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Open AccessArticle

Cardiac Autonomic Derangement Is Associated with Worse Neurological Outcome in the Very Early Phases of Ischemic Stroke

1
Department of Internal Medicine, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
2
Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
3
Department of Anesthesia, Critical Care and Emergency, Fondazione IRCSS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
J. Clin. Med. 2019, 8(6), 852; https://doi.org/10.3390/jcm8060852
Received: 7 May 2019 / Revised: 9 June 2019 / Accepted: 11 June 2019 / Published: 14 June 2019
(This article belongs to the Section Neuroscience)
Background: Acute ischemic stroke (AIS) is associated with autonomic dysfunction. We evaluated the prognostic value of heart rate variability (HRV) and the role of stroke localization and reperfusion treatment (RT) on autonomic control. Methods: Patients with AIS and sinus rhythm were enrolled in the emergency department. Autonomic parameters were recorded at the onset and after a potential RT. Neurological deficit was assessed using the National Institute of Health Stroke Scale (NIHSS) at the onset and residual disability with modified Rankin Scale (mRS) at 3 months. Two analyses were used to assess HRV. Low frequency (LF) and high frequency (HF) are, respectively, markers of sympathetic and respiratory vagal modulation in spectral analysis. Symbolic analysis provides pattern with no variation (0V%) as an index of sympathetic modulation and pattern with two like variations (2LV%) and pattern with two unlike variations (2UV%) as markers of vagal modulation. Results: We enrolled 41 patients. Twenty-seven underwent RT. A prevalent parasympathetic modulation was found in patients with NIHSS ≥14. The group with mRS 3–6 exhibited a higher 2UV% and lower 0V%. Right-sided strokes were associated with a higher respiratory vagal control. RT had no effects on HRV parameters. Conclusions: In the very early phases of AIS, a decreased 0V% and an increased 2UV% may reflect a loss of sympathetic oscillation, predicting a poorer 3 month-outcome. View Full-Text
Keywords: acute ischemic analysis stroke; autonomic; sympathetic; heart rate variability; spectral analysis; symbolic acute ischemic analysis stroke; autonomic; sympathetic; heart rate variability; spectral analysis; symbolic
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Tobaldini, E.; Sacco, R.M.; Serafino, S.; Tassi, M.; Gallone, G.; Solbiati, M.; Costantino, G.; Montano, N.; Torgano, G. Cardiac Autonomic Derangement Is Associated with Worse Neurological Outcome in the Very Early Phases of Ischemic Stroke. J. Clin. Med. 2019, 8, 852.

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