Research Article
The Effect of Stroke Subtypes on Baroreceptor Sensitivity, a
Predict for Acute Stroke Outcome
Wan-Chen Tsai,
1
Hui-Chen Lin,
1
Yun-Ru Lai,
1,2
Che-Wei Hsu ,
1,2
Chih-Cheng Huang ,
1
Hung-Chen Wang ,
3
Chih-Min Su,
4
Yu-Jih Su ,
5
Wei-Che Lin ,
6
Ben-Chung Cheng,
2,5
Wen-Neng Chang,
1
Cheng-Hsien Lu ,
1,2
and Nai-Wen Tsai
1
1
Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine,
Kaohsiung, Taiwan
2
Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan
3
Department of Neurosurgery, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of
Medicine, Kaohsiung, Taiwan
4
Department of Emergency Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of
Medicine, Kaohsiung, Taiwan
5
Department of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine,
Kaohsiung, Taiwan
6
Department of Radiology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine,
Kaohsiung, Taiwan
Correspondence should be addressed to Nai-Wen Tsai; tsainw@yahoo.com.tw
Wan-Chen Tsai and Hui-Chen Lin contributed equally to this work.
Received 5 October 2018; Revised 25 March 2019; Accepted 1 April 2019; Published 18 April 2019
Academic Editor: Gelin Xu
Copyright © 2019 Wan-Chen Tsai et al. Tis is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background. Reduced barorefex sensitivity (BRS) has been reported in patients with acute cardiovascular events. We tested the
hypothesis that BRS varies in diferent subtypes of acute ischemic stroke (AIS) and that BRS is a predictor of clinical outcomes.
Methods. We examined autonomic parameters in 34 patients with AIS, including the small deep hemisphere infarction, the large
hemisphere infarction, and the brainstem infarction groups on Day 1, Day 7, and Day 30 afer AIS. Autonomic parameters were
also evaluated in 18 age- and sex-matched healthy volunteers as a control group. Te clinical outcomes were analyzed using the
modifed Rankin scale at 30 days afer stroke. Results. Te BRS, Valsalva ratio, and heart rate response to deep breathing (HR-DB)
were signifcantly lower in patients afer AIS on admission than in controls (p<0.01). Te frequency domain of HRV (LF/HF ratio)
was signifcantly increased in patients afer AIS compared to controls (p<0.05). BRS was signifcantly reduced in patients with
large hemisphere infarction or brainstem infarction compared to patients with small deep hemisphere infarction on Day 1 afer
AIS (p<0.01). Stepwise logistic regression showed that the levels of BRS and NIHSS are prognostic factors of 1-month outcomes
in patients with AIS. Conclusion. Beside NIHSS score on admission, BRS is a potential prognostic factor of 1-month outcomes in
patients with AIS. Patients with large hemisphere infarction or brainstem infarction have more blunting BRS than do those with
lacunar infarction, which provides some insight into which patients may be expected to have a poor outcome.
1. Introduction
Autonomic dysfunction is a common complication of acute
ischemic stroke (AIS) [1, 2]. Previous studies have shown
that autonomic dysfunction, including increased sympathetic
activity and reduced barorefex, may increase susceptibility to
sudden death and predict adverse clinical outcomes afer AIS
[3, 4]. Te possible mechanisms associated with autonomic
impairment and poor outcome in AIS include increased
cardiovascular events and progression of secondary brain
Hindawi
BioMed Research International
Volume 2019, Article ID 7614828, 9 pages
https://doi.org/10.1155/2019/7614828