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Relationship between Ischemic Stroke and Pulse Rate Variability as a Surrogate of Heart Rate Variability

School of Electrical Engineering and Computer Science, University of North Dakota, Grand Forks, ND 58202, USA
Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
Sanford Brain and Spine Center, Sanford Health, Fargo, ND 58103, USA
Author to whom correspondence should be addressed.
Brain Sci. 2019, 9(7), 162;
Received: 3 June 2019 / Revised: 27 June 2019 / Accepted: 3 July 2019 / Published: 10 July 2019
(This article belongs to the Collection Collection on Systems Neuroscience)
PDF [3331 KB, uploaded 10 July 2019]


Autonomic reflex ascertains cardiovascular homeostasis during standing. Impaired autonomic reflex could lead to dizziness and falls while standing; this is prevalent in stroke survivors. Pulse rate variability (PRV) has been utilized in the literature in lieu of heart rate variability (HRV) for ambulatory and portable monitoring of autonomic reflex predominantly in young, healthy individuals. Here, we compared the PRV with gold standard HRV for monitoring autonomic reflex in ischemic stroke survivors. Continuous blood pressure and electrocardiography were acquired from ischemic stroke survivors (64 ± 1 years) and age-matched controls (65 ± 2 years) during a 10-minute sit-to-stand test. Beat-by-beat heart period (represented by RR and peak-to-peak (PP) intervals), systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse arrival time (PAT), an indicator of arterial stiffness, were derived. Time and frequency domain HRV (from RR intervals) and PRV (from PP intervals) metrics were extracted. PAT was lower (248 ± 7 ms vs. 270 ± 8 ms, p < 0.05) suggesting higher arterial stiffness in stroke survivors compared to controls during standing. Further, compared to controls, the agreement between HRV and PRV was impaired in stroke survivors while standing. The study outcomes suggest that caution should be exercised when considering PRV as a surrogate of HRV for monitoring autonomic cardiovascular control while standing in stroke survivors. View Full-Text
Keywords: autonomic nervous system; baroreceptor reflex; sit-to-stand test autonomic nervous system; baroreceptor reflex; sit-to-stand test

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Verma, A.K.; Aarotale, P.N.; Dehkordi, P.; Lou, J.-S.; Tavakolian, K. Relationship between Ischemic Stroke and Pulse Rate Variability as a Surrogate of Heart Rate Variability. Brain Sci. 2019, 9, 162.

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