心率变异性与ABCD评分相结合预示着轻度中风或短暂性脑缺血发作后的不良预后。

The combination of heart rate variability and ABCD score portends adverse outcomes after minor stroke or transient ischemic attack.

作者信息

Tian Yu, Pan Yuesong, Wang Mengxing, Meng Xia, Zhao Xingquan, Liu Liping, Wang Yongjun, Wang Yilong

机构信息

Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Chinese Institute for Brain Research, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.

出版信息

J Neurol Sci. 2023 Feb 15;445:120522. doi: 10.1016/j.jns.2022.120522. Epub 2022 Dec 12.

DOI:10.1016/j.jns.2022.120522

PMID:36634579

Abstract

BACKGROUND AND PURPOSE

The residual recurrent risk of stroke, which cannot be entirely explained by the traditional ABCD2 score, still existed. Heart rate variability (HRV), a method for reflecting the function of automatic nervous system (ANS), was a novel predictor of secondary stroke events. We aimed to investigate the relationships of combined HRV and ABCD score with adverse outcomes after acute minor stroke (MS) or transient ischemic attack (TIA), and further investigate the independent associations between HRV and adverse outcomes after MS/TIA stratified by ABCD score.

METHODS

Data were obtained from the Third China National Stroke Registry (CNSR-III) study. We assessed the activity of ANS using standard deviation of NN intervals (SDNN), a time domain index of HRV. Trained investigators collected clinical characteristics and estimated ABCD score for each participant. All enrolled patients were categorized into different risk groups based on SDNN level and ABCD score. The clinial outcomes included recurrent stroke, recurrent ischemic stroke, and disability within 1-year follow-up. We evaluated whether combined SDNN and ABCD score were associated with recurrent events using multivariable Cox regression models, and those with disability using multivariable logistic regression models. The independent associations between SDNN and diverse outcomes stratified by ABCD score were explored using multivariable Cox and logistic regression analyses.

RESULTS

A total of 5,743 participants [3,316 (70.02) males, 62.0 (54.0-69.0) years] were included. Patients with low SDNN and ABCD ≥ 4 were associated with higher risk of recurrent stroke within 1 year (10.8% versus 4.9%; [HR] 1.31, 95% [CI] 0.92-1.88, P = 0.14) compared to patients with high SDNN with ABCD < 4. Lower SDNN was associated with higher recurrent stroke in patients with ABCD 0-3 score ([HR] 0.73, 95% [CI] 0.57-0.947, P = 0.01) and ABCD 4-5 score ([HR] 0.85, 95% [CI] 0.74-0.97, P = 0.02), but not in patients with ABCD 6-7 score.

CONCLUSION

The combination of HRV and ABCD score might efficiently stratify the risk of 1-year recurrent stroke after MS/TIA. Moreover, lower SDNN was independently related to recurrent stroke in patients with MS/TIA, especially for those with low-to-moderate traditional vascular risk factors.

摘要

背景与目的

卒中的残余复发风险依然存在，传统的ABCD2评分无法完全解释这一风险。心率变异性（HRV）是一种反映自主神经系统（ANS）功能的方法，是继发性卒中事件的新型预测指标。我们旨在研究HRV与ABCD评分相结合与急性轻度卒中（MS）或短暂性脑缺血发作（TIA）后不良结局之间的关系，并进一步研究按ABCD评分分层的MS/TIA后HRV与不良结局之间的独立关联。

方法

数据来自第三次中国国家卒中登记（CNSR-III）研究。我们使用HRV的时域指标NN间期标准差（SDNN）评估ANS的活性。经过培训的研究人员收集了每位参与者的临床特征并估算了ABCD评分。所有纳入的患者根据SDNN水平和ABCD评分被分为不同的风险组。临床结局包括1年随访内的卒中复发、缺血性卒中复发和残疾。我们使用多变量Cox回归模型评估SDNN与ABCD评分相结合是否与复发事件相关，使用多变量逻辑回归模型评估与残疾相关的情况。使用多变量Cox和逻辑回归分析探索按ABCD评分分层的SDNN与不同结局之间的独立关联。

结果

共纳入5743名参与者[3316名（70.02%）男性，年龄62.0（54.0 - 69.0）岁]。与SDNN高且ABCD<4的患者相比，SDNN低且ABCD≥4的患者在1年内卒中复发风险更高（10.8%对4.9%；风险比[HR]1.31，95%置信区间[CI]0.92 - 1.88，P = 0.14）。在ABCD评分为0 - 3分（[HR]0.73，95%[CI]0.57 - 0.947，P = 0.01）和ABCD评分为4 - 5分（[HR]0.85，95%[CI]0.74 - 0.97，P = 0.02）的患者中，较低的SDNN与更高的卒中复发相关，但在ABCD评分为6 - 7分的患者中并非如此。