Decreased 24-hour Parasympathetic Activity following Intracerebral Hemorrhage - A Key Factor Correlated with Adverse Perihematomal Edema and Poor Functional Outcomes

Sep 30, 2026

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Investigates how autonomic activity measured by 24-hour heart rate variability (HRV) relates to perihematomal edema (PHE) development and 3-month functional outcomes after intracerebral hemorrhage (ICH). Retrospective HRV analysis used 24-hour ECG monitoring within 14 days of onset, with poor outcome defined as mRS ≥3 and adverse PHE defined by relative edema volume ≥2. Logistic regression, partial correlation, and machine-learning models were used to identify predictors. Results support parasympathetic hypoactivity as an independent correlate of adverse PHE and poor outcomes, with XGBoost showing the strongest predictive performance.

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CNS Neuroscience & Therapeutics |
ORIGINAL ARTICLE OPEN ACCESS
Decreased 24-hour Parasympathetic Activity following Intracerebral Hemorrhage: A Key Factor Correlated with Adverse Perihematomal Edema and Poor Functional Outcomes
Kaijiang Kang1,2,3 | Zeqiang Ji1,2,3,4 | Yunyi Hao5 | Jianwei Wu1,2 | Yani Zhang6 | Haiyan Li7 | Hui Lin8 | Yuhao Guo9 | Chuanying Wang1,2,3 | Yang Du1,2,3 | Guangshuo Li1,2,3 | Yongshi Yao1,2,3 | Yijun Lin1,2,3 | Zheng Liu8 | Jiexin Liu1,2,3 | Xingquan Zhao1,2,3
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China | 2China National Clinical Research Center for Neurological Diseases, Beijing, China | 3Neurocardiology Clinical and Research Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China | 4Department of Neurology, Institute of Neuroimmunology, Tianjin Medical University General Hospital, Tianjin, China | 5Department of Clinical Epidemiology and Clinical Trial, Capital Medical University, Beijing, China | 6Department of Internal Medicine, MedStar Washington Hospital Center, Washington, District of Columbia, USA | 7Department of Neurology, Ulanqab Central Hospital, Inner Mongolia, China | 8Department of Electrocardiogram, Beijing Tiantan Hospital, Capital Medical University, Beijing, China | 9Department of Medicine, Danbury Hospital, Zucker School of Medicine at Hofstra/Northwell, Danbury, Connecticut, USA
Correspondence: Zheng Liu ([lzbb1022@163.com](lzbb1022@163.com)) | Jiexin Liu ([jiexinliu@hotmail.com](jiexinliu@hotmail.com)) | Xingquan Zhao ([zxq@vip.163.com](zxq@vip.163.com))
Received: 20 August 2025 | Revised: 27 November 2025 | Accepted: 17 December 2025
Keywords: autonomic activity | intracerebral hemorrhage | perihematomal edema | | --- | | ABSTRACT
Aims: This study aimed to investigate the association between autonomic activity, assessed by 24-hour heart rate variability (HRV), and the development of perihematomal edema (PHE) as well as 3-month functional outcomes following intracerebral hemorrhage (ICH) .
Methods: We retrospectively included patients with ICH who underwent 24-hour electrocardiographic (ECG) monitoring within 14 days of onset from a prospective cohort. HRV parameters were calculated from ECG data. A poor functional outcome at 3 months was defined as a modified Rankin Scale (mRS) score ≥3. PHE volume was measured on 7-day computed tomography scans using 3D Slicer software, and adverse PHE was defined as relative PHE (edema volume/hematoma volume) ≥2. Univariate and multivariate logistic regression analyses were performed to identify predictors of adverse PHE and poor outcomes. Partial correlation analysis was conducted to examine the association between HRV parameters and adverse PHE. Five machine-learning algorithms were applied to develop predictive models for 3-month poor outcomes.
Results: A total of 312 patients were included, of whom 45.2%(141/312) had poor outcomes at 3 months and 48.6%(122/251) had adverse PHE. Parasympathetic hypoactivity, indicated by low high-frequency power, was independently associated with poor 3-month outcomes. In addition, parasympathetic hypoactivity (measured by the root mean square of successive differences between adjacent NN intervals) and relative sympathetic hyperactivity (measured by the ratio of low-frequency to high-frequency power) independently predicted adverse PHE. Among the machine-learning models, the eXtreme Gradient | | | | Kang Kaijiang, Zeqiang Ji, and Yunyi Hao contributed equally to this work. | | This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
© 2026 The Author(s). CNS Neuroscience & Therapeutics published by John Wiley & Sons Ltd. | CNS Neuroscience & Therapeutics, 2026; 32:e70727 1 of 9 [https://doi.org/10.1002/cns.70727](https://doi.org/10.1002/cns.70727

FAQs

What was the study aiming to determine after intracerebral hemorrhage?

To assess whether autonomic activity measured by 24-hour HRV is associated with perihematomal edema development and 3-month functional outcomes after ICH.

How were functional outcomes and adverse perihematomal edema defined?

Poor functional outcome at 3 months was defined as modified Rankin Scale (mRS) score ≥3. Adverse PHE was defined as relative PHE (edema volume/hematoma volume) ≥2 using 7-day CT scans.

Which HRV features were linked to worse outcomes?

Parasympathetic hypoactivity (low high-frequency power) independently associated with poor 3-month outcomes, and parasympathetic hypoactivity plus relative sympathetic hyperactivity (low-frequency/high-frequency ratio) independently predicted adverse PHE.

Sep 30, 2026

Uploaded by jay