The Relationship Between Heart Rate Variability(HRV)and Posterior Circulation Cerebral Infarction And Its Value Of Prognosis Prediction

Objective:The study aims to investigate the characteristic of heart rate variability(HRV)changes in posterior circulation cerebral infarction and its value of prognosis prediction. Methods: Prospective analysis 150 cases from March 2015 to November 2015 in the xinjiang uygur autonomous region people’s hospital of neurology department and clearly continuous hospitalized patients diagnosed with acute cerebral infarction. We divided all cases into anterior circulation infarction group and posterior circulation infarction group according to different infarction localization. We adopt the 24 hours dynamic electrocardiogram(ECG) monitoring and its HRV parameters. In addition, we also collect demographic data, NIHSS score on admission and related risk factors for cardiovascular disease of all patients. By single factor comparison and Multivariable Logistics regression analysis, we discuss the characteristic of HRV changes in posterior circulation cerebral infarction compared with anterior circulation infarction. According to Modified Rankin Scale(m RS) score at onset of 90 days,we divided posterior circulation infarction case into good prognosis group(m RS 0 to 2 points), poor prognosis(m RS3-6points).By single factor comparison and Multivariable Logistics regression analysis,we analysis the correlation between HRV and the prognosis of posterior circulation infarction. Results : The study participants included 96 patients with acute anterior circulation infarction, 54 patients with posterior circulation infarction. Multivariable Logistics regression analysis showed that HRV time-domain parameter SDNN(OR0.979,95%CI0.963-0.996,P=0.012),SDANN(OR0.968,95%CI0.95-0.986,P=0.001,r MSSD(OR0.975, 95%CI0.956-0.994, P=0.01) significantly lower and HRV frequency domain parameter TP(OR1.0,95%CI0.999-1,P=0.011), LF(OR1.003, 95%CI1.001-1.006,P=0.018),LF/HF(OR1.486, 95% CI 1.177-1.876,P=0.001)significantly higher when compared with anterior circulation infarction.The good prognosis patients is35(64.8%) and the poor prognosis patients is 19(35.2%) in posterior circulation infarction.Multivariable Logistics regression analysis showed that stroke-associated pneumonia(SAP)(OR12.131,95%CI 2.333-63.065,P=0.003),24 hours average heart rate(OR1.231, 95%CI 1.069-1.417,P=0.004), SDNN(OR0.915,95%CI0.87-0.962,P=0.000),SDANN(OR0.921,95%CI0.869-0.976,P=0.005),r MSSD(OR0.895,95%CI0.831-0.963,P=0.003),LF/HF(OR1.564,95%CI1.052-2.326,P=0.027)are associated with poor prognosis of posterior at oneset 90 days. Conclusion: Compared with anterior circulation infarction,the HRV was decrease in posterior circulation infarction patients and the sympathetic nervous activity couple with the sympathetic nerve and vagus nerve regulation imbalance.The decreased parameters of SDNN, SDANN, r MSSD and increased LF/HF prompt 90 days poor prognosis in posterior circulation infarction patients.