Abstract：
BACKGROUND: Beat-to-beat blood pressure variability (BPV) is based on each heartbeat and represents a dynamic equilibrium process modulated by artery and cardiac involvement of pressure-receptive reflexes. To date, there remains a lack of prospective studies illustrating the clinical value of beat-to-beat BPV within 24 hours of acute ischemic stroke onset.
RESULTS: This study prospectively monitored beat-to-beat blood pressure and heart rate in patients with acute ischemic stroke within 24 hours of onset using a noninvasive plethysmograph and calculated beat-to-beat BPV, heart rate variability, and the cross-correlation baroreflex sensitivity. A modified Rankin Scale score of ≥2 at 90 days was defined as an unfavorable prognosis. Multivariate logistic regression was performed, and the nomogram model was developed by adding the beat-to-beat BPV to the traditional model for predicting prognosis. Beat-to-beat BPV increased significantly in the unfavorable outcome group (P<0.05) compared with that in the favorable outcome group, whereas no difference was observed in beat-to-beat heart rate variability and cross-correlation baroreflex sensitivity between both groups (P>0.05). Furthermore, beat-to-beat BPV within 24 hours of acute ischemic stroke onset was independently associated with unfavorable outcome at 90 days (P<0.005). The addition of beat-to-beat BPV to the traditional model for predicting prognosis enhanced the area under the receiver operating characteristic curve from 0.816 to 0.830.
CONCLUSIONS: Increased beat-to-beat BPV within 24 hours of acute ischemic stroke onset was independently associated with a poor prognosis at 90 days and may be a potential predictor for discriminating unfavorable prognosis.
RESULTS: This study prospectively monitored beat-to-beat blood pressure and heart rate in patients with acute ischemic stroke within 24 hours of onset using a noninvasive plethysmograph and calculated beat-to-beat BPV, heart rate variability, and the cross-correlation baroreflex sensitivity. A modified Rankin Scale score of ≥2 at 90 days was defined as an unfavorable prognosis. Multivariate logistic regression was performed, and the nomogram model was developed by adding the beat-to-beat BPV to the traditional model for predicting prognosis. Beat-to-beat BPV increased significantly in the unfavorable outcome group (P<0.05) compared with that in the favorable outcome group, whereas no difference was observed in beat-to-beat heart rate variability and cross-correlation baroreflex sensitivity between both groups (P>0.05). Furthermore, beat-to-beat BPV within 24 hours of acute ischemic stroke onset was independently associated with unfavorable outcome at 90 days (P<0.005). The addition of beat-to-beat BPV to the traditional model for predicting prognosis enhanced the area under the receiver operating characteristic curve from 0.816 to 0.830.
CONCLUSIONS: Increased beat-to-beat BPV within 24 hours of acute ischemic stroke onset was independently associated with a poor prognosis at 90 days and may be a potential predictor for discriminating unfavorable prognosis.
摘要：
背景：搏动式血压变异性（BPV）基于每次心跳，代表由压力感受反射的动脉和心脏参与调节的动态平衡过程。迄今为止,目前仍缺乏前瞻性研究来说明急性缺血性卒中发病24小时内逐次搏动BPV的临床价值.
结果：本研究使用无创体积描记器和计算的搏动BPV，前瞻性监测急性缺血性卒中患者发病24小时内的搏动血压和心率，心率变异性,和互相关压力反射敏感性。90天时改良Rankin量表评分≥2被定义为不良预后。进行多因素logistic回归，通过在传统预测预后的模型中加入逐次搏动BPV来建立列线图模型。不良结局组BPV显著高于有利结局组(P<0.05),而两组的逐搏心率变异性和压力反射敏感性无差异(P>0.05)。此外，急性缺血性卒中发病24小时内的逐次搏动BPV与90天的不良结局独立相关(P<0.005).在预测预后的传统模型中添加逐次搏动BPV将受试者工作特征曲线下的面积从0.816增加到0.830。
结论：急性缺血性卒中发病24小时内BPV的增加与90天的不良预后独立相关，可能是鉴别不良预后的潜在预测指标。
结果：本研究使用无创体积描记器和计算的搏动BPV，前瞻性监测急性缺血性卒中患者发病24小时内的搏动血压和心率，心率变异性,和互相关压力反射敏感性。90天时改良Rankin量表评分≥2被定义为不良预后。进行多因素logistic回归，通过在传统预测预后的模型中加入逐次搏动BPV来建立列线图模型。不良结局组BPV显著高于有利结局组(P<0.05),而两组的逐搏心率变异性和压力反射敏感性无差异(P>0.05)。此外，急性缺血性卒中发病24小时内的逐次搏动BPV与90天的不良结局独立相关(P<0.005).在预测预后的传统模型中添加逐次搏动BPV将受试者工作特征曲线下的面积从0.816增加到0.830。
结论：急性缺血性卒中发病24小时内BPV的增加与90天的不良预后独立相关，可能是鉴别不良预后的潜在预测指标。
