Abstract
Background: Acute ischemic stroke (AIS) is associated with autonomic dysfunction. We evaluated the prognostic value of heart rate variability (HRV) and the role of stroke localization and reperfusion treatment (RT) on autonomic control. Methods: Patients with AIS and sinus rhythm were enrolled in the emergency department. Autonomic parameters were recorded at the onset and after a potential RT. Neurological deficit was assessed using the National Institute of Health Stroke Scale (NIHSS) at the onset and residual disability with modified Rankin Scale (mRS) at 3 months. Two analyses were used to assess HRV. Low frequency (LF) and high frequency (HF) are, respectively, markers of sympathetic and respiratory vagal modulation in spectral analysis. Symbolic analysis provides pattern with no variation (0V%) as an index of sympathetic modulation and pattern with two like variations (2LV%) and pattern with two unlike variations (2UV%) as markers of vagal modulation. Results: We enrolled 41 patients. Twenty-seven underwent RT. A prevalent parasympathetic modulation was found in patients with NIHSS ≥14. The group with mRS 3–6 exhibited a higher 2UV% and lower 0V%. Right-sided strokes were associated with a higher respiratory vagal control. RT had no effects on HRV parameters. Conclusions: In the very early phases of AIS, a decreased 0V% and an increased 2UV% may reflect a loss of sympathetic oscillation, predicting a poorer 3 month-outcome.
Highlights
Acute ischemic stroke (AIS) is one of the major causes of disability and mortality worldwide and it is expected to increase in the years, due to the aging of the population [1]
The Spectral analysis (SpA) identifies three main rhythmic components: (a) very low frequency (VLF), frequency band bounded between 0.003–0.04 Hz, marker of humoral and hormonal activity; (b) low frequency component (LF), frequency band bounded between 0.04–0.15 Hz, marker of sympathetic modulation, and (c) high frequency component (HF), frequency band between 0.15–0.4 Hz, marker of vagal modulation and synchronous with respiration
These results suggest that vagus is over-modulated by respiratory inputs while the sympathetic branch is those found by Graff et al, who reported that a greater HF and a lower Low frequency (LF)/HF were associated with a worse 90-days outcome in patients with ischemic lesions [33]
Summary
Acute ischemic stroke (AIS) is one of the major causes of disability and mortality worldwide and it is expected to increase in the years, due to the aging of the population [1]. Several studies have shown an altered HRV in patients with AIS compared to controls [10,11,12] and few studies investigated the prognostic effects of HRV parameters in AIS patients, with contrasting results [13,14,15,16] Another challenging question concerns the possible implication of specific ischemic areas in this process. Our study aimed to evaluate the prognostic role of HRV parameters on neurological outcomes, using both linear and non-linear approaches for the analysis of autonomic control, taking into account the site of the lesion
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