Zawadka-Kunikowska Monika, Słomiński Krzysztof, Słomko Joanna, Tafil-Klawe Małgorzata, Klawe Jacek J, Sokołowski Łukasz, Newton Julia L, Zalewski Paweł
Department of Hygiene, Epidemiology and Ergonomy, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum, Bydgoszcz Nicolaus Copernicus University in Torun, Bydgoszcz, Poland -
Unit of Neurology and Stroke Care, Jan Biziel University Hospital No 2, Bydgoszcz, Poland.
Minerva Cardioangiol. 2018 Aug;66(4):376-385. doi: 10.23736/S0026-4725.18.04511-5. Epub 2018 Feb 1.
The aim of this study was to comprehensively determine hemodynamic and autonomic responses during-head up tilt test (HUT) in the acute and recovery phase of ischemic stroke.
Cardiovascular parameters, baroreflex sensitivity (BRS), spectral-indices of heart rate (HRV), systolic (sBPV) and diastolic blood pressure variability (dBPV) were measured at rest in ischemic stroke patients (N.=17) and control group (N.=34). Dynamic cardiac autonomic function was assessed using HUT (Delta [rest-tilt]. Controls were examined once whereas stroke group at two timepoints: on admission and in day 10 (recovery period).
After a recovery period the stroke group showed significantly higher resting values of systolic blood pressure (sBP, P=0.028), systolic time ratio (STR, P=0.023), high frequency sBPV (HF-sBP, P=0.027), high frequency R-R interval (HF-RRI, P=0.048), power spectral density of sBPV (PSD-sBP, P=0.004) and lower sympathovagal ratio (LF/HF, P=0.005), low frequency R-R interval (LF-RRI, P=0.045), BRS and significantly lower increase in post tilt changes in systolic blood pressure (Delta sBP), total peripheral resistance (Delta TPR) compared to controls. No significant differences were observed for post-tilt in all hemodynamic changes compared to admission. After the recovery period the patient group showed an improved blood pressure profile, left ventricular work index, systolic time ratio and BRS compared to admission.
Patients with acute ischemic stroke after a recovery period presented autonomic imbalance and impaired cardiac sympathetic modulation at rest and in response to orthostatic challenge compared to a control group. Furthermore, there was a statistically significant decrease in baroreflex sensitivity, suggesting parasympathetic deficiency.
本研究旨在全面确定缺血性中风急性期和恢复期头高位倾斜试验（HUT）期间的血流动力学和自主神经反应。
在缺血性中风患者（N = 17）和对照组（N = 34）静息状态下测量心血管参数、压力反射敏感性（BRS）、心率谱指数（HRV）、收缩压（sBPV）和舒张压变异性（dBPV）。使用HUT评估动态心脏自主神经功能（静息-倾斜差值）。对照组检查一次，而中风组在两个时间点检查：入院时和第10天（恢复期）。
恢复期后，中风组的收缩压静息值（sBP，P = 0.028）、收缩期时间比（STR，P = 0.023）、高频sBPV（HF-sBP，P = 0.027）、高频R-R间期（HF-RRI，P = 0.048）、sBPV功率谱密度（PSD-sBP，P = 0.004）显著更高，交感迷走神经比值（LF/HF，P = 0.005）、低频R-R间期（LF-RRI，P = 0.045）、BRS显著更低，与对照组相比，倾斜后收缩压变化（ΔsBP）、总外周阻力（ΔTPR）的增加显著更低。与入院时相比，所有血流动力学变化的倾斜后未观察到显著差异。恢复期后，患者组与入院时相比，血压曲线、左心室作功指数、收缩期时间比和BRS有所改善。
与对照组相比，恢复期后的急性缺血性中风患者在静息状态和对直立性挑战的反应中存在自主神经失衡和心脏交感神经调节受损。此外，压力反射敏感性有统计学意义的降低，提示副交感神经功能不足。
