The state of the autonomic nervous system as a criterion for assessing the progression of the severity of ischemic stroke

Relevance. During the acute phase of intermittent ischemic stroke, it is virtually impossible to predict the patient's condition over the next 2–3 days. Studying changes in the autonomic nervous system (ANS) during the acute phase of ischemic stroke is crucial, as it can be used for risk stratification and prognostication of the subsequent course of the disease.

Objective. To study the dynamics of autonomic changes in patients in the acute period of ischemic stroke and to evaluate the degree of their influence on the course of the acute period.

Materials and methods. The study initially included 162 patients in the acute period of ischemic stroke. Subsequently, 38 patients with minor stroke, 5 patients with regression of neurological symptoms by 21 days, 42 patients with an intermittent course of the acute period, and 14 people with a severe stroke according to the NIHSS scale were excluded. Of the 63 patients remaining under observation, 2 groups were formed: Group 1–25 patients who experienced a rapid deterioration of clinical symptoms from the 10th to the 20th day of observation in the acute period with subsequent transition of the stroke to a more severe form within 2–3 days; Group 2–38 patients with a stable course of the disease. All patients had their blood pressure, pulse, and respiratory rate measured every morning for 10 days. Based on these data, the Kerdo index and Hildebrandt index were calculated as criteria for assessing autonomic nervous system function. The degree of neurological deficit and stroke severity were assessed daily using the NIHSS scale.

Results and discussion. The study found that assessing changes in autonomic function using the Kerdo index and Hildebrandt index has prognostic value and can be used as a specific marker indicating the potential for a sharp deterioration in the short term (2–3 days) in patients with ischemic stroke. Marked progression of neurological deficit with the transition of stroke to a more severe form is associated with an absolute increase in the Kerdo index of ≥18 units and the Hildebrandt coefficient of ≥9.0 units. The high reliability of this method (82.1 %) justifies its implementation in clinical practice for the timely identification of patients requiring enhanced monitoring and therapy.

Conclusion. Assessing changes in autonomic regulation using the Kerdo index and the Hildebrandt coefficient has prognostic value and can be used as a specific marker of a sharp deterioration in the condition of patients with ischemic stroke in the short term (2–3 days).

1. Poverennova I. E., Khivintseva E. V., Zakharov A. V., Vasemazova E. N., Ananyeva S. A. Autonomic dysfunction in patients with chronic cerebral ischemia. Saratov Journal of Medical Scientific Research. 2019; 15 (1): 167–172. (In Russ.).

2. Komissarova N. V. Features of the autonomic nervous system in post-stroke patients as a criterion for determining rehabilitation potential. Medicine. Sociology. Philosophy. Applied research. 2025; 2: 167–170. (In Russ.).

3. Vasemazova E. N. Assessment of the autonomic nervous system state by heart rate variability analysis in chronic cerebral ischemia in patients of different age groups: dis. … cand. of medical sciences. 2020. 142 р. (In Russ.).

4. Kolomentsev S.V, Yanishevsky S. N. Pathogenetic mechanisms of developmen of peripheral vegetative disorders after ischemic stroke and the main directions of their pharmacological correction. Trudnyj pacient. 2018; 5: 16–22. (In Russ.).

5. Zhao M., Guan L., Wang Y. The association of autonomic nervous system function with ischemic stroke, and treatment strategies. Front Neurol. 2020; 10: 1411. https://doi.org/10.3389/fneur.2019.01411

6. Damkjær M., Simonsen S., Heiberg A. et al. Autonomic dysfunction after mild acute ischemic stroke and six months after: a prospective observational cohort study. BMC Neurol. 2023; 23 (1): 26. https://doi.org/10.1186/s12883‑023‑03054‑4

7. Bakumets V.S, Belova K. N. The state of the autonomic nervous system and ecg characteristics of the heart in ischemic stroke. Nauchnyye issledovaniya studentov i uchashchikhsya: sbornik statey viii mezhdunarodnoy nauchno-prakticheskoy konferentsii. Penza; 2023: 179–181. (In Russ.).

8. Khasanova D.R, Magsumova R.L, Danilova T. V. System of autonomic balance in ischemic stroke acute period and its influence on rehabilitation potential. Consilium Medicum. 2020; 22 (2): 13–18. (In Russ.). https://doi.org/10.26442/20751753.2020.2.200030

9. Klassina S. Ya. Hildebrandt index as a prognostic criterion of abandonment of intense physical activity. Science and sport: current trends. 2019; 7 (2): 68–73. (In Russ.).

10. Samuels M. A. The brain-heart connection. Circulation. 2007; 116 (1): 77–84. https://doi.org/10.1161/CIRCULATIONAHA.106.678995

11. Xing C., Hayakawa K., Lo E. H. Mechanisms, Imaging, and Therapy in Stroke Recovery. Transl. Stroke Res. 2017; 8: 1–2. https://doi.org/10.1007/s12975‑016‑0503‑5

12. Scheldeman L., Wouters A., Dupont P., Christensen S., Boutitie F., Cheng B., Ebinger M., Endres M., Fiebach J. B., Gerloff C. et al. Reversible edema in the penumbra correlates with severity of hypoperfusion. Stroke. 2021; 52: 2338–2346. DOI: 10.1161/STROKEAHA.120.033071

13. Kocaeli H. et al. Heart rate variability and its association with mortality in acute brain injury: a systematic review. Journal of Clinical Neuroscience. 2019; 59: 1–6. 14. Zhang F., Liu L., Zhang C. et al. Association of metabolic syndrome and its components with risk of stroke recurrence and mortality: a meta-analysis. Neurology. 2021; 97 (7): 695–705.

14. Chekeeva N. T, Schleifer S. G, Andrianova E. V, Jusupova A. T. The state of vegetative regulation in patients with ischemic stroke in the acute and peracute periods: an observational cohort study. Kuban Scientific Medical Bulletin. 2022; 29 (5): 123–136. (In Russ.). https://doi. org/10.25207/1608‑6228‑2022‑29‑5‑123‑136

15. Mokasheva E. N., Grebennikova I. V., Zemskova V. A., Bolotskikh V. I. Rapid assessment of cardiovascular system parameters using cardiorespiratory indices. Advances in Modern Biology. 2023; 143 (2): 144–150. (In Russ.). https://doi.org/10.31857/S0042132423020072

16. Zhao M., Guan L., Wang Y. The association of autonomic nervous system function with ischemic stroke, and treatment strategies. Front. Neurol. 2020; 10. https://doi.org/10.3389/fneur.2019.01411

17. Solonin Yu. G. Hildebrandt index in skiers and taekwondo athletes at rest and under standard bicycle ergometric loads. Russian Journal of Sports Science: Medicine, Physiology, Training. 2022; 1 (1). (In Russ.). https://doi.org/10.51871/2782-6570_2022_01_01_4