Published Online
on February 27, 2003

A more recent version of this article appeared on March 1, 2003

This Article Full Text (PDF) All Versions of this Article: 34/3/705    most recent 01.STR.0000058493.94875.9Fv1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Robinson, T. G. Articles by Potter, J. F. Search for Related Content PubMed PubMed Citation Articles by Robinson, T. G. Articles by Potter, J. F. Pubmed/NCBI databases Medline Plus Health Information Stroke Related Collections Autonomic, reflex, and neurohumoral control of circulation Acute Cerebral Infarction

Submitted on September 5, 2002
Accepted on October 7, 2002

Cardiac Baroreceptor Sensitivity Predicts Long-Term Outcome After Acute Ischemic Stroke

Thompson G. Robinson MD^*; Suzanne L. Dawson MD; Penelope J. Eames MRCP(UK); Ronney B. Panerai PhD; and John F. Potter MD

From the Divisions of Medicine for the Elderly (T.G.R., S.L.D., P.J.E., J.F.P.) and Medical Physics (R.B.P.), Leicester Warwick Medical School, Leicester, UK.

^* To whom correspondence should be addressed. E-mail: tgr2{at}leicester.ac.uk.

Background and Purpose--The baroreceptor reflex arc is important in the short-term regulation of the cardiovascular system, and small studies have reported impaired cardiac baroreceptor sensitivity (BRS) after acute stroke. However, the prognostic significance of impaired BRS is uncertain.

Methods--One hundred twenty-four patients underwent simultaneous ECG and noninvasive beat-to-beat blood pressure (BP) monitoring within 72 hours of neuroradiologically confirmed acute ischemic stroke. Cardiac BRS was assessed from the combined -index by means of power spectral analysis techniques. Baseline data for acute stroke patients were compared with those of a control group matched for age, sex, and casual BP. Patients were followed up for a median of 1508 days (range, 9 to 2656 days), and outcome was compared between patients with and without impaired BRS.

Results--Median BRS values were significantly lower in stroke patients than in controls (5 [interquartile range, 3.5 to 7.4] versus 6.2 [interquartile range, 4.5 to 8.3] ms/mm Hg; P=0.04). Sixty-one (33 male) patients (mean age, 70.2 [SD 10.5] years) had impaired BRS (5.0 ms/mm Hg) compared with 63 (35 male) patients (mean age, 70.6 [SD 11.7] years) without impaired BRS (>5.0 ms/mm Hg). Stroke patients with impaired BRS values had a significantly poorer prognosis (28% versus 8% mortality rate during the follow-up period) although there were no differences in age, stroke severity, stroke type, or casual or 24-hour BP parameters between the 2 groups.

Conclusions--Impaired cardiac BRS is associated with increased long-term mortality after acute ischemic stroke, irrespective of age, sex, stroke type, and BP. This may reflect cardiac arrhythmias, but the mechanisms underlying this association are unknown, although therapies that improve cardiac BRS after stroke warrant further investigation.

Key words: autonomic nervous system • cerebrovascular disorders • pressoreceptors • prognosis

This article has been cited by other articles:

				M. Dutsch, M. Burger, C. Dorfler, S. Schwab, and M. J. Hilz Cardiovascular autonomic function in poststroke patients Neurology, December 11, 2007; 69(24): 2249 - 2255. [Abstract] [Full Text] [PDF]

				A.-J. Liu, X.-J. Ma, F.-M. Shen, J.-G. Liu, H. Chen, and D.-F. Su Arterial Baroreflex: A Novel Target for Preventing Stroke in Rat Hypertension Stroke, June 1, 2007; 38(6): 1916 - 1923. [Abstract] [Full Text] [PDF]

				G. Parati, G. Mancia, M. D. Rienzo, P. Castiglioni, J. A. Taylor, and P. Studinger Cardiovascular variability is/is not an index of autonomic control of circulation. J Appl Physiol, August 1, 2006; 101(2): 690 - 691. [Full Text] [PDF]

				G. Parati, G. Mancia, M. D. Rienzo, P. Castiglioni, J. A. Taylor, and P. Studinger Point:Counterpoint: Cardiovascular variability is/is not an index of autonomic control of circulation J Appl Physiol, August 1, 2006; 101(2): 676 - 682. [Abstract] [Full Text] [PDF]

				F. Colivicchi, A. Bassi, M. Santini, and C. Caltagirone Prognostic Implications of Right-Sided Insular Damage, Cardiac Autonomic Derangement, and Arrhythmias After Acute Ischemic Stroke Stroke, August 1, 2005; 36(8): 1710 - 1715. [Abstract] [Full Text] [PDF]

				A. McLaren, S. Kerr, L. Allan, I. N. Steen, C. Ballard, J. Allen, A. Murray, and R. A. Kenny Autonomic Function Is Impaired in Elderly Stroke Survivors Stroke, May 1, 2005; 36(5): 1026 - 1030. [Abstract] [Full Text] [PDF]

				G. Gulli, V. E. Claydon, V. L. Cooper, and R. Hainsworth R-R interval-blood pressure interaction in subjects with different tolerances to orthostatic stress Exp Physiol, May 1, 2005; 90(3): 367 - 375. [Abstract] [Full Text] [PDF]

				D. R. Ricardo, M. B. de Almeida, B. A. Franklin, and C. G. S. Araujo Initial and Final Exercise Heart Rate Transients: Influence of Gender, Aerobic Fitness, and Clinical Status Chest, January 1, 2005; 127(1): 318 - 327. [Abstract] [Full Text] [PDF]

				A. M. Makikallio, T. H. Makikallio, J. T. Korpelainen, K. A. Sotaniemi, H. V. Huikuri, and V. V. Myllyla Heart rate dynamics predict poststroke mortality Neurology, May 25, 2004; 62(10): 1822 - 1826. [Abstract] [Full Text] [PDF]

				G J Gibson Sleep disordered breathing and the outcome of stroke Thorax, May 1, 2004; 59(5): 361 - 363. [Full Text] [PDF]