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Manning LS, Mistri AK, Potter J, Rothwell PM, Robinson TG. Short-Term Blood Pressure Variability in Acute Stroke. Stroke 2015; 46:1518-24. [DOI: 10.1161/strokeaha.115.009078] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 03/31/2015] [Indexed: 12/28/2022]
Abstract
Background and Purpose—
Short-term blood pressure variability (BPV) may predict outcome in acute stroke. We undertook a post hoc analysis of data from 2 randomized controlled trials to determine the effect of short-term BPV on 2-week outcome.
Methods—
Controlling Hypertension and Hypotension Immediately Post Stroke (CHHIPS) was a trial of BP-lowering, enrolling 179 acute stroke patients (onset <36 hours). Continue or Stop Post-Stroke Antihypertensives Collaborative Study (COSSACS) compared a strategy of continuation versus temporarily stopping prestroke antihypertensive therapy in 763 acute stroke patients (onset <48 hours). BPV at baseline (defined as SD, coefficient of variation, variation independent of the mean, and average real variability) was derived from standardized casual cuff BP measures (6 readings <30 minutes). Adjusted logistic regression models were used to assess the relation between BPV and death and disability (modified Rankin scale>3) at 2 weeks.
Results—
Seven hundred six (92.5%) and 171 (95.5%) participants were included in the analysis for the COSSACS and CHHIPS data sets, respectively. Adjusted logistic regression analyses revealed no statistically significant associations between any of the included BPV parameters with 2-week death or disability in either study data set: COSSACS, odds ratio SD systolic BP 0.98 (0.78–1.23); CHHIPS, odds ratio SD systolic BP 0.97 (0.90–1.11).
Conclusions—
When derived from casual cuff BP measures, short-term BPV is not a useful predictor of early (2 weeks) outcome after acute stroke. Differing methodology may account for the discordance with previous studies indicating long-term (casual BPV) and short-term (beat-to-beat BPV) prognostic value.
Clinical Trial Registration—
COSSACS was registered on the International Standard Randomised Controlled Trial Register; URL:
http://www.isrctn.com
. Unique identifier: ISRCTN89712435. CHHIPS was registered on the National Research Register; URL:
http://public.ukcrn.org.uk
. Unique identifier: N0484128008.
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Affiliation(s)
- Lisa S. Manning
- From the Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (L.S.M., A.K.M., T.G.R.); Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, United Kingdom (J.P.); and Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom (P.M.R.)
| | - Amit K. Mistri
- From the Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (L.S.M., A.K.M., T.G.R.); Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, United Kingdom (J.P.); and Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom (P.M.R.)
| | - John Potter
- From the Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (L.S.M., A.K.M., T.G.R.); Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, United Kingdom (J.P.); and Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom (P.M.R.)
| | - Peter M. Rothwell
- From the Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (L.S.M., A.K.M., T.G.R.); Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, United Kingdom (J.P.); and Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom (P.M.R.)
| | - Thompson G. Robinson
- From the Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (L.S.M., A.K.M., T.G.R.); Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, United Kingdom (J.P.); and Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom (P.M.R.)
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Tang SC, Jen HI, Lin YH, Hung CS, Jou WJ, Huang PW, Shieh JS, Ho YL, Lai DM, Wu AY, Jeng JS, Chen MF. Complexity of heart rate variability predicts outcome in intensive care unit admitted patients with acute stroke . J Neurol Neurosurg Psychiatry 2015; 86:95-100. [PMID: 25053768 DOI: 10.1136/jnnp-2014-308389] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Heart rate variability (HRV) has been proposed as a predictor of acute stroke outcome. This study aimed to evaluate the predictive value of a novel non-linear method for analysis of HRV, multiscale entropy (MSE) and outcome of patients with acute stroke who had been admitted to the intensive care unit (ICU). METHODS The MSE of HRV was analysed from 1 h continuous ECG signals in ICU-admitted patients with acute stroke and controls. The complexity index was defined as the area under the MSE curve (scale 1-20). A favourable outcome was defined as modified Rankin scale 0-2 at 3 months after stroke. RESULTS The trends of MSE curves in patients with atrial fibrillation (AF) (n=77) were apparently different from those in patients with non-AF stroke (n=150) and controls (n=60). In addition, the values of complexity index were significantly lower in the patients with non-AF stroke than in the controls (25.8±.3 vs. 32.3±4.3, p<0.001). After adjustment for clinical variables, patients without AF who had a favourable outcome were significantly related to higher complexity index values (OR=1.15, 95% CI 1.07 to 1.25, p<0.001). Importantly, the area under the receiver operating characteristic curve for predicting a favourable outcome of patients with non-AF stroke from clinical parameters was 0.858 (95% CI 0.797 to 0.919) and significantly improved to 0.903 (95% CI 0.853 to 0.954) after adding on the parameter of complexity index values (p=0.020). CONCLUSIONS In ICU-admitted patients with acute stroke, early assessment of the complexity of HRV by MSE can help in predicting outcomes in patients without AF.
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Affiliation(s)
- Sung-Chun Tang
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan NTU-NTUH-MediaTek Innovative Medical Electronics Research Center, Taipei, Taiwan
| | - Hsiao-I Jen
- NTU-NTUH-MediaTek Innovative Medical Electronics Research Center, Taipei, Taiwan Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan
| | - Yen-Hung Lin
- NTU-NTUH-MediaTek Innovative Medical Electronics Research Center, Taipei, Taiwan Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Sheng Hung
- NTU-NTUH-MediaTek Innovative Medical Electronics Research Center, Taipei, Taiwan Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Jung Jou
- NTU-NTUH-MediaTek Innovative Medical Electronics Research Center, Taipei, Taiwan Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan
| | - Pei-Wen Huang
- NTU-NTUH-MediaTek Innovative Medical Electronics Research Center, Taipei, Taiwan Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan
| | - Jiann-Shing Shieh
- Department of Mechanical Engineering, Yuan Ze University, Tao-Yuan, Taiwan
| | - Yi-Lwun Ho
- NTU-NTUH-MediaTek Innovative Medical Electronics Research Center, Taipei, Taiwan Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Dar-Ming Lai
- NTU-NTUH-MediaTek Innovative Medical Electronics Research Center, Taipei, Taiwan Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - An-Yeu Wu
- NTU-NTUH-MediaTek Innovative Medical Electronics Research Center, Taipei, Taiwan Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan
| | - Jiann-Shing Jeng
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Fong Chen
- NTU-NTUH-MediaTek Innovative Medical Electronics Research Center, Taipei, Taiwan Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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De Raedt S, De Vos A, De Keyser J. Autonomic dysfunction in acute ischemic stroke: an underexplored therapeutic area? J Neurol Sci 2014; 348:24-34. [PMID: 25541326 DOI: 10.1016/j.jns.2014.12.007] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 11/30/2014] [Accepted: 12/02/2014] [Indexed: 01/04/2023]
Abstract
Impaired autonomic function, characterized by a predominance of sympathetic activity, is common in patients with acute ischemic stroke. This review describes methods to measure autonomic dysfunction in stroke patients. It summarizes a potential relationship between ischemic stroke-associated autonomic dysfunction and factors that have been associated with worse outcome, including cardiac complications, blood pressure variability changes, hyperglycemia, immune depression, sleep disordered breathing, thrombotic effects, and malignant edema. Involvement of the insular cortex has been suspected to play an important role in causing sympathovagal imbalance, but its exact role and that of other brain regions remain unclear. Although sympathetic overactivity in patients with ischemic stroke appears to be a negative prognostic factor, it remains to be seen whether therapeutic strategies that reduce sympathetic activity or increase parasympathetic activity might improve outcome.
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Affiliation(s)
- Sylvie De Raedt
- Department of Neurology, Universitair Ziekenhuis Brussel, Center for Neurosciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
| | - Aurelie De Vos
- Department of Neurology, Universitair Ziekenhuis Brussel, Center for Neurosciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
| | - Jacques De Keyser
- Department of Neurology, Universitair Ziekenhuis Brussel, Center for Neurosciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium; Department of Neurology, Universitair Medisch Centrum Groningen, Groningen, The Netherlands.
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Dames KK, Lopes AJ, de Melo PL. Airflow pattern complexity during resting breathing in patients with COPD: effect of airway obstruction. Respir Physiol Neurobiol 2013; 192:39-47. [PMID: 24334010 DOI: 10.1016/j.resp.2013.12.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 11/29/2013] [Accepted: 12/03/2013] [Indexed: 12/01/2022]
Abstract
We investigated the influence of airway obstruction in the complexity of the airflow pattern in COPD and its use as a marker of disease activity. The sample entropy (SampEnV') and the variability (SDV') of the airflow pattern were measured in a group of 88 subjects with various levels of airway obstruction. Airway obstruction resulted in a reduction in the SampEnV' (p<0.0001) that was significantly correlated with spirometric indices of airway obstruction (R=0.50, p<0.001). The early adverse effects in mild airway obstruction were detected by the SampEnV' with an accuracy of 84%. SDV' increased with airway obstruction (p<0.002). We conclude that (1) the airflow patterns in COPD exhibit reduced complexity compared with healthy subjects; (2) this reduction in complexity is proportional to airway obstruction; and (3) the evaluation of SampEnV' may provide novel respiratory biomarkers suitable to facilitate the diagnosis of respiratory abnormalities in COPD.
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Affiliation(s)
- Karla Kristine Dames
- Biomedical Instrumentation Laboratory, Institute of Biology and Faculty of Engineering, State University of Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- Pulmonary Function Laboratory, Faculty of Medical Sciences, State University of Rio de Janeiro, Brazil
| | - Pedro Lopes de Melo
- Biomedical Instrumentation Laboratory, Institute of Biology and Faculty of Engineering, State University of Rio de Janeiro, Brazil; Clinical and Experimental Research Laboratory in Vascular Biology, Institute of Biology, State University of Rio de Janeiro, Brazil.
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