Datasheet1_Blood pressure variability, nocturnal heart rate variability and endothelial function predict recurrent cerebro-cardiovascular events following ischemic stroke.pdf

IntroductionCardiovascular parameters characterizing blood pressure (BP), heart rate (HR), endothelial function and arterial stiffness predict cerebro-cardiovascular events (CCVE) in the general population. Considering the paucity of data in stroke patients, we assessed these parameters as potential predictors of recurrent CCVE at acute stroke stroke.Patients and methodsThis is a secondary outcome analysis of a prospective observational longitudinal Sleep Deficiency & Stroke Outcome Study (ClinicalTrials.gov Identifier: NCT02559739). The study consecutively recruited acute ischemic stroke patients. Cardiovascular parameters (blood pressure variability [BPV], heart rate variability [HRV], endothelial function, and arterial stiffness) were assessed within the first week post-stroke. Future CCVE were recorded over a 3-year follow-up. Multivariate Cox regression analysis was used to investigate the prognostic value of 48 cardiovascular parameters regarding CCVE risk.ResultsOut of 447 recruited patients, 359 were included in this analysis. 20% of patients developed a future CCVE. A high variability of systolic BP (n = 333) and nocturnal HR (non-linear parameters; n = 187) at acute stroke predicted CCVE risk after adjustment for demographic parameters, cardiovascular risk factors and mean BP or HR, respectively. Endothelial dysfunction (n = 105) at acute stroke predicted CCVE risk after adjustment for age and sex, but not after adjustment for cardiovascular risk factors. Diurnal HR and arterial stiffness at acute stroke were not associated with CCVE risk.ConclusionHigh blood pressure variability, high nocturnal HRV and endothelial function contribute to the risk for future CCVE after stroke.

本研究旨在探讨在普通人群中，表征血压（BP）、心率（HR）、内皮功能和动脉硬度的心血管参数如何预测脑心血管事件（CCVE）。鉴于卒中患者数据的稀缺性，本研究评估了这些参数作为急性卒中后复发性CCVE潜在预测因子的可能性。研究方法：本项研究为前瞻性观察性纵向睡眠不足与卒中预后研究（ClinicalTrials.gov 标识符：NCT02559739）的二次结局分析。研究连续招募急性缺血性卒中患者。在卒中后第一周内评估心血管参数（血压变异性[BPV]、心率变异性[HRV]、内皮功能和动脉硬度）。在3年的随访期间记录未来的CCVE。采用多因素Cox回归分析，研究48项心血管参数对CCVE风险的预测价值。结果：在447名招募的患者中，359名纳入本分析。20%的患者在随访期间发生了未来的CCVE。在调整了人口统计学参数、心血管风险因素及平均血压或心率后，急性卒中时的收缩压变异性（n=333）和夜间心率变异性（非线性参数；n=187）预测了CCVE风险。在调整了年龄和性别后，急性卒中时的内皮功能障碍（n=105）预测了CCVE风险，但在调整心血管风险因素后则不再相关。急性卒中时的日间心率及动脉硬度与CCVE风险无相关性。结论：血压变异性高、夜间心率变异性高以及内皮功能异常均会增加卒中后发生未来CCVE的风险。