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Observational Study
. 2023 Jan 17;23(1):26.
doi: 10.1186/s12883-023-03054-4.

Autonomic dysfunction after mild acute ischemic stroke and six months after: a prospective observational cohort study

Mathias Damkjær  1 , Sofie Amalie Simonsen  2 , Adam Vittrup Heiberg  2 , Jesper Mehlsen  3 , Anders Sode West  2 , Poul Jennum  4   5 , Helle Klingenberg Iversen  2   5
Affiliations
Observational Study

Autonomic dysfunction after mild acute ischemic stroke and six months after: a prospective observational cohort study

Mathias Damkjær et al. BMC Neurol. .

Abstract

Introduction: Autonomic dysfunction is prevalent in ischemic stroke patients and associated with a worse clinical outcome. We aimed to evaluate autonomic dysfunction over time and the tolerability of the head-up tilt table test in an acute stroke setting to optimize patient care.

Patients and method: In a prospective observational cohort study, patients were consecutively recruited from an acute stroke unit. The patients underwent heart rate and blood pressure analysis during the Valsalva maneuver, deep breathing, active standing, and head-up tilt table test if active standing was tolerated. In addition, heart rate variability and catecholamines were measured. All tests were performed within seven days after index ischemic stroke and repeated at six months follow-up.

Results: The cohort was comprised of 91 acute stroke patients, mean (SD) age 66 (11) years, median (IQR) initial National Institute of Health Stroke Scale 2 (1-4) and modified Ranking Scale 2 (1-3). The head-up tilt table test revealed 7 patients (10%) with orthostatic hypotension. The examination was terminated before it was completed in 15%, but none developed neurological symptoms. In the acute state the prevalence of autonomic dysfunction varied between 10-100% depending on the test. No changes were found in presence and severity of autonomic dysfunction over time.

Conclusion: In this cohort study of patients with mild stroke, autonomic dysfunction was highly prevalent and persisted six months after index stroke. Head-up tilt table test may be used in patients who tolerate active standing. Autonomic dysfunction should be recognized and handled in the early phase after stroke.

Keywords: Active standing; Autonomic Dysfunction; Catecholamines; Heart rate response to deep breathing; Stroke; Tilt-table test; Valsalva maneuver.

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Conflict of interest statement

Nothing to disclose.

Figures

Fig. 1
Fig. 1
Overview over participant recruitment, testing and follow-up. VR = Valsalva Ratio; VM = Valsalva maneuver; BP = blood pressure; HRV = heart rate variability
Fig. 2
Fig. 2
An overview of the results. Abnormal test (%) for all participants at inclusion date (Inclusion (all)), for participants with valid tests at inclusion date and follow-up (Inclusion* and Follow-up*)
See this image and copyright information in PMC

References

    1. GBD 2016 Stroke Collaborators. Global, regional, and national burden of stroke, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(5):439–458. doi:10.1016/S1474-4422(19)30034-1 - PMC - PubMed
    1. Nayani S, Sreedharan SE, Namboodiri N, Sarma PS, Sylaja PN. Autonomic dysfunction in first ever ischemic stroke: Prevalence, predictors and short term neurovascular outcome. Clin Neurol Neurosurg. 2016;150:54–58. doi: 10.1016/j.clineuro.2016.08.022. - DOI - PubMed
    1. Xiong L, Leung H, Chen XY, et al. Preliminary findings of the effects of autonomic dysfunction on functional outcome after acute ischemic stroke. Clin Neurol Neurosurg. 2012;114(4):316–320. doi: 10.1016/j.clineuro.2011.10.037. - DOI - PubMed
    1. Xiong L, Tian G, Leung H, et al. Autonomic Dysfunction Predicts Clinical Outcomes After Acute Ischemic Stroke: A Prospective Observational Study. Stroke. 2018;49(1):215–218. doi: 10.1161/STROKEAHA.117.019312. - DOI - PubMed
    1. Oppenheimer SM, Gelb A, Girvin JP, Hachinski VC. Cardiovascular effects of human insular cortex stimulation. Neurology. 1992;42(9):1727–1732. doi: 10.1212/wnl.42.9.1727. - DOI - PubMed

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