Relationship between ischemic stroke locations, etiology subtypes, neurological outcomes, and autonomic cardiac function
Relationship between ischemic stroke locations, etiology subtypes, neurological outcomes, and autonomic cardiac function
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缺血性卒中部位、病因亚型、神经系统结果和自主心脏功能之间的关系
DOI：
10.1080/01616412.2020.1782103
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发表时间：
2020-07
影响因子：
1.9
通讯作者：
Wang Yilong
中科院分区：
文献类型：
--
作者：
Zhao Mengxi;Guan Ling;Collet Jean-Paul;Wang Yilong
摘要背景脑卒中后自主神经功能障碍与心率变异性（HRV）相关的传统危险因素和不良结局。本研究旨在探讨急性缺血性卒中（AIS）患者HRV与梗死部位、病因亚型和神经功能结局之间的关系。方法在这项前瞻性观察性研究中，根据美国国立卫生研究院卒中量表评分（NIHSS）和改良兰金量表评分（mRS）将186例连续患者分为4个主要卒中严重程度类别：轻度（NIHSS 0-4）卒中、中度（NIHSS 5-14）卒中、“有利”（mRS 0-2）组和“不利”（mRS 3-5）组。入院后1周内应用HRV时域参数评价患者的自主神经功能。所有患者根据吐司（改良的ORG 10172急性卒中治疗试验）分类分为不同的病因亚型。对所有参与者进行了HRV与卒中部位、病因亚型、神经学结局的相关性研究。采用单因素和多因素分析探讨心率变异性的预测价值。结果大动脉粥样硬化性梗死（LAA）160例，右侧颈内动脉系统梗死（R-ICA）61例，椎基底动脉系统梗死（VB）61例。VB组患者相邻RR间期的均方根差（RMSSD）和除以间期差>50 ms的比例（pNN 50）均显著低于R-ICA组（P < 0.01）。左心耳组心率变异性显著低于非左心耳组（P < 0.01）。出院时不良组和中度组心率变异性显著降低（P < 0.05）。Logistic单变量和多变量分析后，较低的SDNN（OR = 1.019; 95%CI = 1.003-1.035; p= 0.021）与出院时不利的mRS和较高的NIHSS独立相关（OR = 1.013; 95%CI = 1.003-1.024; p= 0.015）。仅SDNN显示1年时mRS≥3的预测值（OR = 1.012; 95%CI = 1.002-1.022; p= 0.016）。结论入院后测量的HRV与AIS梗死盆地、吐司亚型和出院时的神经功能结局相关，提示HRV在评估AIS和识别高危患者中可能发挥作用。
ABSTRACT Background Post-stroke autonomic nervous dysfunction measured with heart rate variability (HRV) is correlated with the traditional risk factors and poor outcome. This study aimed to investigate the association between HRV and infarct locations, etiology subtypes, and neurological functional outcomes in patients with acute ischemic stroke (AIS). Methods In this prospective observational study, 186 consecutive patients were assigned to four major stroke severity categories based on the National Institutes of Health Stroke Scale score (NIHSS) and the modified Rankin Scale score (mRS): mild (NIHSS 0–4) stroke, moderate (NIHSS 5–14) stroke, ‘favorable’ (mRS 0–2) group, and ‘unfavorable’ (mRS 3–5) group. HRV time domain parameters were applied to evaluate the autonomic function of patients within 1 week after admission. All patients were classified into different etiology subtypes based on the TOAST (modified Trial of ORG 10172 in Acute Stroke Treatment) classification. The association of HRV with stroke location, etiology subtypes, neurological outcome was explored for all participants. Univariate and multivariate analyses were applied to explore the prediction value of HRV. Results 160 participants had large artery atherosclerotic infarction (LAA), 61 had right internal carotid artery system infarction (R-ICA), and 61 had vertebrobasilar artery system infarction (VB). Root-mean-square of differences (RMSSD) of adjacent RR intervals and the proportion calculated by dividing the interbeat interval differences >50 ms (pNN50) in patients of VB group was significantly lower than those of patients in R-ICA group (P < 0.01). HRV parameters in the LAA group was significantly lower than non-LAA group (P < 0.01). At discharge, significant lower HRV presented in the unfavorable group and moderate group (P < 0.05). After logistic univariate and multivariate analysis, lower SDNN (OR = 1.019; 95% CI = 1.003–1.035; p= 0.021) was independently associated with unfavorable mRS and higher NIHSS at discharge (OR = 1.013; 95%CI = 1.003–1.024; p= 0.015). Only SDNN showed predictive value for mRS≥3 (OR = 1.012; 95%CI = 1.002–1.022; p= 0.016) at 1 year. Conclusions HRV measured after admission is related to the AIS infarction basin, TOAST subtypes, and neurological outcomes at discharge suggesting a possible role for HRV in evaluating AIS and identifying high-risk patients.
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影响因子：
8.3
作者：
Chan SL;Bishop N;Li Z;Cipolla MJ
通讯作者：
Cipolla MJ
DOI：
--
发表时间：
--
期刊：
--
影响因子：
--
作者：
J. Koolhaas;A. Bartolomucci;B. Buwalda;S. Boer;G. Flügge;S. Korte;P. Meerlo;R. Murison;B. Olivier;P. Palanza;G. Richter-Levin;A. Sgoifo;T. Steimer;O. Stiedl;G. V. Dijk;M. Wöhr;E. Fuchs
通讯作者：
J. Koolhaas;A. Bartolomucci;B. Buwalda;S. Boer;G. Flügge;S. Korte;P. Meerlo;R. Murison;B. Olivier;P. Palanza;G. Richter-Levin;A. Sgoifo;T. Steimer;O. Stiedl;G. V. Dijk;M. Wöhr;E. Fuchs
影响因子：
3.4
作者：
Acampa M;Lazzerini PE;Martini G
通讯作者：
Martini G
DOI：
10.1097/00002060-200208000-00006
发表时间：
2002-08
影响因子：
3
作者：
M. Arad;H. Ring;S. Abboud;M. Radai;A. Tamir;A. Adunsky
通讯作者：
M. Arad;H. Ring;S. Abboud;M. Radai;A. Tamir;A. Adunsky
影响因子：
8.3
作者：
Tilling, Elliot J.;El Tawil, Salwa;Muir, Keith W.
通讯作者：
Muir, Keith W.