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Individual Patient Data Meta-Analysis of Dynamic Cerebral Autoregulation and Functional Outcome After Ischemic Stroke

Data de publicação:

Autores da FMUP

  • Pedro Miguel Araújo Campos De Castro

    Autor

Participantes de fora da FMUP

  • Beishon, Lucy
  • Vasilopoulos, Terrie
  • Salinet, Angela S. M.
  • Levis, Brooke
  • Barnes, Samuel
  • Hills, Eleanor
  • Ramesh, Pranav
  • Gkargkoula, Panagoula
  • Minhas, Jatinder S.
  • Brassard, Patrice
  • Goettel, Nicolai
  • Gommer, Erik D.
  • Jara, Jose Luis
  • Liu, Jia
  • Mueller, Martin
  • Nasr, Nathalie
  • Payne, Stephen
  • Robertson, Andrew D.
  • Simpson, David
  • Robinson, Thompson G.
  • Panerai, Ronney B.
  • Nogueira, Ricardo C.

Unidades de investigação

Abstract

BACKGROUND: The relationship between dynamic cerebral autoregulation (dCA) and functional outcome after acute ischemic stroke (AIS) is unclear. Previous studies are limited by small sample sizes and heterogeneity. METHODS: We performed a 1-stage individual patient data meta-analysis to investigate associations between dCA and functional outcome after AIS. Participating centers were identified through a systematic search of the literature and direct invitation. We included centers with dCA data within 1 year of AIS in adults aged over 18 years, excluding intracerebral or subarachnoid hemorrhage. Data were obtained on phase, gain, coherence, and autoregulation index derived from transfer function analysis at low-frequency and very low-frequency bands. Cerebral blood velocity, arterial pressure, end-tidal carbon dioxide, heart rate, stroke severity and sub-type, and comorbidities were collected where available. Data were grouped into 4 time points after AIS: <24 hours, 24 to 72 hours, 4 to 7 days, and >3 months. The modified Rankin Scale assessed functional outcome at 3 months. Modified Rankin Scale was analyzed as both dichotomized (0 to 2 versus 3 to 6) and ordinal (modified Rankin Scale scores, 0-6) outcomes. Univariable and multivariable analyses were conducted to identify significant relationships between dCA parameters, comorbidities, and outcomes, for each time point using generalized linear (dichotomized outcome), or cumulative link (ordinal outcome) mixed models. The participating center was modeled as a random intercept to generate odds ratios with 95% CIs. RESULTS: The sample included 384 individuals (35% women) from 7 centers, aged 66.3 +/- 13.7 years, with predominantly nonlacunar stroke (n=348, 69%). In the affected hemisphere, higher phase at very low-frequency predicted better outcome (dichotomized modified Rankin Scale) at <24 (crude odds ratios, 2.17 [95% CI, 1.47-3.19]; P<0.001) hours, 24-72 (crude odds ratios, 1.95 [95% CI, 1.21-3.13]; P=0.006) hours, and phase at low-frequency predicted outcome at 3 (crude odds ratios, 3.03 [95% CI, 1.10-8.33]; P=0.032) months. These results remained after covariate adjustment. CONCLUSIONS: Greater transfer function analysis-derived phase was associated with improved functional outcome at 3 months after AIS. dCA parameters in the early phase of AIS may help to predict functional outcome.

Dados da publicação

ISSN/ISSNe:
1524-4628, 0039-2499

Stroke  Lippincott Williams and Wilkins Ltd.

Tipo:
Article
Páginas:
1235-1244
Link para outro recurso:
www.scopus.com

Citações Recebidas na Web of Science: 3

Citações Recebidas na Scopus: 3

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Keywords

  • acute stroke; autoregulation; cerebrovascular stroke; meta-analysis; transcranial Doppler ultrasonography

Campos de estudo

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Estudo Clínico Académico (Ischemic Stroke) . 2023

A Resposta Inflamatória Sistémica está ligada com a Severidade do Edema Cerebral e Deterioração Neurológica após Recanalização em AVC isquémico

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Estudo Clínico Académico (AVC isquémico) . 2020

Microemboli After Successful Thrombectomy Do Not Affect Outcome But Predict New Embolic Events

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Anemia and its association with global disability outcomes in stroke patients who underwent reperfusion therapy

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Estudo Clínico Académico . 2021

Time trends, collaterals and cerebral autoregulation efficacy in acute ischemic stroke

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Estudo Clínico Académico . 2021

Dynamic transcranial Doppler assessment in Heart Failure patients

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Estudo Clínico Académico . 2020

Neutrophil-to-lymphocyte ratio and perihematomal edema in patients with intracerebral hemorrhage

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Estudo Clínico Académico . 2022

The impact of antipsychotics and benzodiazepines in the outcome of acute ischemic stroke

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Estudo Clínico Académico . 2022

The Impact of Very Short-term Variability of Blood Pressure in Outcome after Successful Thrombectomy

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