Key result
Delirium in acute non-cardioembolic stroke is linked to ~33% lower high-frequency heart rate variability.
Why the study?
Delirium is associated with autonomic dysfunction and increased mortality, prompting investigation into whether heart rate variability analysis can identify autonomic modifications that predispose acute stroke patients to delirium.
Does heart rate variability analysis predict the development of delirium in acute non-cardioembolic stroke patients?
Cohort (n=56)
No
Does heart rate variability analysis predict the development of delirium in acute non-cardioembolic stroke patients?
In acute non-cardioembolic stroke patients, increased heart rate variability and decreased vagal control (lower HF component) are associated with a higher risk of developing delirium.
HRV parameters were associated with delirium risk in acute stroke; leaves open predictive utility pending prospective validation.
OBJECTIVES: Delirium is an acute fluctuating disorder of attention and awareness. It is associated with autonomic dysfunction and increased mortality. The primary endpoint of our study was to measure autonomic activity in acute stroke patients, by means of heart rate variability analysis, in order to identify autonomic modifications that can predispose to delirium. METHODS: Patients were consecutively enrolled from the stroke unit. Inclusion criteria were age ≥ 18 years and diagnosis of stroke with onset within the previous 72 h confirmed by neuroimaging. Exclusion criteria were atrial fibrillation, congestive heart failure, and conditions requiring intensive care unit. Patients were evaluated by means of Richmond Agitation Sedation Scale (RASS) and Confusion Assessment Method-Intensive Care Unit (CAM-ICU) at baseline, after 72 h, or when symptoms suggesting delirium occurred. For each patient, ECG was recorded at baseline assessment and HRV analysis was conducted on five consecutive minutes of artifact-free ECG traces. RESULTS: Fifty-six ECGs were available for analysis. During the study period, 11 patients developed delirium. Patients with and without delirium did not differ for sex, age, severity of stroke, and comorbidities. The delirium group had greater standard deviation of the heart rate (DLR - :9.16 ± 8.28; DLR + : 14.36 ± 5.55; p = 0.026) and lower power spectral density of the HF component (DLR - : 38.23 ± 19.23 n.u.; DLR + : 25.75 ± 8.77 n.u.; p = 0.031). CONCLUSIONS: Acute non-cardioembolic stroke patients with increased variability of heart rate and decreased vagal control are at risk for delirium.
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Rollo et al. (2021) conducted a cohort in Acute non-cardioembolic stroke (n=56). Development of delirium vs. No delirium was evaluated on Power spectral density of the high-frequency (HF) component in normalized units (n.u.) (p=0.031). Acute non-cardioembolic stroke patients who developed delirium exhibited a significantly lower high-frequency component of heart rate variability (25.75 vs 38.23 n.u.) and greater heart rate standard deviation.
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