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Patients were grouped by King\u2019s Clinical Staging and progression rate (\u0394FS, median cut-off 0.67). Heart rate variability parameters were compared across groups. A survival-based cut-point optimization approach was used to determine the cut-off value of standard deviation of all normal-to-normal intervals (SDNN). Kaplan-Meier estimator and multivariable Cox regression analysis were used to evaluate of the effect of SDNN on survival during a median follow-up of 21.5 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      \u0394FS in ALS patients in King\u2019s Stage 4 upon diagnosis was faster (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.007) compared to that of those diagnosed in earlier stages, featuring a higher incidence of respiratory (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001) and bulbar symptoms (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001). In addition, ALS patients in King\u2019s Stage 4 exhibited elevated HR-min (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.007) and decreased RR intervals (RRI) (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.032), SDNN (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.004), and standard deviation of the averages of NN intervals in all 5-min segments (SDANN) values (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.020) compared to controls. Patients in the \u0394FS-fast group had a higher HR-min than those in the \u0394FS-slow group (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.013) and controls (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.003) and lower SDNN (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.018) than controls. Both Kaplan-Meier estimator (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.03) and multivariable Cox regression analysis (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.019) showed that lower SDNN (cut-off value: 111 ms) was associated with poor survival in ALS patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Upon diagnosis, ALS patients in King\u2019s Stage 4 and with faster disease progression demonstrated significantly diminished cardiac autonomic control. Lower SDNN was associated with poor survival in ALS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/22143602261472982","type":"journal-article","created":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T12:07:01Z","timestamp":1784981221000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Cardiac autonomic dysfunction is associated with advanced stage, fast progression and poor survival in amyotrophic lateral sclerosis"],"prefix":"10.1177","author":[{"given":"Zehui","family":"Li","sequence":"first","affiliation":[{"name":"Huazhong University of Science and Technology"},{"name":"Chinese PLA General Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingjing","family":"Fan","sequence":"additional","affiliation":[{"name":"Huazhong University of Science and 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