Key result
Higher heart rate variability (highest vs. lowest quartile of SDNN) was associated with a significantly lower risk of ischemic stroke at one year (HR 0.57), an effect partially mediated by inflammatory markers.
Why the study?
Heart rate variability was thought to correlate with recurrent stroke, functional disability, and inflammatory markers, but whether inflammation mediates this relationship remained unclear.
Does higher heart rate variability (SDNN) predict a lower risk of ischemic stroke and vascular events in patients with acute ischemic stroke or TIA?
Cohort (n=4,592)
Yes
Does higher heart rate variability (SDNN) predict a lower risk of ischemic stroke and vascular events in patients with acute ischemic stroke or TIA?
Higher heart rate variability (SDNN) is independently associated with a lower risk of recurrent stroke and vascular events at one year, a relationship that is partially mediated by systemic inflammation.
Answers are grounded in this paper and cite their sources.
Does not support clinical HRV assessment for stroke prevention; hypothesis-generating for inflammation-mediated autonomic effects.
BackgroundHeart rate variability (HRV), as a sensitive index of autonomic nervous system (ANS) function, was supposed to be associated with risk of recurrent stroke and functional disability, and negatively related with inflammatory marker levels. Some studies showed that significant changes in HRV metrics might precede the development of asymptomatic or inflammatory flare. This study aimed to validate the association of HRV with stroke outcomes and inflammation, and further to investigate whether inflammatory markers were mediators of the association between HRV and stroke outcome.MethodsPatients were derived from the Third China National Stroke Registry from August 2015 to March 2018. HRV and inflammatory markers was measured at baseline. The primary outcome (ischemic stroke) and secondary outcomes (new stroke, composite vascular events, all-cause death and disability) were assessed at 1-year follow-up after stroke symptom onset. Mediation analysis was performed to estimate the mediation effect of inflammatory markers between HRV and stroke outcomes.ResultsA total of 4,592 patients were included in this analysis. The standard deviation of N-N intervals (SDNN) of HRV was negatively associated with inflammatory markers, including high-sensitive C-reactive protein (hs-CRP) and interleukin-6 (IL-6). The adjusted hazard ratio/odds ratio for the fourth vs. the first quartile of SDNN for Primary and all secondary outcomes were significant (P<0.05). The associations between SDNN and ischemic stroke, composite vascular events, all-cause death and disability at one year were mediated by hs-CRP were 3%, 4%, 7%, and 5%, respectively. The mediation proportions of association SDNN with ischemic stroke, composite vascular events, all-cause death and disability by IL-6 were 8%, 7%, 14%, and 13%, respectively. ConclusionsSDNN was an independent predictor for stroke outcomes and had a negative relationship with inflammatory markers. Inflammatory markers may partially mediate the relationship between heart rate variability and stroke outcomes at one year. However, the specific role of inflammation in HRV and stroke outcomes needs to be verified by more studies, and our results might provide clues for future studies.
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Wang et al. (2022) conducted a cohort in Acute ischemic stroke or transient ischemic attack (TIA) (n=4,592). Higher heart rate variability (highest quartile of SDNN) vs. Lowest quartile of SDNN was evaluated on Ischemic stroke at 1 year (HR 0.57, 95% CI 0.42-0.77, p=<0.001). Higher heart rate variability (highest vs. lowest quartile of SDNN) was associated with a significantly lower risk of ischemic stroke at one year (HR 0.57), an effect partially mediated by inflammatory markers.
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