Aktuelle Neurologie 2007; 34 - P810
DOI: 10.1055/s-2007-988079

Impaired baroreflex sensitivity predicts poor short-term outcome in intracerebral haemorrhage – preliminary results

M Sykora 1, J Diedler 1, T Steiner 1
  • 1Heidelberg

Background: The baroreflex normally serves to compensate for excessive rise or fall of blood pressure. Baroreflex failure occurs when afferent baroreceptive nerves or their central connections become impaired. In baroreflex failure, there is loss of buffering ability, and wide excursions of pressure and heart rate occur. Impairment of the baroreflex may produce an unusually broad spectrum of clinical presentations; with acute baroreflex failure, a hypertensive crisis is the most common presentation. In the absence of an acute event, volatile hypertension with periods of hypotension may occur. Abnormalities in the vascular baroreceptors, the glossopharyngeal nerve, their brain stem connections, or interruption of afferent nerves can all potentially lead to baroreflex failure. Accidental trauma, unilateral or bilateral carotid endarectomy, bilateral atherosclerosis of carotid arteries, brain stem stroke and acute ischaemic stroke are all recognized causes of baroreflex failure. Cardiac baroreceptor sensitivity has been related to long-term outcome after acute ischaemic stroke.

Aims: We sought to examine baroreflex sensitivity (BRS) in patients with acute intracerebral haemorrhage and correlate it with short-time outcome measures.

Methods: Patient with acute intracerebral haemorrhage within 72 hours after onset of symptoms were included in an open, prospective study. We excluded patients with atrial fibrillation, diabetes mellitus, chronic renal failure or other medical conditions known to affect autonomic functions. Patients with atherosclerosis of carotid arteries were also excluded. Baroreflex sensitivity was measured non-invasively using Finometer device (FMS, Finapres Medical Systems BV, Amsterdam, Nederlands). Baroreflex gain was calculated as sequential cross-correlation between heart rate and blood pressure. The mean of 30 values was calculated for each subject. Outcome in 10 days was measured by mRS. According to outcome, the patients were dichotomised in to 2 groups, with mRS 0–3 and mRS 4–6, respectively.

Results: We present data of an ongoing study which will be finalized shortly. In the interim analyses, patients with mRS 4–6 had significant lower values of baroreflex gain compared to patients with mRS 0–3.

Conclusions: Low baroreflex gain values may predict poor short-time outcome in patients with acute intracerebral haemorrhage.