Key result
Higher Hunt-and-Hess scores in the acute phase of spontaneous subarachnoid hemorrhage were significantly correlated with a decrease in sympathetic autonomic modulation (rho = -0.524).
Why the study?
The study was conducted to assess associations between clinical severity and possible dysfunction of autonomic cardiovascular modulation within the acute phase after spontaneous subarachnoid hemorrhage.
Observational (n=71)
No
Effect estimate: rho = -0.524
Absolute Event Rate: 72.1% vs 338.6%
p-value: p=0.001
In the acute phase of spontaneous subarachnoid hemorrhage, higher clinical severity is associated with a significant decrease in sympathetic and total autonomic cardiovascular modulation.
Higher H&H scores associate with reduced autonomic modulation acutely after SAH; leaves open whether monitoring alters management or outcomes.
Background and aim To assess associations between clinical severity and possible dysfunction of autonomic cardiovascular modulation within the acute phase after spontaneous subarachnoid hemorrhage (SAH). Methods In this prospective observational study, in 51 patients with spontaneous SAH, Hunt-and-Hess scores (H&H) were assessed and cardiovascular autonomic modulation was monitored within 24 h after SAH-onset. From 5 min time-series of R–R-intervals (RRI) and blood-pressure (BP) recordings, we calculated autonomic parameters including time-domain [RRI-coefficient-of-variation (RRI-CV) and square-root-of-the-mean-squared-differences-of-successive-RRIs (RMSSD)] and frequency-domain parameters [low- and high-frequency-powers of RRI- and BP-modulation (RRI-LF-, RRI-HF-, SBP-LF-powers) and RRI-total-powers]. Data were compared to those of 20 healthy volunteers. Results RRI- and BP-values did not differ between groups. Yet, parameters of sympathetic (RRI-LF-powers 141.0 (18.9–402.4) ms 2 vs 442.3 (246.8–921.2) ms 2 , p = 0.001) and total autonomic modulation (RRI-CV 2.4 (1.2–3.7) ms 2 vs 3.7 (3.1–5.3) ms 2 , p = 0.001) were significantly lower in patients than in controls. Subgroup analyses (patients with H&H < 3 vs H&H ≥ 3) and Spearman-rank-correlations revealed increasing loss of sympathetic (RRI-LF-powers 338.6 (179.7–710.4) ms 2 vs 72.1 (10.1–175.9) ms 2 , p = 0.001, rho = − 0.524) and total autonomic modulation (RRI-CV 3.5 (2.3–5.4) ms 2 vs 1.6 (1.0–2.8) ms 2 , p < 0.001, rho = − 0.519) with higher H&H-scores. Multiple-logistic-regression underlined the significant influence of H&H-scores on sympathetic (RRI-LF-powers, p = 0.033) and total autonomic modulation (RRI-CV, p = 0.040) compared to possible confounders (e.g., age, intubation). Conclusion Within the acute phase, spontaneous SAH induces a decrease in sympathetic and total autonomic cardiovascular modulation. Higher H&H-scores were associated with increasing autonomic dysfunction and may therefore augment the risk of cardiovascular complications and poor clinical outcome.
No takes yet. Share an insight, caveat, or question.
Borutta et al. (2022) conducted an observational in Spontaneous subarachnoid hemorrhage (n=71). Higher clinical severity (Hunt-and-Hess score ≥ 3) vs. Lower clinical severity (Hunt-and-Hess score < 3) was evaluated on Sympathetic autonomic modulation (RRI-LF-powers) (rho = -0.524, p=0.001). Higher Hunt-and-Hess scores in the acute phase of spontaneous subarachnoid hemorrhage were significantly correlated with a decrease in sympathetic autonomic modulation (rho = -0.524).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: