Songul USALP, Berçem TAŞİN, Hatice Soner KEMAL, Belma YAMAN, Onur AKPINAR, Levent CERİT, İ̇lker GÜL, Aziz GÜNSEL, Hamza DUYGU

Kalp Hızı Değişkenliği ve Serebrovasküler Olaylar

Amaç: Kalp hızı değişkenliği (KHD), kalbin otonomik fonksiyonlarını yansıtan noninvaziv bir değerlendirmedir ve sistemik hastalıklarda bozulduğu bilinmektedir. Çalışmamızda, KHD ile akut iskemik inme (Aİİ) arasındaki ilişkiyi araştırmayı amaçladık.Materyal ve metod: Toplam 102 Aİİ hastası ve 66 sağlıklı birey (kontrol grubu) çalışmaya dahil edildi. Aİİ hastaları, iskemik inme (İİ) (n=65) ve geçici iskemik atak (GİA) (n=37) olarak iki gruba ayrıldı. Hasta ve kontrol gruplarına 24 saatlik ritim Holter kaydı yapıldı. Bulgular: Aİİ grubunda hipertansiyon (%60.8’e karşın %33.3, p=0.005) ve diyabetes mellitus (DM) (%39.2’e karşın %15.2, p=0.002) sıklığı ile, serum glukoz (142.4±60.0’a karşı 106.8±20.9, p=0.034) ve kreatinin düzeyleri (0.9±0.3’e karşın 0.8±0.5, p=0.010) anlamlı olarak daha yüksekti, fakat serum yüksek dansiteli lipoprotein düzeyi (44.7±9.7’e karşın 54.6±12.9, p=0.022) ve sol ventrikül ejeksiyon fraksiyonu (SVEF) (53.0 [25-60]’a karşın 58.0 [30-60], p=0.012) daha düşüktü. Ek olarak, KHD parametrelerinden olan SDNN (112.2 [37-1473]’e karşın 134.8 [37-405], p<0.001), SDNN index (44.0 [14-132]’e karşın 55.1 [24-145], p<0.001), üçgen index (1.5 [1-36]’e karşın 2.0 [1-53], p<0.001), HF (22.1 [5-2023]’e karşın 28.0 [13-2701], p=0.014), LF (2.7 [13-2367]’e karşın 3.4 [4-1523], p<0.001) ve VLF (676.3 [7-1795]’e karşın 1014 [291-1881], p<0.001) Aİİ grubunda anlamlı olarak daha düşüktü. İİ ve GİA grupları arasında ise bazal özellikler ve KHD parametreleri açısından anlamlı bir farklılık izlenmedi (p>0.05, hepsi için). Çoklu regresyon analizlerinde, yaş (OR: 1.096, %95 GA: 1.056 – 1.136, p<0.001), SVEF (OR: 0.362, %95 GA: 0.355-0.559, p=0.006) ve DM (OR: 0.860, %95 GA: 0.856-0.931, p<0.001) inme için bağımsız bir risk faktörü olarak saptandıSonuç: Çalışmamızda Aİİ hastalarında KHD parametrelerinin azalmış olduğunu saptadık. Ek olarak; yaş, SVEF ve DM’nin Aİİ için bağımsız birer risk faktörü olduğunu bulduk.Anahtar Kelimeler: Akut serebrovasküler hastalık, Kalp hızı, İskemik inme, Geçici iskemik atak

Anahtar Kelimeler:

Akut serebrovasküler hastalık, kalp hızı değişkenliği, iskemik inme

Heart Rate Variability and Cerebrovascular Events

AbstractBackground: Heart rate variability (HRV) is a noninvasive assessment that reflects the autonomic functions of the heart and it is known to be disrupted in many systematic diseases. In our study, we aimed to investigate the relationship between HRV and acute ischemic stroke (AIS).Materials and Methods: 102 AIS patients and 66 healthy individuals (control group) were included in the study. AIS patients were divided into two groups as ischemic stroke (IS) (n=65) and transient ischemic attack (TIA) (n=37). A 24-hour rhythm Holter record were applied to all patients.Results: The frequency of hypertension (60.8% vs. 33.3%, p=0.005) and diabetes mellitus (DM) (39.2% vs. 15.2%, p=0.002), and serum glucose (142.4±60.0 vs. 106.8±20.9, p=0.034) and creatinine levels (0.9±0.3 vs. 0.8±0.5, p=0.010) were significantly higher in AIS group, whereas serum high-density lipoprotein (44.7±9.7 vs. 54.6±12.9, p=0.022) and left ventricular ejection fraction (LVEF) values were lower (53.0 [25-60] vs. 58.0 [30-60], p=0.012). Also, the HRV parameters SDNN (112.2 [37-1473] vs. 134.8[37-405], p<0.001), SDNN index (44.0 [14-132] vs. 55.1 [24-145], p<0.001), triangular index (1.5 [1-36] vs. 2.0 [1-53], p<0.001), HF (22.1 [5-2023] vs. 28.0 [13-2701], p=0.014), LF 2.7 [13-2367] vs. 3.4 [4-1523], p<0.001), and VLF 676.3 [7-1795] vs. 1014 [291-1881], p<0.001) were lower in the AIS group. There was no significant difference between the TIA and IS groups in terms of basal characteristics and HRV (p>0.05, for all). In multivariable regression analysis, age (OR: 1.096, %95 CI: 1.056 – 1.136, p<0.001), LVEF (OR: 0.362, % 95CI: 0.355-0.559, p=0.006) and DM (OR: 0.860, % 95CI: 0.856-0.931, p<0.001) were independent risk factors for AIS. Conclusion: In our study, we detected that HRV parameters were lower in patients with AIS. We also found that age, LVEF and DM were the independent risk factors for AIS.Key words: Acute cerebrovascular disease, Heart rate, Ischemic stroke, Transient ischemic attack

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1. Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, Culebras A, et al. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013; 44(7):2064–89.
2. Powers WJ, Rabinstein AA, Teri Ackerson, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines fort he Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines fort he Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/ American Stroke Association. Stroke. 2019;50(12):344-418.
3. Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thrombi-embolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on atrial fibrillation. Chest 2010;137:263-272.
4. Guidelines for the management of atrial fibrillation The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the Europan Heart Rhythm Association (EHRA) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2010;31:2369-2429.
5. Saladini F, Di Marco A, Palatini P. Autonomic Dysfunction: How to Identify and When to Treat? High Blood Press Cardiovasc Prev. 2016;23(3):237-43.
6. Al-Qudah ZA, Yacoub HA, Souyah N. Disorders of the Autonomic Nervous System after Hemispheric Cerebrovascular Disorders: An Update. J Vasc Interv Neurol. 2015;8(4):43-52.
7. Gernot Ernst.Heart-Rate Variability-More than Heart Beats? Front Public Health. 2017;5:240.
8. Kleiger RE, Miller JP, Bigger JT Jr, Moss AJ. Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol. 1987;59(4):256-62.
9. Bodapati RK, Kizer JR, Kop WJ, Kamel H, Stein PK. Addition of 24-Hour Heart Rate Variability Parameters to the Cardiovascular Health Study Stroke Risk Score and Prediction of Incident Stroke: The Cardiovascular Health Study. J Am Heart Assoc. 2017;6: (7). pii: e004305.
10. Mitchell C, Rahko PS, Blauwet LA, Canaday B, Finstuen JA, Foster MC, et al.Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in adults: Recommendation from the American Society of Echocardiography.J Am Soc Echocardiogr. 2019;32(1):1-64.
11. Taylor JA, Lipsitz LA. Heart rate variability standards. Circulation 1997;(95)1280-281.
12. Pieper SJ, Hammill SC. Heart rate variability: Technique and investigational applications in cardiovascular medicine. Mayo Clin Proc 1995;70(10): 955-64.
13. Sztajzel J. Heart rate variability: a noninvasive electrocardiographic method to measure the autonomic nervous system.Swiss Med Wkly. 2004:134(35-36):514-22.
14. Novak V, Saul JP, Eckberg DL. Task Force report on heart rate variability. Circulation.1997;96(3): 1056-57.
15. Shaffer F, Ginsberg JP. An overview of Heart Rate Variability Metrics and Norms. Front Public Health. 2017;5:258.
16. Easton JD, Saver JL, Albers GW, Alberts MJ, Chaturvedi S, Feldmann E, et al. Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. The American Academy of Neurology affirms the value of this statement as an educational tool for neurology. Stroke. 2009;40(6):2276-93.
17. Fyfe-Johnson AL, Muller CJ, Alonso A, Folsom AR, Gottesman RF, Rosamond WD, et al. Heart Rate Variability and Incident Stroke: The Atherosclerosis Risk in Communities Study. Stroke 2016;47(6): 1452–58.
18. Korpelainen JT, Sotaniemi KA, Mäkikallio A, Huikuri HV, Myllylä VV. Dynamic behavior of heart rate in ischemic stroke. Stroke. 1999;30(5):1008-13.
19. Tsuji H, Venditti FJ Jr, Manders ES, Evans JC, Larson MG, Feldman CL, et al. Reduced heart rate variability and mortality risk in an elderly cohort. The Framingham Heart Study. Circulation 1994;90(2): 878-93.
20. Binici Z, Mouridsen MR, Køber L, Sajadieh A. Decreased nighttime heart rate variability is associated with increased stroke risk. Stroke. 2011;42:3196-201.
21. Kleiger RE, Stein PK, Bigger JT, Jr. Heart rate variability: measurement and clinical utility. Ann Noninvasive Electrocardiol.2005;10(1):88-101.