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Cardiovascular autonomic function in poststroke patients

From the Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany (M.D., M.B., C.D., S.S., M.J.H.); and Department of Neurology, New York University, New York, NY (M.J.H.).

Address correspondence to Dr. Max J. Hilz, New York University School of Medicine, Department of Neurology, 560 First Avenue, NB 7 W 11, New York, NY 10016; Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany max.hilz{at}neuro.med.uni-erlangen.de

Background: Autonomic dysregulation is frequent in acute ischemic stroke. Several studies concluded that imbalance between sympathetic and parasympathetic cardiovascular function predisposes to malignant cardiac arrhythmia. However, there are few data on cardiovascular autonomic function in post–acute stroke patients.

Objective: To study cardiovascular autonomic function 18 to 43 months after lacunar stroke.

Patients and Methods: We continuously monitored R-R intervals (RR_int), mean blood pressure (BP_mean), and respiration in 15 patients (8 women, aged 43 to 73 years) after right-sided stroke, in 13 patients (7 women, aged 50 to 75 years) after left-sided stroke, and in 21 age- and sex-matched controls at rest. We used autoregressive spectral analysis to assess sympathetic and parasympathetic modulation as powers of RR_int and BP_mean oscillations in the low-frequency (LF: 0.04 to 0.15 Hz) and high-frequency bands (HF: 0.15 to 0.5 Hz).

Results: Mean values of RR_int, BP_mean, and respiratory frequency did not differ between patients after right- or left-sided stroke and controls (p > 0.05). Patients after right-sided stroke showed a trend toward elevated LF power of RR_int as compared with patients after left-sided stroke and controls (p < 0.10). HF powers of RR_int were reduced in patients after right- and left-sided stroke as compared with controls (p < 0.05). LF/HF ratio of RR_int was elevated in patients after right-sided stroke as compared with patients after left-sided stroke and controls (p < 0.05).

Conclusion: Irrespective of the side of the ischemia, post–acute stroke patients showed a parasympathetic cardiac deficit. Additionally, sympathetic cardiovascular modulation was increased in patients after right-sided stroke. Post–acute stroke patients might be at an increased risk for cardiac arrhythmia after unopposed sympathetic stimulation.

Abbreviations: ACE = angiotensin-converting enzyme; BP = blood pressure; BP_mean = mean blood pressure; cpm = cycles per minute; HF = high frequency; HR = heart rate; IAP = intracarotid amobarbital procedure; LF = low frequency; NA = not applicable; RR_int = R-R interval; TOAST = Trial of Org 10172 in Acute Stroke Treatment.

Disclosure: The authors report no conflicts of interest.

Received December 7, 2006. Accepted in final form June 12, 2007.

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				Abnormal Autonomic Function After Lacunar Stroke Journal Watch Neurology, February 26, 2008; 2008(226): 2 - 2. [Full Text]