Cardiac baroreceptor sensitivity predicts long-term outcome after acute ischemic stroke
Cardiac baroreceptor sensitivity predicts long-term outcome after acute ischemic stroke
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DOI：
10.1161/01.str.0000058493.94875.9f
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发表时间：
2003-03-01
期刊：
影响因子：
8.3
通讯作者：
Potter, JF
中科院分区：
文献类型：
--
作者：
Robinson, TG;Dawson, SL;Potter, JF
背景和目的：压力感受器反射弧在心血管系统的短期调节中很重要，小型研究报道了急性卒中后心脏压力感受器敏感性（BRS）受损。然而，BRS受损的预后意义尚不确定。方法：124例经神经放射学证实的急性缺血性脑卒中患者在72小时内同时进行心电图和无创搏动血压监测。采用功率谱分析技术，从综合a指数评价心脏BRS。将急性脑卒中患者的基线数据与年龄、性别和随机血压相匹配的对照组进行比较。患者的中位随访时间为1508天（范围9至2656天），并比较BRS受损和未受损患者的结果。结果：脑卒中患者的中位BRS值显著低于对照组（5[四分位数范围，3.5 ~ 7.4]vs . 6.2[四分位数范围，4.5 ~ 8.3]ms/mm Hg； P=0.04）。61名（33名男性）患者（平均年龄70.2 [SD 10.5]岁）BRS受损（小于或等于5.0 ms/mm Hg），而63名（35名男性）患者（平均年龄70.6 [SD 11.7]岁）BRS未受损（>5.0 ms/mm Hg）。BRS值受损的脑卒中患者预后明显较差（随访期间死亡率为28% vs 8%），尽管两组在年龄、脑卒中严重程度、脑卒中类型、随意或24小时血压参数方面没有差异。结论：心脏BRS受损与急性缺血性卒中后长期死亡率增加相关，与年龄、性别、卒中类型和血压无关。这可能反映了心律失常，但这种关联的机制尚不清楚，尽管改善中风后心脏BRS的治疗方法值得进一步研究。
Background and Purpose-The baroreceptor reflex arc is important in the short-term regulation of the cardiovascular system, and small studies have reported impaired cardiac baroreceptor sensitivity (BRS) after acute stroke. However, the prognostic significance of impaired BRS is uncertain.Methods-One hundred twenty-four patients underwent simultaneous ECG and noninvasive beat-to-beat blood pressure (BP) monitoring within 72 hours of neuroradiologically confirmed acute ischemic stroke. Cardiac BRS was assessed from the combined a-index by means of power spectral analysis techniques. Baseline data for acute stroke patients were compared with those of a control group matched for age, sex, and casual BP. Patients were followed up for a median of 1508 days (range, 9 to 2656 days), and outcome was compared between patients with and without impaired BRS.Results-Median BRS values were significantly lower in stroke patients than in controls (5 [interquartile range, 3.5 to 7.4] versus 6.2 [interquartile range, 4.5 to 8.3] ms/mm Hg; P=0.04). Sixty-one (33 male) patients (mean age, 70.2 [SD 10.5] years) had impaired BRS (less than or equal to5.0 ms/mm Hg) compared with 63 (35 male) patients (mean age, 70.6 [SD 11.7] years) without impaired BRS (>5.0 ms/mm Hg). Stroke patients with impaired BRS values had a significantly poorer prognosis (28% versus 8% mortality rate during the follow-up period) although there were no differences in age, stroke severity, stroke type, or casual or 24-hour BP parameters between the 2 groups.Conclusions-Impaired cardiac BRS is associated with increased long-term mortality after acute ischemic stroke, irrespective of age, sex, stroke type, and BP. This may reflect cardiac arrhythmias, but the mechanisms underlying this association are unknown, although therapies that improve cardiac BRS after stroke warrant further investigation.