EVALUATION OF AUTONOMIC NERVOUS SYSTEM WITH HEART RATE TURBULENCE IN PATIENTS WITH STROKE

Year 2023, Volume: 4 Issue: Ek Sayı, 207 - 211, 16.10.2023

Abdullah Güzel , İbrahim Etem Dural , Hayri Demirbaş

Abstract

Introduction: Autonomic dysfunction usually develops after cerebrovascular diseases. Heart rate turbulence is one of the tests to show autonomic dysfunction. We aimed to evaluate autonomic dysfunction using heart rate turbulence parameters after acute ischemic stroke in this study.
Methods: We included 30 patients hospitalized with acute ischemic stroke and 15 healthy individuals in the study. Computed tomography and magnetic resonance images taken during the hospitalization of the patients were examined. It was divided into 3 classes the right hemisphere, left hemisphere, and brainstem cerebellum lesions. Holter ECG(electrocardiography) records inserted within the first 24 hours of hospitalization of the patients were examined. Turbulence onset (TO) and turbulence slope (TS) parameters, which are heart rate turbulence parameters, were compared with the control group.
Results: There was no significant difference between the groups included in the study in terms of gender, age, hypertension, hyperlipidemia smoking, and biochemical parameters. When TO and TS values were compared with the control group, no significant difference was found. (TO -0.004970 (± 0.02), -0.013627 (± 0.01) p: 0.14, TS 6.81 (± 7.30), 7.67 (± 5.30) p: 0.11). Although there were more abnormal values for TO and TS in patients with left hemisphere lesions, no statistical difference was found.
Conclusion: No relationship has been shown between acute stroke and heart rate turbulence.

Keywords

STROKE, HEART RATE TURBULENCE, AUTONOMİC NERVOUS SYSTEM

İNME GEÇİREN HASTALARDA OTONOMİK SİNİR SİTEMİNİN KALP HIZI TURBULANSI İLE DEĞERLENDİRİLMESİ

Abstract

Giriş: Serebrovasküler hastalıklar sonrası genellikle otonomik disfonksiyon gelişmektedir. Otonomik disfonksiyonu gösteren testlerden biri de kalp hızı türbülansıdır. Bu çalışmada bizim amacımız kalp hızı türbülansı parametrelerini kullanarak akut iskemik inme sonrası otonomik disfonksiyonu değerlendirmektir.
Yöntemler: Çalışmaya 30 akut iskemik inme ile hastaneye yatırılan hasta ve 15 sağlıklı birey dahil edildi. Hastaların yatışları esnasında çekilen bilgisayarlı tomografi ve manyetik rezonans görüntüleri incelendi. Sağ hemisfer, sol hemisfer ve beyin sapı- serebellum lezyonu olarak 3 sınıfa ayrıldı. Hastaların hastaneye yatışlarının ilk 24 saati içerisinde takılmış olan holter EKG(elektrokardiyografi) kayıtları incelendi. Kalp hızı türbülansı parametreleri olan türbülans başlangıcı (TB) ve türbülans eğimi (TE) kontrol grubu ile kıyaslandı.
Bulgular: Çalışmaya alınan gruplar arasında cinsiyet, yaş, hipertansiyon, hiperlipidemi sigara kullanımı ve biyokimyasal parametreler açısından anlamlı bir farklılık yoktu. TB ve TE değerleri kontrol grubu ile kıyaslandığında anlamlı fark saptanmadı. (TB - 0.004970 (±0.02), -0.013627 (±0.01) p: 0.14, TE 6.81(±7.30), 7.67 (±5.30) p: 0.11). Sol hemisfer lezyonlu hastalarda TB ve TE için daha fazla anormal değer saptanmasına karşın istatistiksel fark saptanmadı.
Sonuç: Akut inme ile kalp hızı türbülansı arasında ilişki gösterilememiştir.

Keywords

İNME, KALP HIZI TURBULANSI, OTONOMİK SİNİR SİSTEMİ

References

• 1. Fazekas F, Gattringer T, Enzinger C. Cerebrovascular disorders. Current Opinion in Neurology 2018 Aug;31(4):345-353.
• 2. Meglic B, Kobal J, Osredkar J, Pogacnik T. Autonomic nervous system function in patients with acute brainstem stroke. Cerebrovasc Dis. 2001;11(1):2–8.
• 3. Candemir M, Onder H. Assessing Autonomic Nervous Function by Heart Rate Variability and Heart Rate Turbulence in Patients with Acute Ischemic Stroke. Annals of Indian Academy of Neurology 2020;23 (5):608-615
• 4. Cygankiewicz I. Heart rate turbulence. Prog Cardiovasc Dis. 2013 ;56(2):160-71.
• 5. Tokgözoglu SL, Batur MK, Topçuoglu MA, Saribas O, Kes S, Oto A. Effects of stroke localization on cardiac autonomic balance and sudden death. Stroke 1999 Jul;30(7):1307–11.
• 6. Colivicchi F, Bassi A, Santini M, Caltagirone C. Cardiac autonomic derangement and arrhythmias in right-sided stroke with insular involvement. Stroke 2004 Sep;35(9):2094–8.
• 7. Howard G, Anderson R, Sorlie P, Andrews V, Backlund E, Burke GL. Ethnic differences in stroke mortality between non-Hispanic whites, Hispanic whites, and blacks. The National Longitudinal Mortality Study. Stroke 1994 Nov;25(11):2120–5.
• 8. Bauer A, Malik M, Schmidt G, Barthel P, Bonnemeier H, Cygankiewicz I, Guzik P, Lombardi F, Müller A, Oto A, Schneider R, Watanabe M, Wichterle D, Zareba W. Heart rate turbulence: standards of measurement, physiological interpretation, and clinical use: International Society for Holter and Noninvasive Electrophysiology Consensus. J Am Coll Cardiol. 2008 Oct;52(17):1353–65.
• 9. Wichterle D, Melenovsky V, Simek J, Malik J, Malik M. Hemodynamics and autonomic control of heart rate turbulence. J Cardiovasc Electrophysiol. 2006 Mar;17(3):286–91.
• 10. Melillo P, Izzo R, Orrico A, Scala P, Attanasio M, Mirra M, De Luca N, Pecchia L. Automatic prediction of cardiovascular and cerebrovascular events using heart rate variability analysis. PLoS One 2015;10(3):e0118504.
• 11. Giubilei F, Strano S, Lino S, Calcagnini G, Tisei P, Fiorelli M, Ferretti C, Cerutti S, Fieschi C. Autonomic nervous activity during sleep in middle cerebral artery infarction. Cerebrovasc Dis. 1998 Mar-Apr;8(2):118-23
• 12. Grimm W, Sharkova J, Christ M, Schneider R, Schmidt G, Maisch B. Heart rate turbulence following ventricular premature beats in healthy controls. Ann Noninvasive Electrocardiol. 2003 Apr;8(2):127–31.
• 13. Davis TP, Alexander J, Lesch M. Electrocardiographic changes associated with acute cerebrovascular disease: a clinical review. Prog Cardiovasc Dis. 1993 Nov-Dec;36(3):245-60.
• 14. Lindgren A, Wohlfart B, Pahlm O, Johansson BB. Electrocardiographic changes in stroke patients without primary heart disease. Clin Physiol. 1994 Mar;14(2):223–31.
• 15. Korpelainen JT, Sotaniemi KA, Suominen K, Tolonen U, Myllylä V V. Cardiovascular autonomic reflexes in brain infarction. Stroke 1994 Apr;25(4):787–92.
• 16. Korpelainen JT, Sotaniemi KA, Huikuri H V, Myllyä V V. Abnormal heart rate variability as a manifestation of autonomic dysfunction in hemispheric brain infarction. Stroke 1996 Nov;27(11):2059–63.
• 17. Barron SA, Rogovski Z, Hemli J. Autonomic consequences of cerebral hemisphere infarction. Stroke 1994 Jan;25(1):113–6.
• 18. Al-Qudah Z, Yacoub HA, Souayah N. Serial heart rate variability testing for the evaluation of autonomic dysfunction after stroke. J Vasc Interv Neurol. 2014 Dec; 7(5): 12–17.