国家神经系统疾病临床医学研究中心数据管理与共享系统
Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases
The combination of heart rate variability and ABCD2 score portends adverse outcomes after minor stroke or transient ischemic attack
第一作者：Yu Tian
通讯作者：Yilong Wang
2022-12-07
已发表文章
发表杂志：Journal of the Neurological Sciences
发表类型: Article
影响因子(IF): 4.553
PMID: 36634579 Pubmed原文链接 全文下载
主要研究背景及目的
Traditional risk factors for ischemic stroke or TIA are body stressors that are related to autonomic autonomic system (ANS) dysfunction. The value of ABCD2 score (age, blood pressure, clinical features, duration of symptoms, diabetes) to predict ischemic stroke after transient ischemic attack is compromised by the inclusion of a limited number of stressors. We aimed to assess whether markers of heart rate variability could predict the occurrence of secondary ischemic events after transient ischemic attack or minor stroke.
方法
Data were obtained from the Third China National Stroke Registry (CNSR-III) study. We assessed the activity of ANS using standard deviation of N–N intervals (SDNN), a time domain index of HRV. Trained investigators collected clinical characteristics and estimated ABCD2 score for each participant. All enrolled patients were categorized into different risk groups based on SDNN level and ABCD2 score. The clinial outcomes included recurrent stroke, recurrent ischemic stroke, and disability within 1-year follow-up. We evaluated whether combined SDNN and ABCD2 score were associated with recurrent events using multivariable Cox regression models, and those with disability using multivariable logistic regression models. The independent associations between SDNN and diverse outcomes stratified by ABCD2 score were explored using multivariable Cox and logistic regression analyses.
结论
The combination of HRV and ABCD2 score might efficiently stratify the risk of 1-year recurrent stroke after MS/TIA. Moreover, lower SDNN was independently related to recurrent stroke in patients with MS/TIA, especially for those with low-to-moderate traditional vascular risk factors.
主要结果
A total of 5,743 participants [3,316 (70.02) males, 62.0 (54.0–69.0) years] were included. Patients with low SDNN and ABCD2 ≥ 4 were associated with higher risk of recurrent stroke within 1 year (10.8% versus 4.9%; [HR] 1.31, 95% [CI] 0.92–1.88, P = 0.14) compared to patients with high SDNN with ABCD2 < 4. Lower SDNN was associated with higher recurrent stroke in patients with ABCD2 0–3 score ([HR] 0.73, 95% [CI] 0.57–0.947, P = 0.01) and ABCD2 4–5 score ([HR] 0.85, 95% [CI] 0.74–0.97, P = 0.02), but not in patients with ABCD2 6–7 score.