| Background:Neurovascular coupling(NVC)is a mechanism in which neuronal activity is closely related to local cerebral blood flow in space and time.Posterior circulation cerebral infarction(PCCI)could lead to depression of cerebral blood flow and metabolic,the fatality rate and disability rate is high.Transcranial Doppler(TCD)can measure intracranial blood flow velocity,Quantitative Electroencephalography(QEEG)can reflect changes in brain blood flow and metabolism.TCD combined with QEEG is a new type of neurovascular coupling technique that can be monitored near the bed,and involves synergy between the metabolic and vascular systems.The aim of this study was to combine TCD and QEEG synchronously to monitor brain function and prognostic judgment in patients with PCCI.Methods:This study was a prospective cohort study,prospectively enrolled patients with PCCI who were admitted to the Department of Neurology,First Hospital of Jilin University,between July 2018 to July 2019,quantitative brain function monitoring was performed using a TCD-QEEG recording system(Nicolet EEG Monitor;Natus Medical Inc.,Pleasanton,CA,USA)at the patient's bedside,collected name,sex,clinical datas,and neurophysiological tests(TCD and QEEG relevant parameters),mortality was assessed at 90 d follow-up.The univariate and Cox proportional hazard regression modell were used to analyze the data.The survival rates were assessed by Kaplan-Meier analysis,and the survival curves were compared using a log-rank test.The receiver operating characteristic(ROC)curve analysis was used to evaluate the cut-off point for diastolic flow velocity(VD)and(delta+theta)/(alpha+beta)ratio(DTABR),and the area under the ROC curve was used to assess the predicted validity of variables.Results:1.Forty patients(average age 63.7?±?9.9 years;30 men)were studied,mortality at 90 d was 40%.2.In the univariate analysis,among the clinical variables,only higher Glasgow Coma Scale(GCS)scores(P=0.001)and low full outline of unresponsiveness(FOUR)scores(P=0.008)were associated with mortality.Regarding TCD relevant parameters,lower systolic flow velocity(VS,P?= 0.014),lower VD(P= 0.001)and lower mean flow velocity(VM,P = 0.012),were associated with mortality.Regarding QEEG relevant parameters,higher relative delta power(RDP,P?=?0.033),higher DTABR(P < 0.0001),higher delta/alpha ratio(DAR,P?= 0.027),lower alpha variability(P?= 0.043),lower relative alpha power(P?= 0.027),lower delta ratio(P = 0.02),lower spectral entropy(P = 0.042),lower median frequency(P =0.015)and lower peak frequency(P = 0.022)were associated with mortality.Amplitude integrated EEG,relative theta power,relative beta power,Spectral entropy,95% spectral edge frequency,DTABR,gross energy and median frequency showed significant differences(all P?<?0.05)between patients with posterior PCCI and healthy controls.3.The multivariate analysis shows that the Vd in TCD was independent predictors of prognosis(HR 0.168,95%CI 0.047–0.597,P?=?0.006),DTABR in QEEG was independent predictor of prognosis(hazards ratio 12.527,confidence interval1.637–95.846,P?=?0.015).4.The 90 d survival rate was lower in patients with DTABR > 2 than in patients with DTABR ? 2(37.5% vs 93.8%,P = 0.001),in addition,patients with an VD ? 14.5cm/s had an increased risk of death compared with those with an VD> 14.5cm/s(65% vs 15%,P = 0.001).5.The area under the ROC curve(area under ROC,AUROC)of VD and DTABR was 0.896.The comparison of ROC curves showed that the diagnostic efficacy of VD and DTABR in the diagnosis of mortality in patients with PCCI within 90 d was better than that of GCS score(AUROC 0.75),VD(AUROC 0.76)and DTABR(AUROC 0.781)(all P <0.05).Conclusions:VD and DTABR were independent predictors of clinical outcome in patients with PCCI for 90 d.VD+DTABR was superior to GCS score alone in diagnosing the mortality of patients with PCCI within 90 d.TCD-QEEG can improve predictive accuracy of the prognosis for patients with PCCI. |
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