Heart Rate Variability and Functional Outcomes of Patients with Spontaneous Intracerebral Hemorrhage

Kornelia Laichinger; Annerose Mengel; Rebecca Buesink; Sara Roesch; Maria-Ioanna Stefanou; Constanze Single; Till-Karsten Hauser; Markus Krumbholz; Ulf Ziemann; Katharina Feil

doi:10.3390/biomedicines12081877

Heart Rate Variability and Functional Outcomes of Patients with Spontaneous Intracerebral Hemorrhage

Biomedicines. 2024 Aug 16;12(8):1877. doi: 10.3390/biomedicines12081877.

Authors

Kornelia Laichinger^{1

2}, Annerose Mengel^{1

2}, Rebecca Buesink¹, Sara Roesch¹, Maria-Ioanna Stefanou¹, Constanze Single^{1

2}, Till-Karsten Hauser³, Markus Krumbholz⁴, Ulf Ziemann^{1

2}, Katharina Feil¹

Affiliations

¹ Department of Neurology & Stroke, Eberhard-Karls University of Tübingen, 72076 Tübingen, Germany.
² Hertie Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, 72076 Tübingen, Germany.
³ Department of Neuroradiology, Eberhard-Karls University of Tübingen, 72076 Tübingen, Germany.
⁴ Department of Neurology, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf, Germany.

Abstract

Background: The relationship between heart rate variability (HRV) changes potentially indicating autonomic dysregulation following spontaneous intracerebral hemorrhage (ICH) and functional outcome has not yet been fully elucidated. This study investigated the effects of HRV during the initial 96 h after admission on 90-day functional outcome in ICH patients.

Methods: We included patients with spontaneous ICH in a prospective cohort single-center study. Continuous HR data were retrieved from the Intellispace Critical Care and Anesthesia information system (Philips Healthcare) and analyzed within the following time intervals: 0-2, 0-8, 0-12, 0-24, 0-48, 0-72, and 8-16, 16-24, 24-48, 48-72, 72-96 h after admission. HRV was determined from all available HR values by calculating the successive variability (SV), standard deviation (SD), and coefficient of variation (CV). Low HRV was set as SD ≤ 11.4 ms, and high HRV as SD > 11.4 ms. The clinical severity of ICH was assessed using the National Institutes of Health Stroke Scale (NIHSS) and functional outcome using the modified Rankin Scale (mRS). Good functional outcome was defined as mRS 0-2.

Results: The cohort included 261 ICH patients (mean age ± SD 69.6 ± 16.5 years, 48.7% female, median NIHSS 6 (2, 12), median ICH score 1 (0, 2), of whom 106 (40.6%) had good functional outcome. All patients had the lowest HRV at admission, which increased during the first two days. Comparing ICH patients with low HRV (n = 141) and high HRV (n = 118), those with good outcome showed significantly lower HRV during the first three days (0-72 h: HRV SD good outcome 10.6 ± 3.5 ms vs. poor outcome 12.0 ± 4.0 ms; p = 0.004). Logistic regression revealed that advanced age, high premorbid mRS, and high NIHSS at admission were significant predictors of poor functional outcome, while reduced SD of HRV showed a non-significant trend towards good functional outcome (0-72 h: OR 0.898; CI 0.800-1.008; p = 0.067).

Conclusions: Our results indicate autonomic dysfunction with sympathetic hyperactivity after spontaneous ICH, as reflected by the evidence of the lower HRV in the first days. Initially increased sympathetic tone appears to have a protective effect, as suggested by the comparatively lower HRV in patients with good functional outcome at the first days.

Keywords: acute management; autonomic dysfunction; big data; functional outcome; heart rate variability; intensive care; intracerebral hemorrhage.

Grants and funding

No specific funding received. The authors acknowledge support from the Open Access Publication Fund of the University of Tübingen.