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.

中文翻译：

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缺血性卒中位置，病因亚型，神经系统结局和自主性心脏功能之间的关系。

背景

用心率变异性（HRV）衡量的中风后自主神经功能障碍与传统危险因素和不良预后相关。这项研究旨在调查急性缺血性卒中（AIS）患者的HRV与梗死部位，病因亚型和神经功能预后之间的关系。

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）和改良的Rankin量表评分（mRS），将186名连续患者划分为四个主要的卒中严重程度类别：轻度（NIHSS 0–4）中度（NIHSS 5–14）中风，“有利”（mRS 0–2）组和“不利”（mRS 3–5）组。应用HRV时域参数评估患者入院后1周内的自主神经功能。根据TOAST（急性卒中治疗的ORG 10172改良试验）分类，将所有患者分为不同的病因亚型。研究了所有参与者的HRV与卒中位置，病因亚型和神经系统结局的关系。应用单因素和多因素分析来探索HRV的预测值。

结果

160名参与者患有大动脉粥样硬化性梗塞（LAA），61名患有右颈内动脉系统梗塞（R-ICA），61名患有椎基底动脉系统梗塞（VB）。VB组患者的相邻RR间隔的均方根差（RMSSD）以及通过将心跳间隔差异> 50 ms除以计算的比例（pNN50）显着低于R-ICA组的患者（P < 0.01）。LAA组的HRV参数显着低于非LAA组（P <0.01）。出院时，不利组和中度组HRV明显降低（P <0.05）。经过逻辑单变量和多变量分析后，SDNN降低（OR = 1.019； 95％CI = 1.003–1.035；p= 0.021）与出院时的mRS不利和NIHSS升高相关（OR = 1.013； 95％CI = 1.003–1.024；p = 0.015）。仅SDNN在1年时对mRS≥3（OR = 1.012; 95％CI = 1.002–1.022; p = 0.016）表现出预测价值。

结论

入院后测得的HRV与AIS梗死盆地，TOAST亚型和出院时的神经系统结局有关，提示HRV在评估AIS和识别高危患者中可能发挥作用。