Rapid Assessment of Blood Pressure Variability and Outcome After Successful Thrombectomy.
Rapid Assessment of Blood Pressure Variability and Outcome After Successful Thrombectomy.
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DOI：
10.1161/strokeaha.121.034291
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发表时间：
2021-08
期刊：
影响因子：
8.3
通讯作者：
Petersen N
中科院分区：
文献类型：
--
作者：
Castro P;Ferreira F;Nguyen CK;Payabvash S;Ozan Tan C;Sorond F;Azevedo E;Petersen N
血管内卒中治疗（EVT）后的高血压（BP）变异性与不良预后相关。传统的血压变异性测量需要长时间的记录，限制了其作为指导临床决策的风险评估工具的效用。在这里，我们通过谱分析对血压变异性进行了快速评估，并评估了其与早期临床改善和长期功能结局的关系。我们对146例成功行EVT的前循环缺血性卒中患者进行了一项前瞻性研究。利用5分钟搏动间血压记录的频谱分析来量化血压变异性。结果包括90天的初始临床反应和改良Rankin量表。高频率血压变异性的增加与90天的功能预后不良独立相关（调整优势比[aOR]=1.85, 95% CI 1.07 - 3.25, p=0.03；低/高频比aOR= 0.67, 0.46 - 0.92, p=0.02）和早期神经恢复的可能性降低（aOR=0.62, 0.44 - 0.91, p=0.01; aOR=1.37, 1.03 - 1.87, p=0.04）。再灌注成功后的高频血压振荡可能是有害的，并与神经恢复的可能性降低和良好的功能预后有关。快速评估整个再灌注后时期的血压变异性是可行的，并且可能允许更个性化的血压管理。
High blood pressure (BP) variability after endovascular stroke therapy (EVT) is associated with poor outcome. Conventional BP variability measures require long recordings, limiting their utility as a risk assessment tool to guide clinical decision making. Here, we performed rapid assessment of BP variability by spectral analysis and evaluated its association with early clinical improvement and long-term functional outcomes. We conducted a prospective study of 146 patients with anterior circulation ischemic stroke who underwent successful EVT. Spectral analysis of 5-minute recordings of beat-to-beat BP was used to quantify BP variability. Outcomes included initial clinical response and modified Rankin scale at 90 days. Increased BP variability at high frequencies was independently associated with poor functional outcome at 90 days (adjusted odds ratio [aOR]=1.85, 95% CI 1.07 – 3.25, p=0.03; low/high frequency ratio aOR= 0.67, 0.46 – 0.92, p=0.02) and reduced likelihood of an early neurological recovery (aOR=0.62, 0.44 – 0.91, p=0.01 and aOR=1.37, 1.03 – 1.87, p=0.04, respectively). High-frequency BP oscillations after successful reperfusion may be harmful and associate with a decreased likelihood of neurological recovery and favorable functional outcomes. Rapid assessment of BP variability throughout the post-reperfusion period is feasible and may allow for a more personalized BP management.