Exploring the Correlation Between Heart Rate Variability and Post-Stroke Depression Based on the “Heart Governing the Mind” Theory

Abstract

Post-stroke depression (PSD) is the most common neuropsychiatric complication following stroke, characterized by high prevalence and substantial detriment to neurological recovery and quality of life. However, stable, convenient, and objective physiological markers for early clinical screening of PSD remain lacking. Heart rate variability (HRV), a non-invasive quantitative indicator of autonomic nervous function, has drawn increasing attention in the prediction of PSD in recent years. Grounded in the traditional Chinese medicine (TCM) theory that “the heart governs the mind,” this article systematically reviews the epidemiology, pathogenesis, current prediction and diagnostic approaches for PSD, the physiological basis of HRV, and advances in its application to PSD prediction. Existing evidence indicates that PSD patients commonly exhibit abnormal HRV parameters, manifested primarily as reduced vagal activity indices (rMSSD, PNN50) and an elevated sympathovagal balance index (LF/HF). HRV demonstrates favorable predictive value for PSD (AUC 0.61–0.78), corroborating the intrinsic physiological connection between the “heart” and the “mind” postulated by the “heart governing the mind” theory. This review aims to provide new insights into early objective screening for PSD and to offer scientific evidence for the modern interpretation of TCM theory.