Hernandez-Meilan O, Hernandez-Meilan M, Machado-Curbelo C. Autonomic impairment of patients in coma with different Glasgow coma score assessed with heart rate variability. Heart rate variability in comatose and brain-dead patients. Machado C, Garcia OD, Gutierrez J, Portela L, Garcia MC. Association of Traumatic Brain Injury With the Risk of Developing Chronic Cardiovascular, Endocrine, Neurological, and Psychiatric Disorders. concluded that patients with TBI were at increased risk of developing long-term cardiovascular comorbidities, 1 and assessing the heart function by HRV is extremely effective in evaluating brain function. Therefore, it is important to assess the brain-heart interaction in both directions. A positive predictive value of 95.65% and overall efficiency of 95.74% were found. The Stepwise multiple regression logistic analysis model showed a sensitivity of 95.65% and specificity of 95.83%. A mortality score model was calculated, including three spectral HRV indices: absolute power values of the very low, low-frequency, and the power in normalized units of the very high-frequency bands (0.4-0.6 Hz). The mortality at six months in the group of patients was 42.55 %. The identification of five different patterns of the HRV spectra showed clear differences between patients with different values of the GCS. The most outstanding finding was a HRV reduction with a progressive trend associated with deepening of coma assessed by the Glasgow Coma Scale (GCS), reaching the lowest values in BD. We have compared the functional state of the ANS in healthy individuals with patients in a coma using measures of HRV and evaluated its efficiency in predicting mortality. HRV is a minimally invasive, low-cost methodology particularly suitable for assessing the ANS in patients with disorders of consciousness and BD. Therefore, we have studied patients in coma and brain death (BD) by HRV. Hence, considering the brain-heart interactions, assessing the autonomic nervous system (ANS) by heart rate variability (HRV) is a powerful tool to assess brain function. 2,3 Since several decades ago, several authors have reported in autopsies the presence of subendocardial hemorrhages in subjects who complained of stroke, hypertension, and brain trauma. The brain communicates with the heart directly through the sympathetic and parasympathetic branches of the autonomic nervous system, which consists of multi-synaptic pathways from myocardial cells back to peripheral ganglionic neurons and further to central preganglionic and premotor neurons. Regarding cardiovascular comorbidities, it is important to remark on the brain-heart interactions. concluded that TBI of any severity was associated with a higher risk of chronic cardiovascular, endocrine, and neurological comorbidities in patients without baseline diagnoses.
Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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