Prognostic implications of right-sided insular damage, cardiac autonomic derangement, and arrhythmias after acute ischemic stroke
Prognostic implications of right-sided insular damage, cardiac autonomic derangement, and arrhythmias after acute ischemic stroke
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DOI：
10.1161/01.str.0000173400.19346.bd
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发表时间：
2005-08-01
期刊：
影响因子：
8.3
通讯作者：
Caltagirone, C
中科院分区：
文献类型：
--
作者：
Colivicchi, F;Bassi, A;Caltagirone, C
背景和目的-急性中风与心脏自主平衡受损和心律失常发生率增加有关。这些异常在梗塞区域累及右侧岛叶的情况下显得更为相关。本研究的目的是评估右侧岛叶损伤、心脏自主神经紊乱和心律失常对急性缺血性卒中后临床结果的影响。方法 - 对 208 名连续首次急性缺血性卒中患者进行 24 小时动态心电图监测。在所有情况下都考虑了心率变异性和心律失常的时域和频域测量。所有患者在初次事件发生后均接受 12 个月的随访。结果 - 在 12 个月的随访期间，48 名患者死亡（1 年死亡概率，0.23；95% CI，0.17 至 0.30）。多变量分析表明，年龄（风险比[HR]，1.06；95% CI，1.01至1.10；P = 0.0087）、入院时卒中严重程度（HR，1.25；95% CI，1.13至1.39；P = 0.0001）、存在右侧岛叶损伤（HR，2.01；95% CI， 1.13 至 1.39；P = 0.0187），以及所有正常至正常 RR 间期的 SD 值较低（HR，3.32；95% CI，1.67 至 6.24；P = 0.002），以及动态心电图监测期间存在非持续性室性心动过速（HR，2.99；95% CI，1.58 至5.67；P = 0.0007）是 1 年死亡率的独立预测因素。 结论 - 将传统风险分层与自主神经和心律失常标记相结合，以及仔细寻找右侧岛叶受累，可能是识别有早期死亡风险的中风患者的有效方法。
Background and Purpose - Acute stroke is associated with impairment of cardiac autonomic balance and increased incidence of arrhythmias. These abnormalities appear more relevant in the case of involvement of the right insula in the infarct area. The aim of this study was to assess the impact of right-sided insular damage, cardiac autonomic derangement, and arrhythmias on clinical outcome after acute ischemic stroke.Methods - Holter monitoring for 24 hours was performed in 208 consecutive patients with first-ever acute ischemic stroke. Time- and frequency-domain measures of heart rate variability and arrhythmias were considered in all cases. All patients were followed for a 12-month period after the initial event.Results - During the 12-month follow-up period, 48 patients died (1-year probability of death, 0.23; 95% CI, 0.17 to 0.30). Multivariate analysis demonstrated that age (hazard ratio [HR], 1.06; 95% CI, 1.01 to 1.10; P = 0.0087), stroke severity on admission (HR, 1.25; 95% CI, 1.13 to 1.39; P = 0.0001), presence of right-sided insular damage (HR, 2.01; 95% CI, 1.13 to 1.39; P = 0.0187), as well as lower values of the SD of all normal-to-normal RR intervals (HR, 3.32; 95% CI, 1.67 to 6.24; P = 0.002), and presence of nonsustained ventricular tachycardia during Holter monitoring (HR, 2.99; 95% CI, 1.58 to 5.67; P = 0.0007) were independent predictors of 1-year mortality.Conclusions - The integration of traditional risk stratifiers with autonomic and arrhythmic markers, and the careful search for right-sided insular involvement, may represent an effective approach for identification of stroke patients at risk for early mortality.