Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany.
Eur Stroke J. 2024 Mar;9(1):226-234. doi: 10.1177/23969873231211166. Epub 2023 Nov 6.
Heart rate turbulence (HRT), an ECG-based marker of autonomic cardiac regulation, has shown high prognostic value in patients with established cardiovascular diseases, while data in patients with acute ischemic stroke are scarce.
The HRT parameters turbulence onset and turbulence slope were analyzed using Holter-ECG recordings from patients with acute ischemic stroke, consecutively enrolled in the prospective observational HEBRAS study. HRT was categorized as normal (category 0; both parameters normal), abnormal (category 1; one parameter abnormal), or severely abnormal (category 2; both parameters abnormal). Outcomes of interest were functional outcome according to modified Rankin Scale (mRS) score at 3 months, mortality at 1 year, newly detected atrial fibrillation (AF), and evidence of focal myocardial fibrosis on cardiovascular MRI.
HRT was assessed in 335 patients in sinus rhythm (median age 69 years, 37% female, median NIHSS score 2 on admission), including 262 (78%) with normal HRT, 47 (14%) with abnormal and 26 (8%) with severely abnormal HRT. Compared with normal HRT, severely abnormal HRT was associated with increased disability [higher mRS] at 3 months (adjusted odds ratio [aOR]: 2.9, 95% confidence interval [CI]: 1.3-6.6), new AF (aOR: 3.5, 95% CI: 1.1-10.6), MRI-detected myocardial fibrosis (aOR: 5.8, 95% CI: 1.3-25.9), but not with mortality at 1 year after stroke (aOR: 3.0, 95% CI: 0.7-13.9). Abnormal HRT was not associated with the analyzed outcomes.
Severely abnormal HRT was associated with increased disability and previously unknown cardiac comorbidities. The potential role of HRT in selecting patients for extended AF monitoring and cardiac imaging should be further investigated.
心率震荡（HRT）是一种基于心电图的自主心脏调节标志物，在已确诊心血管疾病患者中具有较高的预后价值，而在急性缺血性脑卒中患者中的数据则较为有限。
使用连续入选前瞻性 HEBRAS 研究的急性缺血性脑卒中患者的动态心电图记录，分析 HRT 参数震荡起始和震荡斜率。HRT 分为正常（类别 0；两个参数均正常）、异常（类别 1；一个参数异常）或严重异常（类别 2；两个参数均异常）。主要研究终点为 3 个月时改良 Rankin 量表（mRS）评分的功能结局、1 年时的死亡率、新发心房颤动（AF）以及心血管 MRI 上局灶性心肌纤维化的证据。
在窦性节律的 335 例患者中评估了 HRT（中位年龄 69 岁，37%为女性，入院时中位 NIHSS 评分为 2），包括 262 例（78%）HRT 正常、47 例（14%）异常和 26 例（8%）严重异常。与 HRT 正常相比，严重异常 HRT 与 3 个月时残疾程度增加（mRS 较高）相关[校正比值比（aOR）：2.9，95%置信区间（CI）：1.3-6.6]、新发 AF（aOR：3.5，95% CI：1.1-10.6）、MRI 检测到的心肌纤维化（aOR：5.8，95% CI：1.3-25.9），但与卒中后 1 年的死亡率无关（aOR：3.0，95% CI：0.7-13.9）。异常 HRT 与分析结果无关。
严重异常 HRT 与残疾程度增加和以前未知的心脏合并症相关。HRT 在选择需要进行延长性 AF 监测和心脏成像的患者中的潜在作用应进一步研究。
