze the impact of hypokalemia, AF, and their combination on the prognosis of patients.

Results: The analysis included 567 patients, 184 with 3-month poor prognosis (modified Rankin Scale score of 3-6). Following adjustment of risk factors, hypokalemia and AF increased the risks for 3-month poor prognosis (adjusted Odds Ratios (aOR) = 4.97; 95% confidence interval (CI), 1.99-12.44, P =.001), early neurological deterioration (END) (aOR=7.98; 95% CI, 3.55-17.95, P <.001), 1-year poor prognosis (aOR=5.05; 95% CI, 1.99-12.81, P =.001), 1-year all-cause death (aOR =6.95; 95% CI, 2.35-20.56, P <.001). Patients with normokalemia and AF merely increased the risk of 1-year all-cause death (aOR=2.69; 95% CI, 1.10-6.61, P=.013). Patients with hypokalemia and non-AF were not associated with any poor prognosis. There were combined and interactive effects of hypokalemia with AF on the 3-month poor prognosis (P for interaction =.039) and END (P for interaction=.005).

Conclusion: Hypokalemia and AF synergistically increased the risk of near-term poor prognosis, END, long-term poor prognosis, and all-cause death of AIS patients following IVT.

Keywords: Hypokalemia, atrial fibrillation, arrhythmia, thrombolysis, stroke, prognosis.

« Previous Next »
[1]
Benjamin EJ, Muntner P, Alonso A, et al. Heart Disease and Stroke Statistics-2019 update: A report from the american heart association. Circulation 2019; 139(10): e56-e528.
[http://dx.doi.org/10.1161/CIR.0000000000000659] [PMID: 30700139]
[2]
Schnabel RB, Haeusler KG, Healey JS, et al. Searching for atrial fibrillation poststroke: A white paper of the AF-SCREEN international collaboration. Circulation 2019; 140(22): 1834-50.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.119.040267] [PMID: 31765261]
[3]
Alkhouli M, Alqahtani F, Aljohani S, Alvi M, Holmes DR. Burden of atrial fibrillation-associated ischemic stroke in the United States. JACC Clin Electrophysiol 2018; 4(5): 618-25.
[http://dx.doi.org/10.1016/j.jacep.2018.02.021] [PMID: 29798789]
[4]
Hayden DT, Hannon N, Callaly E, et al. Rates and determinants of 5-year outcomes after atrial fibrillation-related stroke: A population study. Stroke 2015; 46(12): 3488-93.
[http://dx.doi.org/10.1161/STROKEAHA.115.011139] [PMID: 26470776]
[5]
Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2018; 49(3): 870-947.
[6]
Hu Y, Ji C. Efficacy and safety of thrombolysis for acute ischemic stroke with atrial fibrillation: a meta-analysis. BMC Neurol 2021; 21(1): 66.
[http://dx.doi.org/10.1186/s12883-021-02095-x] [PMID: 33573619]
[7]
Saposnik G, Gladstone D, Raptis R, Zhou L, Hart RG. Atrial fibrillation in ischemic stroke: predicting response to thrombolysis and clinical outcomes. Stroke 2013; 44(1): 99-104.
[http://dx.doi.org/10.1161/STROKEAHA.112.676551] [PMID: 23168456]
[8]
Liu MM, Yang R. Effect of hypokalemia and hyponatremia on short-term prognosis in patients with acute ischemic stroke. J Apoplex Nervous Dis 2020; 37(01): 45-8.
[9]
Wu FF, Hung YC, Tsai YH, et al. The influence of dehydration on the prognosis of acute ischemic stroke for patients treated with tissue plasminogen activator. BMC Cardiovasc Disord 2017; 17(1): 154.
[http://dx.doi.org/10.1186/s12872-017-0590-6] [PMID: 28610565]
[10]
Su J, Fu X, Tian Y, et al. Additional predictive value of serum potassium to Thrombolysis In Myocardial Infarction risk score for early malignant ventricular arrhythmias in patients with acute myocardial infarction. Am J Emerg Med 2012; 30(7): 1089-94.
[http://dx.doi.org/10.1016/j.ajem.2011.07.009] [PMID: 22035586]
[11]
Gariballa SE RT, Fotherby MD. Hypokalemia and potassium excretion in stroke patients. J Am Geriatr Soc 1997; 45(12): 1454-8.
[12]
Gao F, Wang CT, Chen C, et al. Effect of hypokalemia on functional outcome at 3 months post-stroke among first-ever acute ischemic stroke patients. Med Sci Monit 2017; 23: 2825-32.
[http://dx.doi.org/10.12659/MSM.902464] [PMID: 28600907]
[13]
Mattsson N, Nielsen OW, Johnson L, et al. Prognostic impact of mild hypokalemia in terms of death and stroke in the general population-a prospective population study. Am J Med 2018; 131(3): 318 e9-18 e19.
[http://dx.doi.org/10.1016/j.amjmed.2017.09.026]
[14]
Mattsson N, Kumarathurai P, Larsen BS, Nielsen OW, Sajadieh A. Mild hypokalemia and supraventricular ectopy increases the risk of stroke in community-dwelling subjects. Stroke 2017; 48(3): 537-43.
[http://dx.doi.org/10.1161/STROKEAHA.116.015439] [PMID: 28174323]
[15]
Tazmini K, Frisk M, Lewalle A, et al. Hypokalemia promotes arrhythmia by distinct mechanisms in atrial and ventricular myocytes. Circ Res 2020; 126(7): 889-906.
[http://dx.doi.org/10.1161/CIRCRESAHA.119.315641] [PMID: 32070187]
[16]
Cheng CJ, Kuo E, Huang CL. Extracellular potassium homeostasis: Insights from hypokalemic periodic paralysis. Semin Nephrol 2013; 33(3): 237-47.
[http://dx.doi.org/10.1016/j.semnephrol.2013.04.004] [PMID: 23953801]
[17]
Marklund M, Singh G, Greer R, et al. Estimated population wide benefits and risks in China of lowering sodium through potassium enriched salt substitution: modelling study. BMJ 2020; 369: m824.
[http://dx.doi.org/10.1136/bmj.m824] [PMID: 32321724]
[18]
Pan WH, Lai YH, Yeh WT, et al. Intake of potassium- and magnesium-enriched salt improves functional outcome after stroke: A randomized, multicenter, double-blind controlled trial. Am J Clin Nutr 2017; 106(5): 1267-73.
[http://dx.doi.org/10.3945/ajcn.116.148536] [PMID: 28877896]
[19]
Sun Y, Byon CH, Yang Y, et al. Dietary potassium regulates vascular calcification and arterial stiffness. JCI Insight 2017; 2(19): 94920.
[http://dx.doi.org/10.1172/jci.insight.94920] [PMID: 28978809]
[20]
Tazmini K, Fraz MSA, Nymo SH, Stokke MK, Louch WE, Øie E. Potassium infusion increases the likelihood of conversion of recent-onset atrial fibrillation-A single-blinded, randomized clinical trial. Am Heart J 2020; 221: 114-24.
[http://dx.doi.org/10.1016/j.ahj.2019.12.014] [PMID: 31986288]
[21]
Kyo M, Hosokawa K, Ohshimo S, et al. High serum potassium level is associated with successful electrical cardioversion for new-onset atrial fibrillation in the intensive care unit: A retrospective observational study. Anaesth Intensive Care 2019; 47(1): 52-9.
[http://dx.doi.org/10.1177/0310057X18811815] [PMID: 30864476]
[22]
Demaerschalk BM, Kleindorfer DO, Adeoye OM, et al. Scientific rationale for the inclusion and exclusion criteria for intravenous alteplase in acute ischemic stroke: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2016; 47(2): 581-641.
[http://dx.doi.org/10.1161/STR.0000000000000086] [PMID: 26696642]
[23]
January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2014; 64(21): e1-e76.
[http://dx.doi.org/10.1016/j.jacc.2014.03.022] [PMID: 24685669]
[24]
Adams HP Jr, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993; 24(1): 35-41.
[http://dx.doi.org/10.1161/01.STR.24.1.35] [PMID: 7678184]
[25]
Frank B, Fulton R, Weimar C, Shuaib A, Lees KR. Collaborators V. Impact of atrial fibrillation on outcome in thrombolyzed patients with stroke: Evidence from the Virtual International Stroke Trials Archive (VISTA). Stroke 2012; 43(7): 1872-7.
[http://dx.doi.org/10.1161/STROKEAHA.112.650838] [PMID: 22627981]
[26]
Yang Y, Sun W, Li D, et al. Multimode computed-tomography-guided thrombolysis under a prolonged time window in acute ischemic stroke patients with atrial fibrillation. Int Heart J 2019; 60(4): 822-9.
[http://dx.doi.org/10.1536/ihj.18-636] [PMID: 31257338]
[27]
Kallmünzer B, Breuer L, Kahl N, et al. Serious cardiac arrhythmias after stroke: Incidence, time course, and predictors-a systematic, prospective analysis. Stroke 2012; 43(11): 2892-7.
[http://dx.doi.org/10.1161/STROKEAHA.112.664318] [PMID: 22961962]
[28]
Mahesar SA, Memon SF, Mustafa S, Javed A, Butt SM. Evaluation of hyponatremia in ischemic stroke patients in a tertiary care hospital of Karachi, Pakistan. Cureus 2019; 11(1): e3926.
[http://dx.doi.org/10.7759/cureus.3926] [PMID: 30937232]
[29]
Martha SR, Fraser JF, Pennypacker KR. Acid-base and electrolyte changes drive early pathology in ischemic stroke. Neuromolecular Med 2019; 21(4): 540-5.
[http://dx.doi.org/10.1007/s12017-019-08555-5] [PMID: 31280473]
[30]
Chiamvimonvat N, Chen-Izu Y, Clancy CE, et al. Potassium currents in the heart: functional roles in repolarization, arrhythmia and therapeutics. J Physiol 2017; 595(7): 2229-52.
[http://dx.doi.org/10.1113/JP272883] [PMID: 27808412]
[31]
Krijthe BP, Heeringa J, Kors JA, et al. Serum potassium levels and the risk of atrial fibrillation: The Rotterdam Study. Int J Cardiol 2013; 168(6): 5411-5.
[http://dx.doi.org/10.1016/j.ijcard.2013.08.048] [PMID: 24012173]
[32]
El-Sherif N, Turitto G. Electrolyte disorders and arrhythmogenesis. Cardiol J 2011; 18(3): 233-45.
[PMID: 21660912]
[33]
Weiss JN, Qu Z, Shivkumar K. Electrophysiology of hypokalemia and hyperkalemia. Circ Arrhythm Electrophysiol 2017; 10(3): e004667.
[http://dx.doi.org/10.1161/CIRCEP.116.004667] [PMID: 28314851]
[34]
Shibazaki K, Kimura K, Okada Y, Iguchi Y, Terasawa Y, Aoki J. Heart failure may be associated with the onset of ischemic stroke with atrial fibrillation: A brain natriuretic peptide study. J Neurol Sci 2009; 281(1-2): 55-7.
[http://dx.doi.org/10.1016/j.jns.2009.02.374] [PMID: 19321180]
[35]
Skogestad J, Aronsen JM. Hypokalemia-induced arrhythmias and heart failure: new insights and implications for therapy. Front Physiol 2018; 9: 1500.
[http://dx.doi.org/10.3389/fphys.2018.01500] [PMID: 30464746]
[36]
Srivastava TN, Young DB. Impairment of cardiac function by moderate potassium depletion. J Card Fail 1995; 1(3): 195-200.
[http://dx.doi.org/10.1016/1071-9164(95)90024-1] [PMID: 9420651]
[37]
Li N, Qin S, Xie L, et al. Elevated serum potassium concentration alleviates cerebral ischemia-reperfusion injury via mitochondrial preservation. Cell Physiol Biochem 2018; 48(4): 1664-74.
[http://dx.doi.org/10.1159/000492289] [PMID: 30078008]

Rights & Permissions Print Cite
Article Metrics
22
1
© 2024 Bentham Science Publishers | Privacy Policy