Decreased Nighttime Heart Rate Variability Is Associated With Increased Stroke Risk

Binici, Zeynep; Mouridsen, Mette Rauhe; Køber, Lars; Sajadieh, Ahmad

doi:10.1161/strokeaha.110.607697

Cited by 89 publications

(79 citation statements)

References 37 publications

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“…Daily variability in stroke occurrence can reflect autonomic nervous system modulations and even more its modifications with aging, which is suspected to facilitate stroke. Vagal tonic modulation during the night, in fact, is higher in young males and decreases with aging and it has been associated with stroke risk [61, 62]. These differences may partially justify the different circadian distribution of stroke onset between males and females and during aging.…”

Section: Discussionmentioning

confidence: 99%

Daily Variation in the Occurrence of Different Subtypes of Stroke

Ripamonti

Riva

Maioli³

et al. 2017

Stroke Research and Treatment

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Three thousand two hundred and ninety-eight patients admitted to our Stroke Unit with hemorrhagic, large artery atherosclerosis, cardioembolic, small-vessel occlusion, and undetermined etiology-cryptogenic strokes were included in the study. The circadian variability in onset in each stroke subgroup and the associations with various risk factors were analyzed. In each subgroup, a significant minority of patients suffered from stroke during sleep. In the ischemic group, hypercholesterolemia, paroxysmal atrial fibrillation, and previous myocardial infarction facilitated the onset during waking. During waking, stroke onset was significantly higher in the morning compared to the afternoon both in the hemorrhagic and in the ischemic type. In hemorrhagic stroke, a previous stroke was associated with a lower early morning occurrence. In large artery atherosclerosis stroke, males were at higher risk of early morning occurrence (p < 0.01). In small-vessel occlusion stroke, hypertension is significantly more present in the morning compared to the afternoon onset (p < 0.005). Circadian patterns of stroke onset were observed both in hemorrhagic and in ischemic stroke, irrespective of the ischemic subgroup. In all groups, stroke was more likely to occur during waking than during sleep and, in the diurnal period, during morning than during afternoon. Moreover, sex and some clinical factors influence the diurnal pattern.

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Section: Discussionmentioning

confidence: 99%

Daily Variation in the Occurrence of Different Subtypes of Stroke

Ripamonti

Riva

Maioli³

et al. 2017

Stroke Research and Treatment

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show abstract

“…13 Though informative, this study was limited by a small sample size, few stroke events, and examination of time-domain HRV measures only. We have expanded on this work by utilizing a large prospective bi-racial cohort, time- and frequency-domain HRV indices, and by evaluating potential effect modification by diabetes status.…”

Section: Discussionmentioning

confidence: 99%

“…12 Another study reported an association between low nighttime HRV and increased risk of incident ischemic stroke, 13 but was limited by small sample size and few stroke events. The clinical value of HRV for identifying people at high risk of stroke is unknown; no studies have evaluated daytime HRV as would be assessed in a routine clinic visit.…”

Section: Introductionmentioning

confidence: 99%

Heart Rate Variability and Incident Stroke

Fyfe‐Johnson

Muller

Alonso

et al. 2016

Stroke

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Background and Purpose Low heart rate variability (HRV), a marker of cardiac autonomic dysfunction, has been associated with increased all-cause and cardiovascular mortality. We examined the association between reduced HRV and incident stroke in a community-based cohort. Methods The Atherosclerosis Risk in Communities (ARIC) Study measured HRV using 2-minute electrocardiogram readings in 12,550 middle-aged adults at baseline (1987-89). HRV indices were calculated using the standard deviation of RR intervals (SDNN), the mean of all normal RR intervals (MeanNN), the root mean square of successive differences of successive RR intervals (RMSSD), low (LF) and high (HF) frequency power, and the LF/HF ratio. All HRV measures were categorized into quintiles. Incident stroke was adjudicated through 2011. Cox regression was used to estimate hazard ratios (HR) with the lowest HRV quintile as the reference, with and without stratification by prevalent diabetes. Results Over a median follow-up of 22 years, 816 (6.5%) participants experienced incident stroke. After covariate adjustment, there was no strong evidence of association between HRV and stroke risk. In stratified analyses, the lowest HRV quintile was associated with higher stroke risk compared to the highest quintile for SDNN (HR = 2.0, 95% CI = 1.1-4.0), RMSSD (HR = 1.7, 95% CI = 0.9-3.2), LF (HR = 1.5, 95% CI = 0.8-3.0), and HF (HR = 1.7, 95% CI = 0.9-3.0) only among people with diabetes. Conclusions Lower HRV was associated with higher risk of incident stroke among middle-aged adults with prevalent diabetes, but not among people without diabetes.

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“…Lower heart rate variability (HRV) is an early manifestation of some of the shared risk factors of stroke such as poor physical activity, emotional stress, diabetes, hypertension and end-stage renal disease. However, there is paucity n the literature with regards to HRV and incidence of stroke with one study reporting higher stroke rates in those with lower nighttime HRV [75]. This association may be mediated by several pathways including a higher inflammatory milieu, hypercoagulation and risk of arrhythmias, including AF.…”

Section: Heart Rate Variability and Heart Ratementioning

confidence: 99%

ECG abnormalities and stroke incidence

Agarwal¹,

Soliman

2013

Expert Review of Cardiovascular Therapy

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In this review, the authors discuss the role of ECG in prediction of stroke. ECG plays an important role in detection of several stroke risk factors/predictors including atrial fibrillation and left ventricular hypertrophy; both are components of the Framingham Stroke Risk Score. Multiple other ECG traits have also emerged as potential predictors of stroke, namely cardiac electrical/structural remodeling -Q wave, QRS/QT duration, bundle blocks, P wave duration/amplitude/dispersion, other waveform angles and slopes; higher automaticity -ectopic beats; and re-entry -atrial tachyarrhythmia; and higher vulnerability to arrhythmia -heart rate and its variability. Most of these predictors are not ready for prime time yet; however, further research focusing on their role in risk stratification and prevention of stroke may be useful. In this article, the authors discuss the prevalence, mechanisms and clinical applications of traditional and novel ECG markers in the prevention and treatment of stroke. ECG abnormalities and stroke incidenceExpert Rev. Cardiovasc. Ther. 11 (7), 853-861 (2013)

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Decreased Nighttime Heart Rate Variability Is Associated With Increased Stroke Risk

Cited by 89 publications

References 37 publications

Daily Variation in the Occurrence of Different Subtypes of Stroke

Daily Variation in the Occurrence of Different Subtypes of Stroke

Heart Rate Variability and Incident Stroke

ECG abnormalities and stroke incidence

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