Relationship between cerebral white matter hyperintensities and autonomic function in older individuals with cerebral...

Heart rate variability (HRV) has been linked to cerebral small vessel disease (CSVD) development. This study aimed to investigate the relationship between white matter hyperintensity (WMH) and HRV in older patients with CSVD.

Patients with CSVD aged ≥ 60 years, diagnosed via magnetic resonance imaging and treated at Tianjin Huanhu Hospital in October 2022-April 2023, were included. WMH burden was defined as periventricular (PV-WMH) or deep WMH (D-WMH), with Fazekas scores of 3 or 2-3, respectively. Modified WMH burden was categorized based on total Fazekas scores (PV-WMH + D-WMH): grade 0 for 0-2, grade 1 for 3-4, and grade 2 for 5-6. Patient demographics were documented, and HRV was analyzed through 10-min short-range electrocardiography recordings. Time-domain indices included standard deviation of N-N intervals, root-mean-squared differences of successive N-N intervals, and the proportion of N-N intervals exceeding 50 ms. Frequency-domain indices included low-frequency power (LF, 0.04-0.15 Hz), high-frequency power (HF, 0.15-0.4 Hz), and LF/HF. Correlations were examined using univariable and multivariable analyses.

Among 108 patients with CSVD (age 60-87 years; median 66.0 years [interquartile range 63.0-71.0]), WMH burden was associated with sex, age, stroke, LF, and LF/HF (p < 0.05), with LF/HF independently linked in multivariable analysis. Modified WMH burden showed similar associations and remained independently correlated with LF/HF (p < 0.05).

The presence and severity of WMH in CSVD were related to decreased LF/HF. This is possibly due to decreased cardiac sympathetic activity, indicates that decreased LF/HF may be a potential risk factor for WMH, and can be detected via short HRV recordings.