We have investigated the relationship between spectral energy bandwidths and age in control (normal) individuals, without significant cardiac disease, diabetes and hypertension. We have shown that there is an exponential relationship between age and both low (sympathetic) and high (parasympathetic) peaks regulating heart rate variability. We have identified neurogenic ST segment depression in our stroke patients and are detailing the mechanisms. We have shown a proximo-distal gradient in the distribution of significant aortic atheroma found on TEE in our stroke patients. A strong association was found between symptomatic coronary artery disease and plaque in the proximal aorta (p-0.03) and between plaque in the arch and descending aorta and significant (>79%) extracranial carotid stenosis (p<0.01). On univariable and age-adjusted bivariate analysis, multiple risk and demographic factors were predictive of aortic atheroma severity and showed some differential associations according to aorta location. However, on multivariable analysis only smoking showed regional specifity (for the ascending aorta) (p=0.03); no other risk factors were associated with aortic atheroma in any segment. Late potentials predict onset of lethal cardiac arrhythmias. We showed that 21% of strokes are associated with cardiac ischemia; moreover when present they persist over 1 year of follow-up whereas in the stroke group they disappear 1-3 months after stroke onset indicating an association with the cerebral disease. Three stroke patients without cardiac disease have so far been found to have global myocardial contraction abnormalities on TEE, which disappear at 9 months follow-up (neurogenic stunned myocardium); 67% of these patients have late potentials and these data imply abnormal sympathetic influences on the heart secondary to the stroke. No TIA patients have this phenomenon.
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