Correlation between clinical severity and extent of autonomic cardiovascular impairment in the acute phase of subarachnoid hemorrhage

Matthias C Borutta; Stefan T Gerner; Philip Moeser; Philip Hoelter; Tobias Engelhorn; Arnd Doerfler; Hagen B Huttner; Stefan Schwab; Joji B Kuramatsu; Julia Koehn

doi:10.1007/s00415-022-11220-w

Correlation between clinical severity and extent of autonomic cardiovascular impairment in the acute phase of subarachnoid hemorrhage

J Neurol. 2022 Oct;269(10):5541-5552. doi: 10.1007/s00415-022-11220-w. Epub 2022 Jun 20.

Affiliations

¹ Department of Neurology, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany.
² Department of Neurology, University of Giessen, Klinikstrasse 33, 35392, Giessen, Germany.
³ Department of Neuroradiology, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany.
⁴ Department of Neurology, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany. Julia.Koehn@uk-erlangen.de.

Abstract

Background and aim: To assess associations between clinical severity and possible dysfunction of autonomic cardiovascular modulation within the acute phase after spontaneous subarachnoid hemorrhage (SAH).

Methods: In this prospective observational study, in 51 patients with spontaneous SAH, Hunt-and-Hess scores (H&H) were assessed and cardiovascular autonomic modulation was monitored within 24 h after SAH-onset. From 5 min time-series of R-R-intervals (RRI) and blood-pressure (BP) recordings, we calculated autonomic parameters including time-domain [RRI-coefficient-of-variation (RRI-CV) and square-root-of-the-mean-squared-differences-of-successive-RRIs (RMSSD)] and frequency-domain parameters [low- and high-frequency-powers of RRI- and BP-modulation (RRI-LF-, RRI-HF-, SBP-LF-powers) and RRI-total-powers]. Data were compared to those of 20 healthy volunteers.

Results: RRI- and BP-values did not differ between groups. Yet, parameters of sympathetic (RRI-LF-powers 141.0 (18.9-402.4) ms² vs 442.3 (246.8-921.2) ms², p = 0.001) and total autonomic modulation (RRI-CV 2.4 (1.2-3.7) ms² vs 3.7 (3.1-5.3) ms², p = 0.001) were significantly lower in patients than in controls. Subgroup analyses (patients with H&H < 3 vs H&H ≥ 3) and Spearman-rank-correlations revealed increasing loss of sympathetic (RRI-LF-powers 338.6 (179.7-710.4) ms² vs 72.1 (10.1-175.9) ms², p = 0.001, rho = - 0.524) and total autonomic modulation (RRI-CV 3.5 (2.3-5.4) ms² vs 1.6 (1.0-2.8) ms², p < 0.001, rho = - 0.519) with higher H&H-scores. Multiple-logistic-regression underlined the significant influence of H&H-scores on sympathetic (RRI-LF-powers, p = 0.033) and total autonomic modulation (RRI-CV, p = 0.040) compared to possible confounders (e.g., age, intubation).

Conclusion: Within the acute phase, spontaneous SAH induces a decrease in sympathetic and total autonomic cardiovascular modulation. Higher H&H-scores were associated with increasing autonomic dysfunction and may therefore augment the risk of cardiovascular complications and poor clinical outcome.

Keywords: Autonomic nervous system; Heart rate variability; Hunt and Hess; Subarachnoid hemorrhage.

Publication types

Observational Study

MeSH terms

Autonomic Nervous System
Autonomic Nervous System Diseases* / etiology
Blood Pressure
Cardiovascular System*
Heart Rate
Humans
Subarachnoid Hemorrhage* / complications