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Assessing Cerebral Autoregulation via Oscillatory Lower Body Negative Pressure and Projection Pursuit Regression
Published on: December 10, 2014
Association Between Cerebral Autoregulation and Long-Term Outcome in Patients With Acute Ischemic Stroke
Yanxia Shen1, Yanxia Zhou2, Juan Xiong3
1Department of Neurology, South China Hospital of Shenzhen University.
Insights
Dynamic cerebral autoregulation (CA) predicts outcomes in acute ischemic stroke (AIS) patients. Impaired CA, indicated by lower phase values, is linked to poorer long-term recovery after stroke.
Area of Science:
- Neurology
- Cardiovascular Science
- Medical Technology
Background:
- Dynamic cerebral autoregulation (CA) is often impaired in patients with acute ischemic stroke (AIS).
- The predictive value of dynamic CA for long-term outcomes in AIS patients remains unclear.
- Understanding CA's role is crucial for improving stroke patient management and prognostication.
Purpose of the Study:
- To investigate whether dynamic CA can predict long-term outcomes in patients with AIS.
- To identify specific dynamic CA indices that correlate with patient recovery.
- To establish dynamic CA as a potential prognostic marker in AIS.
Main Methods:
- Prospective study of 103 AIS patients within 7 days of onset.
- Measured middle cerebral artery blood flow velocity and blood pressure using transcranial Doppler and Finometer.
- Calculated dynamic CA indices (phase and gain) via transfer function analysis.
- Assessed patient outcomes at 3 and 12 months using the modified Rankin Scale.
Main Results:
- Lower ipsilesional phase parameters were significantly associated with unfavorable outcomes.
- The ipsilesional phase parameter and NIH Stroke Scale score predicted both short-term and long-term outcomes.
- Receiver operating characteristic analysis showed the ipsilesional phase parameter had predictive value (AUC=0.646, P=0.044) with an optimal cut-off of 20.33 degrees.
Conclusions:
- Dynamic CA is an independent predictor of outcomes at 3 and 12 months post-AIS.
- The ipsilesional phase parameter serves as a valuable prognostic indicator for AIS patients.
- These findings support the integration of dynamic CA assessment in stroke care for improved outcome prediction.
Background:
Dynamic cerebral autoregulation (CA) is known to be impaired in patients with acute ischemic stroke (AIS), but whether or not dynamic CA can predict long-term outcomes is unclear.
Materials And Methods:
This prospective study included 103 patients with AIS between September 2017 and April 2019. We measured the middle cerebral artery blood flow velocity and blood pressure within 7 days of AIS onset using a transcranial Doppler and Finometer, respectively. We conducted transfer function analysis to calculate dynamic CA indices (phase and gain), with lower phase and higher gain parameters reflecting less efficient CA. We followed up all patients after 3 and 12 months. Patients with 12-month modified Rankin Scale scores of <2 and ≥2 were defined as having favorable and unfavorable outcomes, respectively. We then analyzed the predictors of unfavorable outcomes after 3 and 12 months using logistic regression.
Results:
The ipsilesional phase parameter was significantly lower in patients with unfavorable outcomes than in those with favorable outcomes. Multiple logistic regression analysis revealed that the ipsilesional phase parameter and the National Institutes of Health Stroke Scale score were nonmodifiable predictors of short-term and long-term outcomes. Moreover, in receiver operating characteristic analysis, the area under the curve of the ipsilesional phase parameter was 0.646 (95% confidence interval: 0.513-0.779, P =0.044). Notably, the optimal cut-off value was 20.33 degrees (sensitivity: 63%, specificity: 70%).
Conclusion:
Dynamic CA is an independent predictor of outcomes at 3 and 12 months in patients with AIS.
