Abstract TP209: Decreased Heart Rate Variability in Patients With Minor Stroke

Introduction: Minor stroke or transient ischemic attack (TIA) is considered to have little effect on autonomic functions. However, it is unclear whether autonomic dysfunction in patients with minor stroke develops during acute stroke phase. Hypothesis: We evaluated whether patients with minor stroke had autonomic dysfunction during acute stroke phase. Methods: Patients with ischemic stroke or TIA were included. Those with diabetes and urological problems were excluded. Quantitative sudomotor axon reflex test (QSART), head-up tilt test (HUTT), sympathetic skin response (SSR), and heart rate variability (HRV) were performed during admission after acute stroke onset. HRV frequency measurements included time-domain and frequency-domain parameters. We analyzed the difference of autonomic function among patients with minor stroke (NIHSS score ≤ 3), major stroke (NIHSS score≥3) and TIA. Results: Total of 81 patients was included. There were 55 with minor ischemic stroke, 15 with major ischemic stroke, and 11 with TIA. RR interval of HRV was significantly different among three groups (938.8 ± 99.1 ms in TIA, 871.4 ± 104.9 ms in minor stroke, and 832.7 ± 107.8 ms in major stroke, P = 0.042). Parameters of HRV in patients with stroke had significantly lower compared to those with TIA [high frequency (HF) 8.9 ± 3.6 ms2 vs 12.2 ± 5.0 ms2, respectively, P = 0.013; the square root of the mean of the sum of the squares of differences between adjacent NN intervals (RMSSD), 23.5 ± 9.3 ms vs 30.7 ± 11.6 ms, respectively, P = 0.023]. Moreover, HF and RMSSD significantly decreased in patients with minor stroke compared to those with TIA (HF, 8.9 ± 3.6 ms2 vs 12.2 ± 5.0 ms2, respectively, P = 0.038; RMSSD, 23.2 ± 9.4 ms vs 30.7 ± 11.6 ms, respectively, P = 0.05). Results of QSART, HUTT and SSR were not different among three groups. Conclusion: Patients with minor stroke had decreased HRV compared to those with TIA, indicating that even minor stroke could be associated with decreased parasympathetic activity at early stroke phase. Further studies will be needed to evaluate effects of autonomic dysfunction on clinical outcome in patients with minor stroke.

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HRV as predicting the outcome of acute stroke

Bulletin of Siberian Medicine ◽

10.20538/1682-0363-2008-5-2-444-447 ◽

2008 ◽

Vol 7 (5-2) ◽

pp. 444-447

Author(s):

I. M. Utochkina ◽

Yu. S. Shamurov ◽

V. A. Mironov

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Spectral Analysis ◽

Ischemic Stroke ◽

Acute Stroke ◽

Hemorrhagic Stroke ◽

Fatal Outcome ◽

Autonomic Regulation

To study the peculiarities of parameters autonomic regulation at various types of stroke in the acutest and after the acute stroke periods, and also the degrees of their influence on the forecast at stroke are appreciated results of the spectral analysis of heart rate variability in patients with hemorrhagic stroke and ischemic stroke. The indexes of heart rate variability for patients with a fatal outcome are exposed.

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Large Vessel Occlusion in Patients With Minor Ischemic Stroke in a Population-Based Study. The Dijon Stroke Registry

Frontiers in Neurology ◽

10.3389/fneur.2021.796046 ◽

2022 ◽

Vol 12 ◽

Author(s):

Gauthier Duloquin ◽

Valentin Crespy ◽

Pauline Jakubina ◽

Maurice Giroud ◽

Catherine Vergely ◽

...

Keyword(s):

Ischemic Stroke ◽

Arterial Occlusion ◽

Population Based ◽

Large Vessel ◽

Minor Stroke ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Nihss Score ◽

Minor Ischemic Stroke ◽

Arterial Imaging

Introduction:Strategy for the acute management of minor ischemic stroke (IS) with large vessel occlusion (LVO) is under debate, especially the benefits of mechanical thrombectomy. The frequency of minor IS with LVO among overall patients is not well established. This study aimed to assess the proportion of minor IS and to depict characteristics of patients according to the presence of LVO in a comprehensive population-based setting.Methods:Patients with acute IS were prospectively identified among residents of Dijon, France, using a population-based registry (2013–2017). All arterial imaging exams were reviewed to assess arterial occlusion. Minor stroke was defined as that with a National Institutes of Health Stroke Scale (NIHSS) score of <6. Proportion of patients with LVO was estimated in the minor IS population. The clinical presentation of patients was compared according to the presence of an LVO.Results:Nine hundred seventy-one patients were registered, including 582 (59.9%) patients with a minor IS. Of these patients, 23 (4.0%) had a LVO. Patients with minor IS and LVO had more severe presentation [median 3 (IQR 2–5) vs. 2 (IQR 1–3), p = 0.001] with decreased consciousness (13.0 vs. 1.6%, p<0.001) and cortical signs (56.5 vs. 30.8%, p = 0.009), especially aphasia (34.8 vs. 15.4%, p = 0.013) and altered item level of consciousness (LOC) questions (26.1 vs. 11.6%, p = 0.037). In multivariable analyses, only NIHSS score (OR = 1.45 per point; 95% CI: 1.11–1.91, p = 0.007) was associated with proximal LVO in patients with minor IS.Conclusion:Large vessel occlusion (LVO) in minor stroke is non-exceptional, and our findings highlight the need for emergency arterial imaging in any patients suspected of acute stroke, including those with minor symptoms because of the absence of obvious predictors of proximal LVO.

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Abstract WP44: NIHSS Score Components Predict Infarct Volume in Minor Ischemic Stroke Patients

Stroke ◽

10.1161/str.47.suppl_1.wp44 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Shadi Yaghi ◽

Charlotte Herber ◽

Amelia K Boehme ◽

Howard Andrews ◽

Joshua Z Willey ◽

...

Keyword(s):

Ischemic Stroke ◽

Language Disorder ◽

Infarct Volume ◽

Final Diagnosis ◽

Minor Stroke ◽

Lesion Volume ◽

Nihss Score ◽

Therapeutic Implications ◽

Significant Relationships ◽

Minor Ischemic Stroke

Background: Prior studies have shown a correlation between the National Institutes of Health Stroke Scale (NIHSS) score and infarct volume on diffusion weighted imaging (DWI); however data are limited in patients with minor stroke whose treatment is controversial. Our aim is to determine the association between DWI lesion(s) volume and the (1) total NIHSS score and (2) NIHSS components in a population of patients with minor ischemic stroke. Methods: We included all patients with minor stroke (NIHSS 0-5) who were enrolled in the prospective Stroke Warning Information and Faster Treatment (SWIFT) study. All patients were admitted to the hospital with a final diagnosis of stroke. We calculated lesion(s) volume (cm 3 ) on DWI sequence using Medical Image Processing, Analysis, and Visualization (MIPAV, NIH, Version 7.1.1). Based on the distribution of lesion volume, we summarized the explanatory value into median cm 3 . We used non-parametric tests to study the association between the primary outcome, DWI lesion(s) volume, and the predictors (NIHSS score and its components). Results: 894 patients had a discharge diagnosis of ischemic stroke; 709 underwent MRI and 510 were DWI positive. There was a weak graded relationship between NIHSS score and median DWI lesion volume in cm 3 : (NIHSS 0: 7.1, NIHSS 1: 8.0, NIHSS 2: 17.1, NIHSS 3: 11.6, NIHSS 4: 19.0, NIHSS 5: 23.6). We also noted highly significant relationships between lesion volume and certain NIHSS components. Compared to patients without the deficit, the median lesion volume was significantly higher in patients with neglect (105.6 vs. 12.5,p=0.025), language disorder (34.6 vs. 11.9,p<0.001), and visual field deficits (185.6 vs. 11.6,p<0.001). Other components of the NIHSS were not associated with lesion volume. Conclusion: In patients with minor stroke, the nature of the neurological deficit improves prediction of infarct volume when added to the total NIHSS score. This may lead to clinical and therapeutic implications.

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Autonomic dysfunction and heart rate variability with Holter monitoring: a diagnostic look at autonomic regulation

Herzschrittmachertherapie + Elektrophysiologie ◽

10.1007/s00399-021-00780-5 ◽

2021 ◽

Author(s):

Beatrice De Maria ◽

Laura Adelaide Dalla Vecchia ◽

Alberto Porta ◽

Maria Teresa La Rovere

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Autonomic Dysfunction ◽

Holter Monitoring ◽

Autonomic Regulation

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25-Hydroxyvitamin D and Its Relationship with Autonomic Dysfunction Using Time- and Frequency-Domain Parameters of Heart Rate Variability in Korean Populations: A Cross-Sectional Study

Nutrients ◽

10.3390/nu6104373 ◽

2014 ◽

Vol 6 (10) ◽

pp. 4373-4388 ◽

Cited By ~ 6

Author(s):

Young Tak ◽

Jeong Lee ◽

Yun Kim ◽

Sang Lee ◽

Byung Cho

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Frequency Domain ◽

Autonomic Dysfunction ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Hydroxyvitamin D ◽

25 Hydroxyvitamin D

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Elevation of troponin I in acute ischemic stroke

PeerJ ◽

10.7717/peerj.1866 ◽

2016 ◽

Vol 4 ◽

pp. e1866 ◽

Cited By ~ 9

Author(s):

Yu-Chin Su ◽

Kuo-Feng Huang ◽

Fu-Yi Yang ◽

Shinn-Kuang Lin

Keyword(s):

Ischemic Stroke ◽

Hospital Mortality ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Barthel Index ◽

Troponin I ◽

Clinical Deterioration ◽

Stroke Severity ◽

Nihss Score ◽

Poor Outcome

Background. Cardiac morbidities account for 20% of deaths after ischemic stroke and is the second commonest cause of death in acute stroke population. Elevation of cardiac troponin has been regarded as a prognostic biomarker of poor outcome in patients with acute stroke.Methods. This retrospective study enrolled 871 patients with acute ischemic stroke from August 2010 to March 2015. Data included vital signs, laboratory parameters collected in the emergency department, and clinical features during hospitalization. National Institutes of Health Stroke Scale (NIHSS), Barthel index, and modified Rankin Scale (mRS) were used to assess stroke severity and outcome.Results.Elevated troponin I (TnI) > 0.01 µg/L was observed in 146 (16.8%) patients. Comparing to patients with normal TnI, patients with elevated TnI were older (median age 77.6 years vs. 73.8 years), had higher median heart rates (80 bpm vs. 78 bpm), higher median white blood cells (8.40 vs. 7.50 1,000/m3) and creatinine levels (1.40 mg/dL vs. 1.10 mg/dL), lower median hemoglobin (13.0 g/dL vs. 13.7 g/dL) and hematocrit (39% vs. 40%) levels, higher median NIHSS scores on admission (11 vs. 4) and at discharge (8 vs. 3), higher median mRS scores (4 vs3) but lower Barthel index scores (20 vs. 75) at discharge (p< 0.001). Multivariate analysis revealed that age ≥ 76 years (OR 2.25, CI [1.59–3.18]), heart rate ≥ 82 bpm (OR 1.47, CI [1.05–2.05]), evidence of clinical deterioration (OR 9.45, CI [4.27–20.94]), NIHSS score ≥ 12 on admission (OR 19.52, CI [9.59–39.73]), and abnormal TnI (OR 1.98, CI [1.18–3.33]) were associated with poor outcome. Significant factors for in-hospital mortality included male gender (OR 3.69, CI [1.45–9.44]), evidence of clinical deterioration (OR 10.78, CI [4.59–25.33]), NIHSS score ≥ 12 on admission (OR 8.08, CI [3.04–21.48]), and elevated TnI level (OR 5.59, CI [2.36–13.27]).C-statistics revealed that abnormal TnI improved the predictive power of both poor outcome and in-hospital mortality. Addition of TnI > 0.01 ug/L or TnI > 0.1 ug/L to the model-fitting significantly improvedc-statistics for in-hospital mortality from 0.887 to 0.926 (p= 0.019) and 0.927 (p= 0.028), respectively.Discussion.Elevation of TnI during acute stroke is a strong independent predictor for both poor outcome and in-hospital mortality. Careful investigation of possible concomitant cardiac disorders is warranted for patients with abnormal troponin levels.

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Risk factors affecting the 1-year outcomes of minor ischemic stroke: results from Xi’an stroke registry study of China[1]

10.21203/rs.3.rs-38303/v2 ◽

2020 ◽

Author(s):

Zhongzhong Liu ◽

Wenjuan Lin ◽

Qingli Lu ◽

Jing Wang ◽

Pei Liu ◽

...

Keyword(s):

Risk Factors ◽

Regression Analysis ◽

Ischemic Stroke ◽

Multivariate Logistic Regression Analysis ◽

Stroke Recurrence ◽

Multivariate Logistic Regression ◽

Factors Affecting ◽

Nihss Score ◽

Minor Ischemic Stroke ◽

Independent Risk Factors

Abstract Background: The incidences of stroke recurrence, disability, and all-cause death of patients with minor ischemic stroke (MIS) remain problematic. The aim of the present was to identify risk factors associated with adverse outcomes at 1-year after MIS in the Xi’an region of China. Methods: The cohort of this prospective cohort study included MIS patients aged 18–97 years with a National Institutes of Health Stroke Scale (NIHSS) score of ≤ 3 who were treated in any of four hospitals in Xi’an region of China between January and December 2015. The 1-year percentage of stroke recurrence, disability, and all-cause death were evaluated. Multivariate logistic regression analysis was performed to assess the association between the identified risk factors and clinical outcomes. Results: Among the 1,121 patients included for analysis, the percentage of stroke recurrence, disability, and all-cause death at 1 year after MIS were 3.4% (38/1121), 9.3% (104/1121), and 3.3% (37/1121), respectively. Multivariate logistic regression analysis identified age, current smoking, and pneumonia as independent risk factors for stroke recurrence. Age, pneumonia, and alkaline phosphatase were independent risk factors for all-cause death. Independent risk factors for disability were age, pneumonia, NIHSS score on admission, and leukocyte count. Conclusions: The 1-year outcomes of MIS is not optimistic in the Xi’an region of China, especially high percentage of disability. In this study, we found the risk factors affecting 1-year stroke recurrence, disability and, all-cause death which need further verification in the subsequent studies.

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Heart Rate Variability During Early Mobilization in Patients with Acute Ischemic Stroke

European Neurology ◽

10.1159/000492794 ◽

2018 ◽

Vol 80 (1-2) ◽

pp. 50-54 ◽

Cited By ~ 2

Author(s):

Masafumi Nozoe ◽

Miho Yamamoto ◽

Miki Kobayashi ◽

Masashi Kanai ◽

Hiroki Kubo ◽

...

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Nervous Activity ◽

Early Mobilization ◽

Sympathetic Nervous Activity ◽

Parasympathetic Nerve ◽

Significant Difference ◽

Sympathetic Nervous

Autonomic dysfunction is one of the predictors of poor outcome in patients with acute ischemic stroke. We compared the heart rate variability (HRV) during early mobilization in patients with or without neurological deterioration (ND). We enrolled 7 acute ischemic patients with ND and 14 without ND and measured their HRV in the rest and mobilization by electrocardiography. There was a significant difference in sympathetic nervous activity during mobilization between the 2 groups. However, no significant differences in blood pressure, heart rate, and parasympathetic nerve activity were observed. In patients with acute ischemic stroke, it is likely that the increase in sympathetic nervous activity during mobilization is associated with ND.

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