Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, Kansas, United States.
Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, United States.
J Appl Physiol (1985). 2024 May 1;136(5):1182-1194. doi: 10.1152/japplphysiol.00601.2023. Epub 2024 Mar 14.
Peripheral vascular dysfunction, measured as flow-mediated dilation (FMD), is present across all phases of stroke recovery and elevates the risk for recurrent cardiovascular events. The objective of this systematic review and meta-analysis was to characterize baseline FMD in individuals' poststroke, with consideration for each phase of stroke recovery. Three databases (PubMed, CINAHL, and Embase) were searched between January 1, 2000 and October 12, 2023 for studies that examined baseline FMD in stroke. Three reviewers conducted abstract and full-text screening, data extraction, and quality assessment. A random effects model was used to estimate FMD across studies. Meta-regression was used to examine the impact of age and time since stroke (acute, subacute, chronic) on FMD. Twenty-eight studies with ischemic and hemorrhagic stroke were included. Descriptive statistics for the demographics and FMD values of each study are presented. For the meta-analysis, average estimate FMD was 3.9% (95% CI: 2.5-5.3%). We report a large amount of heterogeneity (Cochrane's Q value <0.001, and = 99.6%). Differences in average age and the time poststroke between studies were not significantly associated with differences in FMD values. Despite the large heterogeneity for FMD values across studies, our primary finding suggests that FMD remains impaired across all phases of stroke. This systematic review and meta-analysis offers invaluable insight into poststroke vascular function. Despite the inherent heterogeneity among the 28 studies analyzed, we report that peripheral vascular dysfunction, as quantified by flow-mediated dilation, exists across all stages of stroke recovery. This finding underscores the importance for interventions that focus on improving vascular health and secondary stroke prevention.
周围血管功能障碍，以血流介导的扩张（FMD）来衡量，存在于中风恢复的所有阶段，并增加了复发性心血管事件的风险。本系统评价和荟萃分析的目的是描述中风后个体的基础 FMD，并考虑中风恢复的每个阶段。在 2000 年 1 月 1 日至 2023 年 10 月 12 日期间，我们在三个数据库（PubMed、CINAHL 和 Embase）中搜索了研究 FMD 的研究。三位评审员进行了摘要和全文筛选、数据提取和质量评估。使用随机效应模型来估算研究之间的 FMD。使用元回归来检查年龄和中风后时间（急性、亚急性、慢性）对 FMD 的影响。纳入了 28 项缺血性和出血性中风的研究。介绍了每项研究的人口统计学和 FMD 值的描述性统计数据。对于荟萃分析，平均估计 FMD 为 3.9%（95%CI：2.5-5.3%）。我们报告了大量的异质性（Cochrane's Q 值<0.001，I²=99.6%）。研究之间平均年龄和中风后时间的差异与 FMD 值的差异没有显著关联。尽管 FMD 值在研究之间存在很大的异质性，但我们的主要发现表明，FMD 在中风的所有阶段都仍然受损。本系统评价和荟萃分析为中风后的血管功能提供了宝贵的见解。尽管分析的 28 项研究存在内在的异质性，但我们报告说，外周血管功能障碍，如血流介导的扩张所量化的，存在于中风恢复的所有阶段。这一发现强调了关注改善血管健康和二级中风预防的干预措施的重要性。
