Dynamic Cerebral Autoregulation Is an Independent Functional Outcome Predictor of Mild Acute Ischemic Stroke

Area of Science:

• Neurology
• Cardiovascular Physiology
• Medical Diagnostics

Background:

• Cerebral autoregulation, crucial for brain blood flow stability, is often compromised following acute ischemic stroke.
• Understanding factors influencing stroke recovery is vital for patient management and therapeutic development.

Purpose of the Study:

• To determine if dynamic cerebral autoregulation (dCA) indices can serve as independent predictors of functional outcomes in acute ischemic stroke patients.
• To evaluate the relationship between dCA indices and stroke severity markers.

Main Methods:

• Assessed dCA indices in 86 acute ischemic stroke patients (3-7 days post-stroke) and 40 controls during spontaneous hemodynamic changes.
• Compared dCA indices, specifically phase shift at very low frequency (phase_VLF), between patients with favorable (mRS ≤1) and unfavorable (mRS ≥2) outcomes at 3 months.
• Utilized receiver operating characteristic and multivariate analyses to assess phase_VLF as an outcome predictor.

Main Results:

• Patients with unfavorable outcomes exhibited significantly worse phase_VLF compared to those with favorable outcomes.
• Impaired dCA (worse phase_VLF) was linked to higher mean arterial pressure and larger infarct volumes, but also occurred in patients with normal hemodynamics or smaller infarcts.
• Phase_VLF demonstrated predictive value for stroke outcomes (AUC: 0.722, P<0.001).

Conclusions:

• The phase shift at very low frequency (phase_VLF) is a significant independent predictor of functional outcomes in acute ischemic stroke.
• dCA assessment, particularly phase_VLF, offers valuable prognostic information for stroke patients.