Stroke Center, Department of Neurology The First Hospital of Jilin University Chang Chun China.
Neuroscience Research Center, Department of Neurology The First Hospital of Jilin University Chang Chun China.
J Am Heart Assoc. 2024 Aug 6;13(15):e034575. doi: 10.1161/JAHA.124.034575. Epub 2024 Jul 18.
Beat-to-beat blood pressure variability (BPV) is based on each heartbeat and represents a dynamic equilibrium process modulated by artery and cardiac involvement of pressure-receptive reflexes. To date, there remains a lack of prospective studies illustrating the clinical value of beat-to-beat BPV within 24 hours of acute ischemic stroke onset.
This study prospectively monitored beat-to-beat blood pressure and heart rate in patients with acute ischemic stroke within 24 hours of onset using a noninvasive plethysmograph and calculated beat-to-beat BPV, heart rate variability, and the cross-correlation baroreflex sensitivity. A modified Rankin Scale score of ≥2 at 90 days was defined as an unfavorable prognosis. Multivariate logistic regression was performed, and the nomogram model was developed by adding the beat-to-beat BPV to the traditional model for predicting prognosis. Beat-to-beat BPV increased significantly in the unfavorable outcome group (<0.05) compared with that in the favorable outcome group, whereas no difference was observed in beat-to-beat heart rate variability and cross-correlation baroreflex sensitivity between both groups (>0.05). Furthermore, beat-to-beat BPV within 24 hours of acute ischemic stroke onset was independently associated with unfavorable outcome at 90 days (<0.005). The addition of beat-to-beat BPV to the traditional model for predicting prognosis enhanced the area under the receiver operating characteristic curve from 0.816 to 0.830.
Increased beat-to-beat BPV within 24 hours of acute ischemic stroke onset was independently associated with a poor prognosis at 90 days and may be a potential predictor for discriminating unfavorable prognosis.
逐搏血压变异性（BPV）基于每个心跳，代表由动脉和心脏压力感受反射参与调节的动态平衡过程。迄今为止，仍然缺乏前瞻性研究表明急性缺血性脑卒中发病后 24 小时内逐搏 BPV 的临床价值。
本研究前瞻性地使用非侵入性体积描记法监测急性缺血性脑卒中发病后 24 小时内患者的逐搏血压和心率，并计算逐搏 BPV、心率变异性和交叉相关压力感受反射敏感性。90 天时改良 Rankin 量表评分≥2 定义为预后不良。进行多变量逻辑回归，并通过向传统模型中添加逐搏 BPV 来开发预测预后的列线图模型。与预后良好组相比，预后不良组的逐搏 BPV 显著增加（<0.05），而两组之间的逐搏心率变异性和交叉相关压力感受反射敏感性无差异（>0.05）。此外，急性缺血性脑卒中发病后 24 小时内的逐搏 BPV 与 90 天的不良预后独立相关（<0.005）。将逐搏 BPV 添加到预测预后的传统模型中，可将受试者工作特征曲线下面积从 0.816 提高到 0.830。
急性缺血性脑卒中发病后 24 小时内逐搏 BPV 的增加与 90 天的不良预后独立相关，可能是预测不良预后的潜在指标。
