The Effect of Stroke Subtypes on Baroreceptor Sensitivity, a Predict for Acute Stroke Outcome.

Wan-Chen Tsai,Yun-Ru Lai,Chih-Cheng Huang,Yu-Jih Su,Ben-Chung Cheng,Nai-Wen Tsai,Cheng-Hsien Lu,Chih-Min Su,Che-Wei Hsu,Hung-Chen Wang,Wen-Neng Chang,Wei-Che Lin,Hui-Chen Lin

doi:10.1155/2019/7614828

Abstract

Background Reduced baroreflex sensitivity (BRS) has been reported in patients with acute cardiovascular events. We tested the hypothesis that BRS varies in different subtypes of acute ischemic stroke (AIS) and that BRS is a predictor of clinical outcomes. Methods We examined autonomic parameters in 34 patients with AIS, including the small deep hemisphere infarction, the large hemisphere infarction, and the brainstem infarction groups on Day 1, Day 7, and Day 30 after AIS. Autonomic parameters were also evaluated in 18 age- and sex-matched healthy volunteers as a control group. The clinical outcomes were analyzed using the modified Rankin scale at 30 days after stroke. Results The BRS, Valsalva ratio, and heart rate response to deep breathing (HR-DB) were significantly lower in patients after AIS on admission than in controls (p<0.01). The frequency domain of HRV (LF/HF ratio) was significantly increased in patients after AIS compared to controls (p<0.05). BRS was significantly reduced in patients with large hemisphere infarction or brainstem infarction compared to patients with small deep hemisphere infarction on Day 1 after AIS (p<0.01). Stepwise logistic regression showed that the levels of BRS and NIHSS are prognostic factors of 1-month outcomes in patients with AIS. Conclusion Beside NIHSS score on admission, BRS is a potential prognostic factor of 1-month outcomes in patients with AIS. Patients with large hemisphere infarction or brainstem infarction have more blunting BRS than do those with lacunar infarction, which provides some insight into which patients may be expected to have a poor outcome.

Highlights

Autonomic dysfunction is a common complication of acute ischemic stroke (AIS) [1, 2]
Previous studies have shown that autonomic dysfunction, including increased sympathetic activity and reduced baroreflex, may increase susceptibility to sudden death and predict adverse clinical outcomes after AIS [3, 4]
The possible mechanisms associated with autonomic impairment and poor outcome in AIS include increased cardiovascular events and progression of secondary brain

Summary

Introduction

Autonomic dysfunction is a common complication of acute ischemic stroke (AIS) [1, 2]. The areas of the CAN include the insular cortex, anterior cingulate cortex, amygdala, hypothalamus, periaqueductal gray, parabrachial nucleus, nucleus of the solitary tract, ventrolateral reticular formation of the medulla, and medullary raphe [6]. These areas generate stimulus-specific patterns of autonomic and neuroendocrine responses [7]. We examined autonomic parameters in 34 patients with AIS, including the small deep hemisphere infarction, the large hemisphere infarction, and the brainstem infarction groups on Day 1, Day 7, and Day 30 after AIS. BRS was significantly reduced in patients with large hemisphere infarction or brainstem infarction compared to patients with small deep hemisphere infarction on Day 1 after AIS (p

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Conclusion