Rapid recovery of poststroke cardiac autonomic dysfunction: Causes to be considered.
autonomic recovery
cardiovascular autonomic dysregulation
cardiovascular medication
ischemic stroke
stroke severity
Journal
European journal of neurology
ISSN: 1468-1331
Titre abrégé: Eur J Neurol
Pays: England
ID NLM: 9506311
Informations de publication
Date de publication:
08 2023
08 2023
Historique:
revised:
10
04
2023
received:
27
01
2023
accepted:
12
04
2023
medline:
6
7
2023
pubmed:
9
5
2023
entrez:
9
5
2023
Statut:
ppublish
Résumé
Acute stroke frequently causes cardiovascular-autonomic dysfunction (CAD). Studies of CAD recovery are inconclusive, whereas poststroke arrhythmias may wane within 72 h. We evaluated whether poststroke CAD recovers within 72 h upon stroke onset in association with neurological improvement or increased use of cardiovascular medication. In 50 ischemic stroke patients (68 ± 13 years old) who-prior to hospital-admission-had no known diseases nor took medication affecting autonomic modulation, we assessed National Institutes of Health Stroke Scale (NIHSS) scores, RR intervals (RRIs), systolic and diastolic blood pressure (BP), respiration rate, parameters reflecting total autonomic modulation (RRI SD, RRI total powers), sympathetic modulation (RRI low-frequency powers, systolic BP low-frequency powers), and parasympathetic modulation (square root of mean squared differences of successive RRIs [RMSSD], RRI high-frequency powers), and baroreflex sensitivity within 24 h (Assessment 1) and 72 h after stroke onset (Assessment 2) and compared data to those of 31 healthy controls (64 ± 10 years). We correlated delta NIHSS values (Assessment 1 - Assessment 2) with delta values of autonomic parameters (Spearman rank correlation tests; significance: p < 0.05). At Assessment 1, patients were not yet on vasoactive medication and had higher systolic BP, respiration rate, and heart rate, that is, lower RRIs, but lower RRI SD, RRI coefficient of variance, RRI low-frequency powers, RRI high-frequency powers, RRI total powers, RMSSDs, and baroreflex sensitivity. At Assessment 2, patients were on antihypertensives, had higher RRI SD, RRI coefficient of variance, RRI low-frequency powers, RRI high-frequency powers, RRI total powers, RMSSDs, and baroreflex sensitivity but lower systolic blood pressure and NIHSS values than at Assessment 1; values no longer differed between patients and controls except for lower RRIs and higher respiration rate in patients. Delta NIHSS scores correlated inversely with delta values of RRI SD, RRI coefficient of variance, RMSSDs, RRI low-frequency powers, RRI high-frequency powers, RRI total powers, and baroreflex sensitivity. In our patients, CAD recovery was almost complete within 72 h after stroke onset and correlated with neurological improvement. Most likely, early initiation of cardiovascular medication and probably attenuating stress supported rapid CAD recovery.
Sections du résumé
BACKGROUND AND PURPOSE
Acute stroke frequently causes cardiovascular-autonomic dysfunction (CAD). Studies of CAD recovery are inconclusive, whereas poststroke arrhythmias may wane within 72 h. We evaluated whether poststroke CAD recovers within 72 h upon stroke onset in association with neurological improvement or increased use of cardiovascular medication.
METHODS
In 50 ischemic stroke patients (68 ± 13 years old) who-prior to hospital-admission-had no known diseases nor took medication affecting autonomic modulation, we assessed National Institutes of Health Stroke Scale (NIHSS) scores, RR intervals (RRIs), systolic and diastolic blood pressure (BP), respiration rate, parameters reflecting total autonomic modulation (RRI SD, RRI total powers), sympathetic modulation (RRI low-frequency powers, systolic BP low-frequency powers), and parasympathetic modulation (square root of mean squared differences of successive RRIs [RMSSD], RRI high-frequency powers), and baroreflex sensitivity within 24 h (Assessment 1) and 72 h after stroke onset (Assessment 2) and compared data to those of 31 healthy controls (64 ± 10 years). We correlated delta NIHSS values (Assessment 1 - Assessment 2) with delta values of autonomic parameters (Spearman rank correlation tests; significance: p < 0.05).
RESULTS
At Assessment 1, patients were not yet on vasoactive medication and had higher systolic BP, respiration rate, and heart rate, that is, lower RRIs, but lower RRI SD, RRI coefficient of variance, RRI low-frequency powers, RRI high-frequency powers, RRI total powers, RMSSDs, and baroreflex sensitivity. At Assessment 2, patients were on antihypertensives, had higher RRI SD, RRI coefficient of variance, RRI low-frequency powers, RRI high-frequency powers, RRI total powers, RMSSDs, and baroreflex sensitivity but lower systolic blood pressure and NIHSS values than at Assessment 1; values no longer differed between patients and controls except for lower RRIs and higher respiration rate in patients. Delta NIHSS scores correlated inversely with delta values of RRI SD, RRI coefficient of variance, RMSSDs, RRI low-frequency powers, RRI high-frequency powers, RRI total powers, and baroreflex sensitivity.
CONCLUSIONS
In our patients, CAD recovery was almost complete within 72 h after stroke onset and correlated with neurological improvement. Most likely, early initiation of cardiovascular medication and probably attenuating stress supported rapid CAD recovery.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2488-2497Informations de copyright
© 2023 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.
Références
Rincon F, Dhamoon M, Moon Y, et al. Stroke location and association with fatal cardiac outcomes: northern Manhattan study (NOMAS). Stroke. 2008;39(9):2425-2431.
Soros P, Hachinski V. Cardiovascular and neurological causes of sudden death after ischaemic stroke. Lancet Neurol. 2012;11(2):179-188.
Kallmünzer B, Breuer L, Kahl N, et al. Serious cardiac arrhythmias after stroke: incidence, time course, and predictors-a systematic, prospective analysis. Stroke. 2012;43(11):2892-2897.
Sposato LA, Riccio PM, Hachinski V. Poststroke atrial fibrillation: cause or consequence? Critical review of current views. Neurology. 2014;82(13):1180-1186.
Sposato LA, Hilz MJ, Aspberg S, et al. Post-stroke cardiovascular complications and neurogenic cardiac injury: JACC state-of-the-art review. J Am Coll Cardiol. 2020;76(23):2768-2785. doi:10.1016/j.jacc.2020.10.009
Benarroch EE. The central autonomic network. In: Low PA, ed. Clinical Autonomic Disorders. 2nd ed. Lippincott-Raven Publishers; 1997:17-23.
Dütsch M, Burger M, Dorfler C, Schwab S, Hilz MJ. Cardiovascular autonomic function in poststroke patients. Neurology. 2007;69(24):2249-2255.
Hilz MJ, Schwab S. Stroke-induced sudden-autonomic death: areas of fatality beyond the insula. Stroke. 2008;39(9):2421-2422.
Korpelainen JT, Sotaniemi KA, Huikuri HV, Myllya VV. Abnormal heart rate variability as a manifestation of autonomic dysfunction in hemispheric brain infarction. Stroke. 1996;27(11):2059-2063.
Micieli G, Cavallini A. The autonomic nervous system and ischemic stroke: a reciprocal interdependence. Clin Auton Res. 2008;18(6):308-317.
Hilz MJ, Moeller S, Akhundova A, et al. High NIHSS values predict impairment of cardiovascular autonomic control. Stroke. 2011;42(6):1528-1533.
Wang R, Köhrmann M, Kollmar R, et al. Cardiovascular medication seems to promote recovery of autonomic dysfunction after stroke. J Neurol. 2022;269(10):5454-5465.
Xiong L, Leung HH, Chen XY, et al. Comprehensive assessment for autonomic dysfunction in different phases after ischemic stroke. Int J Stroke. 2013;8(8):645-651.
Orlandi G, Fanucchi S, Strata G, et al. Transient autonomic nervous system dysfunction during hyperacute stroke. Acta Neurol Scand. 2000;102(5):317-321.
Kasner SE. Clinical interpretation and use of stroke scales. Lancet Neurol. 2006;5(7):603-612.
Bogert LW, van Lieshout JJ. Non-invasive pulsatile arterial pressure and stroke volume changes from the human finger. Exp Physiol. 2005;90(4):437-446.
Task Force of the European Society of Cardiology and the north American Society of Pacing and Electrophysiology. Heart rate variability: standards of measurement, physiological interpretation, and clinical use. Circulation. 1996;93:1043-1065.
Rudiger H, Klinghammer L, Scheuch K. The trigonometric regressive spectral analysis-a method for mapping of beat-to-beat recorded cardiovascular parameters on to frequency domain compared with Fourier transformation. Comput Methods Programs Biomed. 1999;58:1-15.
Scheitz JF, Nolte CH, Doehner W, Hachinski V, Endres M. Stroke-heart syndrome: clinical presentation and underlying mechanisms. Lancet Neurol. 2018;17(12):1109-1120. doi:10.1016/S474-4422(18)30336-3
Hilz MJ, DeFina PA, Anders S, et al. Frequency analysis unveils cardiac autonomic dysfunction after mild traumatic brain injury. J Neurotrauma. 2011;28(9):1727-1738. doi:10.1089/neu.2010.1497
Sykora M, Czosnyka M, Liu X, et al. Autonomic impairment in severe traumatic brain injury: a multimodal Neuromonitoring study. Crit Care Med. 2016;44(6):1173-1181. doi:10.1097/CCM.0000000000001624
Samuels MA. The brain-heart connection. Circulation. 2007;116(1):77-84. doi:10.1161/CIRCULATIONAHA.106.678995
La Rovere MT, Bersano C, Gnemmi M, Specchia G, Schwartz PJ. Exercise-induced increase in baroreflex sensitivity predicts improved prognosis after myocardial infarction. Circulation. 2002;106(8):945-949. doi:10.1161/01.cir.0000027565.12764.e1
Jurca R, Church TS, Morss GM, Jordan AN, Earnest CP. Eight weeks of moderate-intensity exercise training increases heart rate variability in sedentary postmenopausal women. Am Heart J. 2004;147(5):e21. doi:10.1016/j.ahj.2003.10.024
Gray LJ, Ali M, Lyden PD, Bath PM. Interconversion of the National Institutes of Health stroke scale and Scandinavian stroke scale in acute stroke. J Stroke Cerebrovasc Dis. 2009;18(6):466-468. doi:10.1016/j.jstrokecerebrovasdis.2009.02.003
Winder K, Linker RA, Seifert F, et al. Cerebral lesion correlates of sympathetic cardiovascular activation in multiple sclerosis. Hum Brain Mapp. 2019;40(17):5083-5093. doi:10.1002/hbm.24759
Winder K, Seifert F, Köhrmann M, et al. Lesion mapping of stroke-related erectile dysfunction. Brain. 2017;140(6):1706-1717. doi:10.1093/brain/awx080
Winder K, Linker RA, Seifert F, et al. Neuroanatomic correlates of female sexual dysfunction in multiple sclerosis. Ann Neurol. 2016;80(4):490-498. doi:10.1002/ana.24746 Epub 2016 Aug 19.
Goldstein DS. Stress and the “extended” autonomic system. Auton Neurosci. 2021;236:102889. doi:10.1016/j.autneu.2021.102889
Müller HHO, Czwalinna K, Wang R, et al. Occurence of post-traumatic stress symptoms, anxiety and depression in the acute phase of transient ischemic attack and stroke. Psychiatry Q. 2021;92:905-915.
Pedowitz E, Derby L, Cruz GJ, Trainor A, Edmondson D, Cornelius T. Relationship between NIH stroke symptoms and post-traumatic stress disorder in patients evaluated for transient ischemic attack/stroke. Gen Hosp Psychiatry. 2021;70:98-102. doi:10.1016/j.genhosppsych.2021.03.004
Brys M, Brown CM, Marthol H, Franta R, Hilz MJ. Dynamic cerebral autoregulation remains stable during physical challenge in healthy persons. Am J Physiol Heart Circ Physiol. 2003;285(3):H1048-H1054.
Durocher JJ, Klein JC, Carter JR. Attenuation of sympathetic baroreflex sensitivity during the onset of acute mental stress in humans. Am J Physiol Heart Circ Physiol. 2011;300(5):H1788-H1793. doi:10.1152/ajpheart.00942.2010
Lucini D, Norbiato G, Clerici M, Pagani M. Hemodynamic and autonomic adjustments to real life stress conditions in humans. Hypertension. 2002;39(1):184-188. doi:10.1161/hy0102.100784
Pagani M, Rimoldi O, Pizzinelli P, et al. Assessment of the neural control of the circulation during psychological stress. J Auton Nerv Syst. 1991;35(1):33-41. doi:10.1016/0165-1838(91)90036-3
Langhorne P, Ramachandra S. Organised inpatient (stroke unit) care for stroke: network meta-analysis. Cochrane Database Syst Rev. 2020;4(4):CD000197. doi:10.1002/14651858.CD000197.pub4
Grassi G, Seravalle G, Stella ML, Turri C, Zanchetti A, Mancia G. Sympathoexcitatory responses to the acute blood pressure fall induced by central or peripheral antihypertensive drugs. Am J Hypertens. 2000;13(1 Pt 1):29-34. doi:10.1016/s0895-7061(99)00150-8
Gilsbach R, Hein L. Are the pharmacology and physiology of α₂ adrenoceptors determined by α₂-heteroreceptors and autoreceptors respectively? Br J Pharmacol. 2012;165(1):90-102. doi:10.1111/j.476-5381.2011.01533.x
Ramage AG. Influence of 5-HT1A receptor agonists on sympathetic and parasympathetic nerve activity. J Cardiovasc Pharmacol. 1990;15(Suppl 7):S75-S85.
Eckberg DL, Sleight P. Human Baroreflexes in Health and Disease. Oxford University Press; 1992.
Belkin MR, Schwartz TL. Alpha-2 receptor agonists for the treatment of posttraumatic stress disorder. Drugs Context. 2015;8:212286. doi:10.7573/dic.212286
Parati G, Esler M. The human sympathetic nervous system: its relevance in hypertension and heart failure. Eur Heart J. 2012;33(9):1058-1066. doi:10.1093/eurheartj/ehs041
van Zwieten PA. Modulation of sympathetic outflow by centrally acting antihypertensive drugs. Cardiovasc Drugs Ther. 1996;10(Suppl 1):283-289. doi:10.1007/BF00120498
Bousquet P, Feldman J. Drugs acting on imidazoline receptors: a review of their pharmacology, their use in blood pressure control and their potential interest in cardioprotection. Drugs. 1999;58(5):799-812. doi:10.2165/00003495-199958050-00003
Giustino TF, Fitzgerald PJ, Maren S. Revisiting propranolol and PTSD: memory erasure or extinction enhancement? Neurobiol Learn Mem. 2016;130:26-33. doi:10.1016/j.nlm.2016.01.009
Keller S, Frishman WH. Neuropsychiatric effects of cardiovascular drug therapy. Cardiol Rev. 2003;11(2):73-93. doi:10.1097/01.CRD.0000053453.89776.2D
MacCormack JK, Gaudier-Diaz MM, Armstrong-Carter EL, et al. Beta-adrenergic blockade blunts inflammatory and antiviral/antibody gene expression responses to acute psychosocial stress. Neuropsychopharmacology. 2021;46(4):756-762. doi:10.1038/s41386-020-00897-0
Head GA, Chan CK, Burke SL. Relationship between imidazoline and alpha2-adrenoceptors involved in the sympatho-inhibitory actions of centrally acting antihypertensive agents. J Auton Nerv Syst. 1998;72(2-3):163-169. doi:10.1016/s0165-1838(98)00101-5
Hindricks G, Potpara T, Dagres N, et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European heart rhythm association (EHRA) of the ESC. Eur Heart J. 2021;42(5):373-498.
Jimenez-Ruiz A, Racosta JM, Kimpinski K, Hilz MJ, Sposato LA. Cardiovascular autonomic dysfunction after stroke. Neurol Sci. 2021;42(5):1751-1758.