Admission Heart Rate Variability is Associated with Depression and Cognition in Patients with Acute Mild-Moderate Ischemic Stroke

Abstract Background Stroke has been shown to cause cardiac autonomic dysfunction. Depression and cognitive impairment are common complications after acute ischemic stroke (AIS). The relationship between poststroke depression (PSD) and cognitive impairment (PCI) and heart rate variability(HRV) was unclear. The purpose of this study was to investigate whether the decreased HRV was related to PSD and PCI in patients with mild-moderate AIS. Methods Changes in HRV after AIS were assessed using the nonlinear fractal dimension (FD) method, and patients within 72 hours of AIS were included in the study. 476 patients were included in this study. All patients underwent mood tests, cognitive test at 3 months. Cognitive and mood state were assessed using the Montreal Cognitive Assessment (MoCA) and the 15-item Stroke Specific Geriatric Depression Scale (GDS), respectively. PSD was defined if GDS ≥5 and PSCI was defined if MoCA<26. We assessed the relationship between FD and PSD and PSCI at 3 months. Results 50.84% (242/476) of patients had PSD, and 33.19% (158/476) of patients had PSCI. Compared with no PSD group, the lower NIHSS and FD value,and higher prevalence of FD≤1.05 were more likely in patients with PSD (P<0.05). Compared with no PSCI group, the higher prevalence of FD≤1.05 were more likely in patients with PSCI (P<0.05).In fully adjusted models, the FD ≤1.05 was significantly associated with PSD (adjusted OR, 3.31; 95%CI, 1.81–5.43; P=0.000),and PSCI (adjusted OR,1.88; 95%CI, 1.11–3.16; P=0.018). Conclusions These results suggested that FD≤1.05 after AIS could be used as an objective tool for early prediction of PSD and PSCI, providing guidance for the treatment of PSD and PCI, and improving the prognosis of patients.