Heart rate variability is associated with outcome in spontaneous intracerebral hemorrhage

Szabo, Jozef; Smielewski, Peter; Czosnyka, Marek; Jakubíček, Stanislava; Krebs, Stefan; Šiarnik, Pavel; Sýkora, Marek

doi:10.1016/j.jcrc.2018.08.033

Cited by 29 publications

(45 citation statements)

References 32 publications

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“…28,29 Recent studies have implicated decreased HRV as a marker of outcome in both hemorrhagic and ischemic stroke. 7,8,30 However, we did not identify a direct statistical association between HRV and functional outcome after accounting for the ICH score. This difference may result from our analyses representing HRV with linear methods (SDNN and RMSSD) from 10-second EKG in the acute setting, while other studies used combinations of nonlinear methods or frequency-domain analysis, longer duration recordings (typically 1 to 24 hours), and/or recording after the acute time period.…”

Section: Discussioncontrasting

confidence: 63%

“…In addition, patients who developed fever spent more time mechanically ventilated (i.e. fewer ventilator free days in the first two weeks, median 6.5 [1][2][3][4][5][6][7][8][9][10][11][12][13][14] vs. 14 days, p < 0.001) and were more likely to be diagnosed with pneumonia during hospitalization (25% vs. 1.7%, p < 0.001). While mechanical ventilation was associated with fever, SDNN and standardized SDNN did not significantly differ by mechanical ventilation status (p=0.13 and p=0.37, respectively).…”

Section: Resultsmentioning

confidence: 99%

“…6,7 Decreased HRV has been demonstrated after both ischemic stroke and ICH, and is associated with unfavorable outcome. 8 Several mechanisms have been proposed to explain the association between autonomic nervous system dysfunction and worse outcome, including: impaired cerebral autoregulation, cardiovascular complications, blood pressure fluctuations, and secondary brain injury due to inflammation, hyperglycemia, and bloodbrain barrier disruption. 9 We hypothesized that parasympathetic nervous system dysfunction after ICH may contribute to subsequent fever, which in turn contributes to worse functional outcome.…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, lower HRV was associated with greater fever burden (SDNN vs. febrile days, rho −0.22, p < 0.001). Patients who developed fever had lower admission GCS (median 11[7][8][9][10][11][12][13][14] vs. median 15[13][14][15], p < 0.001), larger hematoma volumes (median 16.5ml[5.4-36] vs. 5.5ml[2.4-14], p < 0.001), and greater intraventricular hemorrhage (initial Graeb score, median 2…”

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confidence: 99%

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Admission Heart Rate Variability is Associated with Fever Development in Patients with Intracerebral Hemorrhage

et al. 2019

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Section: Discussioncontrasting

confidence: 63%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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confidence: 99%

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Admission Heart Rate Variability is Associated with Fever Development in Patients with Intracerebral Hemorrhage

et al. 2019

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“…The pathophysiological mechanisms explaining the apparent association of insular involvement with poor ICH outcome remain unclear. However, changes of autonomic nervous system characterized by impaired cardiovascular regulation and shifted balance between sympathetic and parasympathetic outflows have been found previously in patients with ICH and were attributed to functional outcome 5–7 . Differences in outcomes between left and right insular cortex strokes arise because of the laterality of autonomic representation in the brain, although there is disagreement whether the right or left insula is the one most associated with poor prognosis 8 .…”

Section: Introductionmentioning

confidence: 90%

Effects of insular involvement on functional outcome after intracerebral hemorrhage

et al. 2021

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Objective Ischemic stroke, as well as intracerebral hemorrhage (ICH), involving the insular cortex tends to be more severe. The impact of insular involvement on outcome of ICH remains enigmatic. Methods We analyzed 159 patients with supratentorial ICH. Depending on insular involvement the patients were classified into two groups (ICHnon‐insular vs. ICHinsular). Volume and symptom severity of ICH were assessed. Electrocardiography, chest X‐ray, and laboratory examinations including myocardial enzymes and inflammatory markers were made. In‐hospital death and outcome at discharge from hospital were assessed on the modified Rankin scale (mRS). Results The main finding was an association of insular involvement of ICH with worse short‐term outcome as measured by mRS (common odds ratio: 4.08 (95% CI: 2.09–7.92); p < .001). This association survived adjustment to relevant covariates such as age, sex, ICH volume, intraventricular hemorrhage, pneumonia, and length of stay (adjusted common odds ratio: 2.51 (95% CI: 1.21–5.21); p = .014) but had no predictive value for side of ICH or rate of atrial fibrillation. There was no association of ICH localization with in‐hospital death rate. Conclusion Insular localization of ICH lesions predicts worse short‐term functional outcome independent of side of bleeding or cardiac dysfunction such as new AF. These findings need clarification in larger prospective cohorts assessed by detailed autonomic/cardiac testing, as well as neuroimaging sub‐localization of ICH within the insular region.

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Effect of Bypassing the Closest Stroke Center in Patients with Intracerebral Hemorrhage

Ramos-Pachón,

Rodríguez-Luna,

Martí-Fàbregas

et al. 2023

JAMA Neurol

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ImportancePrehospital transfer protocols are based on rapid access to reperfusion therapies for patients with ischemic stroke. The effect of different protocols among patients receiving a final diagnosis of intracerebral hemorrhage (ICH) is unknown.ObjectiveTo determine the effect of direct transport to an endovascular treatment (EVT)–capable stroke center vs transport to the nearest local stroke center.Design, Setting, and ParticipantsThis was a prespecified secondary analysis of RACECAT, a multicenter, population-based, cluster-randomized clinical trial conducted from March 2017 to June 2020 in Catalonia, Spain. Patients were evaluated by a blinded end point assessment. All consecutive patients suspected of experiencing a large vessel occlusion stroke (Rapid Arterial Occlusion Evaluation Scale [RACE] score in the field &gt;4 on a scale of 0 to 9, with lower to higher stroke severity) with final diagnosis of ICH were included. A total of 1401 patients were enrolled in RACECAT with suspicion of large vessel occlusion stroke. The current analysis was conducted in October 2022.InterventionDirect transport to an EVT-capable stroke center (n = 137) or to the closest local stroke center (n = 165).Main Outcomes and MeasuresThe primary outcome was tested using cumulative ordinal logistic regression to estimate the common odds ratio (OR) and 95% CI of the shift analysis of disability at 90 days as assessed by the modified Rankin Scale (mRS) score (range, 0 [no symptoms] to 6 [death]) in the intention-to-treat population. Secondary outcomes, included 90-day mortality, death or severe functional dependency, early neurological deterioration, early mortality, ICH volume and enlargement, rate of neurosurgical treatment, rate of clinical complications during initial transport, and rate of adverse events until day 5.ResultsOf 1401 patients enrolled, 1099 were excluded from this analysis (32 rejected informed consent, 920 had ischemic stroke, 29 had transient ischemic attack, 12 had subarachnoid hemorrhage, and 106 had stroke mimic). Thus, 302 patients were included (204 [67.5%] men; mean [SD] age 71.7 [12.8] years; and median [IQR] RACE score, 7 [6-8]). For the primary outcome, direct transfer to an EVT-capable stroke center (mean [SD] mRS score, 4.93 [1.38]) resulted in worse functional outcome at 90 days compared with transfer to the nearest local stroke center (mean [SD] mRS score, 4.66 [1.39]; adjusted common OR, 0.63; 95% CI, 0.41-0.96). Direct transfer to an EVT-capable stroke center also suggested potentially higher 90-day mortality compared with transfer to the nearest local stroke center (67 of 137 [48.9%] vs 62 of 165 [37.6%]; adjusted hazard ratio, 1.40; 95% CI, 0.99-1.99). The rates of medical complications during the initial transfer (30 of 137 [22.6%] vs 9 of 165 patients [5.6%]; adjusted OR, 5.29; 95% CI, 2.38-11.73) and in-hospital pneumonia (49 of 137 patients [35.8%] vs 29 of 165 patients [17.6%]; OR, 2.61; 95% CI, 1.53-4.44) were higher in the EVT-capable stroke center group.Conclusions and RelevanceIn this secondary analysis of the RACECAT randomized clinical trial, bypassing the closest stroke center resulted in reduced chances of functional independence at 90 days for patients who received a final diagnosis of ICH.Trial RegistrationClinicalTrials.gov Identifier: NCT02795962

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Heart rate variability is associated with outcome in spontaneous intracerebral hemorrhage

Abstract: Autonomic changes seems to be present in acute ICH and are associated with poor outcome independently. This may have future monitoring and therapeutic implications.

Cited by 29 publications

References 32 publications

Admission Heart Rate Variability is Associated with Fever Development in Patients with Intracerebral Hemorrhage

Admission Heart Rate Variability is Associated with Fever Development in Patients with Intracerebral Hemorrhage

Effects of insular involvement on functional outcome after intracerebral hemorrhage

Effect of Bypassing the Closest Stroke Center in Patients with Intracerebral Hemorrhage

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