TY - JOUR
T1 - Heart rate variability and delirium in acute non-cardioembolic stroke: a prospective, cross-sectional, cohort study
AU - Rollo, Eleonora
AU - Marotta, Jessica
AU - Callea, Antonio
AU - Brunetti, Valerio
AU - Vollono, Catello
AU - Scala, Irene
AU - Imperatori, Claudio
AU - Frisullo, Giovanni
AU - Broccolini, Aldobrando
AU - Della Marca, Giacomo
PY - 2021
Y1 - 2021
N2 - 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.
AB - 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.
KW - Autonomic
KW - CAM-ICU
KW - Stroke unit
KW - Heart rate variability
KW - Stroke
KW - Delirium
KW - Autonomic
KW - CAM-ICU
KW - Stroke unit
KW - Heart rate variability
KW - Stroke
KW - Delirium
UR - http://hdl.handle.net/10807/262955
U2 - 10.1007/s10072-021-05621-4
DO - 10.1007/s10072-021-05621-4
M3 - Article
SN - 1590-3478
SP - N/A-N/A
JO - Neurological Sciences
JF - Neurological Sciences
ER -