Heart Rate Variability Parameter Changes in Patients With Acute Ischemic Stroke Undergoing Intravenous Thrombolysis.
Heart Rate Variability Parameter Changes in Patients With Acute Ischemic Stroke Undergoing Intravenous Thrombolysis.
复制标题
急性缺血性脑卒中患者静脉溶栓后心率变异性参数的变化。
DOI：
10.1161/jaha.122.028778
复制
发表时间：
2023-06-06
影响因子：
5.4
通讯作者：
Guo, Zhen-Ni
中科院分区：
文献类型：
--
作者：
Qu, Yang;Sun, Ying-Ying;Abuduxukuer, Reziya;Si, Xiang-Kun;Zhang, Peng;Ren, Jia-Xin;Fu, Yu-Li;Zhang, Ke-Jia;Liu, Jia;Zhang, Pan-Deng;Jin, Hang;Yang, Yi;Guo, Zhen-Ni
关键词：
急性缺血性卒中患者的自主神经功能障碍与预后不良有关。然而，通过心率变异性（HRV）评估的自主神经系统功能及其与接受静脉溶栓（IVT）患者临床结局的关系仍然未知。前瞻性和连续招募了在2016年9月至2021年8月期间接受和未接受IVT的患者。在卒中后1 - 3天和7 - 10天测量HRV值以评估自主神经系统功能。90天时改良兰金量表评分≥2被定义为不良结局。最后，分析包括466例患者; 224例接受了IVT（48.1%），242例未接受（51.9%）。线性回归显示IVT与卒中后1 - 3天的副交感神经激活相关HRV参数（高频：β=0.213，P=0.002）以及与卒中后7 - 10天的交感神经（低频：β=0.152，P=0.015）和副交感神经激活相关HRV参数（高频：β=0.153，P=0.036）均呈正相关。Logistic回归显示，在对接受IVT的患者的混杂因素进行调整后，卒中后1 - 3天和7 - 10天内的HRV值和自主神经功能与3个月的不良结局独立相关（均P<0.05）。此外，将HRV参数添加到传统风险因素中显著提高了3个月结局的风险预测能力（受试者工作特征曲线下面积从0.784 [0.723-0.846]显著改善至0.855 [0.805-0.906]，P=0.002）。IVT积极影响HRV和自主神经系统的活动，自主神经功能评估的HRV在急性卒中阶段是独立的与接受IVT的患者的不利结果。
Autonomic dysfunction has been revealed in patients with acute ischemic stroke and is associated with poor prognosis. However, autonomic nervous system function assessed by heart rate variability (HRV) and its relationship with clinical outcomes in patients undergoing intravenous thrombolysis (IVT) remain unknown. Patients who did and did not undergo IVT between September 2016 and August 2021 were prospectively and consecutively recruited. HRV values were measured at 1 to 3 and 7 to 10 days after stroke to assess autonomic nervous system function. A modified Rankin scale score ≥2 at 90 days was defined as an unfavorable outcome. Finally, the analysis included 466 patients; 224 underwent IVT (48.1%), and 242 did not (51.9%). Linear regression showed a positive correlation of IVT with parasympathetic activation‐related HRV parameters at 1 to 3 days (high frequency: β=0.213, P=0.002) and with both sympathetic (low frequency: β=0.152, P=0.015) and parasympathetic activation‐related HRV parameters (high frequency: β=0.153, P=0.036) at 7 to 10 days after stroke. Logistic regression showed HRV values and autonomic function within 1 to 3 and 7 to 10 days after stroke were independently associated with 3‐month unfavorable outcomes after adjusting for confounders in patients who underwent IVT (all P<0.05). Furthermore, addition of HRV parameters to conventional risk factors significantly improved risk‐predictive ability of 3‐month outcome (the area under the receiver operating characteristic curve significantly improved from 0.784 [0.723–0.846] to 0.855 [0.805–0.906], P=0.002). IVT positively affected HRV and autonomic nervous system activity, and autonomic function assessed by HRV in acute stroke phase was independently associated with unfavorable outcomes in patients undergoing IVT.