Abstract
BackgroundStroke has been shown to cause cardiac autonomic dysfunction. Depression is common complication after acute ischemic stroke (AIS). The purpose of this study was to investigate whether decreased heart rate variability (HRV) was related to poststroke depression (PSD) in patients with mild-moderate AIS.MethodsIn this study, we assessed autonomic function of ischemic stroke patients within 72 h from symptom onset by fractal dimension (FD). 503 patients (mean age 65.93 ± 10.19) with mild-moderate AIS underwent FD test after admission. Depressive symptoms were assessed using 17-item Hamilton Depression Rating Scale (HDRS) at baseline (within 7 days) and 3 months. Depression were defined if HDRS >6 points. According to the data of FD, we investigated association with early-onset PSD status and 3-month PSD.Results59.24% (293/503) of patients had early-onset PSD status at baseline, and 38.66% (184/476) of patients had PSD at 3 months. ROC curve analysis shown that the optimal cut point of FD for early-onset PSD status and 3-month PSD were FD ≤ 1.27 and FD ≤ 1.19, respectively. In fully adjusted models, higher NIHSS [adjusted odd ratios (OR), 1.15; 95% confidence interval (CI), 1.05–1.27; P=0.005], younger age (adjusted OR, 1.18; 95% CI, 1.01–1.13; P=0.046), and FD ≤ 1.27 (adjusted OR, 3.31; 95% CI, 2.23–4.92; P<0.001) were associated with increased risk of early-onset PSD status. Higher NIHSS (adjusted OR, 1.21; 95% CI, 1.09–1.43; P<0.001) and FD ≤ 1.19 (adjusted OR, 2.68; 95% CI, 1.79–4.03; P=0.000) were associated with increased risk of 3-month PSD.ConclusionsPSD is common after mild-moderate AIS and is highly correlated with decreased HRV, FD could serve as an objective tool to help in prediction of PSD.
Highlights
Stroke is still the leading cause of disability in China [1]
Poststroke depression (PSD) is common after mild-moderate acute ischemic stroke (AIS) and is highly correlated with decreased Heart rate variability (HRV), fractal dimension (FD) could serve as an objective tool to help in prediction of PSD
In the early stage after stroke, 293 (293/503, 58.25%) had Hamilton Depression Rating Scale (HDRS) score >6 indicative of PSD status, 250 had HDRS score between 7 and 16, 38 had HDRS score between 17 and 24 corresponding to moderate PSD status, 5 had severe PSD status (HRDS score > 24). Those with early-onset PSD status had more severe stroke with mean National Institutes of Health Stroke Scale (NIHSS) of 6.54 ± 1.98 compared with 6.16 ± 2.07 (P=0.030), younger age (65.13 ± 9.57 versus 67.05 ± 10.91, P=0.043),and lower FD value (1.17 ± 0.22 vs 1.43 ± 0.35, P
Summary
Stroke is still the leading cause of disability in China [1]. Stroke can lead to physical disability and emotional impairments. Heart rate variability (HRV), a measure of cardiac autonomic nervous system functioning, has emerged as a physiological indicator for emotional regulation and psychological wellbeing. It has been reported that stroke can cause cardiac autonomic dysfunction and HRV decreased, which reflecting poor parasympathetic regulation. In previous studies shown that decreased HRV was associated with PSD [7] and poor cognitive function [8]. Most of these studies used traditional linear HRV methods to predict PSD, and the sample size was small [9]. The purpose of this study was to investigate whether decreased heart rate variability (HRV) was related to poststroke depression (PSD) in patients with mild-moderate AIS
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