Key result
Ischemic stroke patients 6±2 years post-stroke had lower baroreflex gain (p<0.05) and altered blood pressure responses during orthostatic challenge compared to age-matched controls.
Why the study?
Impaired autonomic reflex is associated with orthostatic hypotension and falls post-stroke, and understanding long-term temporal characteristics may assist in developing optimal rehabilitation therapies.
Does ischemic stroke cause long-term impairment in autonomic reflex during orthostatic challenge compared to age-matched controls?
Observational
Does ischemic stroke cause long-term impairment in autonomic reflex during orthostatic challenge compared to age-matched controls?
p-value: p=<0.05
Ischemic stroke is associated with long-term impairment in autonomic regulation and baroreflex sensitivity during orthostatic challenge, suggesting a need for targeted autonomic rehabilitation.
May support long-term autonomic monitoring in stroke survivors; hypothesis-generating and requires prospective validation before practice change.
Impaired autonomic reflex is associated with orthostatic hypotension and falls in ischemic stroke patients. Understanding post-stroke temporal characteristics of autonomic reflex can assist in development of optimal therapy for improving autonomic function and patients’ quality of life. To this end, autonomic reflex 6± 2 years post-stroke was characterized during orthostatic challenge induced by sit-to-stand test. RR intervals (RR), heart rate (HR), systolic blood pressure (SBP), mean arterial pressure (MAP), and diastolic blood pressure (DBP) were extracted from simultaneously recorded electrocardiogram (ECG) and blood pressure waveform from stroke patients and age-matched controls. Shock index (SI), modified shock index (MSI), spectral power of RR in low-frequency (LF, 0.04-0.15 Hz) and high-frequency (HF, 0.15-0.4 Hz) bands and LF baroreflex (SBP <tex-math notation="LaTeX">→ </tex-math> RR) gain were calculated. We observed higher HR, SI, and MSI during both phases in stroke patients compared to controls. Standing caused an increase ( <tex-math notation="LaTeX">p < 0.05 </tex-math> ) in DBP and MAP in stroke patients but blood pressure did not change ( <tex-math notation="LaTeX">p>0.10 </tex-math> ) in controls during standing compared to sitting. Stroke patients had lower ( <tex-math notation="LaTeX">p < 0.05 </tex-math> ) SBP <tex-math notation="LaTeX">→ </tex-math> RR gain during both phases of the study compared to controls. Lastly, standing shifted the sympathovagal balance to sympathetic activity (elevated LF/HF ratio, <tex-math notation="LaTeX">p=0.03 </tex-math> ) in controls but not in patients. The study findings highlight the long-term effects of ischemic stroke on autonomic reflex and underscore the need for novel rehabilitation schemes to mitigate its adverse effect on autonomic reflex. Furthermore, the method proposed in this manuscript can be utilized to evaluate autonomic reflex continuously during rehabilitation, which could assist clinicians in customizing therapy for optimal recovery of autonomic function.
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Wang et al. (2021) conducted an observational in Ischemic stroke. Ischemic stroke vs. Age-matched controls was evaluated on Autonomic reflex during orthostatic challenge (sit-to-stand test) (p=<0.05). Ischemic stroke patients 6±2 years post-stroke had lower baroreflex gain (p<0.05) and altered blood pressure responses during orthostatic challenge compared to age-matched controls.
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