Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany.
Department of Neurology, University Hospital Essen, Essen, Germany.
J Neurol. 2022 Oct;269(10):5454-5465. doi: 10.1007/s00415-022-11204-w. Epub 2022 Jun 12.
Stroke may compromise cardiovascular-autonomic modulation (CAM). The longitudinal post-stroke CAM alterations remain unclear as previous studies excluded patients with cardiovascular medication. This study evaluated whether CAM dysfunction improves after several months in patients under typical clinical conditions, i.e., without excluding patients with cardiovascular medication.
In 82 ischemic stroke patients [33 women, 64.9 ± 8.9 years, NIHSS-scores 2 (interquartile range 1-5)], we evaluated the applications of cardiovascular medication before stroke, during autonomic tests performed within 1 week, 3 and 6 months after stroke onset. We determined resting RR intervals (RRI), systolic, diastolic blood pressures (BPsys), respiration, parameters reflecting total CAM [RRI-standard deviation (RRI-SD), RRI-total powers], sympathetic [RRI-low-frequency powers (RRI-LF), BPsys-LF powers] and parasympathetic CAM [RMSSD, RRI-high-frequency powers (RRI-HF powers)], and baroreflex sensitivity. ANOVA or Friedman tests with post hoc analyses compared patient data with data of 30 healthy controls, significance was assumed for P < 0.05.
More patients had antihypertensive medication after than before stroke. First-week CAM testing showed lower RRIs, RMSSD, RRI-SDs, RRI-total powers, RRI-HF powers, and baroreflex sensitivity, but higher BPsys-LF powers in patients than controls. After 3 and 6 months, patients had significantly higher RRIs, RRI-SDs, RRI-total powers, RMSSDs, RRI-HF powers, and baroreflex sensitivity, but lower BPsys-LF powers than in the 1st week; RMSSDs and RRI-HF powers no longer differed between patients and controls. However, 6-month values of RRIs, RRI-SDs, and baroreflex sensitivity were again lower in patients than controls.
Even mild strokes compromised cardiovagal modulation and baroreflex sensitivity. After 3 months, CAM had almost completely recovered. Recovery might be related to the mild stroke severity. Presumably, CAM recovery was also promoted by the increased application of cardiovascular medication. Yet, slight CAM dysfunction after 6 months suggests continuing autonomic vulnerability.
中风可能会损害心血管自主调节（CAM）。由于先前的研究排除了服用心血管药物的患者，因此中风后 CAM 改变的纵向变化仍不清楚。本研究评估了在典型临床情况下（即不排除服用心血管药物的患者），经过数月后 CAM 功能障碍是否会改善。
在 82 名缺血性中风患者[33 名女性，64.9±8.9 岁，NIHSS 评分为 2（四分位间距 1-5）]中，我们评估了中风前服用心血管药物的情况，以及中风后 1 周、3 个月和 6 个月时进行自主测试期间的情况。我们测定了静息 RR 间隔（RRI）、收缩压、舒张压（BPsys）、呼吸以及反映总 CAM 的参数[RRI 标准差（RRI-SD）、RRI 总功率]、交感神经[RRI 低频功率（RRI-LF）、BPsys-LF 功率]和副交感神经 CAM[RMSSD、RRI 高频功率（RRI-HF 功率）]以及压力反射敏感性。采用 ANOVA 或 Friedman 检验进行事后分析比较患者数据与 30 名健康对照者的数据，P<0.05 时认为差异具有统计学意义。
与中风前相比，更多的患者在中风后使用了降压药物。第 1 周的 CAM 测试显示患者的 RRI、RMSSD、RRI-SD、RRI 总功率、RRI-HF 功率和压力反射敏感性较低，但 BPsys-LF 功率较高。3 个月和 6 个月后，与第 1 周相比，患者的 RRI、RRI-SD、RRI 总功率、RMSSD、RRI-HF 功率和压力反射敏感性显著升高，BPsys-LF 功率降低；但 RMSSD 和 RRI-HF 功率在患者和对照组之间已无差异。然而，6 个月时患者的 RRI、RRI-SD 和压力反射敏感性仍低于对照组。
即使是轻度中风也会损害心脏迷走神经调节和压力反射敏感性。3 个月后，CAM 几乎完全恢复。这种恢复可能与轻度中风的严重程度有关。推测 CAM 的恢复也与心血管药物应用的增加有关。然而，6 个月后 CAM 仍存在轻微的功能障碍，表明自主神经仍存在脆弱性。
