Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany.
Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany.
Eur J Neurol. 2023 Aug;30(8):2488-2497. doi: 10.1111/ene.15853. Epub 2023 May 23.
Acute stroke frequently causes cardiovascular-autonomic dysfunction (CAD). Studies of CAD recovery are inconclusive, whereas poststroke arrhythmias may wane within 72 h. We evaluated whether poststroke CAD recovers within 72 h upon stroke onset in association with neurological improvement or increased use of cardiovascular medication.
In 50 ischemic stroke patients (68 ± 13 years old) who-prior to hospital-admission-had no known diseases nor took medication affecting autonomic modulation, we assessed National Institutes of Health Stroke Scale (NIHSS) scores, RR intervals (RRIs), systolic and diastolic blood pressure (BP), respiration rate, parameters reflecting total autonomic modulation (RRI SD, RRI total powers), sympathetic modulation (RRI low-frequency powers, systolic BP low-frequency powers), and parasympathetic modulation (square root of mean squared differences of successive RRIs [RMSSD], RRI high-frequency powers), and baroreflex sensitivity within 24 h (Assessment 1) and 72 h after stroke onset (Assessment 2) and compared data to those of 31 healthy controls (64 ± 10 years). We correlated delta NIHSS values (Assessment 1 - Assessment 2) with delta values of autonomic parameters (Spearman rank correlation tests; significance: p < 0.05).
At Assessment 1, patients were not yet on vasoactive medication and had higher systolic BP, respiration rate, and heart rate, that is, lower RRIs, but lower RRI SD, RRI coefficient of variance, RRI low-frequency powers, RRI high-frequency powers, RRI total powers, RMSSDs, and baroreflex sensitivity. At Assessment 2, patients were on antihypertensives, had higher RRI SD, RRI coefficient of variance, RRI low-frequency powers, RRI high-frequency powers, RRI total powers, RMSSDs, and baroreflex sensitivity but lower systolic blood pressure and NIHSS values than at Assessment 1; values no longer differed between patients and controls except for lower RRIs and higher respiration rate in patients. Delta NIHSS scores correlated inversely with delta values of RRI SD, RRI coefficient of variance, RMSSDs, RRI low-frequency powers, RRI high-frequency powers, RRI total powers, and baroreflex sensitivity.
In our patients, CAD recovery was almost complete within 72 h after stroke onset and correlated with neurological improvement. Most likely, early initiation of cardiovascular medication and probably attenuating stress supported rapid CAD recovery.
急性中风常导致心血管自主神经功能障碍（CAD）。CAD 恢复的研究结果尚无定论，而中风后心律失常可能在 72 小时内减弱。我们评估了中风后 CAD 是否会在中风发作后 72 小时内恢复，是否与神经功能改善或增加心血管药物使用有关。
在 50 例缺血性中风患者（68±13 岁）中，在入院前无已知疾病且未服用影响自主神经调节的药物，我们评估了 NIHSS 评分、RR 间期（RRIs）、收缩压和舒张压（BP）、呼吸频率、反映总自主神经调节的参数（RRIs SD、RRIs 总功率）、交感神经调节（RRIs 低频功率、收缩压低频功率）和副交感神经调节（RRIs 均方根差的平方根[RMSSD]、RRIs 高频功率）以及中风发作后 24 小时内（评估 1）和 72 小时内（评估 2）的血压反射敏感性，并将数据与 31 名健康对照者（64±10 岁）进行比较。我们将 delta NIHSS 值（评估 1-评估 2）与自主神经参数的 delta 值进行相关性分析（Spearman 等级相关检验；显著性：p<0.05）。
在评估 1 时，患者尚未使用血管活性药物，且收缩压、呼吸频率和心率较高，即 RRIs 较低，但 RRIs SD、RRIs 变异系数、RRIs 低频功率、RRIs 高频功率、RRIs 总功率、RMSSDs 和血压反射敏感性较低。在评估 2 时，患者服用了降压药，RRIs SD、RRIs 变异系数、RRIs 低频功率、RRIs 高频功率、RRIs 总功率、RMSSDs 和血压反射敏感性较高，但收缩压和 NIHSS 值较评估 1 时降低；除了 RRIs 较低和呼吸频率较高外，患者与对照组之间的数值不再有差异。Delta NIHSS 评分与 RRIs SD、RRIs 变异系数、RMSSDs、RRIs 低频功率、RRIs 高频功率、RRIs 总功率和血压反射敏感性的 delta 值呈负相关。
在我们的患者中，中风后 72 小时内 CAD 几乎完全恢复，与神经功能改善有关。很可能是早期开始心血管药物治疗和减轻压力支持 CAD 快速恢复。
