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Research paper
Complexity of heart rate variability predicts outcome in intensive care unit admitted patients with acute stroke 
  1. Sung-Chun Tang1,2,
  2. Hsiao-I Jen2,3,
  3. Yen-Hung Lin2,4,
  4. Chi-Sheng Hung2,4,
  5. Wei-Jung Jou2,3,
  6. Pei-Wen Huang2,3,
  7. Jiann-Shing Shieh5,
  8. Yi-Lwun Ho2,4,
  9. Dar-Ming Lai2,6,
  10. An-Yeu Wu2,3,
  11. Jiann-Shing Jeng1,
  12. Ming-Fong Chen2,4
  1. 1Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
  2. 2NTU-NTUH-MediaTek Innovative Medical Electronics Research Center, Taipei, Taiwan
  3. 3Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan
  4. 4Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
  5. 5Department of Mechanical Engineering, Yuan Ze University, Tao-Yuan, Taiwan
  6. 6Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
  1. Correspondence to Dr Jiann-Shing Jeng, Stroke Center and Department of Neurology, National Taiwan University Hospital, Hospital, No. 7 Chung-Shan South Road, Taipei 10055, Taiwan; jsjeng{at}


Background Heart rate variability (HRV) has been proposed as a predictor of acute stroke outcome. This study aimed to evaluate the predictive value of a novel non-linear method for analysis of HRV, multiscale entropy (MSE) and outcome of patients with acute stroke who had been admitted to the intensive care unit (ICU).

Methods The MSE of HRV was analysed from 1 h continuous ECG signals in ICU-admitted patients with acute stroke and controls. The complexity index was defined as the area under the MSE curve (scale 1–20). A favourable outcome was defined as modified Rankin scale 0–2 at 3 months after stroke.

Results The trends of MSE curves in patients with atrial fibrillation (AF) (n=77) were apparently different from those in patients with non-AF stroke (n=150) and controls (n=60). In addition, the values of complexity index were significantly lower in the patients with non-AF stroke than in the controls (25.8±.3 vs 32.3±4.3, p<0.001). After adjustment for clinical variables, patients without AF who had a favourable outcome were significantly related to higher complexity index values (OR=1.15, 95% CI 1.07 to 1.25, p<0.001). Importantly, the area under the receiver operating characteristic curve for predicting a favourable outcome of patients with non-AF stroke from clinical parameters was 0.858 (95% CI 0.797 to 0.919) and significantly improved to 0.903 (95% CI 0.853 to 0.954) after adding on the parameter of complexity index values (p=0.020).

Conclusions In ICU-admitted patients with acute stroke, early assessment of the complexity of HRV by MSE can help in predicting outcomes in patients without AF.


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