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IntJClinExpMed2020;13(10):7787-7793www.
ijcem.
com/ISSN:1940-5901/IJCEM0116166OriginalArticleAnalysisofneurogenicelectrocardiographicchangesinacutestrokepatientsWeidaGuo1,LeiLiu2,FangWen1,YuechunShen31ElectrocardiographicRoom,Departmentsof2Neurology,3Cardiovasology,TheFirstAffiliatedHospitalofGuangzhouMedicalUniversity,Guangzhou,GuangdongProvince,ChinaReceivedJune12,2020;AcceptedJuly19,2020;EpubOctober15,2020;PublishedOctober30,2020Abstract:Objective:Ouraimwastoexploretheneurogenicelectrocardiographic(ECG)abnormalitiesinacutestrokepatientsandtheECGcharacteristicsindifferenttimeperiods,soastoprovidesupportforclinicaldataofECGchar-acteristicsinstrokepatients.
Methods:Inthisretrospectivestudy,werecruited260patientswithacuteneurogenicstrokewhoreceivedtreatmentduringJanuarytoDecember2019.
Accordingtothestroketype,wedividedthemintocerebralhemorrhage(CH)groupandcerebralischemia(CI)group(n=130each).
TheECGchangesinallpatientsweremonitoredduringtheacutephase(within48hours)andrecoveryphase(2weeksaftertreatment),andthetypicalabnormalitiesoftheECGineachgroupwereanalyzed.
Results:ThetotalincidenceofECGabnormalitiesintheCHgroup(79.
23%,103/130)wassignificantlyhigherthanthatintheCIgroup(68.
46%,89/130;P0.
05),suggestingthetwogroupsarecomparable.
SeeTable1.
ECGabnormalitiesintheacutephaseECGchangesinacutestrokepatients7790IntJClinExpMed2020;13(10):7787-7793ComparisonofincidencesofECGabnormali-tiesintheacutephaseTherewerenosignificantdifferencesintheincidencesofST-Tdepression,Qwaveabnor-malities,QTintervalprolongationandsignifi-cantUwavebetweenthetwogroups(allP>0.
05),whileincidencesofPwaveabnormali-tiesandarrhythmiaweresignificantlyhigherintheCHgroupthanintheCIgroup(P=0.
006andP=0.
041,respectively).
SeeTable3.
Furthermore,asFigure3shows,thecommonECGabnormalitiesintheacutephasewerePwaveabnormalities,ST-Tdepressionandarrhythmia;significantdifferencesintheinci-dencesofPwaveabnormalitiesandarrhythmiawerefoundbetweenthetwogroups(bothP<0.
05).
ComparisonofincidencesofECGabnormali-tiesandcardiacsequelaebetweentheacuteandrecoveryphaseTheCHgroupshowedamoredownwardtrendintheincidenceofECGabnormalitiesintherecoveryphasethanintheacutephase,withthemostsignificantdecreaseintheincidenceofST-Tdepression(P<0.
01),SeeTable5.
TheCIgroupalsoshowedamoredownwardtrendintheincidenceofECGabnormalitiesintherecoveryphasethanintheacutephase,withthemostsignificantdecreasesinincidencesofST-Tdepressionandarrhythmiaintherecoveryphase(P=0.
002andP=0.
035,respectively).
SeeTable6.
TheresultsindicatethatECGabnormalitiesinstrokepatientsatdifferenttimepointsarereversibleandcanreturntonor-malgraduallyaftertreatment.
Additionally,theincidenceofCHDaftertreat-mentintheCIgroup(22.
47%)wassignificantlylowerthanthatintheCHgroup(42.
72%)aftertreatment(P=0.
027).
SeeTable7.
Theresult,combinedwiththeECGfindingsinTables5and6intherecoveryphase,revealsthatCHpatientswithPwaveabnormalitiesandST-Tdepressionintheacutephaseshowacompar-ativelyhighincidenceofCHDaftertreatment.
DiscussionStrokeisoneofthemostcommonCCVDsinclinicalpractice,whichseverelyendangerstheTable3.
ComparisonofincidencesofECGabnormalitiesintheacutephase(n,%)ECGabnormalitiesCHgroupCIgroupχ2PPwaveabnormalities69(53.
08%)47(36.
15%)7.
5340.
006ST-Tdepression59(45.
38%)61(46.
92%)0.
0620.
804Arrhythmia58(44.
62%)42(32.
31%)4.
1600.
041Qwaveabnormalities4(3.
08%)4(3.
08%)0.
0001.
000QTintervalprolongation5(3.
85%)4(3.
08%)0.
0001.
000SignificantUwave4(3.
08%)2(1.
54%)0.
1710.
680Note:CI:cerebralischemia;CH:cerebralhemorrhage;ECG:electrocardio-graphic.
Table4.
Comparisonofincidenceofauto-nomicdysfunction(n,%)GroupCasesAutonomicdysfunctionχ2PCIgroup13019(14.
62%)4.
1220.
042CHgroup13032(24.
62%)Note:CI:cerebralischemia;CH:cerebralhemorrhage.
Figure3.
ComparisonofincidencesofECGabnor-malitiesintheacutephase.
ComparedwiththeCHgroup,*P<0.
05;**P<0.
01.
CI:cerebralischemia;CH:cerebralhemorrhage;ECG:electrocardiographic.
ItcanbeseenfromTable4thattheincidenceofautonomicdys-functionwasmarkedlyhigherintheCHgroupthanintheCIgroup(P=0.
042).
AsshowninTable3,therewasanextremelysignificantdifferenceintheincidenceofPwaveabnormalitiesbetweenthetwogroups.
TheresultssuggestthatPwaveabnormalitiesinacutephasemaybeassociatedwithautonomicdysfunction,whichpro-videsacertainclinicalreference.
ECGchangesinacutestrokepatients7791IntJClinExpMed2020;13(10):7787-7793healthandlivesofpatients.
Forstrokepatients,effectiveclinicaljudgmentandvaliddrugtreat-mentareofgreatimportancetotherehabilita-tionandprognosis[11-13].
ApreviousstudyreportedthatneurogenicECGabnormalitiesmostlyoccurredintheacutestrokepatients,particularlyinpatientswithhemorrhagicstroke,within2daysafteronsetwithanincidencerateof60-90%[14].
ECGwaveformabnormalitiesmayalsolastformorethan2weeksinstrokepatients,anduptoabout4weeksinafewpatients[15].
Inthisstudy,wemonitoredacuteECGchangesinpatientswithacuteneurogenicstrokeandtheresultsshowedthattheinci-denceofECGabnormalitiesinallpatientswas73.
85%,andtheincidenceofECGabnor-malitiesinhemorrhagicstrokepatientswas79.
23%,confirmingahighincidenceofstroketionrate(46.
15%)amongECGabnormalities;thehighlyimproveddetectionrateduringrecov-erysuggeststhatECGabnormalitiesinstrokepatientsarereversibleandcanbebacktonor-malgraduallythroughtreatment.
Inlinewithourstudy,Sudhishetal.
alsoreportedthatpatientswithacuteischemicstrokeshowedasignificantST-Tdepressionwithgradualrecov-ery[18].
Astoarrhythmia,severearrhythmia,especiallytorsadesdepointes,causedbyneu-rogenicstrokemightleadtodeath.
Thismaybebecauseparasympatheticregulationwaseasilyaffectedbycerebralfunctionalimpairment,thuscausingarrhythmia,orcardiovasculardys-functionresultingfromintracranialhemorrhageledtocardiacdamage.
Therefore,it'sessentialtomonitorPwaveandheartrhythmduringrecovery,withparticularfocusontheoccur-Table5.
ComparisonofincidencesofECGabnormalitiesbe-tweentheacuteandrecoveryphaseinCHgroup(n,%)ECGabnormalitiesAcutephaseRecoveryphaseχ2PPwaveabnormalities69(53.
08%)55(42.
31%)3.
0220.
082ST-Tdepression59(45.
38%)33(25.
38%)11.
3720.
001Arrhythmia58(44.
62%)47(36.
15%)1.
9330.
164Qwaveabnormalities4(3.
08%)3(2.
31%)0.
1470.
702QTintervalprolongation5(3.
85%)3(2.
31%)0.
1290.
720SignificantUwave4(3.
08%)2(1.
54%)0.
1710.
680Note:CH:cerebralhemorrhage;ECG:electrocardiographic.
Table6.
ComparisonofincidencesofECGabnormalitiesbe-tweentheacuteandrecoveryphaseinCIgroup(n,%)ECGabnormalitiesAcutephaseRecoveryphaseχ2PPwaveabnormalities47(36.
15%)33(25.
38%)3.
5390.
060ST-Tdepression61(46.
92%)37(28.
46%)9.
4330.
002Arrhythmia42(32.
31%)27(20.
77%)4.
4390.
035Qwaveabnormalities4(3.
08%)1(0.
77%)0.
8160.
366QTintervalprolongation4(3.
08%)2(1.
54%)0.
1710.
680SignificantUwave2(1.
54%)0(0%)0.
5040.
478Note:CI:cerebralischemia;ECG:electrocardiographic.
Table7.
Comparisonofcardiovasculardiseaseincidence(n,%)GroupCasesofECGabnormalitiesintheacutephaseCasesofCHDaftertreatmentχ2PCIgroup8928(31.
46%)4.
9170.
027CHgroup10344(42.
72%)Note:CI:cerebralischemia;CH:cerebralhemorrhage;ECG:electrocardiographic;CHD:coronaryheartdisease.
combinedwithcardiacdiseas-es.
Moreover,previousstudiesofECGchangesinstrokepatientshaveunveiledthatECGchangesareassociatedwithstrokelocationandrecov-erystatus,andstrokepatientsweremorelikelytodevelopcar-diacsequelae,e.
g.
,thosewithPwaveabnormalitiesandsignifi-cantST-Tdepressionintheacutephasehaveahighrateofcardiovascularsequelae[16,17].
Inthisstudy,ECGchangeswe-reanalyzedinpatientswithacutestrokeandtheabnormalwaveformsmainlyconsistedofPwaveabnormalities,ST-Tde-pressionandarrhythmia.
AstoPwaveabnormalities,itmainlyreferredtohighamplitudePwave,whoseincidencerateinhemorrhagestrokepatientswasupto53.
08%.
Intherecov-eryphase(2weeksaftertreat-ment),Pwaveamplitudegradu-allydecreased,whilenosignifi-cantdifferencewasfoundbe-tweenPwaveabnormalitiesintheacuteandrecoveryphase,indicatingthatalongerobser-vationtimemaybeneeded.
AstoST-Tdepression,theresultsdemonstratedaflatorinvertedTwaveandthehighestdetec-ECGchangesinacutestrokepatients7792IntJClinExpMed2020;13(10):7787-7793renceofcardiovasculardiseases.
Inthisstudy,weshowedthattheincidencesofPwaveabnor-malitiesandarrhythmiawerehigherintheCHgroupthantheCIgroupintherecoveryphase,whilenosignificantchangewasobservedbetweentheincidencesduringtheacuteandrecoveryphase.
Furthermore,thisstudydem-onstratedmarkedlyhigherincidencesofCHDandautonomicdysfunctionintheCHgroupthantheCIgroup.
Thismaybebecausehypo-thalamicinjuryresultingfromhemorrhagestrokeledtoactivationofthesympathetic-adrenalsystem.
Hence,wespeculatedthattheECGchangesmaybeoneoftheauxiliaryindica-torsforassessingtherehabilitationstatusofpatientsandtheriskofsequelae.
Currently,thespecificcausesandmechanismsofECGchangesinacutestrokepatientsarestillnotveryclear.
Somephysicianscientistsbelievethatitmayberelatedtothestructureofdiencephalonandbrainstem[19,20].
ThechangesinreleaseofmediatorscausedbyalterationsofsympatheticandvagalnervoustensionresultedinECGabnormalities.
Forexample,theanteriorcranialfossamaycauseECGchanges,andcerebellartonsillardamagemaycauseinfarct-likeECGchanges[21].
Severallimitationsstillremaininthisstudythoughwehaveachievedcertainpositiveresults.
Thediseasetypeswerenotvarious,andthemonitoringtimewaslimitedintherecoveryphase,somorestudiesareneededtogetamorepreciseconclusioninthefuture.
Insummary,wereportahighincidenceofECGabnormalitiesinacuteneurogenicpatients,andareducedabnormalityrateinmostpatientsduringrecoveryaftertreatment.
CHpatientsshowahigherincidenceofabnormalitiesthanCIpatients,andCHpatientswithPwaveabnor-malitiesandsignificantST-Tdepressionintheacutephaseshowacomparativelyhighinci-denceofcardiovascularsequelae.
Hence,ECGmonitoringhascertainclinicalsignificanceforclinicalobservationandprognosisinpatientswithacuteneurogenicstroke.
DisclosureofconflictofinterestNone.
Addresscorrespondenceto:YuechunShen,De-partmentofCardiovasology,TheFirstAffiliatedHospitalofGuangzhouMedicalUniversity,No.
151YanjiangWestRoad,Guangzhou510120,Guang-dongProvince,China.
Tel:+86-020-83063091;E-mail:shenyuechung1ya@163.
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