Impact of total atherosclerosis burden in baroreceptor-resident arteries on newly detected atrial fibrillation after stroke

doi:10.3877/cma.j.issn.1673-9248.2025.03.002

Abstract

Abstract:

Objective

To explore the impact of the total atherosclerosis burden of baroreceptor-resident arteries (TAB-BRA) on atrial fibrillation newly detected after stroke (AFDAS).

Methods

In this prospective cohort study, consecutive acute ischemic stroke (AIS) patients within 7 days of symptom onset who had no prior history of heart disease were recruited. We calculated TAB-BRA by scoring and summing the atherosclerosis severity across 10 segments of the carotid sinuses and aortic arch using one-step computed tomography angiography. Asymptomatic coronary artery stenosis (ACAS) ≥50% was also assessed. All participants underwent electrocardiogram and mobile electrocardiogram monitoring during the first week of hospitalization to detect AFDAS. Twenty-four-hour Holter monitoring was performed to obtain heart rate variability (HRV) parameters reflecting cardiac autonomic nervous system activity. Patients were divided into low-TAB-BRA (<5 points) and high-TAB-BRA (≥5 points) groups based on the median TAB-BRA score. Group differences in AFDAS incidence were analyzed. Multivariate logistic regression was used to determine independent associations of TAB-BRA and ACAS ≥50% with AFDAS. HRV parameters were compared between AFDAS and non-AFDAS groups, and multivariate linear regression assessed the relationship between AFDAS and the low-frequency/high-frequency (LF/HF) ratio.

Results

Among 228 eligible AIS patients [mean age (59±12) years, median TAB-BRA score 5], 21 (9.2%) developed AFDAS. The high-TAB-BRA group had a significantly higher incidence of AFDAS than those in the low-TAB-BRA group (13.8% vs 4.5%, P<0.001). After adjusting for stroke severity, infarct volume, insular involvement, and ACAS ≥50%, TAB-BRA remained independently associated with AFDAS (OR=4.35, 95%CI: 1.58-10.47, P=0.008), whereas ACAS ≥50% showed no significant correlation (OR=0.24, 95%CI: 0.17-21.13, P=0.09). The AFDAS group exhibited a higher LF/HF ratio (median 2.4 vs 1.8, P=0.024), indicating sympathetic dominance. Multivariate analysis confirmed that AFDAS was associated with an elevated LF/HF ratio (β=1.41, 95%CI: 1.04-3.53, P=0.037), which correlated with TAB-BRA (r=0.197, P=0.012).

Conclusion

In AIS patients without pre-existing heart disease, AFDAS is independently linked to TAB-BRA, but not to ACAS ≥50%. Both AFDAS and TAB-BRA are associated with autonomic imbalance, potentially mediated by sympathetic-parasympathetic dysregulation in high-TAB-BRA patients.

Key words: Acute ischemic stroke, Total atherosclerosis burden of baroreceptor-resident arteries, Stroke, Atrial fibrillation

Zhiyong Fu, Xin Ma, Jing Dong, Xiangying Du, Chunlin Yin. Impact of total atherosclerosis burden in baroreceptor-resident arteries on newly detected atrial fibrillation after stroke[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2025, 19(03): 175-183.

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URL: https://zhnxgbzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1673-9248.2025.03.002

https://zhnxgbzz.cma-cmc.com.cn/EN/Y2025/V19/I03/175

Figures/Tables 5

临床特征	总数（228例）	TAB-BRA<5分（112例）	TAB-BRA≥5分（116例）	统计值	P值
人口统计学
年龄（岁， $x ¯ ± s$ ）	59.5±12.1	53.8±12.1	65.0±9.3	t=7.889	<0.001
男性[例（%）]	168（73.7）	79（70.5）	89（76.7）	χ²=1.132	0.289
BMI（kg/m²， $x ¯ ± s$ ）	25.8±3.5	26.1±3.9	25.4±3.2	t=1.486	0.139
吸烟[例（%）]	115（50.4）	49（43.8）	66（56.9）	χ²=3.940	0.047
既往病史[例（%）]
高血压	140（61.4）	56（50.0）	84（72.4）	χ²=12.081	<0.001
糖尿病	79（34.6）	25（22.3）	54（46.6）	χ²=14.768	<0.001
卒中病史	47（20.6）	10（8.9）	37（31.9）	χ²=18.374	<0.001
卒中特征
入院NIHSS[分，M（Q_R）]	3（2，5）	3（2，4）	4（2，5）	W=4859	<0.001
梗死体积[ml，M（Q_R）]	1.9（0.8，8.7）	2.1（0.8，8.6）	1.7（0.8，10.3）	W=6543	0.926
累及岛叶[例（%）]	24（10.5）	12（10.7）	12（10.3）	χ²=0.013	0.928
冠状动脉病变和AFDAS [例（%）]
ACAS≥50%	101（44.3）	28（25.0）	73（62.9）	χ²=33.231	<0.001
AFDAS	21（9.2）	5（4.5）	16（13.8）	χ²=12.694	<0.001

临床特征	总数（228例）	TAB-BRA<5分（112例）	TAB-BRA≥5分（116例）	统计值	P值
人口统计学
年龄（岁， $x ¯ ± s$ ）	59.5±12.1	53.8±12.1	65.0±9.3	t=7.889	<0.001
男性[例（%）]	168（73.7）	79（70.5）	89（76.7）	χ²=1.132	0.289
BMI（kg/m²， $x ¯ ± s$ ）	25.8±3.5	26.1±3.9	25.4±3.2	t=1.486	0.139
吸烟[例（%）]	115（50.4）	49（43.8）	66（56.9）	χ²=3.940	0.047
既往病史[例（%）]
高血压	140（61.4）	56（50.0）	84（72.4）	χ²=12.081	<0.001
糖尿病	79（34.6）	25（22.3）	54（46.6）	χ²=14.768	<0.001
卒中病史	47（20.6）	10（8.9）	37（31.9）	χ²=18.374	<0.001
卒中特征
入院NIHSS[分，M（Q_R）]	3（2，5）	3（2，4）	4（2，5）	W=4859	<0.001
梗死体积[ml，M（Q_R）]	1.9（0.8，8.7）	2.1（0.8，8.6）	1.7（0.8，10.3）	W=6543	0.926
累及岛叶[例（%）]	24（10.5）	12（10.7）	12（10.3）	χ²=0.013	0.928
冠状动脉病变和AFDAS [例（%）]
ACAS≥50%	101（44.3）	28（25.0）	73（62.9）	χ²=33.231	<0.001
AFDAS	21（9.2）	5（4.5）	16（13.8）	χ²=12.694	<0.001

临床特征	未校正OR值（95% CI）	校正OR值（95% CI）^a	校正OR值（95% CI）^b
年龄	1.07（0.99，1.16）	1.11（0.92，1.33）
男性	0.46（0.10，2.13）	0.35（0.07，0.73）
BMI	0.86（0.68，1.08）	0.99（0.69，1.44）
吸烟史	2.52（0.48，13.28）	2.65（0.99，12.04）
高血压史	0.83（0.18，3.82）	1.32（0.10，3.74）
糖尿病史	0.75（0.14，3.95）	0.84（0.04，7.40）
卒中史	0.10（0.01，5.65）	0.15（0.01，5.89）
入院NIHSS评分	1.11（0.84，1.45）	1.31（0.50，3.46）
梗死体积	1.01（1.00，1.02）	1.02（0.98，1.06）
累及岛叶	13.40（2.80，64.15）*	12.01（3.23，65.49）*	13.23（3.20，64.18）*
ACAS≥50%	3.26（0.62，17.14）	0.24（0.17，21.13）
TAB-BRA	3.07（1.37，11.19）*	4.35（1.58，10.47）*	4.02（1.20，12.35）*

HRV	总数（228例）	无AFDAS组（21例）	AFDAS组（207例）	统计值	P值
时域分析（ms， $x ¯ ± s$ ）
rMSSD	27.1±10.2	30.6±10.4	23.9±8.8	t=4.615	<0.001
SDNN	111.0±30.5	116.6±29.4	105.9±30.8	t=2.328	0.021
频域分析[ms²/Hz，M（Q_R）]
HF	149.5（82.2，276.0）	226.4（120.4，355.9）	103.4（69.7，199.3）	W=5255	<0.001
LF	336.7（185.8，566）	396.6（254.7，589.1）	260.0（150.3，438.1）	W=4761	0.002
TP	2025.5（1277.0，2899.9）	2396.2（1531.5，3199.8）	1707.1（1049.8，2569.4）	W=4726	0.003
LF/HF	2.1（1.4，3.0）	1.8（1.4，2.6）	2.4（1.5，3.4）	W=2993	0.024

HRV	总数（228例）	无AFDAS组（21例）	AFDAS组（207例）	统计值	P值
时域分析（ms， $x ¯ ± s$ ）
rMSSD	27.1±10.2	30.6±10.4	23.9±8.8	t=4.615	<0.001
SDNN	111.0±30.5	116.6±29.4	105.9±30.8	t=2.328	0.021
频域分析[ms²/Hz，M（Q_R）]
HF	149.5（82.2，276.0）	226.4（120.4，355.9）	103.4（69.7，199.3）	W=5255	<0.001
LF	336.7（185.8，566）	396.6（254.7，589.1）	260.0（150.3，438.1）	W=4761	0.002
TP	2025.5（1277.0，2899.9）	2396.2（1531.5，3199.8）	1707.1（1049.8，2569.4）	W=4726	0.003
LF/HF	2.1（1.4，3.0）	1.8（1.4，2.6）	2.4（1.5，3.4）	W=2993	0.024

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