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Abstract Details

Rapid Recovery of Post-Stroke Cardiovascular Autonomic Dysfunction Correlates with Neurological Improvement and Initiation of Cardiovascular Medication.
Neuromuscular and Clinical Neurophysiology (EMG)
P9 - Poster Session 9 (5:30 PM-6:30 PM)
4-005

Acute ischemic stroke frequently causes CAD. Studies of CAD-recovery show inconclusive results while post-stroke arrhythmias may wane within 72 hours. We hypothesize that CAD improves within 72 hours after stroke-onset depending on improved stroke-severity and cardiovascular medication.

To evaluate whether post-stroke cardiovascular-autonomic dysfunction (CAD) recovers within 72 hours upon stroke-onset in association with improved stroke-severity or increased use of cardiovascular medication.

In 50 previously unmedicated, ischemic stroke patients (68±13 years; 25 women), we assessed NIHSS-scores, resting electrocardiographic RR-intervals (RRI), systolic, diastolic blood-pressures (BP), respiration-rate (Resp), parameters reflecting total autonomic modulation [RRI-standard-deviation (RRI-SD), RRI-total-powers], sympathetic [RRI-low-frequency-powers, BPsys-low-frequency-powers] and parasympathetic modulation [RMSSD, RRI-high-frequency-powers], and baroreflex-sensitivity within 24 hours, when patients had just been started on cardiovascular medication (assessment-1) and 72 hours after stroke-onset (assessment-2) and compared data to those of 31 age and sex-matched healthy controls (64±10 years; 19 women). We correlated delta-NIHSS-values (assessment-1 – assessment-2) with delta-values of autonomic parameters using Spearman-Rank-correlation tests. Significance was assumed for p<0.05. 

Patients were medication-naïve at assessment-1. During assessment-2,  17 patients were on beta-blockers, 28 on angiotensin-converting-enzyme-inhibitors or angiotensin-receptor-blockers, 16 on calcium-channel-antagonists. Compared to controls, patients at assessment-1 had higher BPsys and Resp, but lower RRIs, RRI-SDs, RRI-CVs, RMSSDs, RRI-low-frequency-powers, RRI-high-frequency-powers, RRI-total-powers, and baroreflex-sensitivity. At assessment-2, patients had higher RRI-SDs, RRI-CVs, RMSSDs, RRI-low-frequency-powers, RRI-high-frequency-powers, RRI-total-powers, and baroreflex-sensitivity but lower BPs and NIHSS-values than at assessment-1, and cardiovascular and autonomic parameters no longer differed between patients and controls except for lower RRIs and higher Resp in patients than controls. Delta-NIHSS scores correlated inversely with the delta-values of RRI-SDs, RRI-CVs, RMSSDs, RRI-low-frequency-powers, RRI-high-frequency-powers, RRI-total-powers, and baroreflex-sensitivity. 

In our patients, CAD almost completely recovered within 72 hours after stroke-onset and CAD-recovery correlated with neurological improvement. Autonomic recovery was likely promoted by early initiation of cardiovascular medication and possibly also by attenuation of psychological stress occurring with stroke-onset.

Authors/Disclosures
Max Josef Hilz, MD, PhD, FAAN
PRESENTER
Dr. Hilz has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for SANOFI. Dr. Hilz has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Pfizer. Dr. Hilz has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier.
Sebastian Moeller Sebastian Moeller has nothing to disclose.
Harald Marthol, MD (Klinikum am Europakanal) Dr. Marthol has nothing to disclose.
Martin Koehrmann Martin Koehrmann has nothing to disclose.
Rainer Kollmar (Klinikum Darmstadt GmbH) Rainer Kollmar has nothing to disclose.
Stefan Schwab, MD (U. of Erlangen, Dept. of Neurology) Dr. Schwab has nothing to disclose.
Bernd Kallmünzer Bernd Kallmünzer has nothing to disclose.
Ruihao Wang, MD (Department of Neurology, University of Erlangen-Nuremberg) Dr. Wang has nothing to disclose.