Heart rate dynamics predict poststroke mortality

Mäkikallio, A. M.; Mäkikallio, T. H.; Korpelainen, J. T.; Sotaniemi, K. A.; Huikuri, H. V.; Myllylä, V. V.

doi:10.1212/01.wnl.0000125190.10967.d5

Cited by 133Heart Rate Variability and Autonomic ControlAcute Ischemic Stroke ManagementCardiac electrophysiology and arrhythmias

Heart rate dynamics predict poststroke mortality

Mäkikallio, A. M., Mäkikallio, T. H., Korpelainen, J. T., Sotaniemi, K. A., Huikuri, H. V., Myllylä, V. V.·2004·Neurology

DOI 10.1212/01.wnl.0000125190.10967.d5

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Abstract

BACKGROUND: Impaired cardiovascular autonomic regulation assessed by heart rate (HR) variability provides prognostic information in patients with heart disease as well as among elderly. Reduced HR variability has been described in stroke patients, but the prognostic significance of HR variability measures after stroke has not been studied. METHODS: A series of 84 patients (mean age 59 +/- 12 years) with an acute first-ever ischemic stroke underwent a comprehensive clinical investigation, laboratory tests, and 24-hour EKG recordings and were followed up for 7 years (mean 83 +/- 54 months). Various conventional and newer qualitative measures of HR variability were analyzed from the baseline 24-hour EKG. Risk factors for all-cause mortality were assessed. RESULTS: During the follow-up, 33 (39%) patients died and 51 survived. Among all the variables analyzed, abnormal long-term HR variability measure power-law slope beta (beta < -1.5), reflecting an altered distribution of spectral characteristics over ultra and very low frequency bands, was the best univariate predictor of death (hazard ratio 4.5, 95% CI 2.2 to 9.5, p < 0.001). High age, poor Scandinavian Stroke Scale score, and abnormal short-term HR variability scaling measure (alpha) also predicted mortality in univariate analysis. In multivariate analysis, after adjustment for age, the only independent predictor of the risk of death was abnormal long-term power-law slope beta (hazard ratio 3.8, CI 1.8 to 8.2, p < 0.001). Conventional HR variability measures showed no prognostic power. CONCLUSION: Abnormal long-term HR dynamics predict poststroke mortality. This measure may have value in the risk stratification of stroke patients.

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The fractal pattern of heart beat variability breaks down with disease and its change is predictive of mortality.
“This fractal pattern breaks down with disease and its change is predictive of mortality”
From The impact of the circadian timing system on cardiovascular and metabolic function (2012) · cites this paper as Mäkikallio et al., 2004

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Authors: Mäkikallio, A. M., Mäkikallio, T. H., Korpelainen, J. T., Sotaniemi, K. A., Huikuri, H. V., & Myllylä, V. V.
Affiliations: From The Graduate School of Circumpolar Wellbeing, Health and Adaptation, Centre for Arctic Medicine (Dr. A.M. Mäkikallio), and Departments of Neurology (Drs. A.M. Mäkikallio, Korpelainen, Sotaniemi, and Myllylä) and Medicine, Division of Cardiology (Drs. T.H. Mäkikallio and Huikuri), University of Oulu, Finland.
University of Oulu (FI)
ORCID: Huikuri, H. V.
Venue: Neurology
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2004-05-25
Volume: 62
Issue: 10
Pages: 1822-1826
ISSN: 0028-3878 (ISSN-L)
1526-632X
DOI: 10.1212/01.wnl.0000125190.10967.d5
OpenAlex: W2098592970
Cited by: 133
References: 33
Citations by year: 2026: 1 · 2025: 5 · 2024: 6 · 2023: 8 · 2022: 4 · 2021: 9 · 2020: 4 · 2019: 8 · 2018: 7 · 2017: 9 · 2016: 8 · 2015: 8 · 2014: 4 · 2013: 6 · 2012: 8
FWCI: 3.08
Type: journal article
Language: en
Open access: closed
Locations: Neurology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
Keywords: heart rate variability, ischemic stroke, post-stroke mortality, cardiovascular autonomic regulation, prognostic factors, risk stratification, autonomic dysfunction, 24-hour ECG
MeSH terms: Aged, Cause of Death, Brain Ischemia, Electrocardiography, Female, Follow-Up Studies, Heart Rate, Humans, Male, Middle Aged, Prospective Studies, Life Tables, Survival Analysis, Risk Assessment

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Heart rate dynamics predict poststroke mortality

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