Exploring the Utility of Autonomic Nervous System Evaluation for Stroke Prognosis

Q: What is the clinical evidence from this study?

Study design: Systematic Review. Population: Stroke (ischemic stroke, hemorrhagic stroke, intracerebral hemorrhage, transient ischemic attack, and acquired brain injury). Intervention: Autonomic nervous system evaluation / Heart rate variability (HRV) and related autonomic dysfunction biomarkers vs. Demographically matched healthy controls (in 10 of 45 studies) or internal cohort comparisons. Primary outcome: Stroke prognosis (mortality, neurological deterioration, and functional outcome).

Q: What does this research mean for the field?

Heart rate variability and biomarkers of autonomic dysfunction demonstrate prognostic value comparable to established clinical variables for predicting mortality, neurological deterioration, and functional outcomes after stroke. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Ilias Orgianelis; Ermis Merkouris; Sofia Kitmeridou; Dimitrios Tsiptsios; Stella Karatzetzou; Anastasia Sousanidou; Aimilios Gkantzios; Foteini Christidi; Efthymia Polatidou; Anastasia Beliani; Anna Tsiakiri; Christos Kokkotis; Stylianos Iliopoulos; Konstantinos Anagnostopoulos; Nikolaos Aggelousis; Κonstantinos Vadikolias

doi:10.3390/neurolint15020042

May 16, 2023Neurology InternationalOpen Access

Exploring the Utility of Autonomic Nervous System Evaluation for Stroke Prognosis

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Key result

Autonomic biomarkers like HRV match standard clinical variables for predicting stroke mortality and outcomes.

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Why the study?

Stroke is an increasing major cause of functional disability, making accurate and timely stroke prognosis essential.

Does evaluation of the autonomic nervous system via heart rate variability and related biomarkers predict mortality, neurological deterioration, and functional outcomes in patients with stroke?

Key Points

To evaluate the prognostic accuracy and clinical utility of heart rate variability and autonomic nervous system biomarkers in patients recovering from stroke.
Conducted a literature review of MEDLINE and Scopus databases covering the last decade for English full-text articles evaluating heart rate variability in stroke prognosis.
Identified and reviewed 45 eligible studies with patient sample sizes ranging from n = 12 to n = 3447 across multiple stroke subtypes.
Autonomic dysfunction biomarkers matched established clinical prognostic variables for predicting mortality, neurological deterioration, and functional outcomes.
In acute ischemic stroke, an elevated resting admission heart rate (≥ 76 beats per minute) was associated with a 1.63-fold increased risk of in-hospital mortality.
Evaluations demonstrated prognostic value across acute ischemic stroke, transient ischemic attack, intracerebral hemorrhage, and traumatic brain injury, while offering predictive insight into poststroke infections, depression, and cardiac events.

Study Design

Type

Systematic Review

Structured PICO

Does evaluation of the autonomic nervous system via heart rate variability and related biomarkers predict mortality, neurological deterioration, and functional outcomes in patients with stroke?

P

Population

45 original studies (individual sample sizes ranging from 12 to 3,447 patients; mean/median ages 51.7 to 75.3 years) evaluating patients with ischemic stroke, hemorrhagic stroke, or transient ischemic attack.

E

Exposure

Autonomic nervous system evaluation using biomarkers of autonomic dysfunction, primarily heart rate variability (HRV), baroreceptor sensitivity (BRS), blood pressure variability (BPV), Ewing battery test, and orthostatic blood pressure changes.

C

Comparator

Demographically matched healthy individuals in 10 of 45 studies; 35 of 45 studies had no healthy control group, and 0 studies included a non-stroke disease-control group.

O

Outcome

Stroke prognosis including mortality, neurological deterioration, and functional outcome (measured via NIHSS, modified Rankin Scale [mRS], Barthel Index [BI], and other clinical scales).hard clinical

Biomarkers of autonomic dysfunction, particularly heart rate variability, offer non-invasive prognostic utility comparable to clinical scales for predicting mortality, functional recovery, and complications such as depression and infection after stroke.

Limitations

No statistical analysis or meta-analysis was performed due to high heterogeneity among the included studies
35 of the 45 included studies did not include a healthy control group
None of the included studies included a disease-control group other than stroke patients
No statistical analysis or meta-analysis was performed due to high heterogeneity among the studies
Only 10 out of 45 studies contrasted stroke patients to demographically matched healthy individuals
None of the studies included a disease-control group other than stroke patients

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Implication

Supports integration of HRV into stroke prognostic models; reinforces its value alongside established clinical predictors.

Abstract

Stroke is a major cause of functional disability and is increasing in frequency. Therefore, stroke prognosis must be both accurate and timely. Among other biomarkers, heart rate variability (HRV) is investigated in terms of prognostic accuracy within stroke patients. The literature research of two databases (MEDLINE and Scopus) is performed to trace all relevant studies published within the last decade addressing the potential utility of HRV for stroke prognosis. Only the full-text articles published in English are included. In total, forty-five articles have been traced and are included in the present review. The prognostic value of biomarkers of autonomic dysfunction (AD) in terms of mortality, neurological deterioration, and functional outcome appears to be within the range of known clinical variables, highlighting their utility as prognostic tools. Moreover, they may provide additional information regarding poststroke infections, depression, and cardiac adverse events. AD biomarkers have demonstrated their utility not only in the setting of acute ischemic stroke but also in transient ischemic attack, intracerebral hemorrhage, and traumatic brain injury, thus representing a promising prognostic tool whose clinical application may greatly facilitate individualized stroke care.

Discussion

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Cite This Study

Orgianelis et al. (2023) conducted a systematic review in Stroke (ischemic stroke, hemorrhagic stroke, intracerebral hemorrhage, transient ischemic attack, and acquired brain injury). Autonomic nervous system evaluation / Heart rate variability (HRV) and related autonomic dysfunction biomarkers vs. Demographically matched healthy controls (in 10 of 45 studies) or internal cohort comparisons was evaluated on Stroke prognosis (mortality, neurological deterioration, and functional outcome). Heart rate variability and autonomic dysfunction biomarkers across 45 studies demonstrated prognostic utility comparable to known clinical variables for predicting stroke mortality and functional outcome.

synapsesocial.com/papers/6a745020372463102b0a5531 https://doi.org/10.3390/neurolint15020042

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Exploring the Utility of Autonomic Nervous System Evaluation for Stroke Prognosis

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Exploring the Utility of Autonomic Nervous System Evaluation for Stroke Prognosis

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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