Neurology Department, Faculty of Medicine, University of Medicine and Pharmacy, No 16, University Street, Iasi 700115, Romania(1).
Department of Biomedical Sciences, Faculty of Medical Bioengineering, University of Medicine and Pharmacy, No 16, University Street, Iasi 700115, Romania.
Neurol Neurochir Pol. 2018 Mar;52(2):194-206. doi: 10.1016/j.pjnns.2017.10.002. Epub 2017 Oct 11.
Cardiovascular system presents cortical modulation. Post-stroke outcome can be highly influenced by autonomic nervous system disruption. Heart rate variability (HRV) analysis is a simple non-invasive method to assess sympatho-vagal balance.
The purpose of this study was to investigate cardiac autonomic activity in ischemic stroke patients and to asses HRV nonlinear parameters beside linear ones.
We analyzed HRV parameters in 15 right and 15 left middle cerebral artery ischemic stroke patients, in rest condition and during challenge (standing and deep breathing). Data were compared with 15 age- and sex-matched healthy controls.
There was an asymmetric response after autonomic stimulation tests depending on the cortical lateralization in ischemic stroke patients. In resting state, left hemisphere stroke patients presented enhanced parasympathetic control of the heart rate (higher values for RMSSD, pNN50 and HF in normalized units). Right hemisphere ischemic stroke patients displayed a reduced cardiac parasympathetic modulation during deep breathing test. Beside time and frequency domain, using short-term ECG monitoring, cardiac parasympathetic modulation can also be assessed by nonlinear parameter SD1, that presented strong positive correlation with time and frequency domain parameters RMSSD, pNN50, HFnu, while DFA α1 index presented negative correlation with the same indices and positive correlation with the LFnu and LF/HF ratio, indicating a positive association with the sympatho-vagal balance.
Cardiac monitoring in clinical routine using HRV analysis in order to identify autonomic imbalance may highlight cardiac dysfunctions, thus helping preventing potential cardiovascular complications, especially in right hemisphere ischemic stroke patients with sympathetic hyperactivation.
心血管系统呈现皮质调制。自主神经系统的破坏会极大地影响中风后的结果。心率变异性（HRV）分析是评估交感神经-副交感神经平衡的一种简单的非侵入性方法。
本研究旨在调查缺血性脑卒中患者的心脏自主活动，并评估 HRV 非线性参数。
我们分析了 15 例右侧和 15 例左侧大脑中动脉缺血性脑卒中患者在静息状态和挑战状态（站立和深呼吸）下的 HRV 参数。将数据与 15 名年龄和性别匹配的健康对照者进行比较。
在自主神经刺激试验后，根据缺血性脑卒中患者的皮质侧化，存在不对称反应。在静息状态下，左侧半球卒中患者的心率呈现出增强的副交感神经控制（归一化单位中 RMSSD、pNN50 和 HF 的值更高）。右侧半球缺血性脑卒中患者在深呼吸试验中表现出心脏副交感神经调节减弱。除了时域和频域参数外，使用短期心电图监测，还可以通过非线性参数 SD1 评估心脏副交感神经调节，SD1 与 RMSSD、pNN50、HFnu 等时域和频域参数呈强正相关，而 DFAα1 指数与这些指数呈负相关，与 LFnu 和 LF/HF 比值呈正相关，表明与交感神经-副交感神经平衡呈正相关。
使用 HRV 分析在临床常规中进行心脏监测，以识别自主神经失衡，可能会突出心脏功能障碍，从而有助于预防潜在的心血管并发症，特别是在右侧半球缺血性脑卒中患者中，这些患者可能存在交感神经兴奋过度。
