Acute Crit Care.  2021 May;36(2):151-161. 10.4266/acc.2020.00703.

Continuous heart rate variability and electroencephalography monitoring in severe acute brain injury: a preliminary study

Affiliations
  • 1Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 2Department of Neurology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Abstract

Background
Decreases in heart rate variability have been shown to be associated with poor outcomes in severe acute brain injury. However, it is unknown whether the changes in heart rate variability precede neurological deterioration in such patients. We explored the changes in heart rate variability measured by electrocardiography in patients who had neurological deterioration following severe acute brain injury, and examined the relationship between heart rate variability and electroencephalography parameters.
Methods
Retrospective analysis of 25 patients who manifested neurological deterioration after severe acute brain injury and underwent simultaneous electroencephalography plus electrocardiography monitoring.
Results
Eighteen electroencephalography channels and one simultaneously recorded electrocardiography channel were segmented into epochs of 120-second duration and processed to compute 10 heart rate variability parameters and three quantitative electroencephalography parameters. Raw electroencephalography of the epochs was also assessed by standardized visual interpretation and categorized based on their background abnormalities and ictalinterictal continuum patterns. The heart rate variability and electroencephalography parameters showed consistent changes in the 2-day period before neurological deterioration commenced. Remarkably, the suppression ratio and background abnormality of the electroencephalography parameters had significant reverse correlations with all heart rate variability parameters.
Conclusions
We observed a significantly progressive decline in heart rate variability from the day before the neurological deterioration events in patients with severe acute brain injury were first observed.

Keyword

brain injuries; critical care; electrocardiography; electroencephalography

Figure

  • Figure 1. Changes in electroencephalography parameters over 2 days before (D–2 to D0) and after (D0 to D+2) neurological deterioration onset. (A) Suppression ratio (B) Asymmetry index. (C) Alpha/delta band power ratio. Values are presented as mean±standard deviation and were compared by Dunn’s pairwise tests after Kruskal-Wallis tests. *Statistically significant (P<0.01) differences compared with the value from the day before. Note that the monitoring was not conducted in D+2 in the non-survivors.

  • Figure 2. Changes in heart rate variability parameters over 2 days before (D–2 to D0) and after (D0 to D+2) neurological deterioration onset. (A) Standard deviations of the normal-normal intervals (SDNN). (B) Root mean square of successive normal-normal interval differences (RMSSD). (C) Log (VLF [very low frequency power]). (D) Low frequency/high frequency power ratio (LF/HF ratio). (E) Ratio of standard deviations along the transverse and longitudinal axis of the Poincaré plots (SD2/SD1 ratio). (F) Approximate entropy (ApEn). Values are presented as mean± standard deviation and were compared by Dunn’s pairwise tests after Kruskal-Wallis tests. *Statistically significant (P<0.01) differences compared with the value from the day before. Note that the monitoring was not conducted in D+2 in the non-survivors.

  • Figure 3. Heatmap of the correlation matrix between the electroencephalography and heart rate variability parameters. Results of the Spearman correlation rs (above the diagonal) and respective P-values for each correlation (below the diagonal). Darker shades of blue (value of 1.0) and red (value of –1.0) represent stronger correlation coefficients. IIC: ictal-interictal continuum; SDNN: standard deviations of the normal-normal intervals; RMSSD: root mean square of successive normal-normal interval differences; VLF: very low frequency power; LF: low frequency power; HF: high frequency power; SD2: standard deviations along the longitudinal axis of the Poincaré plots; SD1: standard deviations along the transverse axis of the Poincaré plots; ApEn: approximate entropy.


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