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Holter parameters score predicts prognosis in patients with acute ischemic stroke: A prospective cohort study
Jinhuan Gao1, Yue Hu2, Lanjing Wang2,3
1Department of Cardiology, National Clinical Research Centre for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, Beijing, China.
Insights
A new composite Holter score effectively predicts poor prognosis in acute ischemic stroke (AIS) patients. This cardiac monitoring tool aids in risk stratification and treatment decisions for better neurological outcomes.
Area of Science:
- Cardiology
- Neurology
- Medical Monitoring
Background:
- Cardiac dysfunction worsens neurological outcomes in acute ischemic stroke (AIS).
- Holter monitoring detects cardiac issues crucial for AIS management.
- Accurate prognostication remains challenging in AIS patients.
Purpose of the Study:
- To evaluate a composite Holter parameter score for predicting prognosis in AIS patients.
- To assess the predictive value of specific Holter parameters for stroke outcomes.
- To improve risk stratification for AIS patients.
Main Methods:
- 113 AIS patients within 7 days of onset were analyzed.
- Holter parameters including QT interval, atrial fibrillation, arrhythmia, ST-T elevation, and heart rate variability were recorded.
- Poor prognosis was defined as a 3-month modified Rankin Scale score > 1; logistic regression identified risk factors.
Main Results:
- A composite Holter score was developed, incorporating prolonged QT interval, ST-T elevation, and heart rate variability.
- The Holter score significantly predicted 3-month prognosis in AIS patients.
- The score improved model discrimination and reclassification, with an AUC of 0.905.
Conclusions:
- The composite Holter score shows significant predictive value for poor prognosis in AIS.
- Incorporating this score can enhance clinical risk stratification and treatment guidance.
- This tool may lead to improved management strategies for AIS patients.
Background:
Cardiac dysfunction significantly contributes to worsened neurological outcomes following acute ischemic stroke (AIS), posing challenges for prognostication. Holter monitoring is widely used to detect occult cardiac dysfunction and plays a crucial role in managing AIS. This study aimed to evaluate the predictive value of a composite Holter parameter score for prognosis in patients with AIS.
Materials And Methods:
A total of 113 patients with AIS within 7 days of stroke onset were enrolled. Holter parameters, including prolonged QT interval, atrial fibrillation, arrhythmia, ST-T elevation, and heart rate variability, were recorded. The primary endpoint was poor prognosis, defined as a 3-month modified Rankin Scale score > 1. Risk factors affecting prognosis were identified using logistic regression analysis.
Results:
A Holter score incorporating prolonged QT interval, partial ST-T elevation, standard deviation average of the RR interval at 24 h and low frequency during the daytime was developed to predict 3 months prognosis in patients with AIS. Logistic regression analysis demonstrated that the Holter score remained significantly associated with prognosis. The inclusion of the Holter score in the conventional model improved discrimination and net reclassification (net reclassification improvement % = 65.13% [25.01%, 105.24%], integrated discrimination improvement % = 6.99% [1.16%, 12.81%]). The area under the receiver operating characteristic curve was 0.905 (0.831-0.978; P < 0.0001), indicating excellent model fit.
Conclusion:
The composite Holter score exhibited a promising predictive value for identifying poor prognosis in patients with AIS. Its incorporation into clinical practice may enhance risk stratification and guide treatment decisions in this patient population.TRIAL REGISTRATION: http://www.clinicaltrials.gov (identifier: NCT03868007).
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