Alshehri Abdulaziz, Panerai Ronney B, Salinet Angela, Lam Man Yee, Llwyd Osian, Robinson Thompson G, Minhas Jatinder S
Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK.
College of Applied Medical Sciences, University of Najran, Najran P.O. Box 1988, Saudi Arabia.
Healthcare (Basel). 2024 May 8;12(10):966. doi: 10.3390/healthcare12100966.
Early differentiation between acute ischaemic (AIS) and haemorrhagic stroke (ICH), based on cerebral and peripheral hemodynamic parameters, would be advantageous to allow for pre-hospital interventions. In this preliminary study, we explored the potential of multiple parameters, including dynamic cerebral autoregulation, for phenotyping and differentiating each stroke sub-type.
Eighty patients were included with clinical stroke syndromes confirmed by computed tomography within 48 h of symptom onset. Continuous recordings of bilateral cerebral blood velocity (transcranial Doppler ultrasound), end-tidal CO (capnography), electrocardiogram (ECG), and arterial blood pressure (ABP, Finometer) were used to derive 67 cerebral and peripheral parameters.
A total of 68 patients with AIS (mean age 66.8 ± SD 12.4 years) and 12 patients with ICH (67.8 ± 16.2 years) were included. The median ± SD NIHSS of the cohort was 5 ± 4.6. Statistically significant differences between AIS and ICH were observed for (i) an autoregulation index (ARI) that was higher in the unaffected hemisphere (UH) for ICH compared to AIS (5.9 ± 1.7 vs. 4.9 ± 1.8 = 0.07); (ii) coherence function for both hemispheres in different frequency bands (AH, < 0.01; UH < 0.02); (iii) a baroreceptor sensitivity (BRS) for the low-frequency (LF) bands that was higher for AIS (6.7 ± 4.2 vs. 4.10 ± 2.13 ms/mmHg, = 0.04) compared to ICH, and that the mean gain of the BRS in the LF range was higher in the AIS than in the ICH (5.8 ± 5.3 vs. 2.7 ± 1.8 ms/mmHg, = 0.0005); (iv) Systolic and diastolic velocities of the affected hemisphere (AH) that were significantly higher in ICH than in AIS (82.5 ± 28.09 vs. 61.9 ± 18.9 cm/s), systolic velocity ( = 0.002), and diastolic velocity ( = 0.05).
Further multivariate modelling might improve the ability of multiple parameters to discriminate between AIS and ICH and warrants future prospective studies of ultra-early classification (<4 h post symptom onset) of stroke sub-types.
基于脑和外周血流动力学参数对急性缺血性卒中（AIS）和出血性卒中（ICH）进行早期鉴别，将有利于开展院前干预。在这项初步研究中，我们探讨了包括动态脑自动调节在内的多个参数对每种卒中亚型进行表型分析和鉴别的潜力。
纳入80例患者，其临床卒中综合征在症状发作后48小时内通过计算机断层扫描得以确诊。使用双侧脑血流速度（经颅多普勒超声）、呼气末二氧化碳（二氧化碳描记法）、心电图（ECG）和动脉血压（ABP，Finometer）进行连续记录以得出67个脑和外周参数。
共纳入68例AIS患者（平均年龄66.8±标准差12.4岁）和12例ICH患者（67.8±16.2岁）。该队列美国国立卫生研究院卒中量表（NIHSS）的中位数±标准差为5±4.6。观察到AIS和ICH之间存在统计学显著差异：（i）自动调节指数（ARI）在ICH的未受影响半球（UH）高于AIS（5.9±1.7对4.9±1.8，P = 0.07）；（ii）不同频段两个半球的相干函数（AH，P < 0.01；UH，P < 0.02）；（iii）AIS的低频（LF）频段压力感受器敏感性（BRS）高于ICH（6.7±4.2对4.10±2.13毫秒/毫米汞柱，P = 0.04），且AIS在LF范围内BRS的平均增益高于ICH（5.8±5.3对2.7±1.8毫秒/毫米汞柱，P = 0.0005）；（iv）ICH中患侧半球（AH）的收缩期和舒张期速度显著高于AIS（82.5±28.09对61.9±18.9厘米/秒），收缩期速度（P = 0.002），舒张期速度（P = 0.05）。
进一步的多变量建模可能会提高多个参数区分AIS和ICH的能力，值得未来对卒中亚型的超早期分类（症状发作后<4小时）进行前瞻性研究。
