Zhongguo quanke yixue (Apr 2023)
Relationship between Heart Rate Variability and Distribution of Enlarged Perivascular Spaces in the Brain
Abstract
Background The enlarged perivascular space (EPVS) is closely associated with cognitive dysfunction, affective disorder, stroke, and adverse outcomes after stroke. So early detection and treatment of EPVS are extremely important. Objective To investigate the relationship between heart rate variability (HRV) and the distribution of EPVS in the brain. Methods One hundred and ninety-nine inpatients with complete examination results of 24-hour ambulatory ECG and brain MRI were selected from Department of Neurology, the Second Affiliated Hospital of Zhengzhou University from January 2020 to May 2022. The sum of EPVS was assessed, and by the sum of EPVS (severity score of EPVS) in basal ganglia region (BG-EPVS), the patients were divided into 3 groups: mild BG-EPVS group〔visual PVS rating scale score developed by Potter (Potter score) =1, 126 cases〕, moderate BG-EPVS group (Potter score=2, 46 cases), severe BG-EPVS group (Potter score=3-4, 27 cases), and by the sum of EPVS in centrum semiovale region (CS-EPVS), the patients were divided into another 3 groups: mild CS-EPVS group (Potter score=1, 131 cases), moderate CS-EPVS group (Potter score=2, 45 cases), severe CS-EPVS group (Potter score=3-4, 23 cases). The dominance models were divided according to the number of BG-EPVS and CS-EPVS, model 1 (BG>CS, 119 cases), model 2 (BG=CS, 20 cases), model 3 (BG<CS, 60 cases). The general data and HRV indexes were compared among groups. Spearman correlation analysis was used to explore the correlation between HRV indexes and EPVS. Statistically different HRV indexes in the univariate analysis were included in a multivariate Logistic regression to screen those independently influencing EPVS severity score and dominance models. Results Age, the root mean square of successive differences of normal-to-normal (NN) intervals for period of interest (rMSSD) and total power (TP) were statistically different between 3 groups of BG-EPVS (P<0.05). Severe BG-EPVS group had older average age, and lower average rMSSD and TP than mild BG-EPVS group (P<0.05). Spearman correlation analysis showed that rMSSD, percentage of adjacent NN intervals that differ from each other by larger than 50 ms (PNN50), and TP were negatively correlated with BG-EPVS severity score (rs=-0.357, -0.153, -0.169, P<0.05). The mean of NN intervals standard deviation every 5 minutes for period of interest (SDNNindex) and rMSSD were positively correlated with the EPVS dominance model (rs=0.155, 0.262, P<0.05). Multivariate Logistic regression analysis after correction for confounders showed that rMSSD independently influenced BG-EPVS〔OR=0.983, 95%CI (0.972, 0.994), P=0.002〕, and also independently affected the EPVS dominance model〔OR=1.017, 95%CI (1.006, 1.028), P=0.003〕. Conclusion The rMSSD had a negative correlation with BG-EPVS severity score and a positive correlation with the EPVS dominance model, and was independently associated with the BG-EPVS severity score and EPVS dominance model, suggesting that an imbalance in the autonomic nervous system induced by declined rMSSD may cause blood-brain barrier disruption or reduced metabolic waste clearance in the brain, which may play a role in the pathophysiological mechanism of BG-EPVS formation.
Keywords
