Prediction of early secondary complications in patients with spontaneous subarachnoid hemorrhage based on accelerated sympathovagal ratios

Su, I‐Chang; Li, Chien-Hsun; Wang, Kuo-Chuan; Lai, Dar‐Ming; Huang, Sheng‐Jean; Shieh, Jiann-Shing; Tu, Yong Kwang

doi:10.1007/s00701-009-0517-9

Cited by 21 publications

(26 citation statements)

References 20 publications

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“…After full article review, 22 studies met the inclusion criteria (http://onlinelibrary.wiley.com/doi/10.1111/ijs.12573/suppinfo) . Ten studies examined HRV and 11 reported on BRS in acute stroke patients. One study examined both parameters .…”

Section: Resultsmentioning

confidence: 99%

“…Thirteen studies included patients with ischemic stroke only (7,11,12,16,21,23,24,26,27,31,32,34,35); five of them focused on middle cerebral artery (MCA) strokes (7,16,21,34,35). Three studies exclusively examined patients with intracerebral hemorrhages (10,28,33) and one study focused on subarachnoid hemorrhages (30). Five studies included multiple stroke subtypes (8,20,22,25,29).…”

Section: Resultsmentioning

confidence: 99%

“…Five studies had a retrospective design (8,10,(33)(34)(35) and prospective data collection was done in 17 studies (7,11,12,16,(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)). Short-term HRV registration (analysis of 5-10 min segments) was performed in six studies (7,11,21,25,30,35); five studies used long-term (20-24 h) recording (12,16,22,26,31). BRS was assessed by short-term registration using beat-to-beat finger arterial pressure monitoring devices in all studies.…”

Section: Datamentioning

confidence: 99%

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Heart Rate Variability and Baroreceptor Sensitivity in Acute Stroke: A Systematic Review

Yperzeele

Hooff

Nagels

et al. 2015

International Journal of Stroke

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Cardiac autonomic dysfunction, represented by reduced heart rate variability or impaired baroreceptor sensitivity, is associated with stroke severity, early and late complications, dependency, and mortality. Large-scale prospective studies applying internationally accepted standards of measures for analysis of heart rate variability and baroreceptor sensitivity are needed in patients with acute stroke.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Datamentioning

confidence: 99%

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Heart Rate Variability and Baroreceptor Sensitivity in Acute Stroke: A Systematic Review

Yperzeele

Hooff

Nagels

et al. 2015

International Journal of Stroke

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“…Sympathetic over-activation has been identified in patients with subarachnoid hemorrhage [18] and is associated with neurogenic cardiomyopathy [19] and other complications [20]. In patients with acute cerebral infarction, increased serum norepinephrine levels have been associated with poor outcome at one year [21].…”

Section: Discussionmentioning

confidence: 99%

β-Blockers associated with no class-specific survival benefit in acute intracerebral hemorrhage

Shoup

Winkler

Czap

et al. 2014

Journal of the Neurological Sciences

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Objectives-Despite the high mortality, there is currently no specific treatment for intracerebral hemorrhage (ICH). Research investigating optimum degree of blood pressure control in patients presenting with ICH and hypertension is ongoing. However, there is limited understanding of the potential benefits of specific classes of antihypertensive therapy. β-Adrenergic antagonists may provide neuroprotection from inflammation-induced injury by inhibiting sympathetic nervous system mediated immune activation. We examined mortality in ICH patients receiving β-adrenergic antagonists to determine whether this class of antihypertensive therapy was associated with improved survival.Methods-A retrospective analysis of a large, prospectively collected database of patients presenting with acute ICH was performed. Patients were grouped by inpatient β-blocker treatment to determine an effect on mortality during the inpatient stay and at 3 months of follow-up. Additional analysis was conducted comparing β-blocker therapy to any other antihypertensive treatment to determine a class-specific association of β-blocker treatment with mortality.Results-The study population included 426 patients with acute, spontaneous ICH. Inpatient β-blocker use was independently associated with decreased rates of inpatient death and mortality at 3 months of follow-up. However, univariate and multivariable analyses comparing β-blocker use to other antihypertensives failed to show any class-specific reduction in mortality at either time point. HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptDiscussion-Our study demonstrates that the improvement seen in patients treated with β-adrenergic antagonists is not an effect unique to this class. This supports ongoing trials to determine optimum levels of blood pressure control using multiple classes of antihypertensives.

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“…It is unclear whether similar mechanisms are at play in seizures following brain injury in humans, as baseline metabolism is altered, waves of spreading depolarization, spreading ischemia, and spreading convulsions are frequent, and vasoreactivity is frequently abnormal . Furthermore, impairment of the autonomic nervous system, including tachycardia and tachypnea, are common after acute brain injury, which may impair typically observed compensatory responses for seizures such as those seen in epilepsy patients…”

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confidence: 99%

Nonconvulsive seizures after subarachnoid hemorrhage: Multimodal detection and outcomes

Claassen

Perotte

Albers

et al. 2013

Annals of Neurology

167

153

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Objective Seizures have been implicated as a cause of secondary brain injury, but the systemic and cerebral physiologic effects of seizures after acute brain injury are poorly understood. Methods We analyzed intracortical EEG and multimodality physiological recordings in 48 comatose subarachnoid hemorrhage patients to better characterize the physiological response to seizures after acute brain injury. Results Intracortical seizures were seen in 38% of patients and 8% had surface seizures. Intracortical seizures were accompanied by elevated heart rate (P=0.001), blood pressure (P<0.001), and respiratory rate (P<0.001). There were trends for rising cerebral perfusion pressure (P=0.03) and intracranial pressure (P =0.06) seen after seizure onset. Intracortical seizure associated increases in global brain metabolism, partial brain tissue oxygenation, and regional cerebral blood flow (rCBF) did not reach significance, but a trend for a pronounced delayed rCBF rise was seen for surface seizures (P=0.08). Functional outcome was very poor for patients with severe background attenuation without seizures and best for those without severe attenuation or seizures (77% vs. 0% dead or severely disabled, respectively). Outcome was intermediate for those with seizures independent of the background EEG and worse for those with intracortical only seizures when compared to those with intracortical and scalp seizures (50% and 25% death or severe disability, respectively). Interpretation We replicated in humans complex physiologic processes associated with seizures after acute brain injury previously described in laboratory experiments and illustrated differences such as the delayed increase in regional cerebral blood flow. These real-world physiologic observations may permit more successful translation of laboratory research to the bedside.

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Prediction of early secondary complications in patients with spontaneous subarachnoid hemorrhage based on accelerated sympathovagal ratios

Abstract: This study confirmed that during early SAH period, patients with and without complications presented different patterns of sympathovagal changes. LF/HF slope during the first 3 days was a significant predictor of secondary complications after SAH.

Cited by 21 publications

References 20 publications

Heart Rate Variability and Baroreceptor Sensitivity in Acute Stroke: A Systematic Review

Heart Rate Variability and Baroreceptor Sensitivity in Acute Stroke: A Systematic Review

β-Blockers associated with no class-specific survival benefit in acute intracerebral hemorrhage

Nonconvulsive seizures after subarachnoid hemorrhage: Multimodal detection and outcomes

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