| ObjectiveIn this study,the heart rate variability(HRV)of patients with acute ischemic stroke(AIS)was detected by 24-hour ambulatory electrocardiogram,and its correlation with the severity of AIS patients and the 90-day prognosis was discussed,providing some reference for the prognosis judgment and early intervention of AIS.Methods1.A total of 147 patients with acute ischemic stroke who were hospitalized in the neurology department of North Jiangsu People’s Hospital for the first time within 7 days of onset(AIS group)and 56 high-risk stroke patients(control group)who came to the hospital for examination during the same period from July 2022 to October 2022 were collected as research objects.General data were collected for both groups[age,sex,height,weight,smoking history,history of hypertension,history of diabetes,admission systolic blood pressure,admission to the National Institutes of Health Scale,NIHSS)score(AIS group),etc.],auxiliary examination data[blood count,blood lipid,liver and kidney function,glycohemoglobin,D-dimer,cranial CT,cranial MRI,etc.]and 24-hour dynamic electrocardiogram HRV indicators(SDNN,SDANN,RMSSD,PNN50,LF,HF,LF/HF).2.Univariate analysis was conducted to compare clinical data and HRV indexes between AIS group and control group,and to explore the difference of HRV between acute ischemic stroke group and control group.Patients in AIS group were divided into mild stroke group(NIHSS≤3 points)and non-mild stroke group(NIHSS>3 points)according to NIHSS score.The differences of HRV indexes between the two groups were compared,and the correlation between HRV indexes and the severity of acute ischemic stroke was analyzed.The 90-day prognosis of patients was evaluated according to modified Rankin Scale(mRS),and the patients were divided into good prognosis group(mRS≤2)and poor prognosis group(mRS>2)according to mRS Score.Multivariate logistic regression analysis was conducted on the prognoses related factors of AIS patients.The predictive value of HRV index in AIS patients was evaluated by ROC curve.Results1.Compare the difference of HRV index between AIS group and control groupA total of 203 subjects were included in this study,including 147 in the AIS group and 56 in the control group.General clinical data of AIS group and control group showed statistical differences in admission systolic blood pressure,white blood cells,mesenchylocyte and glycosylated hemoglobin(P<0.05).There were no significant differences in gender,age,diabetes history,erythrocyte,monocyte,creatinine,uric acid,ALT,AST,blood lipid,homocysteine and D-dimer between the two groups(P>0.05).HRV detection indexes suggested that there were statistical differences in SDNN,SDANN,RMSSD,PNN50,HF and LF/HF between AIS group and control group(P<0.05),while there was no statistical difference in LF between the two groups(P>0.05).Multiple logistic regression indicated that leukocytes,neutrophils,SDNN,SDANN,LF/HF were independently correlated with acute ischemic stroke(P<0.05).White blood cells and neutrophils in AIS group were higher than those in control group(7.38±2.55*10~9/LVS6.25±2.04*10~9/L,P<0.05;5.66±2.86*10~9/LVS3.91±1.80*10~9/L,P<0.05),SDNN and SDANN in AIS group were lower than those in control group(91.98±24.77ms VS 124.98±24.32ms,P<0.05;The LF/HF of AIS group was higher than that of control group(77.46±21.41ms VS 112.02±25.14ms,P<0.05)(1.62±0.97 VS1.02±0.71,P<0.05).2.To explore the correlation between HRV index and AIS severity(NIHSS score on admission)The AIS group was divided into the mild stroke group and the non-mild stroke group according to the NIHSS score at admission.The SDANN and RMSSD of HRV indexes in the non-mild stroke group(NIHSS>3 points)were lower than those in the mild stroke group(NIHSS≤3 points),and the comparison between the two groups was statistically significant(P<0.05).Sperman correlation analysis was used to compare the correlation between SDANN,RMSSD and NIHSS score,and the results showed that SDANN,RMSSD and NIHSS score were correlated(r=-0.425,P<0.05;r=-0.478,P<0.05).3.To explore the predictive value of HRV index for poor prognosis of AIS patientsAccording to the 90-day mRS Score,the patients in the AIS group were divided into 96 Good Prognosis(GP)group and 51 Poor Prognosis(PP)group.In terms of baseline data,the PP group was older than the GP group[66(56,75)VS 62(53,70)],(P<0.05),had a higher admission NIHSS score[9(6,14)VS 2(1,3)],(P<0.05),and had a larger infarct volume[(17.37(6.54,29.72))VS(3.14(1.52,6.18)],(P<0.05);In terms of laboratory data,the D-dimer level of PP group was higher than GP group[0.61(0.34,0.91)VS 0.40(0.25,0.60)],(P<0.05).In terms of HRV index,SDANN and PNN50 in PP group were lower than GP group(72.01±20.35ms VS 80.93±19.54ms,P<0.05;6.15±3.05%VS 7.38±3.12%,P<0.05).Multivariate logistic regression analysis showed that admission NIHSS score,SDANN and PNN50 were independent factors related to poor prognosis of acute ischemic stroke(P<0.05).ROC curve was applied to analyze the predictive value of SDANN and PNN50 for poor prognosis of acute ischemic stroke.The results showed that SDANN:The AUC was 0.706(P<0.05,95%CI0.620-0.782).Youden index showed that the optimal cut-off value was 74.15ms,the sensitivity was68.42%,and the specificity was 78.49%.Pn50:AUC was 0.744(P<0.05,95%CI0.660-0.816).Youden index showed that the optimal cut-off value was 6.45%,the sensitivity was 78.95%and the specificity was 61.29%.The AUC of the two indexes combined was 0.752(P<0.05,95%CI0.669-0.823).Youden index showed that the optimal cut-off value was 0.382,the sensitivity was 63.16%,and the specificity was82.80%.SDANN,PNN50 and their combined detection can all be used to predict the poor prognosis of AIS,and the combined detection is more effective.Conclusion1.Changes in heart rate variability in AIS patients suggest that AIS patients have autonomic nervous dysfunction.2.SDANN and RMSSD are correlated with the severity of AIS patients.3.SDANN and PNN50 may be predictors of poor prognosis in AIS patients. |
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