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(Stroke. 1997;28:2150-2154.)
© 1997 American Heart Association, Inc.

Articles

Circadian Rhythm of Heart Rate Variability Is Reversibly Abolished in Ischemic Stroke

Juha T. Korpelainen, MD, PhD; Kyösti A. Sotaniemi, MD, PhD; Heikki V. Huikuri, MD, PhD; Vilho V. Myllylä, MD, PhD

From the Departments of Neurology (J.T.K., K.A.S., V.V.M.) and Medicine, Division of Cardiology (H.V.H.), University of Oulu, and Department of Neurological Rehabilitation, Deaconess Institute of Oulu (J.T.K.), Oulu, Finland.

Correspondence to Juha Korpelainen, MD, Department of Neurology, University of Oulu, Kajaanintie 50 A, FIN-90220 Oulu, Finland.

Background and Purpose Acute brain infarction significantly decreases heart rate variability as a result of cardiovascular autonomic dysregulation. However, information regarding circadian rhythms of heart rate and heart rate variability is limited.

Methods In this prospective study, we analyzed 24-hour circadian rhythm of heart rate and the time and frequency domain measures of heart rate variability in 24 patients with hemispheric brain infarction, 8 patients with medullary brainstem infarction, and 32 age- and sex-matched healthy control subjects. ECG data were obtained from the patients in the acute phase and at 6 months after the infarction.

Results In the acute phase of stroke, all the components of heart rate variability, ie, standard deviation of RR intervals, total power, high-frequency power, low-frequency power, and very-low-frequency power, were similar at night (from midnight to 6 AM) and during the day (from 9 AM to 9 PM), indicating that the circadian oscillation of heart rate variability had been abolished. At 6 months after brain infarction, the circadian rhythm had returned and, as in the control subjects, the values at night were significantly higher than those in the daytime. The values in hemispheric and in brainstem infarction did not differ significantly from each other.

Conclusions These results suggest that circadian fluctuation of heart rate variability is reversibly abolished in the acute phase of ischemic stroke and that it returns during the subsequent 6 months. The loss of the relative vagal nocturnal dominance may contribute to the incidence of cardiac arrhythmias and other cardiovascular complications after acute stroke.

Key Words: autonomic nervous system • cerebral infarction • spectrum analysis

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