Autonomic dysfunction predicts poor outcome in stroke: Updates on recent autonomic research

Miglis, Mitchell G.; Muppidi, Srikanth

doi:10.1007/s10286-017-0498-3

“…thrombi embolize to the cerebral circulation, leading to severe cerebral infarction. Strokes related to AF are associated with higher mortality and more severe neurologic disability [3][4][5][6].…”

mentioning

confidence: 99%

Prestroke statins use reduces oxidized low density lipoprotein levels and improves clinical outcomes in patients with atrial fibrillation related acute ischemic stroke

He

¹

,

Xu²,

Wang

³

et al. 2019

Preprint

1

0

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Background: Atrial fibrillation (AF) is a common cause of cerebral infarction, which could lead to endothelial dysfunction, increased reactive oxygen species (ROS) and oxidized low density lipoprotein (Ox-LDL).AF is associated with higher mortality and more severe neurologic disability. Statins may exert neuroprotective effects that are independent of LDL-C lowering. The purpose of our study was to investigate whether prestroke statins use could reduce plasma Ox-LDL levels and improve clinical outcomes in patients with AF-related acute ischemic stroke (AIS). Methods: This was a multicenter prospective study that involved four medical centers, 242 AIS patients with AF were identified, who underwent a comprehensive clinical investigation and a 72h-Holter electrocardiogram monitoring. All patients were divided into two groups: prestroke statins use and n o prestroke statins use groups , who were followed up for 3 months. Plasma Ox-LDL levels were measured using enzyme-linked immunosorbent assay (ELISA) on admission and at 3 months. The outcome was death, major disability (modified Rankin Scale score≥3), and composite outcome (death/major disability) at 3 months after AIS. Results: 136 patients were in no prestroke statins use group, and 106 in prestroke statins use group . Plasma Ox-LDL levels were significantly lower in prestroke statins use than in no prestroke statins use on admission and at 3 months (P<0.001). Plasma Ox-LDL levels on admission were associated with 3-month mortality [adjusted odds ratio (OR), 1.05; 95% confidence interval(CI), 0.99-1.12; P=0.047]. In fully adjusted models, prestroke statins use was associated with reduced 3-month mortality [adjusted OR, 0.38; 95% CI, 0.16–0.91; P=0.031)], major disability (adjusted OR, 0.38; 95%CI, 0.15–0.99; P=0.047), and composite outcome (adjusted OR, 0.31; 95% CI,0.17–0.74; P=0.009). Conclusions: Prestroke statins use can reduce plasma Ox-LDL levels and improve clinical outcomes in patients with AF-related AIS.

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“…4,5,6 A cardiac autonomic dysregulation, manifested by an impaired control of blood pressure and heart rate leading to cerebral hypoperfusion and secondary brain injury, may result in the increased susceptibility for post-stroke complications and contribute to an unfavourable functional outcome. 5,7,8 Previous studies have described the development of autonomic imbalance in stroke patients using the analysis of heart rate variability (HRV). 9 The presence of abnormal HRV in patients with stroke has been associated with adverse neurological outcome, post-stroke disability, and all-cause mortality.…”

Section: Introductionmentioning

confidence: 99%

“…There is an evidence of cardiac dysfunction after clinical and experimental stroke 4,5,6 . A cardiac autonomic dysregulation, manifested by an impaired control of blood pressure and heart rate leading to cerebral hypoperfusion and secondary brain injury, may result in the increased susceptibility for post‐stroke complications and contribute to an unfavourable functional outcome 5,7,8 . Previous studies have described the development of autonomic imbalance in stroke patients using the analysis of heart rate variability (HRV) 9 …”

Section: Introductionmentioning

confidence: 99%

Early rehabilitation after stroke: relationship between the heart rate variability and functional outcome

Scherbakov

¹

,

Barkhudaryan

²

,

Ebner

³

et al. 2020

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Aims Impaired autonomic nervous system regulation is frequently observed in patients with stroke. The aim of this prospective study was to evaluate the impact of cardiac autonomic tone on functional outcome after the early post-stroke rehabilitation. Methods and results One hundred and three consecutive patients (67 ± 11 years, body mass index (BMI) 27.1 ± 5.4 kg/m 2 , 64% men) with ischaemic (84% of patients) and haemorrhagic stroke were studied. Depressed heart rate variability (HRV), as a surrogate marker of increased sympathetic tone, was defined by the standard deviation of NN intervals < 100 ms and HRV triangular index ≤ 20 assessed from a 24 h Holter electrocardiogram at admission to rehabilitation (23 ± 16 days after stroke). Twenty-two per cent of patients had depressed HRV at baseline and were comparable with patients with normal HRV with regard to their functional [Barthel Index (BI), modified Rankin Scale (mRS), and Rivermead Motor Assessment (RMA)] and biochemical status. After a 4-week follow-up, 70% of patients with depressed HRV showed a cumulative functional disability, defined by mRS ≥ 4, BI ≤ 70, and RMA ≤ 5, in contrast to patients with normal HRV (35%, P = 0.003). Patients with depressed HRV showed a worse functional status by BI (À16%, P < 0.001), RMA (À12%, P < 0.05), and mRS (+16%, P < 0.01), compared with patients with normal HRV. Cumulative functional disability was associated with depressed HRV (odds ratio 4.25, 95% confidence interval 1.56-11.54, P < 0.005) after adjustment for age, sex, and body mass index (odds ratio 4.6, 95% confidence interval 1.42-14.97, P < 0.05). Conclusions The presence of autonomic cardiovascular dysregulation in patients with subacute stroke was associated with adverse functional outcome after the early post-stroke rehabilitation.

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“…It is believed that prethrombotic forces, along with endothelial dysfunction and blood stasis of AF are the basis of thrombus formation and growth, when large thrombi embolize to the cerebral circulation, leading to severe cerebral infarction. Strokes related to AF are associated with higher mortality and more severe neurologic disability [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Prestroke statins use reduces oxidized low density lipoprotein levels and improves clinical outcomes in patients with atrial fibrillation related acute ischemic stroke

He

¹

,

Xu²,

Wang

³

et al. 2019

Preprint

View full text Add to dashboard Cite

Background: Atrial fibrillation (AF) is a common cause of cerebral infarction, which could lead to endothelial dysfunction, increased reactive oxygen species (ROS) and oxidized low density lipoprotein (Ox-LDL).AF is associated with higher mortality and more severe neurologic disability. Statins may exert neuroprotective effects that are independent of LDL-C lowering. The purpose of our study was to investigate whether prestroke statins use could reduce plasma Ox-LDL levels and improve clinical outcomes in patients with AF-related acute ischemic stroke (AIS). Methods: This was a multicenter prospective study that involved four medical centers, 242 AIS patients with AF were identified, who underwent a comprehensive clinical investigation and a 72h-Holter electrocardiogram monitoring. All patients were divided into two groups: prestroke statins use and n o prestroke statins use groups , who were followed up for 3 months. Plasma Ox-LDL levels were measured using enzyme-linked immunosorbent assay (ELISA) on admission and at 3 months. The outcome was death, major disability (modified Rankin Scale score≥3), and composite outcome (death/major disability) at 3 months after AIS. Results: 136 patients were in no prestroke statins use group, and 106 in prestroke statins use group . Plasma Ox-LDL levels were significantly lower in prestroke statins use than in no prestroke statins use on admission and at 3 months (P<0.001). Plasma Ox-LDL levels on admission were associated with 3-month mortality [adjusted odds ratio (OR), 1.05; 95% confidence interval(CI), 0.99-1.12; P=0.047]. In fully adjusted models, prestroke statins use was associated with reduced 3-month mortality [adjusted OR, 0.38; 95% CI, 0.16–0.91; P=0.031)], major disability (adjusted OR, 0.38; 95%CI, 0.15–0.99; P=0.047), and composite outcome (adjusted OR, 0.31; 95% CI,0.17–0.74; P=0.009). Conclusions: Prestroke statins use can reduce plasma Ox-LDL levels and improve clinical outcomes in patients with AF-related AIS.

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Autonomic dysfunction predicts poor outcome in stroke: Updates on recent autonomic research

Cited by 9 publications

References 8 publications

Prestroke statins use reduces oxidized low density lipoprotein levels and improves clinical outcomes in patients with atrial fibrillation related acute ischemic stroke

Prestroke statins use reduces oxidized low density lipoprotein levels and improves clinical outcomes in patients with atrial fibrillation related acute ischemic stroke

Early rehabilitation after stroke: relationship between the heart rate variability and functional outcome

Prestroke statins use reduces oxidized low density lipoprotein levels and improves clinical outcomes in patients with atrial fibrillation related acute ischemic stroke

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