Heart Rate Variability as a Predictor of Mortality in Traumatic Brain Injury: A Systematic Review and Meta-Analysis

Florez-Perdomo, William Andrés; García-Ballestas, Ezequiel; Moscote-Salazar, Luis Rafael; Konar, Subhas; Raj, Sumit; Chouksey, Pradeep; Shrivastava, Adesh; Mishra, Rakesh; Agrawal, Amit

doi:10.1016/j.wneu.2020.12.132

Cited by 9 publications

(9 citation statements)

References 26 publications

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“…In children with autism spectrum disorder, subjects exhibited significantly lower HRV and HF levels [38]. For moderate to severe traumatic brain injury patients, TP, HF power, and LF/HF ratio were statistically significant for predicting mortality [39]. Low levels of HF have also been shown to be associated with suicidal ideation and behavior in students and depressed patients, rather than non-suicidal controls [40].…”

Section: Discussionmentioning

confidence: 99%

The Dosage Effect of Laser Acupuncture at PC6 (Neiguan) on Heart Rate Variability: A Pilot Study

Chang

Chen

Lay

et al. 2022

Life

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Laser acupuncture (LA) has been more applicated in the clinical practice with good responses, but the dosage and parameter settings are still inconsistent with the arguments. This study is focused on the effect of LA on heart rate variability (HRV) with different energy density (ED). Based on the Arndt–Schulz law, we hypothesized that the effective range should fall within 0.01 to 10 J/cm2 of ED, and settings above 10 J/cm2 would perform opposite or inhibitory results. We recruited healthy adults in both sexes as subjects and choose bilateral PC6 (Neiguan) as the intervention points to observe the HRV indexes changes by an external wrist autonomic nerve system (ANS) watch on the left forearm. The data from the ANS watch, including heart rate, blood pressure, and ANS activity indexes, such as low frequency (LF), high frequency (HF), LF%, HF%, LF/HF ratio, and so on, were analyzed by the one-way ANOVA method to test the possible effect. In this study, every subject received all three different EDs of LA in a randomized order. After analyzing the data of 20 subjects, the index of HF% was upward and LF/HF ratio was downward when the ED was 7.96 J/cm2. Otherwise, the strongest ED 23.87 J/cm2 performed the opposite reaction. Appropriately, LA intervention could affect the ANS activities, with the tendency to increase the ratio of parasympathetic and decrease the ratio of sympathetic nerve system activities with statistically significant results, and different ED interventions are consistent with Arndt–Schulz law with opposite performance below and above 10 J/cm2.

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Section: Discussionmentioning

confidence: 99%

The Dosage Effect of Laser Acupuncture at PC6 (Neiguan) on Heart Rate Variability: A Pilot Study

Chang

Chen

Lay

et al. 2022

Life

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“…16 A meta-analysis on HRV in TBI demonstrated a high mortality for the variables LF/HF ratio and HF peak. 33 This novel finding is important, as children have a significant potential for recovery after TBI and their functional status often evolve over time. This novel information, when made available in real time, may help physician in the acute settings in managing care, prognosticating midterm outcomes, and guiding families.…”

Section: Discussionmentioning

confidence: 98%

Heart Rate Variability in Children with Moderate and Severe Traumatic Brain Injury: A Prospective Observational Study

Martin

Pont‐Thibodeau

Seely

et al. 2022

J Pediatr Intensive Care

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The aim of this study was to assess the feasibility of continuous monitoring of heart rate variability (HRV) in children with traumatic brain injury (TBI) hospitalized in a pediatric intensive care unit (PICU) and collect preliminary data on the association between HRV, neurological outcome, and complications. This is a prospective observational cohort study in a tertiary academic PICU. Children admitted to the PICU ≤24 hours after moderate or severe TBI were included in the study. Children suspected of being brain dead at PICU entry or with a pacemaker were excluded. Children underwent continuous monitoring of electrocardiographic (ECG) waveforms over 7 days post-TBI. HRV analysis was performed retrospectively, using a standardized, validated HRV analysis software (CIMVA). The occurrence of medical complications (“event”: intracranial hypertension, cerebral hypoperfusion, seizure, and cardiac arrest) was prospectively documented. Outcome of children 6 months post-TBI was assessed using the Glasgow Outcome Scale – Extended Pediatric (GOS-E Peds). Fifteen patients were included over a 20-month period. Thirteen patients had ECG recordings available and 4 had >20% of missing ECG data. When ECG was available, HRV calculation was feasible (average 88%; range 70–97%). Significant decrease in overall HRV coefficient of variation and Poincaré SD2 (p < 0.05) at 6 hours post–PICU admission was associated with an unfavorable outcome (defined as GOS-E Peds ≥ 3, or a deterioration of ≥2 points over baseline score). Several HRV metrics exhibited significant and nonsignificant variation in HRV during event. This study demonstrates that it is feasible to monitor HRV in the PICU provided ECG data are available; however, missing ECG data are not uncommon. These preliminary data suggest that altered HRV is associated with unfavorable neurological outcome and in-hospital medical complications. Larger prospective studies are needed to confirm these findings and to explore if HRV offers reliable and clinically useful prediction data that may help clinical decision making.

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“…RMSSD has been shown to strongly correlate with HF power and is preferred over HF power as a measure of vagal tone because it is free of respiratory influence [ 6 , 61 ]. These findings are of major importance given the recognised link between increased LF: HF ratio and all-cause mortality among patients with traumatic brain injury [ 25 ] and haemodynamically stable unselected acute TI [ 62 ]. The longer-term association between HRV measured among non-acute TI remains uncertain and is the primary aim of the ongoing ADVANCE Study [ 58 , 63 ].…”

Section: Discussionmentioning

confidence: 99%

“…recognised link between increased LF: HF ratio and all-cause mortality among patients with traumatic brain injury [25] and haemodynamically stable unselected acute TI [62]. The longer-term association between HRV measured among non-acute TI remains uncertain and is the primary aim of the ongoing ADVANCE Study [58,63].…”

Section: Plos Onementioning

confidence: 99%

“…Examination of the relationship between non-acute T1 and HRV has predominantly been in selected injured populations with the spinal cord, head/brain, and psychological trauma (posttraumatic stress disorder-PTSD and depression) [21][22][23][24]. While systematic reviews have been conducted previously to assess the association between HRV and traumatic brain injury [25], spinal cord injury [26], PTSD [27] and depression [28], the longer-term effects of unselected TI on HRV have not been reviewed and warrant further examination [29]. With a recent study reporting an increase in cardiovascular disease (CVD) risk in injured military veterans [30], understanding the health outcomes among injured military and civilian populations following a traumatic injury is essential.…”

Section: Introductionmentioning

confidence: 99%

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Association between non-acute Traumatic Injury (TI) and Heart Rate Variability (HRV) in adults: A systematic review and meta-analysis

et al. 2023

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Heart rate variability (HRV) is a non-invasive measure of autonomic function. The relationship between unselected long-term traumatic injury (TI) and HRV has not been investigated. This systematic review examines the impact of non-acute TI (>7 days post-injury) on standard HRV indices in adults. Four electronic databases (CINAHL, Medline, Scopus, and Web of Science) were searched. The quality of studies, risk of bias (RoB), and quality of evidence (QoE) were assessed using Axis, RoBANS and GRADE, respectively. Using the random-effects model, mean difference (MD) for root mean square of successive differences (RMSSD) and standard deviation of NN-intervals (SDNN), and standardized mean difference (SMD) for Low-frequency (LF): High-Frequency (HF) were pooled in RevMan guided by the heterogeneity score (I2). 2152 records were screened followed by full-text retrieval of 72 studies. 31 studies were assessed on the inclusion and exclusion criteria. Only four studies met the inclusion criteria. Three studies demonstrated a high RoB (mean RoBANS score 14.5±3.31) with a low QoE. TI was associated with a significantly higher resting heart rate. Meta-analysis of three cross-sectional studies demonstrated a statistically significant reduction in RMSSD (MD -8.45ms, 95%CI-12.78, -4.12, p<0.0001) and SDNN (MD -9.93ms, 95%CI-14.82, -5.03, p<0.0001) (low QoE) in participants with TI relative to the uninjured control. The pooled analysis of four studies showed a higher LF: HF ratio among injured versus uninjured (SMD 0.20, 95%CI 0.01–0.39, p<0.04) (very low QoE). Albeit low QoE, non-acute TI is associated with attenuated HRV indicating autonomic imbalance. The findings might explain greater cardiovascular risk following TI. Trial registration PROSPERO registration number: CRD: CRD42021298530.

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Heart Rate Variability as a Predictor of Mortality in Traumatic Brain Injury: A Systematic Review and Meta-Analysis

Cited by 9 publications

References 26 publications

The Dosage Effect of Laser Acupuncture at PC6 (Neiguan) on Heart Rate Variability: A Pilot Study

The Dosage Effect of Laser Acupuncture at PC6 (Neiguan) on Heart Rate Variability: A Pilot Study

Heart Rate Variability in Children with Moderate and Severe Traumatic Brain Injury: A Prospective Observational Study

Association between non-acute Traumatic Injury (TI) and Heart Rate Variability (HRV) in adults: A systematic review and meta-analysis

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