Introduction: The central nervous system is the generator of the dynamic balance between cholinergic and noradrenergic activity. Different behavioral tendencies are observed in subjects with prevalent parasympatic tone (defense strategy, energy sparing, dissociation) compared to those with sympathic one (relational interaction, high energy expenditure). These responses may influence susceptibility and vulnerability to diseases. The aim of our study was to examine cardiovascular function from the heart to the periphery by 24 hours detection of both heart and pulse rate in cerebrovascular conditions. Materials and Methods: We recruited 113 Acute Ischaemic Syndromes (AIS, age 73,43 sd 12,34), 32 Chronic Cerebro-Vascular Diseases (CCVD, age 75,95 sd 8,06), 30 Other Neurological Diseases (OND, age 50,09 sd 15,05). Cardiovascular reactivity (CR) was defined by beat indices, ratio (R) or difference (D) between higher maximal or minimal heart rate (HR) on higher maximal or minimal pulse rate (PR). A value < 1 or > 1 were considered as negative (NCR) or positive CR (PCR), respectively. Results: Max PR was significantly higher in CCVD and AIS compared to OND. Max CR was lower in CCVD and AIS compared to OND. Increased levels of glycosylated hemoglobin, cardiac biomarkers, abnormal findings at Holter ECG and Echocardiography were particularly observed in case of NCR. Conclusions: NCR may interfere with normal activity of daily living. Higher Hachinski ischaemic scores in these patients point out a higher ischaemic load. Moreover, NCR identified a category of acute patients with worst outcomes, requiring prompt intensive care because of higher risk of complications and mortality. Our observations may be useful for better choosing among therapeutical options, planning rehabilitation and health enhancing physical activity in aging. Moreover, they may reduce the risk of injuries for training overload in athletes.

Pulse rate (PR) may be considered a reflex of heart rate (HR). In sporting, there is no significant mismatch. In hypovolemia PR is higher, in hypervolemia with heart failure, it progressively weans. We defined beat indices the difference (D) and the ratio (R) between maximal (MaxHR) or minimal (MinHR) HR on maximal (MaxPR) or minimal (MinPR) PR, as expression of cardiovascular reactivity (CR). Biomarkers and Holter Arterial Pressure Measurements were assessed in Acute Stroke (AS), Chronic Cerebro-Vascular Diseases (CCVD), Other Neuropsychiatric Diseases (OND). MaxHR, MaxPR and PR Standard Deviation were significantly higher in AS. Max R increased in Atrial Fibrillation-AS (AF-AS), Min R in Normal Rate (NR-AS), Tachycardia (TAC-AS) and AF-AS. Higher the HR, cardiac and renal biomarkers, lower the Glasgow Come Scale and higher the Modified Rankin Scale were in all patients, especially in those in class III-IV New-York-Heart-Association, C/D American-Cardiology-Association scales. MaxCR correlated with cardiac biomarkers in TAC-AS, renal dysfunctions in AF-AS. A reduced MaxCR was observed in CCVD. The central autonomic network is the generator of the dynamic balance between cholinergic and adrenergic activity. Its dysfunction triggers a pathological cascade, leading to allostatic overload. Its persistence is responsible of multiorgan impairments. A similar pattern of CR was observed in TAC and AF-AS and it may relate to worst outcomes. Low CR in CCVD may reflect arteriosclerosis and pharmacological effects. Our observations may be useful for planning rehabilitation in AS, health-enhancing-physical-activity in aging. Moreover, they may reduce the risk of injuries for training overload in athletes.

The activation of clotting cascade occurs in several conditions, from inflammatory to oncologic ones. The detection of early biomarkers may prevent thrombosis and reduce mortality. The aim of our study was to assess fibrinogen and d-dimer for better prediction of thrombophilic risk and for improving reliability of prognosis. We recruited 1720 Acute Strokes (AS), 738 Chronic Cerebro-Vascular Diseases (CCVD) and 285 Other Neuropsychiatric Diseases (OND). We classified them according to cardiological dysfunctions and ongoing therapies. Blood withdrawal was performed within 24 hours. Our preliminary results showed significant differences in fibrinogen and d-dimer levels in all AS compared to OND. Surprisingly, a higher percentage of patients in class I/II New York Heart Association (NYHA), A/B American Cardiology Association (ACA) scales had values over a cut off value of 350 mg/dl of fibrinogen compared to those in class III/IV NYHA, C/D ACA. The difference in fibrinogen levels were statistically more significant in the former, compared to the latter, because of lower standard deviation. Early autonomic dysregulation may lead to a thrombophilic milieu, triggering and or worsening haemodinamic dysfunctions and microemboli formation also in class I/II NYHA, A/B ACA. High fibrinogen level represents an early marker of increased thrombophilic risk, being converted by thrombin into fibrin. It is a red flag in class III/IV NYHA, C/D ACA. D-dimer is a degradation product of fibrin. High d-dimer/fibrinogen ratio may prelude an increased risk of haemorrhagic complications in cerebrovascular diseases as well as in late stage of other severe conditions, as pulmonary thromboembolism and cancers.

High levels of troponin T (hsTroT) and NT-Pro-Brain Natriuretic Peptide (NT-Pro-BNP) were detected in elderly patients affected with cerebrovascular diseases, especially in those in class III/IV, C/D New York Heart Association (NYHA) and American Cardiology Association (ACA) scales (Fiori P. et al., 2018). Our study evaluated whether their increase may account for worst ASPECTS scores in early, acute stroke at Computerized Tomography. The highest levels of hsTroT were detected in class III/IV, C/D patients with at least 50% relative increase (rI) compared to those with at least 50% relative decrease (rD) of NT-Pro-BNP at day VII. These patients had the lowest GCS at admission, as well as the lowest GCS and highest MRS at day VII. ASPECTS scores were tendentially lower in class III/IV AS patients with stable or increased levels of NT-pro-BNP compared to those with at least 100% rD of NT-pro-BNP at day VII. In the former, significant correlations were found between ASPECTS, GCS, hsTroT at admission, GCS and MRS at day VII. Our results highlight that even late may still be brain in all AS, class III/IV, C/D NYHA, ACA included. However, poor collaterals, decreased perfusion, increased diffusion, retrograde venous leakage may account for futile recanalization and increase the risk of haemorrhagic complications. Further studies are needed for better defining the therapeutical window in AS patients suffering from heart failure, decision making concerning the strategy of “scoop and run” to mechanical thrombectomy or “stay and play” with plasminogen activators and/or other pharmacological agents.

Background: Seric and urinary markers are increased in Acute Strokes (AS) and Chronic Cerebrovascular Diseases (CCVD) compared to Other Neurological Diseases (OND) (intergroup variability). No significant fluctuations were found within each group of patients at repeated measurements (intragroup unvariability). Objective: The aim of our current study is to evaluate the predictive values and the correlations with clinical, echographic and radiological findings. Patients and Methods: So far, we recruited 129 OND, 398 CCVD, 483 AS. We classified them in subgroups according to the severity of neurological and heart dysfunctions. Results: The most significant alterations of cardiac and urinary markers were detected in AS in class III/C, IV/C and IV/D of New York Heart Association / American Cardiology Association scales, especially in cases with concomitant CCVD, and in unstable CCVD. No significant intragroup differences were found at repeated measurements. CRP, Tro ths, NT-pro-BNP, proteinuria had predictive values. Correlations were found with CHAD2DS2VAsc, HAS BLED, Hachinski, Apache, Glasgow Coma Scale, Glasgow Outcome Scale, Modified Rankin Scale, echocardiographic parameters, Simplified Pulmonary Embolism Severity and Pulmonary Embolism Severity Indices. Conclusions: Our data highlight important features within the same category of AS accounting for worst outcomes, restricting therapeutical effectiveness, prolonging hospitalization and predicting bounce backs, above all in patients affected with CCVD and severe cardiac dysfunctions. While more sophisticated radiological techniques may show a continuum from physiological to subtle pathological conditions, the other parameters allow early identifying and treating emergencies. Computerized modeling would monitor decision making and better define the burden, reversibility and lesional load of cerebrovascular disease.

The aim of our study is to characteris/INS;e cerebrovascular patients concerning cardiovascular functions.

Excessive preoccupation, denial, neglect or even exhibition of flaws in appearance are expressions of a dysfunctional body image (Fiori P, Giannetti LM, 20). This may prelude the appearance of behavioral and cognitive dysfunction (Fiori P et al./INS;, Rankin KP et al./INS;, 2003). Although the borderline is wider than frank pathological manifestations, the subtle pervasive features of such condition may have individual and social consequences.