Association of Heart Rate Variability With Silent Brain Infarcts in Patients With Atrial Fibrillation

Peter Hämmerle; Christian Eick; Sven Poli; Steffen Blum; Vincent Schlageter; Axel Bauer; Konstantinos D Rizas; Ceylan Eken; Michael Coslovsky; Stefanie Aeschbacher; Philipp Krisai; Pascal Meyre; Jens Wuerfel; Tim Sinnecker; Jean-Marc Vesin; Jürg H Beer; Giorgio Moschovitis; Leo H Bonati; Christian Sticherling; David Conen; Stefan Osswald; Michael Kühne; Christine S Zuern

doi:10.3389/fcvm.2021.684461

Association of Heart Rate Variability With Silent Brain Infarcts in Patients With Atrial Fibrillation

Front Cardiovasc Med. 2021 May 21:8:684461. doi: 10.3389/fcvm.2021.684461. eCollection 2021.

Authors

Peter Hämmerle^{1

2}, Christian Eick³, Sven Poli⁴, Steffen Blum^{1

2}, Vincent Schlageter², Axel Bauer⁵, Konstantinos D Rizas^{6

7}, Ceylan Eken², Michael Coslovsky², Stefanie Aeschbacher², Philipp Krisai^{1

2}, Pascal Meyre^{1

2}, Jens Wuerfel⁸, Tim Sinnecker^{8

9}, Jean-Marc Vesin¹⁰, Jürg H Beer¹¹, Giorgio Moschovitis¹², Leo H Bonati⁹, Christian Sticherling^{1

2}, David Conen^{2

13}, Stefan Osswald^{1

2}, Michael Kühne^{1

2}, Christine S Zuern^{1

2}

Affiliations

¹ Department of Cardiology, University Hospital Basel, Basel, Switzerland.
² Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.
³ Department of Cardiology, University Hospital Tübingen, Tübingen, Germany.
⁴ Department of Neurology & Stroke, Hertie Institute for Clinical Brain Research, Eberhard-Karls University Tübingen, Tübingen, Germany.
⁵ University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria.
⁶ Medizinische Klinik und Poliklinik I, Munich University Clinic, Munich, Germany.
⁷ German Center for Cardiovascular Research Partner Site, Munich Heart Alliance, Munich, Germany.
⁸ Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
⁹ Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland.
¹⁰ Institute of Electrical Engineneering, Swiss Federal Institute of Technology, Lausanne University Hospital, Lausanne, Switzerland.
¹¹ Department of Internal Medicine, Cantonal Hospital Baden, Aargau, Switzerland.
¹² Division of Cardiology, Ospedale Regionale di Lugano-Civico e Italiano, Lugano, Switzerland.
¹³ Population Health Research Institute, McMaster University, Hamilton, ON, Canada.

Abstract

Purpose: Silent brain infarcts (SBI) are frequently detected in patients with atrial fibrillation (AF), but it is unknown whether SBI are linked to autonomic dysfunction. We aimed to explore the association of autonomic dysfunction with SBI in AF patients. Methods: 1,358 AF patients without prior stroke or TIA underwent brain MRI and 5-min resting ECG. We divided our cohort into AF patients who presented in sinus rhythm (SR-group, n = 816) or AF (AF-group, n = 542). HRV triangular index (HRVI), standard deviation of normal-to-normal intervals, mean heart rate, root mean square root of successive differences of normal-to-normal intervals, 5-min total power and power in the low frequency, high frequency and very low frequency range were calculated. Primary outcome was presence of SBI in the SR group, defined as large non-cortical or cortical infarcts. Secondary outcomes were SBI volumes and topography. Results: Mean age was 72 ± 9 years, 27% were female. SBI were detected in 10.5% of the SR group and in 19.9% of the AF group (p < 0.001). HRVI <15 was the only HRV parameter associated with the presence of SBI after adjustment for clinical covariates in the SR group [odds ratio (OR) 1.67; 95% confidence interval (CI): 1.03-2.70; p = 0.037]. HRVI <15 was associated with larger brain infarct volumes [β (95% CI) -0.47 (-0.84; -0.09), p = 0.016] in the SR group and was more frequently observed in patients with right- than left-hemispheric SBI (p = 0.017). Conclusion: Impaired HRVI is associated with SBI in AF patients. AF patients with autonomic dysfunction might undergo systematic brain MRI screening to initiate intensified medical treatment. Clinical Trials Gov Identifier: NCT02105844.

Keywords: HRV triangular index; atrial fibrillation; autonomic dysfunction; heart rate variability; silent brain infarct.

Copyright © 2021 Hämmerle, Eick, Poli, Blum, Schlageter, Bauer, Rizas, Eken, Coslovsky, Aeschbacher, Krisai, Meyre, Wuerfel, Sinnecker, Vesin, Beer, Moschovitis, Bonati, Sticherling, Conen, Osswald, Kühne and Zuern.

Associated data

ClinicalTrials.gov/NCT02105844