Cardiac autonomic dysfunction and functional outcome after ischaemic stroke

Clinical prognostic significance of heart abnormality and heart rate variability in patients with stroke

OBJECTIVE

To investigate the difference of heart rate variability (HRV) and serum creatine kinase isoenzyme (CK-MB) activity between right-sided and left-sided stroke, and the relative impact of cardiac autonomic imbalance and heart abnormality on death by serum CK-MB activity and fractal dimension (FD) detection in patients with stroke.

METHODS

Three hundred and twenty-seven patients (mean age: 61.12 +/- 9.74 years) with an acute first-ever stroke underwent a comprehensive clinical investigation and laboratory tests, and were followed up for 1 month. Serum CK-MB activity and FD of heart rate variability were detected on the next day after admission.

RESULTS

During the 1 month follow-up period, 42 out of 327 (12.84%) patients had died. Among all the variables analysed, FD decreased and serum CK-MB activity increased after stroke, and decreased FD was more common in the right-sided stroke. This study also demonstrated that acute phase increased serum CK-MB activity [odds ratio (OR)=0.226, 95% CI: 0.103-0.493, p= 0.000) and decreased FD (OR=0.276, 95% CI: 0.135-0.567, p=0.000) had been linked with the risk of death.

CONCLUSIONS

Right-sided stroke and left-sided stroke had different influences on cardiac autonomic nerve activity. Acute phase increased serum CK-MB activity and decreased FD are well-established prognostic factors of death in patients with stroke. Assessment of FD and serum CK-MB activity may provide additional information on the risk of death in stroke patients.