{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T19:51:00Z","timestamp":1790106660517,"version":"4.0.1"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T00:00:00Z","timestamp":1747094400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>Acute ischemic stroke (AIS) is a leading cause of disability and mortality, with poor functional outcomes often linked to autonomic dysfunction. Deceleration capacity (DC), a marker of vagal activity, has been shown to predict cardiovascular outcomes, but its prognostic value in AIS remains underexplored. This study investigates the role of DC in predicting stroke recovery at 2 weeks and 3 months post-stroke.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and methods<\/jats:title><jats:p>This prospective study included 423 AIS patients treated at a single center between January 2022 and December 2023. Cardiac autonomic function was assessed using DC and heart rate variability (HRV) parameters (SDNN, SDANN, RMSSD), derived from 24-hour Holter ECG monitoring. Patients were categorized into two groups based on DC: DC &amp;gt; 4.5 ms and DC \u2264 4.5 ms. Functional outcomes were measured using the modified Rankin Scale (mRS) at 2 weeks and 3 months post-stroke. Logistic regression models and Restricted Cubic Splines (RCS) were used to analyze the relationship between DC and stroke outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients with lower DC (\u22644.5ms) had significantly worse functional outcomes, as indicated by higher mRS scores at both 2 weeks and 3 months. The DC \u2264 4.5 ms group also had a higher prevalence of comorbidities such as diabetes and hypertension. RCS analysis revealed a non-linear relationship between DC and stroke outcomes, with a significant threshold at DC = 4.5 ms. The 3-month outcome model, including age and DC, demonstrated strong predictive ability with an AUC of 0.744.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study highlights the importance of DC as a prognostic marker for short-term stroke recovery. Lower DC values are associated with worse outcomes, suggesting that DC may serve as an early predictor of stroke prognosis. Future research should focus on validating these findings in larger, multicenter cohorts and exploring interventions targeting autonomic dysfunction to improve stroke recovery.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2025.1601346","type":"journal-article","created":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T04:10:25Z","timestamp":1747109425000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Prognostic value of heart rate deceleration capacity for functional outcomes in acute ischemic stroke: a prospective study"],"prefix":"10.3389","volume":"16","author":[{"given":"Huizhong","family":"Zhou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaqi","family":"Zhong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changman","family":"Deng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingde","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanhong","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiajun","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,5,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2357","DOI":"10.3390\/ijms22052357","article-title":"Targeting the autonomic nervous system for risk stratification, outcome prediction and neuromodulation in ischemic stroke","volume":"22","author":"Carandina","year":"2021","journal-title":"Int J Mol Sci"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1212\/wnl.0000000000207387","article-title":"Global burden, risk factor analysis, and prediction study of ischemic stroke, 1990-2030","volume":"101","author":"Fan","year":"2023","journal-title":"Neurology"},{"key":"B3","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/j.ejim.2015.11.030","article-title":"Ischemic stroke outcome: A review of the influence of post-stroke complications within the different scenarios of stroke care","volume":"29","author":"Bustamante","year":"2016","journal-title":"Eur J Intern Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"856","DOI":"10.3390\/life13040856","article-title":"Can HRV predict prolonged hospitalization and favorable or unfavorable short-term outcome in patients with acute ischemic stroke","volume":"13","author":"Aftyka","year":"2023","journal-title":"Life (Basel)"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.2147\/cia.S99542","article-title":"Changes of deceleration and acceleration capacity of heart rate in patients with acute hemispheric ischemic stroke","volume":"11","author":"Xu","year":"2016","journal-title":"Clin Interv Aging"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2023.1115164","article-title":"Jan \u017b. Heart rate variability as a predictor of stroke course, functional outcome, and medical complications: A systematic review","volume":"14","author":"Joanna","year":"2023","journal-title":"Front Physiol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1161\/jaha.116.004305","article-title":"Addition of 24-hour heart rate variability parameters to the cardiovascular health study stroke risk score and prediction of incident stroke: the cardiovascular health study","volume":"6","author":"Bodapati","year":"2017","journal-title":"J Am Heart Assoc"},{"key":"B8","doi-asserted-by":"publisher","first-page":"300","DOI":"10.3390\/jcm8030300","article-title":"Baroreceptor sensitivity predicts functional outcome and complications after acute ischemic stroke","volume":"8","author":"Lin","year":"2019","journal-title":"J Clin Med"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1109\/embc48229.2022.9870894","article-title":"Maternal autonomic responsiveness is attenuated in healthy pregnancy: a phase rectified signal averaging analysis","volume":"2022","author":"Bester","year":"2022","journal-title":"Annu Int Conf IEEE Eng Med Biol Soc"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(06)68735-7","article-title":"Deceleration capacity of heart rate as a predictor of mortality after myocardial infarction: cohort study","volume":"367","author":"Bauer","year":"2006","journal-title":"Lancet"},{"key":"B11","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1016\/j.medengphy.2014.12.001","article-title":"Evaluation of acceleration and deceleration cardiac processes using phase-rectified signal averaging in healthy and idiopathic dilated cardiomyopathy subjects","volume":"37","author":"Bas","year":"2015","journal-title":"Med Eng Phys"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/9763826","article-title":"Preprocessing unevenly sampled RR interval signals to enhance estimation of heart rate deceleration and acceleration capacities in discriminating chronic heart failure patients from healthy controls","volume":"2020","author":"Cao","year":"2020","journal-title":"Comput Math Methods Med"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00013.2010","article-title":"Phase-rectified signal averaging as a sensitive index of autonomic changes with aging","volume":"108","author":"Campana","year":"2010","journal-title":"J Appl Physiol (1985)"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1136\/svn-2020-000378","article-title":"Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of ischaemic cerebrovascular diseases","volume":"5","author":"Liu","year":"2020","journal-title":"Stroke Vasc Neurol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.114.007773","article-title":"Classification of subtypes of ischemic stroke: history of the trial of org 10172 in acute stroke treatment classification","volume":"46","author":"Adams","year":"2015","journal-title":"Stroke"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2023.1055445","article-title":"The connection between heart rate variability (HRV), neurological health, and cognition: A literature review","volume":"17","author":"Arakaki","year":"2023","journal-title":"Front Neurosci"},{"key":"B17","doi-asserted-by":"publisher","first-page":"e0050","DOI":"10.1097\/hc9.0000000000000050","article-title":"Heart rate variability is associated with disease severity and portal hypertension in cirrhosis","volume":"7","author":"Miceli","year":"2023","journal-title":"Hepatol Commun"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.107.489351","article-title":"Shift analysis versus dichotomization of the modified Rankin scale outcome scores in the NINDS and ECASS-II trials","volume":"38","author":"Savitz","year":"2007","journal-title":"Stroke"},{"key":"B19","doi-asserted-by":"publisher","first-page":"e0241364","DOI":"10.1371\/journal.pone.0241364","article-title":"Restricted cubic splines for modelling periodic data","volume":"15","author":"Lusa","year":"2020","journal-title":"PloS One"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.864858","article-title":"Dysregulated hypothalamic-pituitary-adrenal axis is associated with increased inflammation and worse outcomes after ischemic stroke in diabetic mice","volume":"13","author":"Sehee","year":"2022","journal-title":"Front Immunol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1007\/s11357-022-00616-1","article-title":"The role of age-associated autonomic dysfunction in inflammation and endothelial dysfunction","volume":"44","author":"Yunqiu","year":"2022","journal-title":"Geroscience"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2007.01875.x","article-title":"Cardiac autonomic dysfunction and functional outcome after ischaemic stroke","volume":"14","author":"Bassi","year":"2007","journal-title":"Eur J Neurol Aug"},{"key":"B23","doi-asserted-by":"publisher","first-page":"e12771","DOI":"10.1111\/anec.12771","article-title":"Predictive values of heart rate variability, deceleration and acceleration capacity of heart rate in post-infarction patients with LVEF \u226535","volume":"25","author":"Liu","year":"2020","journal-title":"Ann Noninvasive Electrocardiol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eux167","article-title":"Bedside autonomic risk stratification after myocardial infarction by means of short-term deceleration capacity of heart rate","volume":"20","author":"Rizas","year":"2018","journal-title":"Europace"},{"key":"B25","doi-asserted-by":"publisher","first-page":"23617","DOI":"10.1038\/srep23617","article-title":"Deceleration and acceleration capacities of heart rate associated with heart failure with high discriminating performance","volume":"6","author":"Hu","year":"2016","journal-title":"Sci Rep"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1111\/jcpt.13258","article-title":"Deceleration capacity of heart rate predicts trastuzumab-related cardiotoxicity in patients with HER2-positive breast cancer: A prospective observational study","volume":"46","author":"Feng","year":"2021","journal-title":"J Clin Pharm Ther"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2016.06.205","article-title":"Deceleration capacity: A novel predictor for total mortality in patients with non-ischemic dilated cardiomyopathy","volume":"221","author":"Demming","year":"2016","journal-title":"Int J Cardiol"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2023.1115164","article-title":"Heart rate variability as a predictor of stroke course, functional outcome, and medical complications: A systematic review","volume":"14","author":"Aftyka","year":"2023","journal-title":"Front Physiol"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1089\/acm.2019.0267","article-title":"Neuromodulating influence of two electroacupuncture treatments on heart rate variability, stress, and vagal activity","volume":"26","author":"Armstrong","year":"2020","journal-title":"J Altern Complement Med"},{"key":"B30","doi-asserted-by":"publisher","first-page":"2446","DOI":"10.3390\/jcm12072446","article-title":"Vagal nerve activity and short-term clinical outcomes after stroke: what is left may not be right","volume":"12","author":"Badarny","year":"2023","journal-title":"J Clin Med"},{"key":"B31","doi-asserted-by":"publisher","first-page":"102986","DOI":"10.1016\/j.autneu.2022.102986","article-title":"Sympathovagal imbalance in early ischemic stroke is linked to impaired cerebral autoregulation and increased infarct volumes","volume":"241","author":"Castro","year":"2022","journal-title":"Autonomic Neurosci"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2022.09.013","article-title":"Vagus nerve stimulation paired with rehabilitation for stroke: Implantation experience from the VNS-REHAB trial","volume":"105","author":"Liu","year":"2022","journal-title":"J Clin Neurosci"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1016\/j.saa.2021.120652","article-title":"A variable selection method based on mutual information and variance inflation factor","volume":"268","author":"Cheng","year":"2022","journal-title":"Spectrochim Acta A Mol Biomol Spectrosc"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1601346\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T10:29:19Z","timestamp":1747391359000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1601346\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,13]]},"references-count":33,"alternative-id":["10.3389\/fendo.2025.1601346"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2025.1601346","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,13]]},"article-number":"1601346"}}