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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: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Olma MC, Tütüncü S, Fiessler C, Kunze C, Krämer M, Steindorf‐Sabath L, Jawad‐Ul‐Qamar M, Kirchhof P, Laufs U, Schurig J, Kraft P, Röther J, Günther A, Thomalla G, Dimitrijeski B, Nabavi DG, Veltkamp R, Heuschmann PU, Haeusler KG, Endres M. In-Hospital ECG Findings, Changes in Medical Management, and Cardiovascular Outcomes in Patients With Acute Stroke or Transient Ischemic Attack. J Am Heart Assoc 2023; 12:e027149. [PMID: 36628982 PMCID: PMC9939074 DOI: 10.1161/jaha.122.027149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background In patients with acute ischemic stroke, little is known regarding the frequency of abnormal ECG findings other than atrial fibrillation and their association with cardiovascular outcomes. We aim to analyze the frequency and type of abnormal ECG findings, subsequent changes in medical treatment, and their association with cardiovascular outcomes in patients with acute ischemic stroke. Methods and Results In the investigator-initiated multicenter MonDAFIS (impact of standardized monitoring for detection of atrial fibrillation in ischemic stroke) study, 3465 patients with acute ischemic stroke or transient ischemic attack and without known atrial fibrillation were randomized 1:1 to receive Holter-ECG for up to 7 days in-hospital with systematic evaluation in a core cardiology laboratory (intervention group) or standard diagnostic care (control group). Outcomes included predefined abnormal ECG findings (eg, pauses, atrial fibrillation, brady-/tachycardias), medical management in the intervention group, and combined vascular end point (recurrent stroke, myocardial infarction, major bleeds, or all-cause death) and mortality at 24 months in both randomization groups. Predefined abnormal ECG findings were detected in 326 of 1693 (19.3%) patients in the intervention group. Twenty of these 326 patients (6.1%) received a pacemaker, and 62 of 326 (19.0%) patients had newly initiated or discontinued β-blocker medication. Discontinuation of β-blockers was associated with a higher death rate in the control group than in the intervention group during 24 months after enrollment (adjusted hazard ratio, 11.0 [95% CI, 2.4-50.4]; P=0.025 for interaction). Conclusions Systematic in-hospital Holter ECG reveals abnormal findings in 1 of 5 patients with acute stroke, and mortality was lower at 24 months in patients with systematic ECG recording in the hospital. Further studies are needed to determine the potential impact of medical management of abnormal ECG findings. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02204267.
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Affiliation(s)
- Manuel C. Olma
- Center for Stroke Research BerlinCharité ‐ Universitätsmedizin BerlinBerlinGermany
- Berlin Institute of Health (BIH)BerlinGermany
| | - Serdar Tütüncü
- Center for Stroke Research BerlinCharité ‐ Universitätsmedizin BerlinBerlinGermany
| | - Cornelia Fiessler
- Institute of Clinical Epidemiology and BiometryUniversity WürzburgWürzburgGermany
| | - Claudia Kunze
- Center for Stroke Research BerlinCharité ‐ Universitätsmedizin BerlinBerlinGermany
| | - Michael Krämer
- Center for Stroke Research BerlinCharité ‐ Universitätsmedizin BerlinBerlinGermany
| | | | - Muhammad Jawad‐Ul‐Qamar
- Institute of Cardiovascular SciencesCollege of Medical and Dental Sciences, Medical SchoolUniversity of BirminghamBirminghamUnited Kingdom
| | - Paulus Kirchhof
- Institute of Cardiovascular SciencesCollege of Medical and Dental Sciences, Medical SchoolUniversity of BirminghamBirminghamUnited Kingdom
- University Heart and Vascular Center HamburgHamburgGermany
- German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/LübeckHamburgGermany
| | - Ulrich Laufs
- Department of CardiologyUniversity Hospital, Leipzig UniversityLeipzigGermany
| | - Johannes Schurig
- Center for Stroke Research BerlinCharité ‐ Universitätsmedizin BerlinBerlinGermany
| | - Peter Kraft
- Department of NeurologyUniversity Hospital WürzburgWürzburgGermany
- Department of NeurologyHospital Main‐Spessart LohrLohr a. MainGermany
| | - Joachim Röther
- Department of NeurologyAsklepios Hospital AltonaHamburgGermany
| | | | - Götz Thomalla
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | | | | | - Roland Veltkamp
- Department of NeurologyAlfried Krupp KrankenhausEssenGermany
- Department of Brain SciencesImperial College LondonLondonUnited Kingdom
| | - Peter U. Heuschmann
- Institute of Clinical Epidemiology and BiometryUniversity WürzburgWürzburgGermany
- Clinical Trial Center WürzburgUniversity Hospital WürzburgWürzburgGermany
| | | | - Matthias Endres
- Center for Stroke Research BerlinCharité ‐ Universitätsmedizin BerlinBerlinGermany
- German Center for Neurodegenerative Diseases (DZNE)Partner Site BerlinBerlinGermany
- German Center for Cardiovascular Research (DZHK)Partner Site BerlinBerlinGermany
- Excellence Cluster NeuroCureBerlinGermany
- Berlin Institute of Health (BIH)BerlinGermany
- Department of Neurology with Experimental NeurologyCharité ‐ Universitätsmedizin BerlinBerlinGermany
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Yao SL, Chen XW, Liu J, Chen XR, Zhou Y. Effect of mean heart rate on 30-day mortality in ischemic stroke with atrial fibrillation: Data from the MIMIC-IV database. Front Neurol 2022; 13:1017849. [DOI: 10.3389/fneur.2022.1017849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe relationship of mean heart rate (MHR) with 30-day mortality in ischemic stroke patients with atrial fibrillation in the intensive care unit (ICU) remains unknown. This study aimed to investigate the association between MHR within 24 h of admission to the ICU and 30-day mortality among patients with atrial fibrillation and ischemic stroke.MethodsThis retrospective cohort study used data on US adults from the Medical Information Mart for Intensive Care-IV (MIMIC-IV, version 1.0) database. Patients with ischemic stroke who had atrial fibrillation for and first time in ICU admission were identified from the MIMIC-IV database. We used multivariable Cox regression models, a restricted cubic spline model, and a two-piecewise Cox regression model to show the effect of the MHR within 24 h of ICU admission on 30-day mortality.ResultsA total of 1403 patients with ischemic stroke and atrial fibrillation (mean [SD] age, 75.9 [11.4] years; mean [SD] heart rate, 83.8[16.1] bpm; 743 [53.0%] females) were included. A total of 212 (15.1%) patients died within 30 days after ICU admission. When MHR was assessed in tertials according to the 25th and 50th percentiles, the risk of 30-day mortality was higher in participants in group 1 (< 72 bpm; adjusted hazard ratio, 1.23; 95% CI, 0.79–1.91) and group 3 (≥82 bpm; adjusted hazard ratio, 1.77; 95% CI, 1.23–2.57) compared with those in group 2 (72–82 bpm). Consistently in the threshold analysis, for every 1-bpm increase in MHR, there was a 2.4% increase in 30-day mortality (adjusted HR, 1.024; 95% CI, 1.01–1.039) in those with MHR above 80 bpm. Based on these results, there was a J-shaped association between MHR and 30-day mortality in ischemic stroke patients with atrial fibrillation admitted to the ICU, with an inflection point at 80 bpm of MHR.ConclusionIn this retrospective cohort study, MHR within 24 h of admission was associated with 30-day mortality (nonlinear, J-shaped association) in patients with ischemic stroke and atrial fibrillation in the ICU, with an inflection point at about 80 bpm and a minimal risk observed at 72 to 81 bpm of MHR. This association was worthy of further investigation. If further confirmed, this association may provide a theoretical basis for formulating the target strategy of heart rate therapy for these patients.
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Shimada T, Shindo A, Imai H, Momosaki R, Suzuki H, Tomimoto H. Relationship between Neurological Deterioration and Blood Pressure/Heart Rate Variability in Patients with Acute Cerebral Infarction. J Stroke Cerebrovasc Dis 2022; 31:106504. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/18/2022] [Accepted: 04/04/2022] [Indexed: 11/17/2022] Open
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Demir A, Eren F. The relationship between age shock index, and severity of stroke and in-hospital mortality in patients with acute ischemic stroke. J Stroke Cerebrovasc Dis 2022; 31:106569. [PMID: 35777082 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/27/2022] [Accepted: 05/15/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Shock index (SI) has been reported to help us predict adverse prognosis in patients with acute ischemic stroke (AIS). However, the prognostic value of age SI and age modified shock index (MSI) in acute ischemic stroke is unknown. In our study, we aimed to examine the association between the severity of the stroke and in-hospital mortality, age SI and age MSI in patients with AIS. METHODS A total of 256 patients were enrolled in this study. The National Institutes of Health Stroke Scale (NIHSS) was used to determine the severity of stroke. Patients were divided into two groups according to the NIHSS score calculated during hospitalization (NIHSS>14: severe disability group, NIHSS<15: moderate and mild disability group). Shock indexes were calculated using the blood pressure and heart rate values measured as a result of the cardiovascular examinations of the patients. We looked for correlations between increased NIHSS and in-hospital mortality with age shock index and age modified shock index. RESULTS Age SI and age MSI values were higher in the severe disability group than those without severe disability, and the results were statistically significant (p<0.001, p<0.001, respectively). Also, a positive correlation was determined between the height of NIHSS and the age SI and the age MSI (p=0.002, r=0.197, p=0.001, r=0.215, respectively). Thirty-two (12.5%) of 256 patients included in the study died during hospitalization. Patients who died were older (77.1±11.0 vs. 67.5±13.5, respectively; p<0.001). According to Point-Biserial correlation analysis, there was a positive correlation between mortality and age SI, and age MSI (p<0.001, r=0.258 ve p<0.001, r=0.274, respectively). CONCLUSIONS As a result of our study, the relationship between stroke severity and increasing age SI and age MSI was significant and there was a positive correlation. In addition, there was a significant and positive relationship between in-hospital mortality and age SI and age MSI.
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Lee JD, Kuo YW, Lee CP, Huang YC, Lee M, Lee TH. Initial in-hospital heart rate is associated with long-term survival in patients with acute ischemic stroke. Clin Res Cardiol 2021; 111:651-662. [PMID: 34687320 PMCID: PMC9151537 DOI: 10.1007/s00392-021-01953-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/13/2021] [Indexed: 11/24/2022]
Abstract
Aims Increased heart rate has been associated with stroke risk and outcomes. The purpose of this study was to explore the long-term prognostic value of initial in-hospital heart rate in patients with acute ischemic stroke (AIS). Methods We analyzed data from 21,655 patients with AIS enrolled (January 2010–September 2018) in the Chang Gung Research Database. Mean initial in-hospital heart rates were averaged and categorized into 10-beat-per-minute (bpm) increments. The primary and secondary outcomes were all-cause mortality and cardiovascular death. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable adjusted Cox proportional hazard models, using the heart rate < 60 bpm subgroup as the reference. Results The adjusted HRs for all-cause mortality were 1.23 (95% CI 1.08–1.41) for heart rate 60–69 bpm, 1.74 (95% CI 1.53–1.97) for heart rate 70–79 bpm, 2.16 (95% CI 1.89–2.46) for heart rate 80–89 bpm, and 2.83 (95% CI 2.46–3.25) for heart rate ≥ 90 bpm compared with the reference group. Likewise, heart rate ≥ 60 bpm was also associated with an increased risk of cardiovascular death (adjusted HR 1.18 [95% CI 0.95–1.46] for heart rate 60–69 bpm, 1.57 [95% CI 1.28–1.93] for heart rate 70–79 bpm, 1.98 [95% CI 1.60–2.45] for heart rate 80–89 bpm, and 2.36 [95% CI 1.89–2.95] for heart rate ≥ 90 bpm). Conclusions High initial in-hospital heart rate is an independent predictor of all-cause mortality and cardiovascular death in patients with AIS. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00392-021-01953-5.
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Affiliation(s)
- Jiann-Der Lee
- Department of Neurology, Chiayi Chang Gung Memorial Hospital, Chiayi, and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ya-Wen Kuo
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan
| | - Chuan-Pin Lee
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yen-Chu Huang
- Department of Neurology, Chiayi Chang Gung Memorial Hospital, Chiayi, and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Meng Lee
- Department of Neurology, Chiayi Chang Gung Memorial Hospital, Chiayi, and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tsong-Hai Lee
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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