skip to main content

Multiparameter Biosignal Analysis in Elderly Ischemic Stroke Patients

Muhammad Zakariyah  -  Department of Informatics, Faculty of Industrial Technology, Universitas Islam Indonesia, Indonesia
*Alvin Sahroni orcid scopus  -  Electrical Engineering Department, Faculty of Industrial Technology, Universitas Islam Indonesia, Indonesia
Erlina Marfianti  -  Department of Medical Education, Medical Faculty, Universitas Islam Indonesia, Indonesia

Citation Format:
Abstract
Biosignal can provide information about body conditions, including physiological conditions of ischemic stroke. The regulation of blood in the brain is regulated through the mechanism of Cerebral Autoregulation (CA). Some parameters that can be used to determine this mechanism are Blood Flow Velocity (BFV) and Blood Pressure (BP). Stroke is also related to nervous system activity, which is represented through the Heart Rate Variability (HRV). This study aims to determine the relationship between those biosignals and their effects on the physiology of ischemic stroke sufferers. The subjects were divided into two groups (20 strokes and 20 controls). BFV data is obtained in the Middle Cerebral Artery (MCA), BP is obtained through the arteries of the upper arms, and 3 leads electrocardiogram is placed in the chest. The results showed that there was a relationship between BP and BFV in the control group (p-value < 0.05; r = -0.574). This correlation was not found in the stroke group. The relationship between BP and HRV was only found in the stroke group, which was associated with high sympathetic activity and lower parasympathetic activity (p-values < 0.05 and r > 0.4). It was based on SDRR, RMSSD, CVRR, LF, and SD1 parameters. In the control group, there was no relationship between HRV and BP. The relationship between BFV and HRV in the control group was not found statistically. Still, in the stroke group, this relationship was found in the LF and LF/HF Ratio parameters (p-value < 0.05; r > 0.4). Based on this research, parameters on HRV that can be used to determine the characteristics of stroke patients in all positions are MeanRR, VLF, and LF
Fulltext View|Download
Keywords: Ischemic Stroke, Biosignal, Blood Pressure, Blood Flow Velocity, Heart Rate Variability

Article Metrics:

  1. C. Molnar and J. Gair, "Blood Flow and Blood Pressure Regulation," in Concepts of Biology-1st Canadian Edition, Texas, OpenStax College, 2013, pp. 25-30
  2. E. J. Benjamin, S. S. Virani, C. W. Callaway, A. M. Chamberlain, A. R. Chang and S. Cheng, "Heart Disease and Stroke Statistics-2018 Update," American Heart Association, Dallas, 2018
  3. M. Lutski, I. Zucker, T. Shohat and D. Tanne, "Characteristics and Outcomes of Young Patients with First-Ever Ischemic Stroke Compared to Older Patients: The National Acute Stroke ISraeli Registry," Front Neurol., vol. 8, p. 421, 2017
  4. K. Nedeltchev, T. A. der Maur, D. Georgiadis, M. Arnold, V. Caso, H. P. Mattle, G. Schroth, L. Remonda, M. Sturzenegger, U. Fischer and R. W. Baumgartner, "Ischaemic stroke in young adults: predictors of outcome and recurrence," J. Neurol Neurosurg Psychiatry, vol. 76, no. 2, pp. 191-195, 2005
  5. A. Adunsky, M. Hershkowitz, R. Rabbi, L. Asher-Sivron and A. Ohry, "Functional recovery in young stroke patients," Arch. Phys. Med. Rehabil, vol. 73, no. 9, pp. 859-862, 1992
  6. D. Smajlovic, D. Salihovic, O. C. Ibrahimagic and O. Sinanovic, "Characteristics of stroke in young adults in Tuzla Canton, Bosnia and Herzegovina," Coll Antropol, vol. 37, no. 2, pp. 515-519, 2013
  7. M. A. Ritter, A. Rohde, P. U. Heuschmann, R. Dziewas, J. Stypmann, D. G. Nabavi and B. E. Ringelstein, "Heart rate monitoring on the stroke unit. What does heart beat tell about prognosis? An observational study," BMC Neurology, vol. 11, no. 47, pp. 1-8, 2011
  8. Z. Chen, K. Hu, H. E. Stanley, V. Novak and P. C. Ivanov, "Cross-correlation of instantaneous phase increments in pressureflow fluctuations: Applications to cerebral autoregulation," Physical review. E, Statistical, nonlinear, and soft matter physics, vol. 73, p. 031915, 2006
  9. M. J. Aries, J. W. Elting, J. D. Keyser, B. P. Kremer and P. C. Vroomen, "Cerebral Autoregulation in Stroke," Stroke, vol. 41, pp. 2697-2704, 2010
  10. J. P. Appleton, N. Sprigg and P. M. Bath, "Blood pressure management in acute stroke," Stroke and Vascular Neurology, vol. 1, no. 2, pp. 72-82, 2016
  11. M. C. Aoi, K. Hu, M.-T. Lo, M. Selim, M. S. Olufsen and V. Novak, "Impaired Cerebral Autoregulation Is Associated with Brain Atrophy and Worse Functional Status in Chronic Ischemic Stroke," PLoS ONE, vol. 7, no. 10, p. e46794, 2012
  12. G. Ernst, "Heart-Rate variability - More than Heart Beats?," Front. Public Health, vol. 5, no. 240, 2017
  13. V. Novak, "Cerebral Vasoregulation in Elderly with Stroke," MIT Laboratory for Computational Physiology, 4 October 2018. [Online]. Available: https://physionet.org/content/cves/1.0.0/. [Accessed 26 March 2019]
  14. V. Novak, K. Hu, L. Desrochers, P. Novak, L. Caplan, L. Lipsitz and M. Selim, "Cerebral flow velocities during daily activities depend on blood pressure in patients with chronic ischemic infarctions," Stroke: a Journal of Cerebral Circulation, vol. 41, no. 1, pp. 61-66, 2010
  15. E. O'Brien, R. Asmar, L. Beilin, Y. Imai, J. Mallion, G. Mancia, T. Mengden, M. Myers, P. Padfield, P. Palatini, G. Parati, T. Pickering, J. Redon, J. Staessen, G. Stergiou and P. Verdecchia, "European Society of Hypertension recommendations for conventional, ambulatory and home blood pressure measurement," J. Hypertens., vol. 21, no. 5, pp. 821-848, 2003
  16. P. Eames, M. Blake, S. Dawson, R. Panerai and J. Potter, "Dynamic cerebral autoregulation and beat-to-beat blood pressure control are impaired in acute ischaemic stroke.," J. Neurol Neurosurg Psychiatry, vol. 72, pp. 467-473, 2002
  17. S. Schwarz, A. Georgiades, A. Aschoff and S. S., "Effects of induced hypertension on inctracranial pressure and flow velocities of the middle cerebral arteries in patients with large hemispheric stroke," Stroke, vol. 33, pp. 998-1004, 2002
  18. V. Novak, A. Chowdhary, B. Farrar, H. Nagaraja, J. Braun, R. Kanard, P. Novak and A. Slivka, "Altered cerebral vasoregulation in hypertension and stroke," Neurology, vol. 60, pp. 1657-1663, 2003
  19. N. Smalheiser, Data Literacy 1st Edition How to Make Your Experiments Robust and Reproducible, Illinois, USA: Academic Press, 2017
  20. R. L. Yadav, P. K. Yadav, L. K. Yadav, K. Agrawal, S. K. Sah and M. N. Islam, "Association between obesity and heart rate variability indices: an intuition toward cardiac autonomic alteration – a risk of CVD," Diabetes Metab. Syndr. Obes., vol. 10, pp. 57-64, 2017
  21. R. Bowry, D. D. Navalkele and N. R. Gonzales, "Blood pressure management in stroke: Five new things," Neurology Clinical Practice, vol. 4, no. 5, pp. 419-426, 2014
  22. Z. Gaciong, M. Siński and J. Lewandowski, "Blood Pressure Control and Primary Prevention of Stroke: Summary of the Recent Clinical Trial Data and Meta-Analyses," Current Hypertension Reports, vol. 15, no. 6, pp. 559-574, 2013
  23. B. Carlberg, K. Asplund and E. Hagg, "Course of blood pressure in different subsets of patients after an acute stroke," Cerebrovasc Dis, vol. 1, no. 5, pp. 281-287, 1991
  24. P. Jansen, B. Schulte, E. Poels and F. Gribnau, "Course of blood pressure after cerebral infarction and transient ischemic attack," Clin Neurol Neurosurg, vol. 89, no. 4, pp. 243-246, 1987
  25. T. G. Pickering, J. E. Hall, L. J. Appel, B. E. Falkner, J. Graves, M. N. Hill, D. W. Jones, T. Kurtz, S. G. Sheps and E. J. Roccella, "Recommendations for Blood Pressure Measurement in Humans and Experimental Animals," Hypertension, vol. 45, no. 1, pp. 142-161, 2005
  26. S. Ishikawa, K. Kazuomi, K. Kayaba, T. Gotoh, N. Nago, Y. Nakamura, A. Tsutsumi and E. Kajii, "Linear relationship between blood pressure and stroke: the Jichi Medical School Cohort Study," J. Clin. Hypertens (Greenwich), vol. 9, no. 9, pp. 677-683, 2007
  27. T. Gori, P. S. Wild, R. Schnabel, A. Schulz, N. Pfeiffer, M. Blettner, M. E. Beutel, S. Forconi, F. Jung, K. J. Lackner, S. Blankenberg and T. Münzel, "The distribution of whole blood viscosity, its determinants and relationship with arterial blood pressure in the community: cross-sectional analysis from the Gutenberg Health Study," Therapeutic Advances in Cardiovascular Disease, pp. 354-365, 2015
  28. S. H. Song, J. H. Kim, J. H. Lee, Y.-M. Yun, D.-H. Choi and H. Y. Kim, "Elevated blood viscosity is associated with cerebral small vessel disease in patients with acute ischemic stroke," BMC Neurol, vol. 17, no. 1, p. 20, 2017
  29. I. Antelmi, R. S. D. Paula, A. R. Shinzato, C. A. Peres, A. J. Mansur and C. J. Grupi, "Influence of Age, Gender, Body Mass Index, and Functional Capacity on Heart Rate Variability in a Cohort of Subjects Without Heart Disease," Am. J. Cardiol., vol. 93, pp. 381-385, 2004
  30. P. E. d. Andrade, J. A. T. d. Amaral, L. d. S. Paiva, F. Adami, J. Z. Raimudo, V. E. Valenti, L. C. d. Abreu and R. D. Raimundo, "Reduction of heart rate variability in hypertensive elderly," BLOOD PRESSURE, 2017
  31. E. Moon, S.-H. Lee, D.-H. Kim and B. Hwang, "Comparative Study of Heart Rate Variability in Patients with Schizophrenia, Bipolar Disorder, Post-traumatic Stress Disorder, or Major Depressive Disorder," Clin. Psychopharmacol Neurosci, vol. 11, no. 3, pp. 137-143, 2013
  32. O. Carr, M. d. Vos and K. E. A. Saunders, "Heart rate variability in bipolar disorder and borderline personality disorder: a clinical review," Evid. Based Ment. Health, vol. 21, no. 1, pp. 23-30, 2018
  33. J. Korpelainen, K. Sotaniemi, A. Mäkikallio, H. Huikuri and V. Myllylä, "Dynamic behavior of heart rate in ischemic stroke," Stroke, vol. 30, no. 5, pp. 1008-1013, 1999
  34. H. Otzenberger, C. Gronfier, C. Simon, A. Charloux, J. Ehrhart, F. Piquard and G. Brandenberger, "Dynamic heart rate variability: a tool for exploring sympathovagal balance continuously during sleep in men," Am. J. Physiol., vol. 275, no. 3, pp. 946-950, 1998
  35. D. Eckberg, "Human sinus arrhythmia as an index of vagal outflow," Journal of Applied Physiology, pp. 961-966, 1983
  36. F. Shaffer and J. P. Ginsberg, "An Overview of Heart Rate Variability Metrics and Norms," Frontiers in Public Health, vol. 5, p. 258, 2017
  37. J. Sztajzel, "Heart rate variability: a noninvasive electrocardiographic method to measure the autonomic nervous system," Swiss Med Wkly, vol. 134, pp. 514-522, 2004
  38. J. J. Bigger, J. Fleiss, R. Steinman, L. Rolnitzky, R. Kleiger and J. Rottman, "Correlations among time and frequency domain measures of heart period variability two weeks after acute myocardial infarction," Am. J. Cardiol., vol. 69, no. 9, pp. 891-898, 1992
  39. K. Umetani, D. Singer, R. McCraty and M. Atkinson, "Twenty-four hour time domain heart rate variability and heart rate: relations to age and gender over nine decades," J. Am. Coll. Cardiol., vol. 31, no. 3, pp. 593-601, 1998
  40. C. Calvert and T. Wall, "Correlations among time and frequency measures of heart rate variability recorded by use of a Holter monitor in overtly healthy Doberman pinschers with and without echocardiographic evidence of dilated cardiomyopathy," Am. J. Vet. Res., vol. 62, no. 11, pp. 1787-1792, 2001
  41. D. Lucini, G. Norbiato, M. Clerici and M. Pagani, "Hemodynamic and autonomic adjustments to real life stress conditions in humans," Hypertension, vol. 39, no. 1, pp. 184-188, 2002
  42. J. Brosschot, E. van Dijk and J. Thayer, "Daily worry is related to low heart rate variability during waking and the subsequent nocturnal sleep period," Int. J. Psychophysiol, vol. 63, no. 1, pp. 39-47, 2007
  43. F. Lombardi and P. Stein, "Origin of heart rate variability and turbulence: An appraisal of autonomic modulation of cardiovascular function," Front. Physiol., vol. 2, no. 95, 2011
  44. D. S. Silver, S. R. Markoff, L. Naghi, M. Silver and L. May, "Reduction in Parasympathetic Autonomic Nervous System Function in Fibromyalgia Patients," Arch Med, vol. 8, pp. 1-7, 2016
  45. R. McCraty, Science of the Heart, Volume 2 Exploring the Role of the Heart in Human Performance An Overview of Research Conducted by the HeartMath Institute, 2016
  46. R. Lampert, J. Bremner, S. Su, A. Miller, F. Lee, F. Cheema, J. Goldberg and V. Vaccarino, "Decreased heart rate variability is associated with higher levels of inflammation in middle-aged men," Am Heart J., vol. 156, no. 4, pp. 759.e1-7, 2008
  47. J. J. Bigger, J. Fleiss, R. Steinman, L. Rolnitzky, R. Kleiger and J. Rottman, "Frequency domain measures of heart period variability and mortality after myocardial infarction," Circulation, vol. 85, no. 1, pp. 164-171, 1992
  48. N. Verma, "Sympathetic Nervous System and Hypertension," Hypertension Journal, vol. 3, no. 1, pp. 27-36, 2017
  49. M. Esler, "The Sympathetic System and Hypertension," American Journal of Hypertension, vol. 13, no. 3, pp. 99S-105S, 2000
  50. P. Kamen, H. Krum and A. Tonkin, "Poincaré plots of heart rate variability allows quantitative display of parasympathetic nervous activity in humans," Clinical Science, vol. 91, no. 2, pp. 201-208, 1996
  51. M. Tulppo, T. Mäkikallio, T. Takala, T. Seppänen and H. Huikuri, "Quantitative beat-to-beat analysis of heart rate dynamics during exercise," American Journal of Physiology, vol. 271, no. 1, pp. H244-252, 1996
  52. L. Guan, J.-P. Collet, G. Mazowita and V. E. Claydon, "Autonomic Nervous System and Stress to Predict Secondary Ischemic Events after Transient Ischemic Attack or Minor Stroke: Possible Implications of Heart Rate Variability," Front Neurol, vol. 9, p. 90, 2018
  53. E.-S. A. Shokr, "Effect of Exam Stress on Heart Rate Variability Parameters in Healthy Students," Egypt. Acad. J. Biol. Sci., vol. 7, no. 1, pp. 75-81, 2015
  54. S. Hammoud, R. Karam, R. Mourad, I. Saad and M. Kurdi, "Stress and Heart Rate Variability during University Final Examination among Lebanese Students," Behav. Sci., vol. 9, no. 1, p. 3, 2019
  55. M. E. Papp, P. Lindfors, N. Storck and P. E. Wändell, "Increased heart rate variability but no effect on blood pressure from 8 weeks of hatha yoga – a pilot study," BMC Research Notes, vol. 6, no. 59, 2015
  56. N. Wahlgren, G. Hellström, C. Lindquist and A. Rudehill, "Sympathetic Nerve Stimulation in Humans Increases Middle Cerebral Artery Blood Flow Velocity," Cerebrovasc Dis, vol. 2, no. 6, pp. 359-364, 1992
  57. T. B.-J. Kuo, C.-M. Chern, W.-Y. Sheng, W.-J. Wong and H.-H. Hu, "Frequency Domain Analysis of Cerebral Blood Flow Velocity and its Correlation with Arterial Blood Pressure," Journal of Cerebral Blood Flow & Metabolism, vol. 18, no. 3, pp. 311-318, 1998

Last update:

No citation recorded.

Last update:

No citation recorded.