Department of Neurology, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany.
Department of Neurology, University of Giessen, Klinikstrasse 33, 35392, Giessen, Germany.
J Neurol. 2022 Oct;269(10):5541-5552. doi: 10.1007/s00415-022-11220-w. Epub 2022 Jun 20.
To assess associations between clinical severity and possible dysfunction of autonomic cardiovascular modulation within the acute phase after spontaneous subarachnoid hemorrhage (SAH).
In this prospective observational study, in 51 patients with spontaneous SAH, Hunt-and-Hess scores (H&H) were assessed and cardiovascular autonomic modulation was monitored within 24 h after SAH-onset. From 5 min time-series of R-R-intervals (RRI) and blood-pressure (BP) recordings, we calculated autonomic parameters including time-domain [RRI-coefficient-of-variation (RRI-CV) and square-root-of-the-mean-squared-differences-of-successive-RRIs (RMSSD)] and frequency-domain parameters [low- and high-frequency-powers of RRI- and BP-modulation (RRI-LF-, RRI-HF-, SBP-LF-powers) and RRI-total-powers]. Data were compared to those of 20 healthy volunteers.
RRI- and BP-values did not differ between groups. Yet, parameters of sympathetic (RRI-LF-powers 141.0 (18.9-402.4) ms vs 442.3 (246.8-921.2) ms, p = 0.001) and total autonomic modulation (RRI-CV 2.4 (1.2-3.7) ms vs 3.7 (3.1-5.3) ms, p = 0.001) were significantly lower in patients than in controls. Subgroup analyses (patients with H&H < 3 vs H&H ≥ 3) and Spearman-rank-correlations revealed increasing loss of sympathetic (RRI-LF-powers 338.6 (179.7-710.4) ms vs 72.1 (10.1-175.9) ms, p = 0.001, rho = - 0.524) and total autonomic modulation (RRI-CV 3.5 (2.3-5.4) ms vs 1.6 (1.0-2.8) ms, p < 0.001, rho = - 0.519) with higher H&H-scores. Multiple-logistic-regression underlined the significant influence of H&H-scores on sympathetic (RRI-LF-powers, p = 0.033) and total autonomic modulation (RRI-CV, p = 0.040) compared to possible confounders (e.g., age, intubation).
Within the acute phase, spontaneous SAH induces a decrease in sympathetic and total autonomic cardiovascular modulation. Higher H&H-scores were associated with increasing autonomic dysfunction and may therefore augment the risk of cardiovascular complications and poor clinical outcome.
评估自发性蛛网膜下腔出血（SAH）后急性期自主心血管调节的临床严重程度与潜在功能障碍之间的相关性。
在这项前瞻性观察性研究中，对 51 例自发性 SAH 患者进行了 Hunt-Hess 评分（H&H）评估，并在 SAH 发病后 24 小时内监测心血管自主调节功能。从 R-R 间期（RRI）和血压（BP）记录的 5 分钟时间序列中，我们计算了自主参数，包括时域[RRI 变异性系数（RRI-CV）和相邻 RRI 均方根差的平方根（RMSSD）]和频域参数[RRI 和 BP 调制的低频和高频功率（RRI-LF-、RRI-HF-、SBP-LF 功率）和 RRI 总功率]。将数据与 20 名健康志愿者进行了比较。
组间 RRI 和 BP 值无差异。然而，与对照组相比，患者的交感神经（RRI-LF 功率 141.0（18.9-402.4）ms 比 442.3（246.8-921.2）ms，p=0.001）和总自主调节（RRI-CV 2.4（1.2-3.7）ms 比 3.7（3.1-5.3）ms，p=0.001）的参数明显较低。亚组分析（H&H<3 与 H&H≥3）和 Spearman 秩相关分析显示，随着 H&H 评分的增加，交感神经（RRI-LF 功率 338.6（179.7-710.4）ms 比 72.1（10.1-175.9）ms，p=0.001，rho=-0.524）和总自主调节（RRI-CV 3.5（2.3-5.4）ms 比 1.6（1.0-2.8）ms，p<0.001，rho=-0.519）的丧失程度也逐渐增加。多因素逻辑回归强调了 H&H 评分对交感神经（RRI-LF 功率，p=0.033）和总自主调节（RRI-CV，p=0.040）的显著影响，与可能的混杂因素（如年龄、插管）相比。
在急性期，自发性 SAH 会导致交感神经和总自主心血管调节功能下降。较高的 H&H 评分与自主神经功能障碍的增加有关，因此可能会增加心血管并发症和不良临床结局的风险。
