Evaluation of cardiac autonomic function and analysis on adverse neurological outcomes in acute large artery atherosclerotic cerebral infarction
ZHONG Wei
LIU Hui
ZHAO Zongbo
ZHUO Ziliang
CHEN Mulai
YAN Manyun
WU Tao
Abstract：Objective To evaluate the cardiac autonomic function in patients with large artery atherosclerosis(LAA)acute cerebral infarction(ACI)by deceleration capacity(DC)and acceleration capacity(AC)of heart rate,and analyze the early warning capability of the two indicators for neurological outcomes after discharge.Methods A total of 302 patients who survived from first LAA-ACI within 7 d of onset admitted in our neurological department from December 2021 to December 2023 were consecutively enrolled in this study.24-hour Holter electrocardiography was applied for DC and AC values.According to modified Rankin scale(mRS)for neurological outcomes at discharge,the patients was divided into a good outcome group(mRS score:0-2,207 cases)and a poor outcome group(mRS score:3-5,95 cases).Clinical data were compared between the two groups.Receiver operating characteristic(ROC)curve,calibration curve,and decision curve analyses were performed to evaluate the early warning capacities of DC,absolute value of AC(|AC|),and DC or|AC|combined with DC/|AC|day-night ratio.Results In the poor neurological outcome group,the levels of DC,|AC|,DC/|AC|,and the proportion of cases with elevated nighttime DC were significantly lower than those of the good outcome group[3.51(2.56,4.24)vs 5.23(4.39,6.48),4.35(3.52,5.58)vs 5.79(4.89,7.08),0.81(0.65,0.92)vs 0.94(0.87,0.97),58.07％vs 78.26％,P＜0.01],while the DC/|AC|day-night ratio was higher[1.00(0.95,1.11)vs 0.98(0.93,1.01),P＜0.01].DC,|AC|and DC/|AC|day-night ratio were risk factors for good prognosis in LAA-ACI patients at discharge(P＜0.05,P＜0.01).The AUC value of DC and DC/|AC|day-night ratio in predicting poor prognosis in LAA-ACI patients at discharge was 0.804,with a Brier index of 0.155,and a net benefit of 16.57％at the optimal cutoff value.Conclusion Prominent damage to vagal tone detected in early stage of LAA-ACI is associated with circadian rhythm decline and comparatively sympathetic hyperactivity,and is correlated with poor outcomes.Combination of declined DC and elevated DC/|AC|day-night ratio shows good early warning capacity for neurological outcomes in LAA-ACI patients at discharge.
Keywords：brain infarctionheart rateautonomic nervous systemcircadian rhythm
Publication Date：2025-12-15
Online Publishing Date：2025-12-29(First online date of this platform, not the publication date of the document)
Pages：6( 1687-1692 )