Impact of Supratentorial Cerebral Hemorrhage on the Complexity of Heart Rate Variability in Acute Stroke

Abstract

Acute stroke commonly affects cardiac autonomic responses resulting in reduced heart rate variability (HRV). Multiscale entropy (MSE) is a novel non-linear method to quantify the complexity of HRV. This study investigated the influence of intracerebral hemorrhage (ICH) locations and intraventricular hemorrhage (IVH) on the complexity of HRV. We recruited 93 supratentorial ICH patients (male 59%, mean age 61 years), and the locations of ICH included basal ganglia (n = 40), thalamus (n = 35), and lobar (n = 18) group. Continuous one-hour electrocardiography signals were obtained from patients after admission, and the complexity index was defined as the area under the MSE curve. The complexity index was lower in lobar ICH (21.6 ± 7.9) than basal ganglia (27.9 ± 6.4) and thalamus (28.5 ± 7.2) groups. The complexity index was inversely correlated with initial stroke severity (r = −0.26), size of hematoma (r = −0.35) and ICH score (r = −0.26), especially among patients with intraventricular hemorrhage (r = −0.60, −0.60, and −0.41 respectively). A higher complexity can predict a good functional outcome (adjusted odds ratio 1.09, 95% confidence intervals 1.00–1.19) at post-stroke 3 months. In summary, more severe stroke and larger hematoma volume resulted in lower complexity of HRV. Lobar hemorrhage and IVH had great impacts on the cardiac autonomic function.

The effect of unilateral stroke on autonomic function in the term newborn

“…34 The insula is directly connected, likely through both excitatory and inhibitory pathways, to deeper centers in the thalamus, hypothalamus, brainstem, and cerebellum. 34,35 What mechanisms might underlie the differences in autonomic dysfunction in studies of insular stroke, including the current study? The autonomic changes may result from direct insular cortex injury 36,37 or dysfunction in downstream insulofugal pathways (excitatory and inhibitory) to deeper brainstem and diencephalon centers, or direct concurrent injury to these brainstem and diencephalon centers.…”

Changes of Electrocardiogram and Myocardial Enzymes in Patients with Intracerebral Hemorrhage

“…Hematoma extension to the third and fourth ventricles may trigger destruction of the baroreflex receptors around the area [ 26 ], because of the abundant network structures controlling autonomic nerve function around the third and fourth ventricles, involving the paraventricular nucleus of the hypothalamus, periaqueductal gray matter, brain stem, and so on. Expansion of the intraventricular hematoma may lead to acute autonomic nervous system disorders and elevated circulating catecholamine levels, which could lead to cardiac complications [ 27 ]. In addition, the central control of the autonomic nervous system was thought to be located in the insular cortex, cingulate gyrus, amygdala, and hypothalamus [ 28 ].…”

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

“…There are various methods to analyze HRV including linear time-domain variables (SDNN and RMSSD), frequency-domain parameters (low-frequency power and high-frequency power), and more recently non-linear parameters utilizing multiscale entropy. 7,14,[22][23][24] In this study we utilized HRV calculated as the standard deviation of normal R to normal R intervals (SDNN) on 10-second standard hospital admission EKG's as our primary metric of HRV. This method has previously been validated as an accurate measure of HRV, is strongly correlated with SDNN from 4-5 minute recordings, and is representative of parasympathetic function when compared to prolonged heart rate monitoring methods.…”