Predictive Value of Subacute Heart Rate Variability for Determining Outcome Following Adolescent Concussion

Abstract

Objective assessments of concussion recovery are crucial for facilitating effective clinical management. However, predictive tools for determining adolescent concussion outcomes are currently limited. Research suggests that heart rate variability (HRV) represents an indirect and objective marker of central and peripheral nervous system integration. Therefore, it may effectively identify underlying deficits and reliably predict the symptomology following concussion. Thus, the present study sought to evaluate the relationship between HRV and adolescent concussion outcomes. Furthermore, we sought to examine its predictive value for assessing outcomes. Fifty-five concussed adolescents (12–17 years old) recruited from a local sports medicine clinic were assessed during the initial subacute evaluation (within 15 days postinjury) and instructed to follow up for a post-acute evaluation. Self-reported clinical and depressive symptoms, neurobehavioral function, and cognitive performance were collected at each timepoint. Short-term HRV metrics via photoplethysmography were obtained under resting conditions and physiological stress. Regression analyses demonstrated significant associations between HRV metrics, clinical symptoms, neurobehavioral function, and cognitive performance at the subacute evaluation. Importantly, the analyses illustrated that subacute HRV metrics significantly predicted diminished post-acute neurobehavioral function and cognitive performance. These findings indicate that subacute HRV metrics may serve as a viable predictive biomarker for identifying underlying neurological dysfunction following concussion and predict late cognitive outcomes.

Perceived Stress, Mindfulness, and Clinical Concussion Outcomes in Adults with a Concussion History

“…However, post-hoc correlations between the HRV outcomes and COVID-19 diagnosis (yes/no) suggested no correlation ( P > 0.05). With HRV being one of many outcomes investigated in the current study, we separated seated and standing outcomes to remain consistent with previous concussion research (39,43–45). Future HRV concussion studies should investigate more in-depth ways to analyze HRV to better understand ANS reactivity and provide researchers with an analysis protocol that is most impactful for interpreting HRV outcomes in concussion populations.…”

“…Data processing was done using a protocol previously reported in the concussion literature (40): 1) raw R-R data were processed using Kubios HRV (version 3.5.0; Biosignal Analysis and Imaging Group, Kuopio, Finland), 2) Kubios's automatic beat correction was utilized in accordance with their validated algorithm (41), and 3) manual inspection was completed with outliers and ectopic beats removed when necessary (42). The HRV assessment outcomes were average heart rate, SD of heart rate, mean of R-R internals, SD of R-R internals, LF/HF ratio, and total power for each trial (seated 1, standing, and seated 2) (39,(43)(44)(45).…”

Refractory Autonomic Instability in Mild Traumatic Brain Injury: A Case Report

“…A greater HRV at rest was noted in patients with more severe emotional and cognitive symptoms. Additionally, a greater HRV at rest was indicative of worsened performance on cognitive and recall tasks (Groton Maze Learning, One-Back, and Groton Maze Delayed-Recall), with acceptable validity and reliability [15].…”

“…HRV accounts for the "beat-to-beat" alterations in one's heart rate at a resting state and, therefore, reflects the inhibitory control of the parasympathetic nervous system on the sinoatrial node [14]. When responding to environmental stressors, greater HRV signifies an adequate response of the ANS [15]. In turn, a lesser or reduced HRV signifies an inadequate response to stressors and a more pronounced imbalance between parasympathetic and sympathetic input.…”

“…This leads to hyperarousal, as the body remains in a continual sympathetically-mediated state [17]. One preliminary study of HRV completed in 2021 demonstrated an association with learning, memory, and attention in patients during the post-acute phase of concussion injury [15]. A greater HRV at rest was noted in patients with more severe emotional and cognitive symptoms.…”