Holter parameters score predicts prognosis in patients with acute ischemic stroke: A prospective cohort study

Abstract: BACKGROUND: Cardiac dysfunction significantly contributes to worsened neurological outcomes following acute ischemic stroke (AIS), posing challenges for prognostication. Holter monitoring is widely used to detect occult cardiac dysfunction and plays a crucial role in managing AIS. This study aimed to evaluate the predictive value of a composite Holter parameter score for prognosis in patients with AIS. MATERIALS AND METHODS: A total of 113 patients with AIS within 7 days of stroke onset were enrolled. Holter parameters, including prolonged QT interval, atrial fibrillation, arrhythmia, ST-T elevation, and heart rate variability, were recorded. The primary endpoint was poor prognosis, defined as a 3-month modified Rankin Scale score > 1. Risk factors affecting prognosis were identified using logistic regression analysis. RESULTS: A Holter score incorporating prolonged QT interval, partial ST-T elevation, standard deviation average of the RR interval at 24 h and low frequency during the daytime was developed to predict 3 months prognosis in patients with AIS. Logistic regression analysis demonstrated that the Holter score remained significantly associated with prognosis. The inclusion of the Holter score in the conventional model improved discrimination and net reclassification (net reclassification improvement % = 65.13% [25.01%, 105.24%], integrated discrimination improvement % = 6.99% [1.16%, 12.81%]). The area under the receiver operating characteristic curve was 0.905 (0.831–0.978; P < 0.0001), indicating excellent model fit. CONCLUSION: The composite Holter score exhibited a promising predictive value for identifying poor prognosis in patients with AIS. Its incorporation into clinical practice may enhance risk stratification and guide treatment decisions in this patient population. TRIAL REGISTRATION: http://www.clinicaltrials.gov (identifier: NCT03868007).