The cardiac autonomic nervous system response to different daily demands among patients at the sub-acute phase post ischemic stroke and healthy controls

Beer, Noa Raphaely; Soroker, Nachum; Bornstein, Nathan M.; Katz‐Leurer, Michal

doi:10.3233/nre-172295

Cited by 6 publications

(10 citation statements)

References 19 publications

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“…Our results are in line with recent clinical trials showing an association between cardiac autonomic control and cognitive performance or rehabilitation outcomes 27,28 . Previously, an association between SDNN and BI was observed after rehabilitation 29 .…”

Section: Discussionsupporting

confidence: 93%

Early rehabilitation after stroke: relationship between the heart rate variability and functional outcome

et al. 2020

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Aims Impaired autonomic nervous system regulation is frequently observed in patients with stroke. The aim of this prospective study was to evaluate the impact of cardiac autonomic tone on functional outcome after the early post-stroke rehabilitation. Methods and results One hundred and three consecutive patients (67 ± 11 years, body mass index (BMI) 27.1 ± 5.4 kg/m 2 , 64% men) with ischaemic (84% of patients) and haemorrhagic stroke were studied. Depressed heart rate variability (HRV), as a surrogate marker of increased sympathetic tone, was defined by the standard deviation of NN intervals < 100 ms and HRV triangular index ≤ 20 assessed from a 24 h Holter electrocardiogram at admission to rehabilitation (23 ± 16 days after stroke). Twenty-two per cent of patients had depressed HRV at baseline and were comparable with patients with normal HRV with regard to their functional [Barthel Index (BI), modified Rankin Scale (mRS), and Rivermead Motor Assessment (RMA)] and biochemical status. After a 4-week follow-up, 70% of patients with depressed HRV showed a cumulative functional disability, defined by mRS ≥ 4, BI ≤ 70, and RMA ≤ 5, in contrast to patients with normal HRV (35%, P = 0.003). Patients with depressed HRV showed a worse functional status by BI (À16%, P < 0.001), RMA (À12%, P < 0.05), and mRS (+16%, P < 0.01), compared with patients with normal HRV. Cumulative functional disability was associated with depressed HRV (odds ratio 4.25, 95% confidence interval 1.56-11.54, P < 0.005) after adjustment for age, sex, and body mass index (odds ratio 4.6, 95% confidence interval 1.42-14.97, P < 0.05). Conclusions The presence of autonomic cardiovascular dysregulation in patients with subacute stroke was associated with adverse functional outcome after the early post-stroke rehabilitation.

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Section: Discussionsupporting

confidence: 93%

Early rehabilitation after stroke: relationship between the heart rate variability and functional outcome

et al. 2020

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“…After the acute phase, patients with autonomic nerve system dysfunction need more help in their daily rehabilitation tasks (30). Poor adaptability of the cardiac autonomic nerve system in different rehabilitation training activities and poor rehabilitation dependence impact the rehabilitation effects (30,31). At the same time, autonomic nerve system dysfunction is not only associated with overall cognitive function, processing speed, executive function, and poor retrospective memory performance in patients (32,33) but also associated with post-stroke depression (34).…”

Section: Discussionmentioning

confidence: 99%

The Association Between Heart Rate Variability and 90-Day Prognosis in Patients With Transient Ischemic Attack and Minor Stroke

Meng

Pan

et al. 2021

Front. Neurol.

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Background: Low heart rate variability (HRV) is known to be associated with increased all-cause, cardiovascular, and cerebrovascular mortality but its association with clinical outcomes in patients with transient ischemic attack (TIA) or minor stroke is unclear.Methods: We selected TIA and minor stroke patients from a prospective registration study. From each continuous electrocardiograph (ECG) record, each QRS complex was detected and normal-to-normal (N-N) intervals were determined. The standard deviation of all N-N intervals (SDNN) and the square root of the mean squared differences of successive N-N intervals (RMSSD) were calculated. Logistic regression analysis and Cox regression analysis were performed to assess the outcomes of patients at 90 days, and the odds and risk ratios (OR/HR) of each index quartile were compared.Results: Compared with SDNN patients in the lowest quartile, neurological disability was significantly reduced in other quartile groups at 90 days, with significant differences [OR of group Q2 was 0.659; 95% confidence interval (CI), 0.482–0.900; p = 0.0088; OR of group Q3 was 0.662; 95% CI, 0.478–0.916; p = 0.0127; OR of group Q4 was 0.441; 95% CI, 0.305–0.639; p <0.0001]. Compared with the lowest quartile, the recurrence rate of TIA or minor stroke in patients of the two higher quartiles (Q3 and Q4) of SDNN was significantly reduced at 90 days (HR of Q3 group was 0.732; 95% CI, 0.539–0.995; p = 0.0461; HR of Q4 group was 0.528; 95% CI, 0.374–0.745; p = 0.0003).Conclusions: Based on our findings, autonomic dysfunction is an adverse indicator for neurological function prognosis and stroke recurrence 90 days after TIA or minor stroke.

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“…We excluded 18 studies because they were considered one of the following types of articles: case report, case series, self-controlled study, review, or a study that was not relevant. The remaining two RCTs 22,23 and two non-RCTs 15,24 were included in this review.…”

Section: Resultsmentioning

confidence: 99%

“…The other three studies 22-24 divided the individuals into intervention and control groups. Beer et al (2018) described the control group as healthy individuals. Two studies 22,24 included only individuals with one stroke, two evaluated patients within 1 to 10 days of an ischemic stroke 15,23 , one study evaluated individuals' post-acute stroke 24 , and another study evaluated individuals at 15 days after a stroke 22 .…”

Section: Characteristics Of the Participants And Groupsmentioning

confidence: 99%

Effects of rehabilitation programs on heart rate variability after stroke: a systematic review

Belli

Souza

Bazan

et al. 2021

Arq. Neuro-Psiquiatr.

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Background: It has been shown that the autonomic nervous system can be modulated by physical exercise after stroke, but there is a lack of evidence showing rehabilitation can be effective in increasing heart rate variability (HRV). Objective: To investigate the effectiveness and safety of rehabilitation programs in modulating HRV after stroke. Methods: The search strategy was based in the PICOT (patients: stroke; interventions: rehabilitation; comparisons: any control group; outcomes: HRV; time: acute, subacute and chronic phases of stroke). We searched MEDLINE, CENTRAL, CINAHL, LILACS, and SCIELO databases without language restrictions, and included randomized controlled trials (RCTs), quasi-randomized controlled trials (quasi-RCTs), and non-randomized controlled trials (non-RCTs). Two authors independently assessed the risk of bias and we used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to rate the certainty of the evidence for each included study. Results: Four studies (two RCTs with low certainty of the evidence and two non-RCTs with very low certainty of the evidence) were included. Three of them showed significant cardiac autonomic modulation during and after stroke rehabilitation: LF/HF ratio (low frequency/high frequency) is higher during early mobilization; better cardiac autonomic balance was observed after body-mind interaction in stroke patients; and resting SDNN (standard deviation of normal R-R intervals) was significantly lower among stroke patients indicating less adaptive cardiac autonomic control during different activities. Conclusions: There are no definitive conclusions about the main cardiac autonomic repercussions observed in post-stroke patients undergoing rehabilitation, although all interventions are safe for patients after stroke.

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The cardiac autonomic nervous system response to different daily demands among patients at the sub-acute phase post ischemic stroke and healthy controls

Abstract: Patients post-stroke experience hyper sympathetic function at rest and less adaptive cardiac autonomic control during different activities, which all may have an impact on rehabilitation outcomes.

Cited by 6 publications

References 19 publications

Early rehabilitation after stroke: relationship between the heart rate variability and functional outcome

Early rehabilitation after stroke: relationship between the heart rate variability and functional outcome

The Association Between Heart Rate Variability and 90-Day Prognosis in Patients With Transient Ischemic Attack and Minor Stroke

Effects of rehabilitation programs on heart rate variability after stroke: a systematic review

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