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Barkhudaryan A, Doehner W, Jauert N. Autonomic dysfunction after stroke: an overview of recent clinical evidence and perspectives on therapeutic management. Clin Auton Res 2025:10.1007/s10286-025-01120-0. [PMID: 40131648 DOI: 10.1007/s10286-025-01120-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2024] [Accepted: 02/18/2025] [Indexed: 03/27/2025]
Abstract
PURPOSE Central autonomic dysfunction is common in acute stroke and is associated with cardiovascular complications and increased mortality. The aim of this review is to present novel diagnostic and therapeutic approaches to the management of this disorder and the latest data on its impact on the clinical outcome after stroke. METHODS We performed a narrative review of recent literature, with a particular focus on articles related to underlying pathophysiological mechanisms of cardiac autonomic dysregulation, the role of cardiac autonomic dysregulation in the activation of neuroinflammatory response and the development of cardiovascular, respiratory and metabolic complications in patients with ischemic and hemorrhagic stroke. RESULTS The assessment of central autonomic dysfunction by non-invasive diagnostic techniques, including heart rate variability and baroreflex sensitivity, has gained wide practical application in recent years, and they may have a predictive role for evaluating disease prognosis. The emerging evidence derived from recent trials demonstrates that the presence of autonomic imbalance may lead to increased mortality and have an adverse effect on post-stroke rehabilitation. CONCLUSION The early detection and treatment of central autonomic system dysfunction may lead to improved survival of patients with stroke. Among the available therapeutic approaches, neuromodulatory techniques and pharmacological interventions are promising strategies which may be implemented as part of standard acute stroke care to improve patient recovery. Future studies are warranted to address the long-term effects of potential therapeutic agents on the modulation of cardiovascular autonomic function in stroke survivors.
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Affiliation(s)
- Anush Barkhudaryan
- Department of Cardiology, Clinic of General and Invasive Cardiology, University Hospital No. 1, Yerevan State Medical University, Yerevan, Armenia.
- Yerevan Scientific Medical Center, Yerevan, Armenia.
| | - Wolfram Doehner
- Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.
- Berlin Institute of Health-Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, Berlin, Germany.
- Deutsches Herzzentrum der Charité, Department of Cardiology, Campus Virchow, Charité Universitätsmedizin Berlin, Berlin, Germany.
| | - Nadja Jauert
- Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health-Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, Berlin, Germany
- Deutsches Herzzentrum der Charité, Department of Cardiology, Campus Virchow, Charité Universitätsmedizin Berlin, Berlin, Germany
- Division of Physiology, Department of Human Medicine, Medical School Berlin (MSB), Berlin, Germany
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Bari V, Cairo B, Gelpi F, Fancoli F, Curcio N, Matrone G, Righini P, Nano G, Porta A, Mazzaccaro D. Joint Analysis of Cardiovascular Control and Shear Wave Elastography to Determine Carotid Plaque Vulnerability. J Clin Med 2025; 14:648. [PMID: 39860656 PMCID: PMC11766208 DOI: 10.3390/jcm14020648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2024] [Revised: 01/13/2025] [Accepted: 01/14/2025] [Indexed: 01/27/2025] Open
Abstract
Background/Objectives: Carotid artery stenosis (CAS) is one of the main causes of stroke, and the vulnerability of plaque has been proved to be a determinant. A joint analysis of shear wave elastography, a radiofrequency echo-based wall tracking technique for arterial stiffness evaluation, and of autonomic and baroreflex function is proposed to noninvasively, preoperatively assess plaque vulnerability in asymptomatic CAS patients scheduled for carotid endarterectomy. Methods: Elastographic markers of arterial stiffness were derived preoperatively in 78 CAS patients (age: 74.2 + 7.7 years, 27 females). Autonomic and baroreflex markers were also assessed by means of an analysis of the beat-to-beat fluctuations in heart period and systolic arterial pressure, derived at rest in supine position (REST) and during active standing. Postoperative analysis identified 36 patients with vulnerable plaque (VULN) and 42 with stable plaque (STABLE). Results: Baroreflex sensitivity (BRS) at a respiratory rate decreased during STAND only in VULN patients, being much higher at REST compared to STABLE levels. Autonomic indexes were not helpful in separating experimental conditions and/or populations. The Young's modulus (YM) of the plaque was lower in the VULN group than in the STABLE one. Cardiovascular control and elastographic markers were significantly correlated only in VULN patients. A multivariate logistic regression model built combining YM and BRS at the respiratory rate improved the prediction of plaque vulnerability, reporting an area under the ROC curve of 0.694. Conclusions: Noninvasive techniques assessing shear wave elastography and baroreflex control could contribute to the early detection of plaque vulnerability in patients with asymptomatic CAS.
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Affiliation(s)
- Vlasta Bari
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy; (B.C.); (G.N.); (A.P.)
- Department of Cardiothoracic, Vascular Anaesthesia and Intensive Care, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy;
| | - Beatrice Cairo
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy; (B.C.); (G.N.); (A.P.)
| | - Francesca Gelpi
- Department of Cardiothoracic, Vascular Anaesthesia and Intensive Care, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy;
| | - Fabiana Fancoli
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (F.F.); (P.R.); (D.M.)
| | - Nicoletta Curcio
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy;
| | - Giulia Matrone
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, 27100 Pavia, Italy;
| | - Paolo Righini
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (F.F.); (P.R.); (D.M.)
| | - Giovanni Nano
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy; (B.C.); (G.N.); (A.P.)
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (F.F.); (P.R.); (D.M.)
| | - Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy; (B.C.); (G.N.); (A.P.)
- Department of Cardiothoracic, Vascular Anaesthesia and Intensive Care, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy;
| | - Daniela Mazzaccaro
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (F.F.); (P.R.); (D.M.)
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Ma M, Huang T, Ru N, Pan X, Wang D. Effect of blood pressure variability on the outcomes of acute ischemic stroke patients undergoing intravenous thrombolysis. J Clin Neurosci 2025; 131:110935. [PMID: 39591696 DOI: 10.1016/j.jocn.2024.110935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Revised: 11/06/2024] [Accepted: 11/20/2024] [Indexed: 11/28/2024]
Abstract
BACKGROUND There is limited research on the relationship between blood pressure variability (BPV) and outcomes among patients receiving intravenous thrombolysis (IVT) for acute ischemic stroke (AIS). This study aimed to investigate the effect of 24-h BPV on the outcome of patients with AIS treated with IVT. METHODS A retrospective analysis was conducted on clinical data of patients with AIS who had undergone IVT treatment. During the initial 24 h after IVT, various BPV parameters for systolic and diastolic blood pressure were calculated, including the maximum BP, minimum BP, mean BP, standard deviation, coefficient of variation, and average real variability (ARV). Follow-up was conducted at 90 days post-onset, with outcomes classified as "good" or "poor" based on a modified Rankin Scale score of ≤2 or >2, respectively. RESULTS A total of 216 patients were included in the study and divided into two groups based on their outcomes: a good-outcome group (n = 151, 69.9 %) and a poor-outcome group (n = 65, 30.1 %). A comparison of the poor-outcome group with the other group revealed significant differences in age, baseline National Institutes of Health Stroke Scale, Trial of Org 10172 in Acute Stroke Treatment classification, diabetes mellitus, and atrial fibrillation (P < 0.05). The maximum systolic blood pressure (163.58 ± 19.76 vs. 173.91 ± 18.51 mmHg) and average rate of ventricular response (10.35 vs. 12.09) in the good-outcome group were lower than those in the poor-outcome group (all P < 0.05). After adjusting for confounding factors in the binary logistic regression analysis, the maximum systolic blood pressure (odds ratio = 1.023, 95 % confidence interval = 1.004-1.043, P = 0.019] and ARV (odds ratio = 1.103, 95 % confidence interval = 1.007-1.208, P = 0.035) were significantly associated with adverse outcomes. CONCLUSION The maximum systolic blood pressure and mean true variation rate were negatively correlated with outcomes.
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Affiliation(s)
- Mingwei Ma
- Department of the First Affiliated Hospital of Soochow University, 899 Ping hai road, Suzhou, Jiangsu Province, China
| | - Tingting Huang
- Department of the First Affiliated Hospital of Soochow University, 899 Ping hai road, Suzhou, Jiangsu Province, China
| | - Ning Ru
- Department of Fu Yang People's Hospital, 501 Shang qing Road, Yingzhou District, Fuyang, Anhui Province, China.
| | - Xi Pan
- Department of the First Affiliated Hospital of Soochow University, 899 Ping hai road, Suzhou, Jiangsu Province, China.
| | - Dapeng Wang
- Department of the First Affiliated Hospital of Soochow University, 899 Ping hai road, Suzhou, Jiangsu Province, China.
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Roy S, Lam MY, Panerai RB, Robinson TG, Minhas JS. Blood pressure variability at rest and during pressor challenges in patients with acute ischemic stroke. Blood Press Monit 2024; 29:232-241. [PMID: 38841869 DOI: 10.1097/mbp.0000000000000710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
INTRODUCTION Patients with acute ischemic stroke (AIS) have elevated blood pressure (BP) variability (BPV) and reduced baroreflex sensitivity (BRS) at rest for several days after initial stroke symptoms. We aimed to assess BPV and BRS in AIS patients during pressor challenge maneuvers in the acute and subacute phases of stroke. Pressor challenge maneuvers simulate day-to-day activities and can predict the quality of life. METHODS Continuous beat-to-beat BP and ECG in 15 AIS patients (mean age 69 ± 7.5 years) and 15 healthy controls (57 ± 16 years) were recorded at rest and during a 5-min rapid head positioning (RHP) paradigm. Patients were assessed within 24 h (acute phase) and 7 days (subacute phase) of stroke onset. Low frequency (LF) SBP power (measure of BPV), LF-α, and combined α-index (measure of BRS) were calculated from the recordings. RESULTS In the acute phase, at rest, LF-SBP power was higher ( P = 0.024) and α-index was lower ( P = 0.006) in AIS patients than in healthy controls. There was no change in LF-SBP during RHP in the patients but in healthy controls, it increased significantly ( P = 0.018). In the subacute phase, at rest, the alpha-index increased ( P = 0.037) and LF-SBP decreased ( P = 0.029) significantly in the AIS patients, however, there was still no rise in the LF-SBP power during RHP ( P = 0.240). CONCLUSION AIS patients have a high resting BPV. High resting BPV may be responsible for blunted BPV responses during pressor challenge maneuvers such as RHP, suggesting ongoing autonomic dysfunction and compromised quality of life.
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Affiliation(s)
- Sankanika Roy
- Department of Cardiovascular Sciences, University of Leicester
| | - Man Y Lam
- Department of Cardiovascular Sciences, University of Leicester
| | - Ronney B Panerai
- Department of Cardiovascular Sciences, University of Leicester
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Thompson G Robinson
- Department of Cardiovascular Sciences, University of Leicester
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Jatinder S Minhas
- Department of Cardiovascular Sciences, University of Leicester
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
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Wu MJ, Dewi SRK, Hsu WT, Hsu TY, Liao SF, Chan L, Lin MC. Exploring Relationships of Heart Rate Variability, Neurological Function, and Clinical Factors with Mortality and Behavioral Functional Outcome in Patients with Ischemic Stroke. Diagnostics (Basel) 2024; 14:1304. [PMID: 38928719 PMCID: PMC11202750 DOI: 10.3390/diagnostics14121304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 06/10/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Ischemic stroke is a leading cause of mortality and disability. The relationships of heart rate variability (HRV) and stroke-related factors with mortality and functional outcome are complex and not fully understood. Understanding these relationships is crucial for providing better insights regarding ischemic stroke prognosis. The objective of this study is to examine the relationship between HRV, neurological function, and clinical factors with mortality and 3-month behavioral functional outcome in ischemic stroke. We prospectively collected the HRV data and monitored the behavioral functional outcome of patients with ischemic stroke. The behavioral functional outcome was represented by a modified Rankin Scale (mRS) score. This study population consisted of 58 ischemic stroke patients (56.9% male; mean age 70) with favorable (mRS score ≤ 2) and unfavorable (mRS score ≥ 3) outcome. The analysis indicated that the median of the mean RR interval (RR mean) showed no statistical difference between mortality groups. Conversely, the median of the RR mean had significant association with unfavorable outcome (OR = 0.989, p = 0.007). Lower hemoglobin levels had significant association with unfavorable outcome (OR = 0.411, p = 0.010). Higher National Institute of Health Stroke Scale (NIHSS) score at admission had significant association with unfavorable outcome (OR = 1.396, p = 0.002). In contrast, age, stroke history, NIHSS score at admission, and hemoglobin showed no significant association with mortality in ischemic stroke. These results imply that HRV, as indicated by the median of RR mean, alongside specific clinical factors and neurological function at admission (measured by NIHSS score), may serve as potential prognostic indicators for 3-month behavioral functional outcome in ischemic stroke.
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Affiliation(s)
- Mei-Jung Wu
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, New Taipei City 235, Taiwan
- Nursing Department, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
| | - Sari R. K. Dewi
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, New Taipei City 235, Taiwan
| | - Wan-Ting Hsu
- Nursing Department, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
| | - Tien-Yu Hsu
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Sleep Research Center, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Shu-Fen Liao
- Department of Medical Research, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
- School of Public Health, College of Public Health, Taipei Medical University, New Taipei City 235, Taiwan
| | - Lung Chan
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 110, Taiwan
| | - Ming-Chin Lin
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, New Taipei City 235, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 110, Taiwan
- Department of Neurosurgery, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
- Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan
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Alshehri A, Panerai RB, Salinet A, Lam MY, Llwyd O, Robinson TG, Minhas JS. A Multi-Parametric Approach for Characterising Cerebral Haemodynamics in Acute Ischaemic and Haemorrhagic Stroke. Healthcare (Basel) 2024; 12:966. [PMID: 38786378 PMCID: PMC11120760 DOI: 10.3390/healthcare12100966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/22/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND AND PURPOSE 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. METHODS 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 CO2 (capnography), electrocardiogram (ECG), and arterial blood pressure (ABP, Finometer) were used to derive 67 cerebral and peripheral parameters. RESULTS 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 p = 0.07); (ii) coherence function for both hemispheres in different frequency bands (AH, p < 0.01; UH p < 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, p = 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, p = 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 (p = 0.002), and diastolic velocity (p = 0.05). CONCLUSION 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.
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Affiliation(s)
- Abdulaziz Alshehri
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK; (A.A.); (R.B.P.); (A.S.); (M.Y.L.); (T.G.R.)
- College of Applied Medical Sciences, University of Najran, Najran P.O. Box 1988, Saudi Arabia
| | - Ronney B. Panerai
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK; (A.A.); (R.B.P.); (A.S.); (M.Y.L.); (T.G.R.)
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester LE3 9QP, UK
| | - Angela Salinet
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK; (A.A.); (R.B.P.); (A.S.); (M.Y.L.); (T.G.R.)
| | - Man Yee Lam
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK; (A.A.); (R.B.P.); (A.S.); (M.Y.L.); (T.G.R.)
| | - Osian Llwyd
- Wolfson Centre for Prevention of Stroke and Dementia, Department of Clinical Neurosciences, University of Oxford, Oxford OX1 2JD, UK;
| | - Thompson G. Robinson
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK; (A.A.); (R.B.P.); (A.S.); (M.Y.L.); (T.G.R.)
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester LE3 9QP, UK
| | - Jatinder S. Minhas
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK; (A.A.); (R.B.P.); (A.S.); (M.Y.L.); (T.G.R.)
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Orgianelis I, Merkouris E, Kitmeridou S, Tsiptsios D, Karatzetzou S, Sousanidou A, Gkantzios A, Christidi F, Polatidou E, Beliani A, Tsiakiri A, Kokkotis C, Iliopoulos S, Anagnostopoulos K, Aggelousis N, Vadikolias K. Exploring the Utility of Autonomic Nervous System Evaluation for Stroke Prognosis. Neurol Int 2023; 15:661-696. [PMID: 37218981 DOI: 10.3390/neurolint15020042] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/09/2023] [Accepted: 05/15/2023] [Indexed: 05/24/2023] Open
Abstract
Stroke is a major cause of functional disability and is increasing in frequency. Therefore, stroke prognosis must be both accurate and timely. Among other biomarkers, heart rate variability (HRV) is investigated in terms of prognostic accuracy within stroke patients. The literature research of two databases (MEDLINE and Scopus) is performed to trace all relevant studies published within the last decade addressing the potential utility of HRV for stroke prognosis. Only the full-text articles published in English are included. In total, forty-five articles have been traced and are included in the present review. The prognostic value of biomarkers of autonomic dysfunction (AD) in terms of mortality, neurological deterioration, and functional outcome appears to be within the range of known clinical variables, highlighting their utility as prognostic tools. Moreover, they may provide additional information regarding poststroke infections, depression, and cardiac adverse events. AD biomarkers have demonstrated their utility not only in the setting of acute ischemic stroke but also in transient ischemic attack, intracerebral hemorrhage, and traumatic brain injury, thus representing a promising prognostic tool whose clinical application may greatly facilitate individualized stroke care.
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Affiliation(s)
- Ilias Orgianelis
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Ermis Merkouris
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Sofia Kitmeridou
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Dimitrios Tsiptsios
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Stella Karatzetzou
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Anastasia Sousanidou
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Aimilios Gkantzios
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Foteini Christidi
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Efthymia Polatidou
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Anastasia Beliani
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Anna Tsiakiri
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Christos Kokkotis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece
| | - Stylianos Iliopoulos
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece
| | | | - Nikolaos Aggelousis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece
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Park EJ. Association between vitamin B12 status and heart rate variability in patients with ischemic stroke. Medicine (Baltimore) 2023; 102:e33428. [PMID: 37083795 PMCID: PMC10118344 DOI: 10.1097/md.0000000000033428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/13/2023] [Indexed: 04/22/2023] Open
Abstract
Autonomic dysfunction is common in patients with ischemic stroke. An ischemic stroke may induce abnormalities in autonomic tone, resulting in poor heart rate regulation and an increased risk of severe cardiac arrest and sudden death. Heart rate variability (HRV) is a reliable index for evaluating autonomic dysfunction. Vitamin B12 deficiency is frequent among older adults and is a known risk factor for ischemic stroke. As vitamin B12 deficiency affects the peripheral nerves and the central nervous system, it can lead to autonomic dysfunction. However, no study has been published on the correlation between HRV and vitamin B12 status in patients with ischemic stroke. This study aimed to investigate the relationship between HRV and vitamin B12 status and to determine whether the serum vitamin B12 level can be a predictor of HRV parameters. This retrospective study enrolled patients with ischemic stroke between January 2015 and December 2022. The patients underwent serum vitamin B12 level measurements and 24-h Holter monitoring. Pearson correlation analysis was used to investigate the correlation between serum vitamin B12 levels and HRV parameters. The impact of serum vitamin B12 status on HRV parameters was determined using multiple linear regression analysis. A total of 87 patients with ischemic stroke were included in this study. HRV parameters were significantly correlated with serum vitamin B12 status in the frequency domain. In multiple linear regression analysis, the serum vitamin B12 status was a significant predictor of HRV parameters. HRV parameters may be correlated with serum vitamin B12 status in patients with ischemic stroke. Therefore, the serum vitamin B12 status may be a significant predictor of autonomic dysfunction. Our results may provide objective evidence for the impact of serum vitamin B12 status on autonomic dysfunction in patients with ischemic stroke.
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Affiliation(s)
- Eo Jin Park
- Department of Rehabilitation Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
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Aftyka J, Staszewski J, Dębiec A, Pogoda-Wesołowska A, Żebrowski J. Heart rate variability as a predictor of stroke course, functional outcome, and medical complications: A systematic review. Front Physiol 2023; 14:1115164. [PMID: 36846317 PMCID: PMC9947292 DOI: 10.3389/fphys.2023.1115164] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
Background: Heart rate variability (HRV) is a non-invasive marker of autonomic nervous system function that is based on the analysis of length differences between subsequent RR intervals of the electrocardiogram. The aim of this systematic review was to assess the current knowledge gap in the utility of HRV parameters and their value as predictors of the acute stroke course. Methods: A systematic review was performed in accordance with the PRISMA guidelines. Relevant articles published between 1 January 2016 and 1 November 2022 available in the PubMed, Web of Science, Scopus, and Cochrane Library databases were obtained using a systematic search strategy. The following keywords were used to screen the publications: "heart rate variability" AND/OR "HRV" AND "stroke." The eligibility criteria that clearly identified and described outcomes and outlined restrictions on HRV measurement were pre-established by the authors. Articles assessing the relationship between HRV measured in the acute phase of stroke and at least one stroke outcome were considered. The observation period did not exceed 12 months. Studies that included patients with medical conditions influencing HRV with no established stroke etiology and non-human subjects were excluded from the analysis. To minimize the risk of bias, disagreements throughout the search and analysis were resolved by two independent supervisors. Results: Of the 1,305 records obtained from the systematic search based on keywords, 36 were included in the final review. These publications provided insight into the usability of linear and non-linear HRV analysis in predicting the course, complications, and mortality of stroke. Furthermore, some modern techniques, such as HRV biofeedback, for the improvement of cognition performance after a stroke are discussed. Discussion: The present study showed that HRV could be considered a promising biomarker of a stroke outcome and its complications. However, further research is needed to establish a methodology for appropriate quantification and interpretation of HRV-derived parameters.
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Affiliation(s)
- Joanna Aftyka
- Faculty of Physics, Warsaw University of Technology, Warsaw, Poland,*Correspondence: Joanna Aftyka,
| | - Jacek Staszewski
- Clinic of Neurology, Military Institute of Medicine, Warsaw, Poland
| | | | | | - Jan Żebrowski
- Faculty of Physics, Warsaw University of Technology, Warsaw, Poland
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Zhu L, Huang L, Le A, Wang TJ, Zhang J, Chen X, Wang J, Wang J, Jiang C. Interactions between the Autonomic Nervous System and the Immune System after Stroke. Compr Physiol 2022; 12:3665-3704. [PMID: 35766834 DOI: 10.1002/cphy.c210047] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Acute stroke is one of the leading causes of morbidity and mortality worldwide. Stroke-induced immune-inflammatory response occurs in the perilesion areas and the periphery. Although stroke-induced immunosuppression may alleviate brain injury, it hinders brain repair as the immune-inflammatory response plays a bidirectional role after acute stroke. Furthermore, suppression of the systemic immune-inflammatory response increases the risk of life-threatening systemic bacterial infections after acute stroke. Therefore, it is essential to explore the mechanisms that underlie the stroke-induced immune-inflammatory response. Autonomic nervous system (ANS) activation is critical for regulating the local and systemic immune-inflammatory responses and may influence the prognosis of acute stroke. We review the changes in the sympathetic and parasympathetic nervous systems and their influence on the immune-inflammatory response after stroke. Importantly, this article summarizes the mechanisms on how ANS regulates the immune-inflammatory response through neurotransmitters and their receptors in immunocytes and immune organs after stroke. To facilitate translational research, we also discuss the promising therapeutic approaches modulating the activation of the ANS or the immune-inflammatory response to promote neurologic recovery after stroke. © 2022 American Physiological Society. Compr Physiol 12:3665-3704, 2022.
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Affiliation(s)
- Li Zhu
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Leo Huang
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Anh Le
- Washington University in St. Louis, Saint Louis, Missouri, USA
| | - Tom J Wang
- Winston Churchill High School, Potomac, Maryland, USA
| | - Jiewen Zhang
- Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Xuemei Chen
- Department of Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, PR China
| | - Junmin Wang
- Department of Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, PR China
| | - Jian Wang
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China.,Department of Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, PR China
| | - Chao Jiang
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
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Lee Y, Walsh RJ, Fong MWM, Sykora M, Doering MM, Wong AWK. Heart rate variability as a biomarker of functional outcomes in persons with acquired brain injury: Systematic review and meta-analysis. Neurosci Biobehav Rev 2021; 131:737-754. [PMID: 34626686 PMCID: PMC9006352 DOI: 10.1016/j.neubiorev.2021.10.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 01/09/2023]
Abstract
This review aimed to quantify correlations between heart rate variability (HRV) and functional outcomes after acquired brain injury (ABI). We conducted a literature search from inception to January 2020 via electronic databases, using search terms with HRV, ABI, and functional outcomes. Meta-analyses included 16 studies with 906 persons with ABI. Results demonstrated significant associations: Low frequency (LF) (r = -0.28) and SDNN (r = -0.33) with neurological function; LF (r = -0.33), High frequency (HF) (r = -0.22), SDNN (r = -0.22), and RMSSD (r = -0.23) with emotional function; and LF (r = 0.34), HF (r = 0.41 to 0.43), SDNN (r = 0.43 to 0.51), and RMSSD (r = 0.46) with behavioral function. Results indicate that higher HRV is related to better neurological, emotional, and behavioral functions after ABI. In addition, persons with stroke showed lower HF (SMD = -0.50) and SDNN (SMD = -0.75) than healthy controls. The findings support the use of HRV as a biomarker to facilitate precise monitoring of post-ABI functions.
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Affiliation(s)
- Yejin Lee
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, 63110, USA.
| | - Ryan J Walsh
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, 63110, USA.
| | - Mandy W M Fong
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63108, USA.
| | - Marek Sykora
- Department of Neurology, St. John's Hospital, Vienna, Austria; Medical Faculty, Sigmund Freud University, Vienna, Austria; Department of Neurology, Comenius University in Bratislava, Bratislava, Slovakia.
| | - Michelle M Doering
- Bernard Becker Medical Library, Washington University School of Medicine, St. Louis, MO, 63110, USA.
| | - Alex W K Wong
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA; Department of Physical Medicine and Rehabilitation and Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
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Abstract
Perioperative stroke is defined as an ischemic cerebrovascular event that occurs during or within 30 days after surgery and is associated with an increased perioperative risk of morbidity and mortality. Depending on the type of surgery stroke is diagnosed in up to 11% of all patients in the perioperative period. Patients with a history of ischemic stroke or transitory ischemic attack have an increased risk for perioperative stroke. Therefore, a critical assessment of indications and the timing of surgery are crucial to prevent recurring stroke in this patient population. Importantly, individualized blood pressure management is essential for optimization of cerebral perfusion during the perioperative period.This article provides a summary of the epidemiology, risk factors, and etiology of perioperative stroke. Moreover, possible preventive strategies relevant for the anesthesiologist are reviewed.
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Affiliation(s)
- M Fischer
- Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| | - U Kahl
- Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
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