1
|
Osei J, Vaccarino V, Wang M, Shah AS, Lampert RJ, Li LY, Ko YA, Pearce BD, Kutner M, Garcia E, Piccinelli M, Raggi P, Bremner JD, Quyyumi AA, Sun YV, Ahmed H, Haddad G, Daaboul O, Roberts T, Stefanos L, Correia L, Shah AJ. Stress-Induced Autonomic Dysfunction is Associated With Mental Stress-Induced Myocardial Ischemia in Patients With Coronary Artery Disease. Circ Cardiovasc Imaging 2024; 17:e016596. [PMID: 38868952 PMCID: PMC11187646 DOI: 10.1161/circimaging.124.016596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/30/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Mental stress-induced myocardial ischemia (MSIMI) is associated with adverse cardiovascular outcomes in individuals with coronary artery disease, but the mechanisms underlying this phenomenon are unknown. We examined the relationship between stress-induced autonomic dysfunction, measured by low heart rate variability (HRV) in response to stress, and MSIMI in patients with stable coronary artery disease. We hypothesized that stress-induced autonomic dysfunction is associated with higher odds of MSIMI. METHODS In 735 participants with stable coronary artery disease, we measured high- and low-frequency HRV in 5-minute intervals before and during a standardized laboratory-based speech stressor using Holter monitoring. HRV at rest and stress were categorized into low HRV (first quartile) versus high HRV (second to fourth quartiles); the low category was used as an indicator of autonomic dysfunction. Multivariable logistic regression models were used to examine the association of autonomic dysfunction with MSIMI. RESULTS The mean age was 58 (SD, ±10) years, 35% were women, 44% were Black participants, and 16% developed MSIMI. Compared with high HRV during stress, low HRV during stress (both high and low frequencies) was associated with higher odds of MSIMI after adjusting for demographic and clinical factors (odds ratio for high-frequency HRV, 2.1 [95% CI, 1.3-3.3]; odds ratio for low-frequency HRV, 2.1 [95% CI, 1.3-3.3]). Low-frequency HRV at rest was also associated with MSIMI but with slightly reduced effect estimates. CONCLUSIONS In individuals with coronary artery disease, mental stress-induced autonomic dysfunction may be a mechanism implicated in the causal pathway of MSIMI.
Collapse
Affiliation(s)
- Jeffery Osei
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Emory Clinical Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Maggie Wang
- Emory Clinical Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anish S. Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Rachel J. Lampert
- Division of Cardiology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Louis Y. Li
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Brad D. Pearce
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Michael Kutner
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Ernest Garcia
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Paolo Raggi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - J. Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Arshed A. Quyyumi
- Emory Clinical Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Yan V. Sun
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Hashir Ahmed
- Emory Clinical Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - George Haddad
- Emory Clinical Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Obada Daaboul
- Emory Clinical Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Tatum Roberts
- Emory Clinical Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lewam Stefanos
- Emory Clinical Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Luis Correia
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Amit J. Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Emory Clinical Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| |
Collapse
|
2
|
Huang M, Shah AJ, Lampert R, Bliwise DL, Johnson DA, Clifford GD, Sloan R, Goldberg J, Ko Y, Da Poian G, Perez‐Alday EA, Almuwaqqat Z, Shah A, Garcia M, Young A, Moazzami K, Bremner JD, Vaccarino V. Heart Rate Variability, Deceleration Capacity of Heart Rate, and Death: A Veteran Twins Study. J Am Heart Assoc 2024; 13:e032740. [PMID: 38533972 PMCID: PMC11179789 DOI: 10.1161/jaha.123.032740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/01/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Autonomic function can be measured noninvasively using heart rate variability (HRV), which indexes overall sympathovagal balance. Deceleration capacity (DC) of heart rate is a more specific metric of vagal modulation. Higher values of these measures have been associated with reduced mortality risk primarily in patients with cardiovascular disease, but their significance in community samples is less clear. METHODS AND RESULTS This prospective twin study followed 501 members from the VET (Vietnam Era Twin) registry. At baseline, frequency domain HRV and DC were measured from 24-hour Holter ECGs. During an average 12-year follow-up, all-cause death was assessed via the National Death Index. Multivariable Cox frailty models with random effect for twin pair were used to examine the hazard ratios of death per 1-SD increase in log-transformed autonomic metrics. Both in the overall sample and comparing twins within pairs, higher values of low-frequency HRV and DC were significantly associated with lower hazards of all-cause death. In within-pair analysis, after adjusting for baseline factors, there was a 22% and 27% lower hazard of death per 1-SD increment in low-frequency HRV and DC, respectively. Higher low-frequency HRV and DC, measured during both daytime and nighttime, were associated with decreased hazard of death, but daytime measures showed numerically stronger associations. Results did not substantially vary by zygosity. CONCLUSIONS Autonomic inflexibility, and especially vagal withdrawal, are important mechanistic pathways of general mortality risk, independent of familial and genetic factors.
Collapse
Affiliation(s)
- Minxuan Huang
- Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaGA
| | - Amit J. Shah
- Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaGA
- Department of Medicine (Cardiology), School of MedicineEmory UniversityAtlantaGA
- Atlanta Veteran Affairs Medical CenterDecaturGA
| | | | - Donald L. Bliwise
- Department of Neurology, School of MedicineEmory UniversityAtlantaGA
| | - Dayna A. Johnson
- Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaGA
| | - Gari D. Clifford
- Department of Biomedical Informatics, School of MedicineEmory UniversityAtlantaGA
- Department of Biomedical EngineeringGeorgia Institute of Technology and Emory UniversityAtlantaGA
| | - Richard Sloan
- Department of Psychiatry, College of Physicians and SurgeonsColumbia UniversityNew YorkNY
| | - Jack Goldberg
- Department of Epidemiology, School of Public HealthUniversity of WashingtonSeattleWA
- Vietnam Era Twin Registry, Seattle Epidemiologic Research and Information CenterUS Department of Veterans AffairsSeattleWA
| | - Yi‐An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public HealthEmory UniversityAtlantaGA
| | - Giulia Da Poian
- Department of Health Sciences and TechnologyETH ZurichZurichSwitzerland
| | - Erick A. Perez‐Alday
- Department of Biomedical Informatics, School of MedicineEmory UniversityAtlantaGA
| | - Zakaria Almuwaqqat
- Department of Medicine (Cardiology), School of MedicineEmory UniversityAtlantaGA
| | - Anish Shah
- Department of Medicine (Cardiology), School of MedicineEmory UniversityAtlantaGA
| | - Mariana Garcia
- Department of Medicine (Cardiology), School of MedicineEmory UniversityAtlantaGA
| | - An Young
- Department of Medicine (Cardiology), School of MedicineEmory UniversityAtlantaGA
| | - Kasra Moazzami
- Department of Medicine (Cardiology), School of MedicineEmory UniversityAtlantaGA
| | - J. Douglas Bremner
- Atlanta Veteran Affairs Medical CenterDecaturGA
- Department of Psychiatry and Behavioral Sciences, School of MedicineEmory UniversityAtlantaGA
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaGA
- Department of Medicine (Cardiology), School of MedicineEmory UniversityAtlantaGA
| |
Collapse
|
3
|
Hasan MZ, Semmens EO, DuBose KN, McCray LK, Noonan CW. Subclinical Measures of Cardiovascular Health Among Wildland Firefighters. J Occup Environ Med 2024; 66:e116-e121. [PMID: 38234129 PMCID: PMC11104274 DOI: 10.1097/jom.0000000000003041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
OBJECTIVE The aim of the study is to compare subclinical measures of cardiovascular health among wildland firefighters (WFFs) to the US general population. METHODS Our cross-sectional study compared body mass index, total cholesterol, and blood pressure in 11,051 WFFs aged 17 to 64 years using Department of the Interior Medical Screening Program clinical screening examinations between 2014-2018 to National Health and Nutrition Examination Survey of 2015-2016 cycle using adjusted logistic regression analyses. RESULTS The logistic regression model shows significantly higher odds of hypertension and prehypertension in WFFs (2.84 times more with 95% CI: 2.28-3.53) than US general population. There were no consistent differences in body mass index or total cholesterol between the two population. CONCLUSIONS Hypertension and prehypertension were more prevalent in WFFs compared with the US general population, which suggests the need for actions for protecting against cardiovascular disease among WFFs.
Collapse
Affiliation(s)
- Md. Zahid Hasan
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana
| | - Erin O. Semmens
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana
| | | | | | - Curtis W. Noonan
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana
| |
Collapse
|
4
|
Oi Y, Hirose M, Togo H, Yoshinaga K, Akasaka T, Okada T, Aso T, Takahashi R, Glasser MF, Hayashi T, Hanakawa T. Identifying and reverting the adverse effects of white matter hyperintensities on cortical surface analyses. Neuroimage 2023; 281:120377. [PMID: 37714391 DOI: 10.1016/j.neuroimage.2023.120377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 08/22/2023] [Accepted: 09/12/2023] [Indexed: 09/17/2023] Open
Abstract
The Human Connectome Project (HCP)-style surface-based brain MRI analysis is a powerful technique that allows precise mapping of the cerebral cortex. However, the strength of its surface-based analysis has not yet been tested in the older population that often presents with white matter hyperintensities (WMHs) on T2-weighted (T2w) MRI (hypointensities on T1w MRI). We investigated T1-weighted (T1w) and T2w structural MRI in 43 healthy middle-aged to old participants. Juxtacortical WMHs were often misclassified by the default HCP pipeline as parts of the gray matter in T1w MRI, leading to incorrect estimation of the cortical surfaces and cortical metrics. To revert the adverse effects of juxtacortical WMHs, we incorporated the Brain Intensity AbNormality Classification Algorithm into the HCP pipeline (proposed pipeline). Blinded radiologists performed stereological quality control (QC) and found a decrease in the estimation errors in the proposed pipeline. The superior performance of the proposed pipeline was confirmed using an originally-developed automated surface QC based on a large database. Here we showed the detrimental effects of juxtacortical WMHs for estimating cortical surfaces and related metrics and proposed a possible solution for this problem. The present knowledge and methodology should help researchers identify adequate cortical surface biomarkers for aging and age-related neuropsychiatric disorders.
Collapse
Affiliation(s)
- Yuki Oi
- Department of Integrated Neuroanatomy and Neuroimaging, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan; Laboratory for Brain Connectomics Imaging, Center for Biosystems Dynamics Research, RIKEN, Kobe, Japan
| | - Masakazu Hirose
- Department of Integrated Neuroanatomy and Neuroimaging, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroki Togo
- Department of Integrated Neuroanatomy and Neuroimaging, Kyoto University Graduate School of Medicine, Kyoto, Japan; Laboratory for Brain Connectomics Imaging, Center for Biosystems Dynamics Research, RIKEN, Kobe, Japan; Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Kenji Yoshinaga
- Department of Integrated Neuroanatomy and Neuroimaging, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Thai Akasaka
- Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tomohisa Okada
- Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Toshihiko Aso
- Laboratory for Brain Connectomics Imaging, Center for Biosystems Dynamics Research, RIKEN, Kobe, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Matthew F Glasser
- Departments of Radiology and Neuroscience, Washington University School of Medicine, St. Louis, MO, United States
| | - Takuya Hayashi
- Laboratory for Brain Connectomics Imaging, Center for Biosystems Dynamics Research, RIKEN, Kobe, Japan; Department of Brain Connectomics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takashi Hanakawa
- Department of Integrated Neuroanatomy and Neuroimaging, Kyoto University Graduate School of Medicine, Kyoto, Japan; Laboratory for Brain Connectomics Imaging, Center for Biosystems Dynamics Research, RIKEN, Kobe, Japan; Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Kodaira, Japan; Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| |
Collapse
|
5
|
Seifen C, Zisiopoulou M, Ludwig K, Pordzik J, Muthuraman M, Gouveris H. Heart Rate Variability as a Surrogate Marker of Severe Chronic Coronary Syndrome in Patients with Obstructive Sleep Apnea. Diagnostics (Basel) 2023; 13:2838. [PMID: 37685374 PMCID: PMC10486866 DOI: 10.3390/diagnostics13172838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/17/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Obstructive sleep apnea (OSA) is a known risk factor for chronic coronary syndrome (CCS). CCS and OSA are separately associated with significant changes in heart rate variability (HRV). In this proof-of-concept study, we tested whether HRV values are significantly different between OSA patients with concomitant severe CCS, and OSA patients without known CCS. MATERIAL AND METHODS The study comprised a retrospective assessment of the historical and raw polysomnography (PSG) data of 32 patients who presented to a tertiary university hospital with clinical complaints of OSA. A total of 16 patients (four females, mean age 62.94 ± 2.74 years, mean body mass index (BMI) 31.93 ± 1.65 kg/m2) with OSA (median apnea-hypopnea index (AHI) 39.1 (30.5-70.6)/h) and severe CCS were compared to 16 patients (four females, mean age 62.35 ± 2.06 years, mean BMI 32.19 ± 1.07 kg/m2) with OSA (median AHI 40 (30.6-44.5)/h) but without severe CCS. The short-long-term HRV (in msec) was calculated based on the data of a single-lead electrocardiogram (ECG) provided by one full-night PSG, using the standard deviation of the NN, normal-to-normal intervals (SDNN) and the heart rate variability triangular index (HRVI) methods, and compared between the two groups. RESULTS A significant reduction (p < 0.05) in both SDNN and HRVI was found in the OSA group with CCS compared to the OSA group without CCS. CONCLUSIONS Severe CCS has a significant impact on short-long-term HRV in OSA patients. Further studies in OSA patients with less-severe CCS may shed more light onto the involved mechanistic processes. If confirmed in future larger studies, this physiologic metric has the potential to provide a robust surrogate marker of severe CCS in OSA patients.
Collapse
Affiliation(s)
- Christopher Seifen
- Sleep Medicine Center & Department of Otolaryngology, Head and Neck Surgery, University Medical Center Mainz, 55131 Mainz, Germany; (C.S.); (K.L.); (J.P.)
| | - Maria Zisiopoulou
- Department of Cardiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60629 Frankfurt am Main, Germany;
| | - Katharina Ludwig
- Sleep Medicine Center & Department of Otolaryngology, Head and Neck Surgery, University Medical Center Mainz, 55131 Mainz, Germany; (C.S.); (K.L.); (J.P.)
| | - Johannes Pordzik
- Sleep Medicine Center & Department of Otolaryngology, Head and Neck Surgery, University Medical Center Mainz, 55131 Mainz, Germany; (C.S.); (K.L.); (J.P.)
| | - Muthuraman Muthuraman
- Neural Engineering with Signal Analytics and Artificial Intelligence, Department of Neurology, University Medical Center Würzburg, 97080 Würzburg, Germany;
| | - Haralampos Gouveris
- Sleep Medicine Center & Department of Otolaryngology, Head and Neck Surgery, University Medical Center Mainz, 55131 Mainz, Germany; (C.S.); (K.L.); (J.P.)
| |
Collapse
|
6
|
Sara JDS, Orbelo D, Maor E, Lerman LO, Lerman A. Guess What We Can Hear-Novel Voice Biomarkers for the Remote Detection of Disease. Mayo Clin Proc 2023; 98:1353-1375. [PMID: 37661144 PMCID: PMC10043966 DOI: 10.1016/j.mayocp.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 02/08/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023]
Abstract
The advancement of digital biomarkers and the provision of remote health care greatly progressed during the coronavirus disease 2019 global pandemic. Combining voice/speech data with artificial intelligence and machine-based learning offers a novel solution to the growing demand for telemedicine. Voice biomarkers, obtained from the extraction of characteristic acoustic and linguistic features, are associated with a variety of diseases and even coronavirus disease 2019. In the current review, we (1) describe the basis on which digital voice biomarkers could facilitate "telemedicine," (2) discuss potential mechanisms that may explain the association between voice biomarkers and disease, (3) offer a novel classification system to conceptualize voice biomarkers depending on different methods for recording and analyzing voice/speech samples, (4) outline evidence revealing an association between voice biomarkers and a number of disease states, and (5) describe the process of developing a voice biomarker from recording, storing voice samples, and extracting acoustic and linguistic features relevant to training and testing deep and machine-based learning algorithms to detect disease. We further explore several important future considerations in this area of research, including the necessity for clinical trials and the importance of safeguarding data and individual privacy. To this end, we searched PubMed and Google Scholar to identify studies evaluating the relationship between voice/speech features and biomarkers and various diseases. Search terms included digital biomarker, telemedicine, voice features, voice biomarker, speech features, speech biomarkers, acoustics, linguistics, cardiovascular disease, neurologic disease, psychiatric disease, and infectious disease. The search was limited to studies published in English in peer-reviewed journals between 1980 and the present. To identify potential studies not captured by our database search strategy, we also searched studies listed in the bibliography of relevant publications and reviews.
Collapse
Affiliation(s)
| | - Diana Orbelo
- Division of Otolaryngology, Mayo Clinic College of Medicine and Science, Rochester, MN; Chaim Sheba Medical Center, Tel HaShomer, Israel
| | - Elad Maor
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Mayo Clinic Rochester, MN
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN.
| |
Collapse
|
7
|
Gruenewald T, Seeman TE, Choo TH, Scodes J, Snyder C, Pavlicova M, Weinstein M, Schwartz JE, Mukkamala R, Sloan RP. Cardiovascular variability, sociodemographics, and biomarkers of disease: the MIDUS study. Front Physiol 2023; 14:1234427. [PMID: 37693005 PMCID: PMC10484414 DOI: 10.3389/fphys.2023.1234427] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction: Like heart rate, blood pressure (BP) is not steady but varies over intervals as long as months to as short as consecutive cardiac cycles. This blood pressure variability (BPV) consists of regularly occurring oscillations as well as less well-organized changes and typically is computed as the standard deviation of multiple clinic visit-to-visit (VVV-BP) measures or from 24-h ambulatory BP recordings (ABPV). BP also varies on a beat-to-beat basis, quantified by methods that parse variation into discrete bins, e.g., low frequency (0.04-0.15 Hz, LF). However, beat-to-beat BPV requires continuous recordings that are not easily acquired. As a result, we know little about the relationship between LF-BPV and basic sociodemographic characteristics such as age, sex, and race and clinical conditions. Methods: We computed LF-BPV during an 11-min resting period in 2,118 participants in the Midlife in the US (MIDUS) study. Results: LF-BPV was negatively associated with age, greater in men than women, and unrelated to race or socioeconomic status. It was greater in participants with hypertension but unrelated to hyperlipidemia, hypertriglyceridemia, diabetes, elevated CRP, or obesity. LF-diastolic BPV (DBPV), but not-systolic BPV (SBPV), was negatively correlated with IL-6 and s-ICAM and positively correlated with urinary epinephrine and cortisol. Finally, LF-DBPV was negatively associated with mortality, an effect was rendered nonsignificant by adjustment by age but not other sociodemographic characteristics. Discussion: These findings, the first from a large, national sample, suggest that LF-BPV differs significantly from VVV-BP and ABPV. Confirming its relationship to sociodemographic risk factors and clinical outcomes requires further study with large and representative samples.
Collapse
Affiliation(s)
- Tara Gruenewald
- Department of Psychology, Chapman University, Orange, CA, United States
| | - Teresa E. Seeman
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Tse-Hwei Choo
- Mental Health Data Science Division, New York State Psychiatric Institute, New York, NY, United States
| | - Jennifer Scodes
- Mental Health Data Science Division, New York State Psychiatric Institute, New York, NY, United States
| | - Clayton Snyder
- Mental Health Data Science Division, New York State Psychiatric Institute, New York, NY, United States
| | - Martina Pavlicova
- Department of Biostatistics, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, United States
| | | | - Joseph E. Schwartz
- Renaissance School of Medicine, Stony Brook University, New York, NY, United States
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Ramakrishna Mukkamala
- Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - Richard P. Sloan
- Division of Behavioral Medicine, Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
- New York State Psychiatric Institute, New York, NY, United States
| |
Collapse
|
8
|
Watkins LL, LoSavio ST, Calhoun P, Resick PA, Sherwood A, Coffman CJ, Kirby AC, Beaver TA, Dennis MF, Beckham JC. Effect of cognitive processing therapy on markers of cardiovascular risk in posttraumatic stress disorder patients: A randomized clinical trial. J Psychosom Res 2023; 170:111351. [PMID: 37178469 PMCID: PMC10283083 DOI: 10.1016/j.jpsychores.2023.111351] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/27/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) is associated with elevated risk of coronary heart disease (CHD); however, the effects of PTSD treatment on CHD biomarkers is unknown. This study examined whether cognitive processing therapy (CPT) improves 24-hourheart rate variability (HRV), a predictor of CHD mortality. METHODS Individuals between the ages of 40 and 65 years with PTSD (n = 112) were randomized to receive 12 sessions of CPT or a Waiting List (WL) intervention comprised of 6 weekly telephone checks of emotional status. The primary outcome variable was 24-hour HRV estimated from the standard deviation of all normal R-R intervals (SDNN); secondary outcomes were the root mean square of successive differences between heart beats (RMSSD), low-frequency HRV (LF-HRV) and high-frequency HRV (HF-HRV). Secondary outcomes also included 24-hour urinary catecholamine excretion, plasma C-reactive protein (CRP), and flow-mediated dilation (FMD) of the brachial artery. For outcomes, linear mixed longitudinal models were used to estimate mean differences (Mdiff). RESULTS Participants randomized to the CPT group did not show improved SDNN (Mdiff = 9.8; 95%CI, -2.7 to 22.3; p = 0.12), the primary outcome variable, but showed improved RMSSD (Mdiff = 3.8; 95% CI, 0.5 to 7.1; p = 0.02), LF- HRV (Mdiff =0.3; 95% CI, 0.1 to 0.5; p = 0.01), and HF-HRV (Mdiff = 0.3; 95% CI, 0.0 to 0.6; p = 0.03) compared to WL. There were no differences between groups in catecholamine excretion, FMD, or inflammatory markers. CONCLUSION Treating PTSD may not only improve quality of life but may also help ameliorate heightened CHD risk characteristics of PTSD.
Collapse
Affiliation(s)
- Lana L Watkins
- Duke University Medical Center, Durham, NC, United States of America.
| | | | - Patrick Calhoun
- Duke University Medical Center, Durham, NC, United States of America; Durham VA Healthcare System, Durham, NC, United States of America; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, United States of America
| | - Patricia A Resick
- Duke University Medical Center, Durham, NC, United States of America
| | - Andrew Sherwood
- Duke University Medical Center, Durham, NC, United States of America
| | - Cynthia J Coffman
- Duke University Medical Center, Durham, NC, United States of America; Durham VA Healthcare System, Durham, NC, United States of America; Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, United States of America
| | - Angela C Kirby
- Duke University Medical Center, Durham, NC, United States of America; Durham VA Healthcare System, Durham, NC, United States of America; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, United States of America
| | - Tiffany A Beaver
- Duke University Medical Center, Durham, NC, United States of America; Durham VA Healthcare System, Durham, NC, United States of America
| | - Michelle F Dennis
- Duke University Medical Center, Durham, NC, United States of America; Durham VA Healthcare System, Durham, NC, United States of America
| | - Jean C Beckham
- Duke University Medical Center, Durham, NC, United States of America; Durham VA Healthcare System, Durham, NC, United States of America; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, United States of America
| |
Collapse
|
9
|
Arsiwala-Scheppach LT, Ramulu PY, Sharrett AR, Kamath V, Deal JA, Guo X, Du S, Garcia Morales EE, Mihailovic A, Chen H, Abraham AG. Associations among Visual, Auditory, and Olfactory Functions in Community-Based Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study. Transl Vis Sci Technol 2022; 11:2. [PMID: 36322079 PMCID: PMC9639698 DOI: 10.1167/tvst.11.11.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
PURPOSE Objective examination of relationships among visual, hearing, and olfactory function may yield mechanistic insights and inform our understanding of the burden of multiple-sensory impairments. METHODS This cross-sectional study capitalized on continuous measures of visual acuity (VA), contrast sensitivity, pure tone audiometry, Quick Speech-in-Noise (QuickSIN), and Sniffin' Sticks from a subset of ARIC participants at two community sites (EyeDOC Study, 2017-2019). Scales of all measures were aligned such that higher values indicated greater impairment. Intersensory bivariate associations were assessed graphically, and correlations assessed using Kendall's tau. Intersensory associations, independent of age, education, smoking, diabetes, and hypertension, were examined using linear regression. Analyses were stratified by community/race (Washington County/White vs Jackson/Black) and sex (men vs women) to explore community-sex heterogeneity. RESULTS We included 834 participants (mean age, 79 years); 39% were from Jackson and 63% females. We found weak intersensory correlations (tau generally ≤0.15). In the demographics-adjusted regression models, results were heterogeneous across communities and sex. Worse near VA, contrast sensitivity, and olfaction were associated with worse QuickSIN and worse near VA was associated with worse olfaction in some but not all community/race-sex groups (e.g., Jackson/Black women, 0.1 logMAR worse near VA was associated with 0.27 units increase in QuickSIN [95% confidence interval, 0.10-0.45]). Associations were modestly attenuated by adjustment for the shared risk factors of smoking, diabetes, and hypertension. CONCLUSIONS Visual dysfunction showed little or no association with hearing or olfaction impairments, suggesting a modest role for shared risk factors. TRANSLATIONAL RELEVANCE Visually impaired individuals have only a modestly higher risk of other sensory impairment.
Collapse
Affiliation(s)
| | - Pradeep Y. Ramulu
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - A. Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Vidyulata Kamath
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jennifer A. Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA,Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA,Johns Hopkins Center on Aging and Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Xinxing Guo
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Simo Du
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Emmanuel E. Garcia Morales
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Aleksandra Mihailovic
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Honglei Chen
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Alison G. Abraham
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA,Department of Epidemiology, School of Public Health, University of Colorado, Denver, CO, USA,Department of Ophthalmology, School of Medicine, University of Colorado, Denver, CO, USA
| |
Collapse
|
10
|
Heart rate variability and the risk of heart failure and its subtypes in post-menopausal women: The Women's Health Initiative study. PLoS One 2022; 17:e0276585. [PMID: 36282885 PMCID: PMC9595519 DOI: 10.1371/journal.pone.0276585] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
Background Low heart rate variability (HRV), a measure of autonomic imbalance, is associated with increased risk of coronary heart disease (CHD) and heart failure (HF). However, its relationship with HF subtypes; heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) has not been studied prior. Methods and findings We conducted a longitudinal study in Women’s Health Initiative study cohort to investigate the association of baseline quartiles of resting heart rate (rHR) and HRV measures; SDNN (SD of normal-to-normal RR interval) and RMSSD (root mean square of successive difference of RR interval) measured by twelve-lead electrocardiogram (ECG) on enrollment, with the risk of hospitalized HF and its subtypes. Total of 28,603 post-menopausal women, predominantly non-Hispanic whites (69%), with a mean (SD) age of 62.6 (7.1) years, free of baseline CHD and HF were included. In a fully adjusted cox-proportional hazards regression model which adjusted for age, race, BMI, alcohol intake, education, physical activity, hyperlipidemia, hypertension, left ventricular hypertrophy, use of beta-blocker, calcium-channel blocker, hormone therapy, and time-varying incident CHD, the hazard ratios of lowest quartile of HRV (Q1) with HF risk were significant (Q1 SDNN compared to Q4 SDNN: 1.22, 95% CI 1.07, 1.39; Q1 RMSSD compared to Q4 RMSSD: 1.17, 95% CI 1.02, 1.33). On subgroup analysis of HF subtypes, low HRV was associated with elevated HFpEF risk (Q1 vs Q4 SDNN: 1.22, 95% CI 1.02, 1.47) but not with HFrEF (Q1 vs Q4 SDNN: 1.19, 95% CI 0.95, 1.50; Q1 RMSSD: 1.13, 95% CI 0.90, 1.43). Conclusion Low HRV is associated with elevated overall hospitalized HF risk and HFpEF risk in post-menopausal women. Whether interventions to increase HRV through healthy lifestyle changes will decrease HF risk warrants further investigation.
Collapse
|
11
|
Park HS, Seo K, Kim HS, Im SI, Kim BJ, Kim BK, Heo JH. Postoperative effects of bariatric surgery on heart rate recovery and heart rate variability. KOSIN MEDICAL JOURNAL 2022. [DOI: 10.7180/kmj.22.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: Several studies have reported associations between obesity and autonomic dysfunction. However, little research has investigated the effect of bariatric surgery on heart rate recovery (HRR) in the treadmill test and heart rate variability (HRV) in 24-hour Holter monitoring. We investigated the effects of bariatric surgery on HRR and HRV, which are parameters related to autonomic dysfunction. Methods: We retrospectively investigated patients who underwent bariatric surgery in 2019. The treadmill test, 24-hour Holter monitoring, and echocardiography were performed before and 6 months after surgery. We compared the changes in HRR in the treadmill test and HRV parameters such as the time domain and spectral domain in 24-hour Holter monitoring before and after surgery. Results: Of the 40 patients who underwent bariatric surgery, 25 patients had the treadmill test or 24-hour Holter monitoring both before and after surgery. Body weight and body mass index significantly decreased after surgery (112.86±24.37 kg vs. 89.10±20.26 kg, p<0.001; 39.22±5.69 kg/m2 vs. 31.00±5.09 kg/m2, p<0.001, respectively). HRR significantly increased (n=23; 43.00±20.97 vs. 64.29±18.49, p=0.001). The time domain of HRV parameters increased (n=21; standard deviation of the N-N interval 123.57±28.05 vs. 152.57±39.49, p=0.002 and mean N-N interval 791.57±88.84 vs. 869.05±126.31, p=0.002).Conclusions: Our data showed that HRR after exercise and HRV during 24-hour Holter monitoring improved after weight reduction with bariatric surgery through improved cardiac autonomic function.
Collapse
|
12
|
Sara JDS, Maor E, Orbelo D, Gulati R, Lerman LO, Lerman A. Noninvasive Voice Biomarker Is Associated With Incident Coronary Artery Disease Events at Follow-up. Mayo Clin Proc 2022; 97:835-846. [PMID: 35341593 DOI: 10.1016/j.mayocp.2021.10.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 09/24/2021] [Accepted: 10/15/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the association between a preidentified voice biomarker and incident coronary artery disease (CAD) events. METHODS Patients referred for clinically indicated coronary angiography underwent a total of three 30-second voice recordings using the Vocalis Health smartphone application between January 1, 2015, and February 28, 2017. A pre-established voice biomarker was derived from each individual recording, and the mean biomarker value was calculated for each patient. Individuals were clinically observed through December 31, 2019. The prespecified primary outcome was a composite of presenting to the emergency department with chest pain, being admitted to the hospital with chest pain, or having an acute coronary syndrome; the prespecified secondary outcome was a composite of a positive stress test result at follow-up or the presence of CAD at follow-up coronary angiography. RESULTS In the final analysis, 108 patients were included (mean age, 59.47±11.44 years; male, 59 [54.6%]). The median follow-up time was 24 months (range, 1 to 60 months). In multivariable Cox proportional hazards models adjusting for CAD grade on baseline angiography, a high baseline mean voice biomarker was significantly associated with both the primary (hazard ratio, 2.61; 95% CI, 1.42 to 4.80; P=.002) and secondary (hazard ratio, 3.13; 95% CI, 1.13 to 8.68; P=.03) composite outcomes. CONCLUSION This study found a significant association between a noninvasive voice biomarker and incident CAD events at follow-up. These results may have important clinical implications for the remote and noninvasive screening of patients to identify those at risk of coronary disease and its complications.
Collapse
Affiliation(s)
| | - Elad Maor
- Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Diana Orbelo
- Division of Laryngology, Mayo Clinic, Rochester, MN
| | | | - Lliach O Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | | |
Collapse
|
13
|
Engström G, Hamrefors V, Fedorowski A, Persson A, Johansson ME, Ostenfeld E, Goncalves I, Markstad H, Johnson LSB, Persson M, Carlson J, Platonov PG. Cardiovagal Function Measured by the Deep Breathing Test: Relationships With Coronary Atherosclerosis. J Am Heart Assoc 2022; 11:e024053. [PMID: 35352566 PMCID: PMC9075454 DOI: 10.1161/jaha.121.024053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The cardiovagal function can be assessed by quantification of respiratory sinus arrhythmia (RSA) during a deep breathing test. However, population studies of RSA and coronary atherosclerosis are lacking. This population‐based study examined the relationship between RSA during deep breathing and coronary atherosclerosis, assessed by coronary artery calcium score (CACS). Methods and Results SCAPIS (Swedish Cardiopulmonary Bioimage Study) randomly invited men and women aged 50 to 64 years from the general population. CACS was obtained from computed tomography scanning, and deep breathing tests were performed in 4654 individuals. Expiration–inspiration differences (E‐Is) of heart rates were calculated, and reduced RSA was defined as E‐I in the lowest decile of the population. The relationship between reduced RSA and CACS (CACS≥100 or CACS≥300) was calculated using multivariable‐adjusted logistic regression. The proportion of CACS≥100 was 24% in the lowest decile of E‐I and 12% in individuals with E‐I above the lowest decile (P<0.001), and the proportion of CACS≥300 was 12% and 4.8%, respectively (P<0.001). The adjusted odds ratio (OR) for CACS≥100 was 1.42 (95% CI, 1.10–1.84) and the adjusted OR for CACS≥300 was 1.62 (95% CI, 1.15–2.28), when comparing the lowest E‐I decile with deciles 2 to 10. Adjusted ORs per 1 SD lower E‐I were 1.17 (P=0.001) for CACS≥100 and 1.28 (P=0.001) for CACS≥300. Conclusions Low RSA during deep breathing is associated with increased coronary atherosclerosis as assessed by CACS, independently of traditional cardiovascular risk factors. Cardiovagal dysfunction could be a prevalent and modifiable risk factor for coronary atherosclerosis in the general population.
Collapse
Affiliation(s)
- Gunnar Engström
- Department of Clinical Sciences in Malmö Lund University Malmö Sweden
| | - Viktor Hamrefors
- Department of Clinical Sciences in Malmö Lund University Malmö Sweden.,Department of Internal Medicine Skåne University Hospital Malmö Sweden
| | - Artur Fedorowski
- Department of Clinical Sciences in Malmö Lund University Malmö Sweden.,Department of Cardiology Skåne University Hospital Malmö Sweden
| | - Anders Persson
- Department of Clinical Sciences in Malmö Lund University Malmö Sweden
| | - Maria E Johansson
- Department of Physiology Institute of Neuroscience and PhysiologyUniversity of Gothenburg Sweden
| | - Ellen Ostenfeld
- Department of Clinical Sciences in Lund Lund University Lund Sweden.,Department of Medical Imaging and Clinical Physiology Skåne University Hospital Lund Sweden
| | - Isabel Goncalves
- Department of Clinical Sciences in Malmö Lund University Malmö Sweden.,Department of Cardiology Skåne University Hospital Malmö Sweden
| | - Hanna Markstad
- Department of Clinical Sciences in Malmö Lund University Malmö Sweden.,Department of Medical Imaging and Clinical Physiology Skåne University Hospital Lund Sweden
| | - Linda S B Johnson
- Department of Clinical Sciences in Malmö Lund University Malmö Sweden
| | | | - Jonas Carlson
- Department of Clinical Sciences in Lund Lund University Lund Sweden
| | - Pyotr G Platonov
- Department of Clinical Sciences in Lund Lund University Lund Sweden
| |
Collapse
|
14
|
ECG and Heart Rate Variability in Sleep-Related Breathing Disorders. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1384:159-183. [PMID: 36217084 DOI: 10.1007/978-3-031-06413-5_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Here we discuss the current perspectives of comprehensive heart rate variability (HRV) analysis in electrocardiogram (ECG) signals as a non-invasive and reliable measure to assess autonomic function in sleep-related breathing disorders (SDB). It is a tool of increasing interest as different facets of HRV can be implemented to screen and diagnose SDB, monitor treatment efficacy, and prognose adverse cardiovascular outcomes in patients with sleep apnea. In this context, the technical aspects, pathophysiological features, and clinical applications of HRV are discussed to explore its usefulness in better understanding SDB.
Collapse
|
15
|
Heart rate complexity: An early prognostic marker of patient outcome after cardiac arrest. Clin Neurophysiol 2021; 134:27-33. [PMID: 34953334 DOI: 10.1016/j.clinph.2021.10.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/21/2021] [Accepted: 10/23/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Early prognostication in comatose patients after cardiac arrest (CA) is difficult but essential to inform relatives and optimize treatment. Here we investigate the predictive value of heart-rate variability captured by multiscale entropy (MSE) for long-term outcomes in comatose patients during the first 24 hours after CA. METHODS In this retrospective analysis of prospective multi-centric cohort, we analyzed MSE of the heart rate in 79 comatose patients after CA while undergoing targeted temperature management and sedation during the first day of coma. From the MSE, two complexity indices were derived by summing values over short and long time scales (CIs and CIl). We splitted the data in training and test datasets for analysing the predictive value for patient outcomes (defined as best cerebral performance category within 3 months) of CIs and CIl. RESULTS Across the whole dataset, CIl provided the best sensitivity, specificity, and accuracy (88%, 75%, and 82%, respectively). Positive and negative predictive power were 81% and 84%. CONCLUSIONS Characterizing the complexity of the ECG in patients after CA provides an accurate prediction of both favorable and unfavorable outcomes. SIGNIFICANCE The analysis of heartrate variability by means of MSE provides accurate outcome prediction on the first day of coma.
Collapse
|
16
|
Feofanova EV, Lim E, Chen H, Lee M, Liu CT, Cupples LA, Boerwinkle E. Exome sequence association study of levels and longitudinal change of cardiovascular risk factor phenotypes in European Americans and African Americans from the Atherosclerosis Risk in Communities Study. Genet Epidemiol 2021; 45:651-663. [PMID: 34167169 PMCID: PMC9047057 DOI: 10.1002/gepi.22390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/09/2021] [Accepted: 05/04/2021] [Indexed: 12/21/2022]
Abstract
Cardiovascular disease (CVD) is responsible for 31% of all deaths worldwide. Among CVD risk factors are age, race, increased systolic blood pressure (BP), and dyslipidemia. Both BP and blood lipids levels change with age, with a dose-dependent relationship between the cumulative exposure to hyperlipidemia and the risk of CVD. We performed an exome sequence association study using longitudinal data with up to 7805 European Americans (EAs) and 3171 African Americans (AAs) from the Atherosclerosis Risk in Communities (ARIC) study. We assessed associations of common (minor allele frequency > 5%) nonsynonymous and splice-site variants and gene-based sets of rare variants with levels and with longitudinal change of seven CVD risk factor phenotypes (BP traits: systolic BP, diastolic BP, pulse pressure; lipids traits: triglycerides, total cholesterol, high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C]). Furthermore, we investigated the relationship of the identified variants and genes with select CVD endpoints. We identified two novel genes: DCLK3 associated with the change of HDL-C levels in AAs and RAB7L1 associated with the change of LDL-C levels in EAs. RAB7L1 is further associated with an increased risk of heart failure in ARIC EAs. Investigation of the contribution of genetic factors to the longitudinal change of CVD risk factor phenotypes promotes our understanding of the etiology of CVD outcomes, stressing the importance of incorporating the longitudinal structure of the cohort data in future analyses.
Collapse
Affiliation(s)
- Elena V. Feofanova
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Elise Lim
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Han Chen
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Center for Precision Health, School of Public Health & School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - MinJae Lee
- Division of Biostatistics, Department of Population & Data Sciences, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Ching-Ti Liu
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - L. Adrienne Cupples
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- Framingham Heart Study, Framingham, MA, USA
| | - Eric Boerwinkle
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
17
|
Chan PHY, Kwok KM, Chan MHM, Li AM, Chan IHS, Fok TF, Lam HS. Prenatal methylmercury exposure is associated with decrease heart rate variability in children. ENVIRONMENTAL RESEARCH 2021; 200:111744. [PMID: 34310966 DOI: 10.1016/j.envres.2021.111744] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/19/2021] [Accepted: 07/19/2021] [Indexed: 05/10/2023]
Abstract
BACKGROUND Although several epidemiological studies have suggested mercury (Hg) might be associated with cardiotoxicity, the impact of Hg exposure on cardiac autonomic activity and blood pressure in children has not been investigated at Hg exposure levels equivalent to the Environmental Protection Agency (EPA) reference dose. OBJECTIVE To investigate the association between low dose prenatal and recent methylmercury (MeHg) exposures and cardiac autonomic function and blood pressure with adjustment for factors such as fish consumption among children from a high fish consumption coastal city. METHODS Children aged 7-8 years were recruited from the birth cohort of our previous study. Heart rate variability (HRV), resting heart rate (RHR) and blood pressure were measured as surrogate markers of cardiac autonomic function. Cord blood and current whole blood Hg concentration were used as biomarkers of prenatal and recent MeHg exposure, respectively. Recent fish consumption information was estimated with a food frequency questionnaire. RESULTS Among 604 children, median cord blood and whole blood Hg concentrations were 45.9 nmol/L (IQR: 32.8-65.03 nmol/L) and 13.57 nmol/L (IQR: 9.29-19.72 nmol/L), respectively. Our results demonstrated that prenatal MeHg exposure was associated with decreased HRV (i.e. low CVRR, SDRR, and RMSSD), reflecting reduced parasympathetic activity (i.e. low CCVHF and HF), and a sympathovagal balance shift toward sympathetic predominance (i.e. high %LF and LF/HF ratio). Adjustment of recent fish consumption further increased the significance and magnitude of the adverse associations of MeHg. CONCLUSION The results of this study suggest that prenatal MeHg exposure is associated with decreased parasympathetic modulation of cardiac autonomic function in children.
Collapse
Affiliation(s)
- Peggy Hiu Ying Chan
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; Brain and Mind Institute, The Chinese University of Hong Kong, Hong Kong
| | - Ka Ming Kwok
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Michael Ho Ming Chan
- Department of Chemical Pathology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Albert Martin Li
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Iris Hiu Shuen Chan
- Department of Chemical Pathology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Tai Fai Fok
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Hugh Simon Lam
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
| |
Collapse
|
18
|
Gondalia R, Baldassari A, Holliday KM, Justice AE, Stewart JD, Liao D, Yanosky JD, Engel SM, Sheps D, Jordahl KM, Bhatti P, Horvath S, Assimes TL, Demerath EW, Guan W, Fornage M, Bressler J, North KE, Conneely KN, Li Y, Hou L, Baccarelli AA, Whitsel EA. Epigenetically mediated electrocardiographic manifestations of sub-chronic exposures to ambient particulate matter air pollution in the Women's Health Initiative and Atherosclerosis Risk in Communities Study. ENVIRONMENTAL RESEARCH 2021; 198:111211. [PMID: 33895111 PMCID: PMC8179344 DOI: 10.1016/j.envres.2021.111211] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/10/2021] [Accepted: 04/19/2021] [Indexed: 06/03/2023]
Abstract
BACKGROUND Short-duration exposure to ambient particulate matter (PM) air pollution is associated with cardiac autonomic dysfunction and prolonged ventricular repolarization. However, associations with sub-chronic exposures to coarser particulates are relatively poorly characterized as are molecular mechanisms underlying their potential relationships with cardiovascular disease. MATERIALS AND METHODS We estimated associations between monthly mean concentrations of PM < 10 μm and 2.5-10 μm in diameter (PM10; PM2.5-10) with time-domain measures of heart rate variability (HRV) and QT interval duration (QT) among U.S. women and men in the Women's Health Initiative and Atherosclerosis Risk in Communities Study (nHRV = 82,107; nQT = 76,711). Then we examined mediation of the PM-HRV and PM-QT associations by DNA methylation (DNAm) at three Cytosine-phosphate-Guanine (CpG) sites (cg19004594, cg24102420, cg12124767) with known sensitivity to monthly mean PM concentrations in a subset of the participants (nHRV = 7,169; nQT = 6,895). After multiply imputing missing PM, electrocardiographic and covariable data, we estimated associations using attrition-weighted, linear, mixed, longitudinal models adjusting for sociodemographic, behavioral, meteorological, and clinical characteristics. We assessed mediation by estimating the proportions of PM-HRV and PM-QT associations mediated by DNAm. RESULTS We found little evidence of PM-HRV association, PM-QT association, or mediation by DNAm. CONCLUSIONS The findings suggest that among racially/ethnically and environmentally diverse U.S. populations, sub-chronic exposures to coarser particulates may not exert appreciable, epigenetically mediated effects on cardiac autonomic function or ventricular repolarization. Further investigation in better-powered studies is warranted, with additional focus on shorter duration exposures to finer particulates and non-electrocardiographic outcomes among relatively susceptible populations.
Collapse
Affiliation(s)
- Rahul Gondalia
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
| | - Antoine Baldassari
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Katelyn M Holliday
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Anne E Justice
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; Geisinger Health System, Danville, PA, USA
| | - James D Stewart
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Duanping Liao
- Division of Epidemiology, Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Jeff D Yanosky
- Division of Epidemiology, Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Stephanie M Engel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - David Sheps
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Kristina M Jordahl
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Parveen Bhatti
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Steve Horvath
- Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; Biostatistics, School of Public Health, University of California Los Angeles, Los Angeles, USA
| | | | - Ellen W Demerath
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Weihua Guan
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Myriam Fornage
- Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jan Bressler
- Human Genetics Center, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kari E North
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; Carolina Center for Genome Sciences, University of North Carolina, Chapel Hill, NC, USA
| | - Karen N Conneely
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Yun Li
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA; Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; Department of Computer Science, University of North Carolina, Chapel Hill, NC, USA
| | - Lifang Hou
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University Chicago, Evanston, IL, USA; Center for Population Epigenetics, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Andrea A Baccarelli
- Laboratory of Environmental Epigenetics, Departments of Environmental Health Sciences and Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Eric A Whitsel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| |
Collapse
|
19
|
Min JW, Chang JY, Lee H, Park Y, Ko EJ, Cho JH, Yang CW, Chung BH. Clinical significance of heart rate variability for the monitoring of cardiac autonomic neuropathy in end-stage renal disease patients. Nutr Metab Cardiovasc Dis 2021; 31:2089-2098. [PMID: 33975739 DOI: 10.1016/j.numecd.2021.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/01/2021] [Accepted: 03/17/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS The aim of this study is to determine whether the measurement of continuous heart rate variability (HRV) is useful in the evaluation of cardiac autonomic neuropathy (CAN) in end-stage renal disease (ESRD) patients. METHODS AND RESULTS This cross-sectional study was performed at Seoul St. Mary's hospital between June 2017 and February 2018. Seventy-seven ESRD patients, and 29 healthy controls (HCs) were asked to wear a continuous ambulatory HRV monitor for 24 h. General cardiac function was evaluated using transthoracic echocardiogram (TTE), pulse wave velocity (PWV), coronary calcium scoring (CCS), and 24-h ambulatory blood pressure monitoring (ABPM). HRV parameters of ESRD patients and HCs, and the correlation of HRV parameters with cardiovascular screening methods were observed. All HRV parameters were significantly decreased in ESRD patients compared to HCs (P < 0.001). In the correlation analysis between TTE results and HRV parameters, 24-h standard deviation of all N-N intervals (24SDNN), 24-h standard deviation of sequential 5-min N-N interval means (24DANN) and Low Frequency Power/High Frequency Power (LF/HF) ratio showed negative correlations with E/e', LAVI and TR velocity which are representative indices for the diastolic function of the heart (P < 0.05). HRV parameters showed negative correlations with baPWV, CCS, and 24-h ABPM results as well (P < 0.05). Hemoglobin and serum albumin showed positive correlations with HRV parameters, and glucose, BUN, creatinine, and iPTH levels showed negative correlations (P < 0.05). CONCLUSION Continuous HRV monitoring may be a useful tool for the evaluation of CAN in ESRD.
Collapse
Affiliation(s)
- Ji Won Min
- Division of Nephrology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ji-Yeun Chang
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hanbi Lee
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yohan Park
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Eun Jeong Ko
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jae Hyoung Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Chul Woo Yang
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Byung Ha Chung
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
| |
Collapse
|
20
|
LoSavio ST, Beckham JC, Wells SY, Resick PA, Sherwood A, Coffman CJ, Kirby AC, Beaver TA, Dennis MF, Watkins LL. The effect of reducing posttraumatic stress disorder symptoms on cardiovascular risk: Design and methodology of a randomized clinical trial. Contemp Clin Trials 2021; 102:106269. [PMID: 33429088 PMCID: PMC8009821 DOI: 10.1016/j.cct.2021.106269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/19/2020] [Accepted: 12/31/2020] [Indexed: 12/19/2022]
Abstract
Posttraumatic stress disorder (PTSD) has been associated with accelerated progression of coronary heart disease (CHD). However, the underlying pathophysiological pathway has remained elusive and it is unclear whether there is a direct link between PTSD and CHD risk. This paper describes the methods of a randomized controlled trial developed to examine how changes in PTSD symptoms affect CHD disease pathways. One hundred twenty participants with current PTSD and who are free of known CHD will be randomized to receive either an evidence-based treatment for PTSD (Cognitive Processing Therapy; CPT) or a waitlist control (WL). Before and after CPT/WL, participants undergo assessment of CHD risk biomarkers reflecting autonomic nervous system dysregulation, systemic inflammation, and vascular endothelial dysfunction. The primary hypothesis is that individuals who show improvement in PTSD symptoms will show improvement in CHD risk biomarkers, whereas individuals who fail to improve or show worsening PTSD symptoms will have no change or worsening in CHD biomarkers. This study is expected to provide knowledge of the role of both the direct impact of PTSD symptoms on CHD risk pathways and the role of these systems as candidate mechanisms underlying the relationship between PTSD and CHD risk. Further, results will provide guidance on the utility of cognitive therapy as a tool to mitigate the accelerated progression of CHD in PTSD. Clinical Trials Registration: https://clinicaltrials.gov/ct2/show/NCT02736929; Unique identifier: NCT02736929.
Collapse
Affiliation(s)
| | - Jean C Beckham
- Duke University Medical Center, Durham, NC, USA; Durham VA Healthcare System, Durham, NC, USA
| | - Stephanie Y Wells
- Duke University Medical Center, Durham, NC, USA; Durham VA Healthcare System, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, United States of America
| | | | | | - Cynthia J Coffman
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, United States of America; Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, NC, United States of America
| | - Angela C Kirby
- Duke University Medical Center, Durham, NC, USA; Durham VA Healthcare System, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, United States of America
| | - Tiffany A Beaver
- Duke University Medical Center, Durham, NC, USA; Durham VA Healthcare System, Durham, NC, USA
| | - Michelle F Dennis
- Duke University Medical Center, Durham, NC, USA; Durham VA Healthcare System, Durham, NC, USA
| | | |
Collapse
|
21
|
Lee M, Zeleniuch-Jacquotte A, Liu M. Empirical evaluation of sub-cohort sampling designs for risk prediction modeling. J Appl Stat 2020; 48:1374-1401. [DOI: 10.1080/02664763.2020.1861225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Myeonggyun Lee
- Department of Population Health, NYU School of Medicine, New York, NY, USA
| | - Anne Zeleniuch-Jacquotte
- Department of Population Health, NYU School of Medicine, New York, NY, USA
- Department of Environmental Medicine, NYU School of Medicine, New York, NY, USA
| | - Mengling Liu
- Department of Population Health, NYU School of Medicine, New York, NY, USA
- Department of Environmental Medicine, NYU School of Medicine, New York, NY, USA
| |
Collapse
|
22
|
Error Estimation of Ultra-Short Heart Rate Variability Parameters: Effect of Missing Data Caused by Motion Artifacts. SENSORS 2020; 20:s20247122. [PMID: 33322560 PMCID: PMC7764161 DOI: 10.3390/s20247122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 02/05/2023]
Abstract
Application of ultra–short Heart Rate Variability (HRV) is desirable in order to increase the applicability of HRV features to wrist-worn wearable devices equipped with heart rate sensors that are nowadays becoming more and more popular in people’s daily life. This study is focused in particular on the the two most used HRV parameters, i.e., the standard deviation of inter-beat intervals (SDNN) and the root Mean Squared error of successive inter-beat intervals differences (rMSSD). The huge problem of extracting these HRV parameters from wrist-worn devices is that their data are affected by the motion artifacts. For this reason, estimating the error caused by this huge quantity of missing values is fundamental to obtain reliable HRV parameters from these devices. To this aim, we simulate missing values induced by motion artifacts (from 0 to 70%) in an ultra-short time window (i.e., from 4 min to 30 s) by the random walk Gilbert burst model in 22 young healthy subjects. In addition, 30 s and 2 min ultra-short time windows are required to estimate rMSSD and SDNN, respectively. Moreover, due to the fact that ultra-short time window does not permit assessing very low frequencies, and the SDNN is highly affected by these frequencies, the bias for estimating SDNN continues to increase as the time window length decreases. On the contrary, a small error is detected in rMSSD up to 30 s due to the fact that it is highly affected by high frequencies which are possible to be evaluated even if the time window length decreases. Finally, the missing values have a small effect on rMSSD and SDNN estimation. As a matter of fact, the HRV parameter errors increase slightly as the percentage of missing values increase.
Collapse
|
23
|
Davis KM, Iwaniuk ME, Dennis RL, Harris PA, Burk AO. Effects of grazing muzzles on behavior, voluntary exercise, and physiological stress of miniature horses housed in a herd. Appl Anim Behav Sci 2020. [DOI: 10.1016/j.applanim.2020.105108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
24
|
Shively CA, Appt SE, Chen H, Day SM, Frye BM, Shaltout HA, Silverstein-Metzler MG, Snyder-Mackler N, Uberseder B, Vitolins MZ, Register TC. Mediterranean diet, stress resilience, and aging in nonhuman primates. Neurobiol Stress 2020; 13:100254. [PMID: 33344709 PMCID: PMC7739065 DOI: 10.1016/j.ynstr.2020.100254] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/18/2020] [Accepted: 09/28/2020] [Indexed: 02/06/2023] Open
Abstract
Persistent psychological stress increases the risk of many chronic diseases of aging. Little progress has been made to effectively reduce stress responses or mitigate stress effects suggesting a need for better understanding of factors that influence stress responses. Limited evidence suggests that diet may be a factor in modifying the effects of stress. However, long-term studies of diet effects on stress reactive systems are not available, and controlled randomized clinical trials are difficult and costly. Here we report the outcomes of a controlled, randomized preclinical trial of the effects of long-term consumption (31 months, ~ equivalent to 9 human years) of Western versus Mediterranean - like diets on behavioral and physiological responses to acute (brief social separation) and chronic (social subordination) psychosocial stress in 38 adult, socially-housed, female cynomolgus macaques. Compared to animals fed a Western diet, those fed the Mediterranean diet exhibited enhanced stress resilience as indicated by lower sympathetic activity, brisker and more overt heart rate responses to acute stress, more rapid recovery, and lower cortisol responses to acute psychological stress and adrenocorticotropin (ACTH) challenge. Furthermore, age-related increases in sympathetic activity and cortisol responses to stress were delayed by the Mediterranean diet. Population level diet modification in humans has been shown to be feasible. Our findings suggest that population-wide adoption of a Mediterranean-like diet pattern may provide a cost-effective intervention on psychological stress and promote healthy aging with the potential for widespread efficacy. There is no population level treatment to reduce stress and associated disease. Mediterranean diet reduced sympathetic activity. Mediterranean diet reduced cortisol response to acute stress and to ACTH challenge. Mediterranean diet delayed age-related increases in sympathetic activity and cortisol responses to stress. These results suggest a dietary strategy to increase stress resilience.
Collapse
Affiliation(s)
- Carol A Shively
- Department of Pathology/Comparative Medicine, Wake Forest School of Medicine, USA
| | - Susan E Appt
- Department of Pathology/Comparative Medicine, Wake Forest School of Medicine, USA
| | - Haiying Chen
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, USA
| | - Stephen M Day
- Department of Internal Medicine/Gerontology and Geriatric Medicine, Wake Forest School of Medicine, USA
| | - Brett M Frye
- Department of Pathology/Comparative Medicine, Wake Forest School of Medicine, USA
| | - Hossam A Shaltout
- Department of Obstetrics and Gynecology, Wake Forest School of Medicine, USA
| | | | - Noah Snyder-Mackler
- School of Life Sciences, Center for Evolution and Medicine, Arizona State University, USA
| | - Beth Uberseder
- Department of Pathology/Comparative Medicine, Wake Forest School of Medicine, USA
| | - Mara Z Vitolins
- Department of Epidemiology & Prevention, Wake Forest School of Medicine, USA
| | - Thomas C Register
- Department of Pathology/Comparative Medicine, Wake Forest School of Medicine, USA
| |
Collapse
|
25
|
Davis KM, Iwaniuk ME, Dennis RL, Harris PA, Burk AO. Effects of grazing muzzles on behavior and physiological stress of individually housed grazing miniature horses. Appl Anim Behav Sci 2020. [DOI: 10.1016/j.applanim.2020.105067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
26
|
Vrinceanu T, Lagacé-Lavoie G, Kaushal N, Esmail A, Vu TTM, Berryman N, Nigam A, Bherer L. Mind the Rhythm: ECG QT Dispersion and Cognition in Healthy Older Adults. Front Psychol 2020; 11:566341. [PMID: 33117235 PMCID: PMC7561416 DOI: 10.3389/fpsyg.2020.566341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/14/2020] [Indexed: 12/19/2022] Open
Abstract
Background Autonomic function has been linked to cognitive abilities in aging. Even in non-clinical states, a certain variability in heart rhythm regulation can be measured with QT dispersion (QTcD), an ECG marker of ventricular repolarization which has been linked to autonomic function and cardiovascular health. QTcD has been shown to be higher in individuals with mild cognitive impairment, and the highest in individuals with Alzheimer’s disease. The goal of this study was to see if QTcD is associated with cognitive performance in healthy individuals. Methods Sixty-three healthy inactive older adults (> 60 years) completed an extensive cognitive assessment (including inhibition, divided attention, updating, working memory, and processing speed), a physical fitness assessment, and underwent a resting ECG. Results After controlling for age, sex, and education, QTcD significantly predicted global cognition (MoCA) scores (R2 = 0.17, F(4.58) = 3.00, p < 0.03, β = −0.36). Exploratory analysis on the MoCA subcomponents revealed a significant association between the visual/executive subcomponent and QTcD (R2 = 0.12, F(1.61) = 7.99, p < 0.01, β = −0.34). In individuals with high QTcD, QTcD values were linked to executive functions (R2 = 0.37), processing speed (R2 = 0.34), and dual-task performances (R2 = 0.47). No significant associations were found within the low QTcD group. Conclusion This study shows an association between ventricular repolarization (QTcD) and cognitive performance, in particular speed and executive functions, in healthy older adults. The results provide further support for linking autonomic heart regulation and age-related cognitive changes, and suggest that deviations on ECG, even within-normal range, could help detect early cognitive deficits.
Collapse
Affiliation(s)
- Tudor Vrinceanu
- Department of Medicine, Université de Montréal, Montreal, QC, Canada.,Research Centre, Montreal Heart Institute, Montreal, QC, Canada.,Research Centre, Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada
| | | | - Navin Kaushal
- Department of Health Sciences, School of Health & Human Sciences, Indiana University, Indianapolis, IN, United States
| | - Alida Esmail
- École de Réadaptation, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
| | - T T Minh Vu
- Department of Medicine, Université de Montréal, Montreal, QC, Canada.,Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.,Centre de Recherché du CHUM, Montreal, QC, Canada
| | - Nicolas Berryman
- Research Centre, Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada.,Département des Sciences de l'Activité Physique, Université du Québec à Montréal, Montreal, QC, Canada
| | - Anil Nigam
- Department of Medicine, Université de Montréal, Montreal, QC, Canada.,Research Centre, Montreal Heart Institute, Montreal, QC, Canada
| | - Louis Bherer
- Department of Medicine, Université de Montréal, Montreal, QC, Canada.,Research Centre, Montreal Heart Institute, Montreal, QC, Canada.,Research Centre, Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada
| |
Collapse
|
27
|
Takahashi N, Takahashi Y, Tabara Y, Kawaguchi T, Kuriyama A, Ueshima K, Kosugi S, Sekine A, Yamada R, Matsuda F, Nakayama T. Descriptive epidemiology of high frequency component based on heart rate variability from 10-second ECG data and daily physical activity among community adult residents: the Nagahama Study. Biosci Trends 2020; 14:241-247. [PMID: 32624526 DOI: 10.5582/bst.2020.03146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Characteristics of high frequency (HF) component based on heart rate variability (HRV) in a large general population remain unclear, particularly on the relationship with daily physical activity. We aimed to characterize the distribution of HF component and examine the association with daily physical activity among community residents. We performed spectral analysis of HRV from 10-second ECG recordings among 9135 residents aged 30 to 74 years in Nagahama City, Japan. HF components were log-transformed to consider the distribution. Simple correlations between HF and age were determined. Age-adjusted mean values of HF component were calculated for each questionnaire item related to daily physical activity. Multiple regression analysis was performed to examine the effect of daily physical activity on HF component value. Mean values of logarithmically-transformed HF component (lnHF) were higher in women than in men (p < 0.001). lnHF was inversely associated with age (r = -0.40, -0.49 for men, women, respectively). Adjusted mean lnHF for physically active people was significantly higher than that in inactive people (p < 0.001). HF components from 10-second ECG recordings were moderately and negatively correlated with age in both sexes, and positively correlated with daily physical activity in the general adult population. Maintaining the level of daily physical activity, especially to exercise regularly could keep the parasympathetic function high.
Collapse
Affiliation(s)
- Naomi Takahashi
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Yoshimitsu Takahashi
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Yasuharu Tabara
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takahisa Kawaguchi
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akira Kuriyama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Kenji Ueshima
- Department of EBM Research, Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan
| | - Shinji Kosugi
- Department of Medical Ethics and Medical Genetics, Kyoto University School of Public Health, Kyoto, Japan
| | - Akihiro Sekine
- Department of Omics-based Medicine, Clinical Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Ryo Yamada
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | | |
Collapse
|
28
|
AlJaroudi W. Heart rate and 123I-MIBG in heart failure with preserved ejection fraction: More variability and slower washout-A secret recipe for better survival. J Nucl Cardiol 2020; 27:843-848. [PMID: 30414060 DOI: 10.1007/s12350-018-01514-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 10/30/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Wael AlJaroudi
- Division of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, Lebanon.
| |
Collapse
|
29
|
Sara JDS, Maor E, Borlaug B, Lewis BR, Orbelo D, Lerman LO, Lerman A. Non-invasive vocal biomarker is associated with pulmonary hypertension. PLoS One 2020; 15:e0231441. [PMID: 32298301 PMCID: PMC7162478 DOI: 10.1371/journal.pone.0231441] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 03/08/2020] [Indexed: 12/19/2022] Open
Abstract
Emerging data suggest that noninvasive voice biomarker analysis is associated with coronary artery disease. We recently showed that a vocal biomarker was associated with hospitalization and heart failure in patients with heart failure. We evaluate the association between a vocal biomarker and invasively measured indices of pulmonary hypertension (PH). Patients were referred for an invasive cardiac hemodynamic study between January 2017 and December 2018, and had their voices recorded on three separate occasions to their smartphone prior to each study. A pre-established vocal biomarker was determined based on each individual recording. The intra-class correlation co-efficient between the separate voice recording biomarker values for each individual participant was 0.829 (95% CI 0.740-0.889) implying very good agreement between values. Thus, the mean biomarker was calculated for each patient. Patients were divided into two groups: high pulmonary arterial pressure (PAP) defined as ≥ 35 mmHg (moderate or greater PH), versus lower PAP. Eighty three patients, mean age 61.6 ± 15.1 years, 37 (44.6%) male, were included. Patients with a high mean PAP (≥ 35 mmHg) had on average significantly higher values of the mean voice biomarker compared to those with a lower mean PAP (0.74 ± 0.85 vs. 0.40 ± 0.88 p = 0.046). Multivariate logistic regression showed that an increase in the mean voice biomarker by 1 unit was associated with a high PAP, odds ratio 2.31, 95% CI 1.05-5.07, p = 0.038. This study shows a relationship between a noninvasive vocal biomarker and an invasively derived hemodynamic index related to PH obtained during clinically indicated cardiac catheterization. These results may have important practical clinical implications for telemedicine and remote monitoring of patients with heart failure and PH.
Collapse
Affiliation(s)
- Jaskanwal Deep Singh Sara
- Department of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN, United States of America
| | - Elad Maor
- Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Barry Borlaug
- Department of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN, United States of America
| | - Bradley R. Lewis
- Division of Biomedical Statistics and Informatics, Mayo College of Medicine, Rochester, MN, United States of America
| | - Diana Orbelo
- Divison of Laryngology, Mayo College of Medicine, Rochester, MN, United States of America
| | - Lliach O. Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, United States of America
| | - Amir Lerman
- Department of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN, United States of America
| |
Collapse
|
30
|
Shah AS, Lampert R, Goldberg J, Bremner JD, Li L, Thames MD, Vaccarino V, Shah AJ. Alterations in heart rate variability are associated with abnormal myocardial perfusion. Int J Cardiol 2020; 305:99-105. [PMID: 32024598 PMCID: PMC8019069 DOI: 10.1016/j.ijcard.2020.01.069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/24/2020] [Accepted: 01/27/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Abnormalities in the autonomic nervous system may occur in ischemic heart disease, but the mechanisms by which they are linked are not fully defined. The risk of cardiac events is increased during morning hours. Studying the contributions of autonomic mechanisms may yield insights into risk stratification and treatment. We hypothesize that autonomic dysfunction, measured by decreased heart rate variability (HRV), associates with abnormal stress myocardial perfusion imaging (MPI). METHODS We performed a cross-sectional study of the association between abnormal myocardial stress perfusion with HRV using 276 middle-aged veteran twins without known ischemic heart disease. The primary independent variable was cardiac autonomic regulation measured with 24-hour electrocardiogram (ECG) monitoring, using linear and non-linear (multipole density, or Dyx) HRV metrics. The primary outcome was abnormal perfusion (>5% affected myocardium) during adenosine stress on [13N]-ammonia myocardial perfusion imaging with positron emission tomography. RESULTS The mean (SD) age was 53 (3) years and 55 (20%) had abnormal perfusion. HRV (by Dyx) was reduced during morning hours in subjects with abnormal perfusion. At 7 AM, each standard deviation (SD) decrease in Dyx was associated a 4.8 (95% CI, 1.5 - 15.8) odds ratio (OR) for abnormal MPI. With Dyx < 2.0, the 7 AM OR for abnormal MPI was 11.8 (95% CI, 1.2 - 111.4). CONCLUSIONS Autonomic dysfunction, measured by non-linear HRV in the morning hours, was associated with an increased OR of abnormal MPI. These results suggest a potentially important role of ECG-based biomarkers in risk stratification for individuals with suspected ischemic heart disease.
Collapse
Affiliation(s)
- Anish S Shah
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Rachel Lampert
- Division of Cardiology, Department of Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - Jack Goldberg
- Vietnam Era Twin Registry, Seattle Epidemiologic Research and Information Center, US Department of Veterans Affairs, Seattle, WA, United States of America; Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, United States of America
| | - J Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America; Department of Radiology, Emory University School of Medicine, Atlanta, GA, United States of America; Atlanta Veterans Affairs Medical Center, Atlanta, GA, United States of America
| | - Lian Li
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, United States of America
| | - Marc D Thames
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Viola Vaccarino
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, United States of America; Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Amit J Shah
- Atlanta Veterans Affairs Medical Center, Atlanta, GA, United States of America; Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, United States of America; Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America.
| |
Collapse
|
31
|
Alajam R, Alqahtani AS, Liu W. Effect of Body Weight-Supported Treadmill Training on Cardiovascular and Pulmonary Function in People With Spinal Cord Injury: A Systematic Review. Top Spinal Cord Inj Rehabil 2020; 25:355-369. [PMID: 31844387 DOI: 10.1310/sci2504-355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective: To assess the current evidence with regard to the effects of body weight-supported treadmill training (BWSTT) on cardiovascular and pulmonary function in people with spinal cord injury (SCI) with a focus on outcomes of heart rate (HR), blood pressure (BP), and respiratory parameters. Methods: A systematic literature search was conducted through MEDLINE/PubMed, the Cumulative Index to Nursing and Allied Health Literature, and Physiotherapy Evidence Database. Clinical trials involving adults with SCI and focusing on the effects of BWSTT on HR, BP, and respiratory measurements were included. The quality of included studies was assessed using the Downs and Black scale. The level of evidence of each study was identified using the Spinal Cord Injury Rehabilitation Evidence system. Results: Nine studies that met inclusion criteria were evaluated and included in this review. Overall, the quality index of all included studies was low. All studies scored less than 21 out of 28 on the Downs and Black scale. The level of evidence varied from level 2 to level 4. Level 4 evidence supports the use of BWSTT to decrease resting and exercise HR and improve heart rate variability. The use of BWSTT to improve respiratory parameters after SCI is supported by one study with level 2 evidence. The evidence that supports the use of BWSTT to improve resting BP is inconclusive. Conclusion: There has been low to moderate evidence to support the use of BWSTT in individuals with SCI to improve cardiovascular and pulmonary health. Future randomized controlled trials are needed to investigate the effect of BWSTT on cardiovascular and pulmonary function in people with SCI and compare BWSTT to other physical rehabilitation interventions.
Collapse
Affiliation(s)
- Ramzi Alajam
- Jazan University Faculty of Applied Medical Science, Jazan, Saudi Arabia.,University of Kansas Medical Center, Department of Physical Therapy and Rehabilitation Science, Kansas City, Kansas
| | | | - Wen Liu
- University of Kansas Medical Center, Department of Physical Therapy and Rehabilitation Science, Kansas City, Kansas
| |
Collapse
|
32
|
Koza Y, Aydın MD, Bayram E, Sipal S, Altaş E, Soyalp C, Koza EA. The Role of Cardiac Ganglia in the Prevention of Coronary Atherosclerosis: An Analytical Examination of Cholesterol-fed Rabbits. Balkan Med J 2020; 37:79-83. [PMID: 31712246 PMCID: PMC7094178 DOI: 10.4274/balkanmedj.galenos.2019.2019.8.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background The heart is innervated by the autonomic nervous system, which contributes to the control of the heart’s rhythm and coronary circulation. It has been suggested that the cardiac fibers of the vagus nerve play important roles in controlling circulatory functions and in protecting against atherosclerotic pathologies in coronary arteries. Aims To investigate the presence of atherosclerotic differences in the coronary arteries of cholesterol-fed rabbits by measuring the density of cardiac ganglia neurons. Study Design Animal experiment. Methods This study was conducted using 45 male rabbits. Over a period of 16 weeks, they were kept on an atherogenic diet of water ad libitum and high fat (8.6%) containing saturated fatty acids with 205 mg/kg of cholesterol (1%) per day. Then, their hearts were removed and examined by histopathological methods. Atherosclerotic plaques of the main coronary arteries were examined using the Cavalieri method. Atherosclerosis index values (AIVs) were estimated as the wall surface area/plaque surface area, and the results were analyzed with the Kruskal-Wallis and Mann-Whitney U tests. Results While the average atherosclerosis index value was estimated to be ≤8% in 21 animals, the atherosclerosis index value was 9-20% in animals with minor plaque detection (n=11) and ≥20% in animals with major plaque detection (n=10). Increased atherosclerosis index values were more common in animals with low neuron densities than in animals with high neuron densities (p<0.017). Conclusion The low neuron density of the cardiac ganglia in cholesterol-fed rabbits is associated with an increased atherosclerotic plaque incidence and volume.
Collapse
Affiliation(s)
- Yavuzer Koza
- Department of Cardiology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Mehmet Dumlu Aydın
- Department of Neurosurgery, Atatürk University School of Medicine, Erzurum, Turkey
| | - Ednan Bayram
- Department of Cardiology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Sare Sipal
- Department of Pathology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Ender Altaş
- Clinic of Cardiology, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Celaleddin Soyalp
- Department of Anesthesiology, 100. Yıl University School of Medicine, Van, Turkey
| | - Enise Armağan Koza
- Clinic of Anesthesiology, Erzurum Training and Research Hospital, Erzurum, Turkey
| |
Collapse
|
33
|
Cosgun A, Oren H. Variation of the T-wave peak-end interval and heart rate variability values in healthy males and females at various hours of the same day, and relationship of them. J Arrhythm 2020; 36:118-126. [PMID: 32071630 PMCID: PMC7011832 DOI: 10.1002/joa3.12296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/03/2019] [Accepted: 12/12/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The prolongation of repolarization time between the myocardial epicardium and endocardial cells is closely related to malignant ventricular arrhythmias. The purpose of our study was to compare repolarization markers, namely, T-wave peak-end interval (Tp-e), QT, corrected QT (QTc), Tp-e/QT, Tp-e/corrected QT (QTc), and Heart Rate Variability (HRV) values in healthy men and women and to investigate their daily variations. METHODS A total of 74 male and 78 female participants, being a government employee, and having no health problems, were included in the two study groups (males and females). A 24-hour, 12-lead Holter monitoring was performed on the volunteers. Then, the Tp-e interval and QT interval were measured on recordings. cTp-e and QTc were calculated by the use of Bazzet's formula. RESULTS There was no statistically significant difference between the groups in the cTp-e interval at 07.00 pm; however, it was significantly lower in the female group as compared with the male group at 07.00 am and 01.00 pm. It was significantly higher in the female group at 01.00 am compared with the male group. There were statistically significant moderate negative correlations between Tp-e intervals and a standard deviation of between two normal beats interval (SDNN) values at various hours of the same day. CONCLUSION There were statistically significant differences in terms of Tp-e and cTp-e intervals at various hours of the same day in both groups. In addition, there were statistically significant moderate negative correlations between Tp-e intervals and SDNN at various hours of the same day.
Collapse
Affiliation(s)
- Ayhan Cosgun
- Department of CardiologySincan State HospitalAnkaraTurkey
| | - Huseyin Oren
- Department of CardiologyAnkara City HospitalAnkaraTurkey
| |
Collapse
|
34
|
Chen YY, Wang CC, Kao TW, Wu CJ, Chen YJ, Lai CH, Zhou YC, Chen WL. The relationship between lead and cadmium levels and functional dependence among elderly participants. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:5932-5940. [PMID: 31863379 DOI: 10.1007/s11356-019-07381-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 12/10/2019] [Indexed: 06/10/2023]
Abstract
The adverse impacts of lead and cadmium exposure on health outcomes have been reported in the past. Few studies have been conducted on the relationship between lead and cadmium exposures and disability. We evaluated whether lead and cadmium exposures were associated with functional dependence including the total number of disabilities, activities of daily living (ADL), instrumental activities of daily living (IADL), leisure and social activities (LSA), lower extremity mobility (LEM), and general physical activities (GPA) in an elderly population. A total of 5513 eligible subjects were enrolled in the study from the National Health and Nutrition Examination Survey 2001-2006. Serum lead and cadmium exposure assessments were performed using atomic absorption spectrometry. Functional dependence was assessed by 19 structured questions. The relationships between lead and cadmium exposures and functional dependence were investigated using by multivariable linear regression models. Q2, Q3, and Q4 of lead exposure were significantly associated with the total number of disabilities, with β coefficients of - 0.62 (95% CI - 0.99, - 0.24), - 0.64 (95% CI - 1.02, - 0.26), and - 0.81 (95% CI - 1.19, - 0.42), respectively. This relationship remained significant in males. Furthermore, we analyzed the relationships between lead and cadmium exposure quartiles and various functional dependence metrics, and we determined that lead content was significantly associated with decreased ADL, LEM, and GPA (p < 0.05) and cadmium content was inversely associated with ADL (p < 0.05). Our study demonstrated a strong relationship between exposure to lead and cadmium and functional dependence in an elderly population.
Collapse
Affiliation(s)
- Yuan-Yuei Chen
- Department of Internal Medicine, Tri-Service General Hospital Songshan Branch, and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Department of General Medicine, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chung-Ching Wang
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Tung-Wei Kao
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Graduate Institute of Clinical Medical, College of Medicine, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Chen-Jung Wu
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Division of Family Medicine, Department of Community Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan, Republic of China
| | - Ying-Jen Chen
- Department of Ophthalmology, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Ching-Huang Lai
- School of Public Health, National Defense Medical Center, Taipei, Republic of China
| | - Yi-Chao Zhou
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Wei-Liang Chen
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.
- Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.
| |
Collapse
|
35
|
Goldenberg I, Goldkorn R, Shlomo N, Einhorn M, Levitan J, Kuperstein R, Klempfner R, Johnson B. Heart Rate Variability for Risk Assessment of Myocardial Ischemia in Patients Without Known Coronary Artery Disease: The HRV-DETECT (Heart Rate Variability for the Detection of Myocardial Ischemia) Study. J Am Heart Assoc 2019; 8:e014540. [PMID: 31838969 PMCID: PMC6951049 DOI: 10.1161/jaha.119.014540] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Detecting significant coronary artery disease (CAD) in the general population is complex and relies on combined assessment of traditional CAD risk factors and noninvasive testing. We hypothesized that a CAD‐specific heart rate variability (HRV) algorithm can be used to improve detection of subclinical or early ischemia in patients without known CAD. Methods and Results Between 2014 and 2018 we prospectively enrolled 1043 patients with low to intermediate pretest probability for CAD who were screened for myocardial ischemia in tertiary medical centers in the United States and Israel. Patients underwent 1‐hour Holter testing, with immediate HRV analysis using the HeartTrends DyDx algorithm, followed by exercise stress echocardiography (n=612) or exercise myocardial perfusion imaging (n=431). The threshold for low HRV was identified using receiver operating characteristic analysis based on sensitivity and specificity. The primary end point was the presence of myocardial ischemia detected by exercise stress echocardiography or exercise myocardial perfusion imaging. The mean age of patients was 61 years and 38% were women. Myocardial ischemia was detected in 66 (6.3%) patients. After adjustment for CAD risk factors and exercise stress testing results, low HRV was independently associated with a significant 2‐fold increased likelihood for myocardial ischemia (odds ratio, 2.00; 95% CI, 1.41–2.89 [P=0.01]). Adding HRV to traditional CAD risk factors significantly improved the pretest probability for myocardial ischemia. Conclusions Our data from a large prospective international clinical study show that short‐term HRV testing can be used as a novel digital‐health modality for enhanced risk assessment in low‐ to intermediate‐risk individuals without known CAD. Clinical Trial Registration URL: http://www.ClinicalTrials.gov. Unique identifiers: NCT01657006, NCT02201017).
Collapse
Affiliation(s)
- Ilan Goldenberg
- Division of Cardiology University of Rochester Medical Center Rochester NY.,Leviev Heart Center and the Israeli Association for Cardiovascular Trials Sheba Medical Center Tel Hashomer Israel.,Tel Aviv University Tel Aviv Israel
| | | | - Nir Shlomo
- Leviev Heart Center and the Israeli Association for Cardiovascular Trials Sheba Medical Center Tel Hashomer Israel
| | - Michal Einhorn
- Leviev Heart Center and the Israeli Association for Cardiovascular Trials Sheba Medical Center Tel Hashomer Israel
| | | | - Raphael Kuperstein
- Leviev Heart Center and the Israeli Association for Cardiovascular Trials Sheba Medical Center Tel Hashomer Israel
| | - Robert Klempfner
- Leviev Heart Center and the Israeli Association for Cardiovascular Trials Sheba Medical Center Tel Hashomer Israel
| | - Bruce Johnson
- Cardiac Rehabilitation Center Mayo Clinic Rochester MN
| |
Collapse
|
36
|
Shah AS, El Ghormli L, Vajravelu ME, Bacha F, Farrell RM, Gidding SS, Levitt Katz LE, Tryggestad JB, White NH, Urbina EM. Heart Rate Variability and Cardiac Autonomic Dysfunction: Prevalence, Risk Factors, and Relationship to Arterial Stiffness in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) Study. Diabetes Care 2019; 42:2143-2150. [PMID: 31501226 PMCID: PMC6804614 DOI: 10.2337/dc19-0993] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/22/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine whether prior type 2 diabetes (T2D) treatment or glycemic control over time are independently associated with heart rate variability (HRV) and whether the presence of cardiac autonomic dysfunction is associated with arterial stiffness in young adults with youth-onset T2D enrolled in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study. RESEARCH DESIGN AND METHODS Heartbeats over 10 min were measured to derive the normal R-Rs (NN intervals). Outcomes included the standard deviation of the NN intervals (SDNN), the root mean square differences of successive NN intervals (RMSSD), percent of NN beats that differ by more than 50 ms (PNN50), and the low-frequency (LF) power domain, high-frequency (HF) power domain, and their ratio (LF:HF). Autonomic dysfunction was defined as ≥3 of 5 abnormal HRV indices compared with obese controls from a separate study. RESULTS A total of 397 TODAY participants were evaluated 7 years after randomization. TODAY participants had reduced HRV (SDNN 58.1 ± 29.6 ms vs. controls 67.1 ± 25.4 ms; P < 0.0001) with parasympathetic loss (RMSSD 53.2 ± 36.7 ms vs. controls 67.9 ± 35.2 ms; P < 0.0001) with sympathetic overdrive (LF:HF ratio 1.4 ± 1.7 vs. controls 1.0 ± 1.1; P < 0.0001). Cardiac autonomic dysfunction was present in 8% of TODAY participants, and these participants had greater pulse wave velocity compared with those without dysfunction (P = 0.0001). HRV did not differ by randomized treatment, but higher hemoglobin A1c (HbA1c) over time was independently associated with lower SDNN and RMSSD and higher LF:HF ratio after adjustment for age, race-ethnicity, sex, and BMI. CONCLUSIONS Young adults with youth-onset T2D show evidence of cardiac autonomic dysfunction with both parasympathetic and sympathetic impairments that are associated with higher HbA1c.
Collapse
Affiliation(s)
- Amy S Shah
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH
| | - Laure El Ghormli
- George Washington University Biostatistics Center, Rockville, MD
| | | | - Fida Bacha
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | | | | | | | | | - Neil H White
- Washington University in St. Louis, St. Louis, MO
| | - Elaine M Urbina
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH
| |
Collapse
|
37
|
Wagner JA, Feinn R, Lampert R, Bermúdez-Millán A, Pérez-Escamilla R. Changes in negative affect and changes in heart rate variability among low-income latinos with type 2 diabetes in a randomized, controlled stress management trial. J Psychosom Res 2019; 124:109774. [PMID: 31443815 DOI: 10.1016/j.jpsychores.2019.109774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 07/05/2019] [Accepted: 07/05/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Structural equation modeling examined the relationship between change in negative affect (NA) and change in heart rate variability (HRV) among 121 Latinos with type 2 diabetes. METHODS This study leveraged data from the Community Health Workers Assisting Latinos Manage Stress and Diabetes (CALMSD) study which compared diabetes education vs diabetes education plus stress management. Participants completed surveys of NA at baseline and again 8-10 weeks later. They also wore 7‑lead, 3-channel ambulatory ECG monitors for 24 h at both time points. The latent variable NA was modeled by observed scores on symptoms of depression, anxiety, diabetes distress, and wellbeing (reversed). The latent variable HRV was modeled by observed scores in the time domain (the standard deviation of the R-R interval [SDNN] and the root mean square of the successive differences [RMSSD]) and in the frequency domain, i.e., log-transformed ultra-low frequency, very-low frequency, low frequency, and high frequency. RESULTS At baseline, there were strong, negative cross-sectional associations between NA and HRV. Baseline NA predicted change in HRV, whereas baseline HRV did not predict change in NA. Controlling for fasting glucose and treatment assignment did not meaningfully alter the findings. Stress management improved NA but not HRV. At followup, a greater reduction (improvement) in NA was associated with a larger increase (improvement) in HRV, with a small-to-medium negative association that approached statistical significance. CONCLUSIONS Findings indicate a longitudinal relationship between NA and HRV, and suggest that improvement in one may be associated with improvement in the other.
Collapse
Affiliation(s)
- Julie A Wagner
- University of Connecticut Schools of Medicine and Dental Medicine, United States of America.
| | - Richard Feinn
- Quinnipiac University School of Medicine, United States of America
| | - Rachel Lampert
- Yale University School of Medicine, United States of America
| | | | | |
Collapse
|
38
|
Heritability and genetic correlations of heart rate variability at rest and during stress in the Oman Family Study. J Hypertens 2019; 36:1477-1485. [PMID: 29557905 PMCID: PMC5991177 DOI: 10.1097/hjh.0000000000001715] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Supplemental Digital Content is available in the text Introduction: Individual differences in heart rate variability (HRV) can be partly attributed to genetic factors that may be more pronounced during stress. Using data from the Oman Family Study (OFS), we aimed to estimate and quantify the relative contribution of genes and environment to the variance of HRV at rest and during stress; calculate the overlap in genetic and environmental influences on HRV at rest and under stress using bivariate analyses of HRV parameters and heart rate (HR). Methods: Time and frequency domain HRV variables and average HR were measured from beat-to-beat HR obtained from electrocardiogram recordings at rest and during two stress tests [mental: Word Conflict Test (WCT) and physical: Cold Pressor Test (CPT)] in the OFS – a multigenerational pedigree consisting of five large Arab families with a total of 1326 participants. SOLAR software was used to perform quantitative genetic modelling. Results: Heritability estimates for HRV and HR ranged from 0.11 to 0.31 for rest, 0.09–0.43 for WCT, and 0.07–0.36 for CPT. A large part of the genetic influences during rest and stress conditions were shared with genetic correlations ranging between 0.52 and 0.86 for rest-WCT and 0.60–0.92 for rest-CPT. Nonetheless, genetic rest–stress correlations for most traits were significantly smaller than 1 indicating some stress-specific genetic effects. Conclusion: Genetic factors significantly influence HRV and HR at rest and under stress. Most of the genetic factors that influence HRV at rest also influence HRV during stress tests, although some unique genetic variance emerges during these challenging conditions.
Collapse
|
39
|
Otsuka K, Cornelissen G, Kubo Y, Shibata K, Mizuno K, Ohshima H, Furukawa S, Mukai C. Anti-aging effects of long-term space missions, estimated by heart rate variability. Sci Rep 2019; 9:8995. [PMID: 31222071 PMCID: PMC6586662 DOI: 10.1038/s41598-019-45387-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 06/05/2019] [Indexed: 02/07/2023] Open
Abstract
Reports that aging slows down in space prompted this investigation of anti-aging effects in humans by analyzing astronauts' heart rate variability (HRV). Ambulatory 48-hour electrocardiograms from 7 astronauts (42.1 ± 6.8 years; 6 men) 20.6 ± 2.7 days (ISS01) and 138.6 ± 21.8 days (ISS02) after launch were divided into 24-hour spans of relative lower or higher magnetic disturbance, based on geomagnetic measures in Tromso, Norway. Magnetic disturbances were significantly higher on disturbed than on quiet days (ISS01: 72.01 ± 33.82 versus 33.96 ± 17.90 nT, P = 0.0307; ISS02: 71.06 ± 51.52 versus 32.53 ± 27.27 nT, P = 0.0308). SDNNIDX was increased on disturbed days (by 5.5% during ISS01, P = 0.0110), as were other HRV indices during ISS02 (SDANN, 12.5%, P = 0.0243; Triangular Index, 8.4%, P = 0.0469; and TF-component, 17.2%, P = 0.0054), suggesting the action of an anti-aging or longevity effect. The effect on TF was stronger during light (12:00-17:00) than during darkness (0:00-05:00) (P = 0.0268). The brain default mode network (DMN) was activated, gauged by increases in the LF-band (9.7%, P = 0.0730) and MF1-band (9.9%, P = 0.0281). Magnetic changes in the magnetosphere can affect and enhance HRV indices in space, involving an anti-aging or longevity effect, probably in association with the brain DMN, in a light-dependent manner and/or with help from the circadian clock.
Collapse
Affiliation(s)
- Kuniaki Otsuka
- Executive Medical Center, Totsuka Royal Clinic, Tokyo Women's Medical University, Tokyo, Japan.
- Halberg Chronobiology Center, University of Minnesota, Minneapolis, Minnesota, USA.
| | - Germaine Cornelissen
- Halberg Chronobiology Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Yutaka Kubo
- Department of Medicine, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan
| | - Koichi Shibata
- Department of Medicine, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan
| | - Koh Mizuno
- Faculty of Education, Tohoku Fukushi University, Miyagi, Japan
- Space Biomedical Research Group, Japan Aerospace Exploration Agency, Tokyo, Japan
| | - Hiroshi Ohshima
- Space Biomedical Research Group, Japan Aerospace Exploration Agency, Tokyo, Japan
| | - Satoshi Furukawa
- Space Biomedical Research Group, Japan Aerospace Exploration Agency, Tokyo, Japan
| | - Chiaki Mukai
- Space Biomedical Research Group, Japan Aerospace Exploration Agency, Tokyo, Japan
| |
Collapse
|
40
|
Psychological Traits, Heart Rate Variability, and Risk of Coronary Heart Disease in Healthy Aging Women-The Women's Health Initiative. Psychosom Med 2019; 81:256-264. [PMID: 30688770 PMCID: PMC6443472 DOI: 10.1097/psy.0000000000000672] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Psychological traits such as optimism and hostility affect coronary heart disease (CHD) risk, but mechanisms for this association are unclear. We hypothesized that optimism and hostility may affect CHD risk via changes in heart rate variability (HRV). METHODS We conducted a longitudinal analysis using data from the Women's Health Initiative Myocardial Ischemia and Migraine Study. Participants underwent 24-hour ambulatory electrocardiogram monitoring 3 years after enrollment. Optimism (Life Orientation Test-Revised), cynical hostility (Cook-Medley), demographics, and coronary risk factors were assessed at baseline. HRV measures included standard deviation of average N-N intervals (SDNN); standard deviation of average N-N intervals for 5 minutes (SDANN); and average heart rate (HR). CHD was defined as the first occurrence of myocardial infarction, angina, coronary angioplasty, and bypass grafting. Linear and Cox regression models adjusted for CHD risk factors were used to examine, respectively, associations between optimism, hostility, and HRV and between HRV and CHD risk. RESULTS Final analyses included 2655 women. Although optimism was not associated with HRV, hostility was inversely associated with HRV 3 years later (SDANN: adjusted β = -0.54; 95% CI = -0.97 to -0.11; SDNN: -0.49; 95% CI = -0.93 to -0.05). HRV was inversely associated with CHD risk; for each 10-millisecond increase in SDNN or SDANN, there was a decrease in CHD risk of 9% (p = .023) and 12% (p = .006), respectively. CONCLUSIONS HRV did not play a major role in explaining why more optimistic women seem to be somewhat protected from CHD risk. Although hostility was inversely associated with HRV, its role in explaining the association between hostility and CHD risk remains to be established.
Collapse
|
41
|
Heart rate variability for treatment response between patients with major depressive disorder versus panic disorder: A 12-week follow-up study. J Affect Disord 2019; 246:157-165. [PMID: 30583140 DOI: 10.1016/j.jad.2018.12.048] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 11/08/2018] [Accepted: 12/16/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Heart Rate Variability (HRV) parameters have been used to evaluate the autonomic nervous system. We hypothesized that patients with major depressive disorder (MDD) and panic disorder (PD) showed different HRV profiles compared to healthy controls. We also hypothesized that we could predict the responder groups in the MDD and PD patients, using differences in HRV indices between the stress and rest phases. METHODS 28 MDD patients and 29 PD patients were followed for 12 weeks, and we also followed 39 healthy control subjects. We measured HRV parameters at the rest, stress, and recovery phases. RESULTS Patients with MDD and PD demonstrated lower pNN50 than controls during the stress (F = 7.49, p = 0.001), and recovery phases (F = 9.43, p = 0.0001). Patients with MDD and PD also showed higher LF/HF ratio than controls during the stress phase (F = 6.15, p = 0.002). Responders in the PD group presented a lower level of LF/HF ratio during the stress phase compared to non-responders (F = 10.14, p = 0.002), while responders in the MDD group showed a lower level of heart rate during all three phases, compared to non-responders. Additionally, we could predict treatment response in patients with MDD using ΔLF/HF ratio (OR: 1.33, 95% CI = 1.07-1.65, p = 0.011) and ΔpNN50 (OR: 1.49, 95% CI 1.09-1.77, p = 0.014). CONCLUSION The changes of HRV parameters of pNN50 and LF/HF ratio between the stress and recovery phase may be clinical markers of predictors of treatment responsiveness in MDD and PD patients.
Collapse
|
42
|
de Geus EJC, Gianaros PJ, Brindle RC, Jennings JR, Berntson GG. Should heart rate variability be "corrected" for heart rate? Biological, quantitative, and interpretive considerations. Psychophysiology 2019; 56:e13287. [PMID: 30357862 PMCID: PMC6378407 DOI: 10.1111/psyp.13287] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 12/30/2022]
Abstract
Metrics of heart period variability are widely used in the behavioral and biomedical sciences, although somewhat confusingly labeled as heart rate variability (HRV). Despite their wide use, HRV metrics are usually analyzed and interpreted without reference to prevailing levels of cardiac chronotropic state (i.e., mean heart rate or mean heart period). This isolated treatment of HRV metrics is nontrivial. All HRV metrics routinely used in the literature exhibit a known and positive relationship with the mean duration of the interval between two beats (heart period): as the heart period increases, so does its variability. This raises the question of whether HRV metrics should be "corrected" for the mean heart period (or its inverse, the heart rate). Here, we outline biological, quantitative, and interpretive issues engendered by this question. We provide arguments that HRV is neither uniformly nor simply a surrogate for heart period. We also identify knowledge gaps that remain to be satisfactorily addressed with respect to assumptions underlying existing HRV correction approaches. In doing so, we aim to stimulate further progress toward the rigorous use and disciplined interpretation of HRV. We close with provisional guidance on HRV reporting that acknowledges the complex interplay between the mean and variability of the heart period.
Collapse
Affiliation(s)
- Eco J. C. de Geus
- Department of Biological PsychologyVrije UniversiteitAmsterdamThe Netherlands
| | - Peter J. Gianaros
- Departments of Psychology and PsychiatryUniversity of PittsburghPittsburghPennsylvania
| | - Ryan C. Brindle
- Department of Psychology & Neuroscience ProgramWashington and Lee UniversityLexingtonVirginia
| | - J. Richard Jennings
- Departments of Psychology and PsychiatryUniversity of PittsburghPittsburghPennsylvania
| | | |
Collapse
|
43
|
Berntson GG. Presidential Address 2011: Autonomic modes of control and health. Psychophysiology 2019; 56:e13306. [PMID: 30556212 DOI: 10.1111/psyp.13306] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/30/2018] [Accepted: 10/30/2018] [Indexed: 12/19/2022]
Abstract
Understanding psychosomatic relations, and their implications for heath, is importantly dependent on our conceptual and measurement models. The historical view of reciprocal control of the autonomic branches is applicable in some contexts, but not others. Control of the autonomic branches can vary reciprocally, independently, and even coactively. Assessment of sympathovagal balance, based on a reciprocal model of regulation of the autonomic branches, may have applications in orthostatic contexts and in insulin resistance in diabetes. However, it does not adequately capture the pattern of autonomic control that is relevant for myocardial infarction (MI; in humans) and experimental cardiac arrest (in mice). A measure of sympathovagal balance (cardiac autonomic balance) was predictive and informative of the autonomic contributions to diabetes but was blind to autonomic contributions to cardiac arrest and its sequelae. However, a metric designed to capture the coactivity dimension of cardiac autonomic regulation (CAR) was predictive of MI and its sequelae. Both human and animal model studies revealed that low CAR (low sympathetic and especially low parasympathetic control) predicted the occurrence of MI and the neuroinflammatory consequences of cardiac arrest. These effects were importantly modulated by social support in both humans and animals, via an apparent oxytocinergic pathway that impacts parasympathetic cardiac control and CAR, and thus neuroinflammation. Results indicate the importance of a physiologically meaningful model of autonomic control in understanding health implications of the modes of autonomic control.
Collapse
Affiliation(s)
- Gary G Berntson
- Department of Psychology, The Ohio State University, Columbus, Ohio
| |
Collapse
|
44
|
Wang ML, Lin PL, Huang CH, Huang HH. Decreased Parasympathetic Activity of Heart Rate Variability During Anticipation of Night Duty in Anesthesiology Residents. Anesth Analg 2018; 126:1013-1018. [PMID: 29200073 DOI: 10.1213/ane.0000000000002439] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND In residency programs, it is well known that autonomic regulation is influenced by night duty due to workload stress and sleep deprivation. A less investigated question is the impact on the autonomic nervous system of residents before or when anticipating a night duty shift. In this study, heart rate variability (HRV) was evaluated as a measure of autonomic nervous system regulation. METHODS Eight residents in the Department of Anesthesiology were recruited, and 5 minutes of electrocardiography were recorded under 3 different conditions: (1) the morning of a regular work day (baseline); (2) the morning before a night duty shift (anticipating the night duty); and (3) the morning after a night duty shift. HRV parameters in the time and frequency domains were calculated. Repeated measures analysis of variance was performed to compare the HRV parameters among the 3 conditions. RESULTS There was a significant decrease of parasympathetic-related HRV measurements (high-frequency power and root mean square of the standard deviation of R-R intervals) in the morning before night duty compared with the regular work day. The mean difference of high-frequency power between the 2 groups was 80.2 ms (95% confidence interval, 14.5-146) and that of root mean square of the standard deviation of R-R intervals was 26 milliseconds (95% confidence interval, 7.2-44.8), with P = .016 and .007, respectively. These results suggest that the decrease of parasympathetic activity is associated with stress related to the condition of anticipating the night duty work. On the other hand, the HRV parameters in the morning after duty were not different from the regular workday. CONCLUSIONS The stress of anticipating the night duty work may affect regulation of the autonomic nervous system, mainly manifested as a decrease in parasympathetic activity. The effect of this change on the health of medical personnel deserves our concern.
Collapse
Affiliation(s)
- Man-Ling Wang
- From the Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pei-Lin Lin
- From the Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Hsiang Huang
- From the Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Hui-Hsun Huang
- From the Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| |
Collapse
|
45
|
Fonkoue IT, Norrholm SD, Marvar PJ, Li Y, Kankam ML, Rothbaum BO, Park J. Elevated resting blood pressure augments autonomic imbalance in posttraumatic stress disorder. Am J Physiol Regul Integr Comp Physiol 2018; 315:R1272-R1280. [PMID: 30303706 DOI: 10.1152/ajpregu.00173.2018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Posttraumatic stress disorder (PTSD) is characterized by increased sympathetic nervous system (SNS) activity, blunted parasympathetic nervous system (PNS) activity, and impaired baroreflex sensitivity (BRS), which contribute to accelerated cardiovascular disease. Patients with PTSD also have chronic stress-related elevations in resting blood pressure (BP), often in the prehypertensive range; yet, it is unclear if elevated resting blood pressure (ERBP) augments these autonomic derangements in PTSD. We hypothesized that compared with normotensive PTSD (N-PTSD), those with ERBP (E-PTSD) have further increased SNS, decreased PNS activity, and impaired BRS at rest and exaggerated SNS reactivity, PNS withdrawal, and pressor responses during stress. In 16 E-PTSD and 17 matched N-PTSD, we measured continuous BP, ECG, muscle sympathetic nerve activity (MSNA), and heart rate variability (HRV) markers reflecting cardiac PNS activity [standard deviation of R-R intervals (SDNN), root mean square of differences in successive R-R intervals (RMSSD), and high frequency power (HF)] during 5 min of rest and 3 min of mental arithmetic. Resting MSNA ( P = 0.943), sympathetic BRS ( P = 0.189), and cardiovagal BRS ( P = 0.332) were similar between groups. However, baseline SDNN (56 ± 6 vs. 78 ± 8 ms, P = 0.019), RMSSD (39 ± 6 vs. 63 ± 9 ms, P = 0.018), and HF (378 ± 103 vs. 693 ± 92 ms2, P = 0.015) were lower in E-PTSD versus N-PTSD. During mental stress, the systolic blood pressure response ( P = 0.011) was augmented in E-PTSD. Although MSNA reactivity was not different ( P > 0.05), the E-PTSD group had an exaggerated reduction in HRV during mental stress ( P < 0.05). PTSD with ERBP have attenuated resting cardiac PNS activity, coupled with exaggerated BP reactivity and PNS withdrawal during stress.
Collapse
Affiliation(s)
- Ida T Fonkoue
- Renal Division, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia.,Research Service Line, Atlanta Veteran Affairs Medical Center, Decatur, Georgia
| | - Seth D Norrholm
- Mental Health Service Line, Atlanta Veteran Affairs Medical Center, Decatur, Georgia.,Psychiatry and Behavioral Sciences, Emory University , Atlanta, Georgia
| | - Paul J Marvar
- Department of Pharmacology and Physiology, Institute for Neuroscience, George Washington University , Washington, District of Columbia
| | - Yunxiao Li
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University , Atlanta, Georgia
| | - Melanie L Kankam
- Renal Division, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia.,Research Service Line, Atlanta Veteran Affairs Medical Center, Decatur, Georgia
| | - Barbara O Rothbaum
- Department of Pharmacology and Physiology, Institute for Neuroscience, George Washington University , Washington, District of Columbia
| | - Jeanie Park
- Renal Division, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia.,Research Service Line, Atlanta Veteran Affairs Medical Center, Decatur, Georgia
| |
Collapse
|
46
|
Dedhia RC, Shah AJ, Bliwise DL, Quyyumi AA, Strollo PJ, Li Q, Da Poian G, Clifford GD. Hypoglossal Nerve Stimulation and Heart Rate Variability: Analysis of STAR Trial Responders. Otolaryngol Head Neck Surg 2018; 160:165-171. [PMID: 30223721 DOI: 10.1177/0194599818800284] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Hypoglossal nerve stimulation represents a novel therapy for the treatment of moderate-severe obstructive sleep apnea; nonetheless, its cardiovascular effects are not known. We examine the effects of hypoglossal nerve stimulation on heart rate variability, a measure of autonomic function. STUDY DESIGN Substudy of the STAR trial (Stimulation Therapy for Apnea Reduction): a multicenter prospective single-group cohort. SETTING Academic and private practice centers in the United States and Europe. SUBJECTS AND METHODS A subset of responder participants (n = 46) from the STAR trial was randomized to therapy withdrawal or therapy maintenance 12 months after surgery. Heart rate variability analysis included standard deviation of the R-R interval (SDNN), low-frequency power of the R-R interval, and high-frequency power of the R-R interval. Analysis was performed by sleep with 5-minute sliding window epochs during baseline, 12 months, and the maintenance/withdrawal period. RESULTS A significant improvement from baseline to 12 months in heart rate variability was seen for SDNN and low frequency across all sleep stages. SDNN analysis demonstrated no change in the wake period (mean ± SD: 0.042 ± 0.01 vs 0.077 ± 0.07, P = .19). Reduction in SDNN was correlated to improvement in apnea-hypopnea index ( r = 0.39, P = .03). In the therapy withdrawal group, no significant changes in SDNN were seen for N1/N2, N3, or rapid eye movement sleep. CONCLUSION Hypoglossal nerve stimulation therapy appears to reduce heart rate variability during sleep. This reduction was not affected by a 1-week withdrawal period. Larger prospective studies are required to better understand the effect of hypoglossal nerve stimulation on autonomic dysfunction in obstructive sleep apnea.
Collapse
Affiliation(s)
- Raj C Dedhia
- 1 Department of Otolaryngology, School of Medicine, Emory University, Atlanta, Georgia, USA.,2 Emory Sleep Center, Emory Healthcare, Atlanta, Georgia, USA
| | - Amit J Shah
- 3 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | - Arshed A Quyyumi
- 4 Division of Cardiology, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Patrick J Strollo
- 5 Division of Pulmonary, Allergy and Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Qiao Li
- 6 Department of Biomedical Informatics, Emory University, Atlanta, Georgia, USA.,7 Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Giulia Da Poian
- 6 Department of Biomedical Informatics, Emory University, Atlanta, Georgia, USA.,7 Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Gari D Clifford
- 6 Department of Biomedical Informatics, Emory University, Atlanta, Georgia, USA.,7 Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| |
Collapse
|
47
|
Cha SA, Park YM, Yun JS, Lee SH, Ahn YB, Kim SR, Ko SH. Time- and frequency-domain measures of heart rate variability predict cardiovascular outcome in patients with type 2 diabetes. Diabetes Res Clin Pract 2018; 143:159-169. [PMID: 30006307 PMCID: PMC6278593 DOI: 10.1016/j.diabres.2018.07.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/07/2018] [Accepted: 07/02/2018] [Indexed: 12/18/2022]
Abstract
AIMS To evaluate the association between impaired heart rate variability (HRV) and cardiovascular disease (CVD) in patients with type 2 diabetes (T2DM). METHODS A total of 655 patients with T2DM who underwent cardiovascular autonomic function testing were consecutively recruited and followed up prospectively. Time- and frequency-domain HRV were assessed for 5 min by beat-to-beat heart rate recording. We estimated the development of CVD events during a follow-up period. RESULTS During a median follow-up of 7.8 years, 9.6% (n = 49) of patients developed CVD (10.6 per 1000 patient-years). The mean age and diabetes duration were 54.9 ± 8.6 years and 9.4 ± 7.3 years, respectively. Patients who had cardiovascular autonomic neuropathy (CAN) had decreased HRV compared with those with normal autonomic function. Multivariable cox hazard regression analysis revealed the lowest 10th percentile of the SD of the normal-to-normal interval (HR 2.62; 95% CI 1.30-5.31), total power (HR 2.81; 95% CI 1.37-5.79), low-frequency power (HR 2.68; 95% CI 1.28-5.59), and high-frequency power (HR 2.24; 95% CI 1.09-4.59) were significant predictors for developing CVD in patients with T2DM. CONCLUSIONS Time- and frequency-domain measures of HRV independently predicted cardiovascular outcome in patients with T2DM.
Collapse
Affiliation(s)
- Seon-Ah Cha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea
| | - Yong-Moon Park
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - Jae-Seung Yun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea
| | - Seung-Hwan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yu-Bae Ahn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea
| | - Sung-Rae Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea
| | - Seung-Hyun Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea.
| |
Collapse
|
48
|
Takahashi N, Kuriyama A, Kanazawa H, Takahashi Y, Nakayama T. Validity of spectral analysis based on heart rate variability from 1-minute or less ECG recordings. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 40:1004-1009. [PMID: 28594089 DOI: 10.1111/pace.13138] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 04/15/2017] [Accepted: 05/26/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND To broaden the utility of heart rate variability (HRV) in clinical medicine and mass screening, results based on shorter electrocardiogram (ECG) recordings require validation with those based on standard 5-minute recordings. We investigated the association between HRV variables obtained from 5-minute ECGs with those obtained from ECGs shorter than 5 minutes. METHODS Twenty-two participants aged 20-69 years underwent 5-minute resting ECG recordings in the supine position with natural breathing. Spectral analysis using MemCalc method was performed to calculate high-frequency (HF, which required at least 10 seconds) and low-frequency (LF, which required at least 30 seconds) components. Participants were not strictly preconditioned as in previous experimental studies in order to simulate a setting similar to that of a general health checkup. Associations of each variable between the 5-minute ECG recordings and those for shorter recordings were examined by Pearson's correlation coefficients and Bland-Altman plots. RESULTS HF and LF components were log-transformed based on their distributions. Correlation coefficients between 5-minute data and shorter recordings in the supine position with natural breathing ranged from 0.80 to 0.91 (HF by 10-second recording, 0.80; LF by 30-second recording, 0.83, respectively). Bland-Altman plots showed that gaps between the values from both methods slightly increased as the HF and LF component values increased. CONCLUSIONS Although slight proportional errors were possible, values from standard 5-minute and shorter recordings in the supine position were strongly correlated. Our findings suggest that shorter ECG data without strict preconditioning can be reliably used for spectral analysis.
Collapse
Affiliation(s)
- Naomi Takahashi
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Akira Kuriyama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Hoshinori Kanazawa
- Department of Mechano-Informatics, Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Yoshimitsu Takahashi
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| |
Collapse
|
49
|
Huang M, Shah A, Su S, Goldberg J, Lampert RJ, Levantsevych OM, Shallenberger L, Pimple P, Bremner JD, Vaccarino V. Association of Depressive Symptoms and Heart Rate Variability in Vietnam War-Era Twins: A Longitudinal Twin Difference Study. JAMA Psychiatry 2018; 75:705-712. [PMID: 29799951 PMCID: PMC6059565 DOI: 10.1001/jamapsychiatry.2018.0747] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Depressive symptoms are associated with lower heart rate variability (HRV), an index of autonomic dysregulation, but the direction of the association remains unclear. OBJECTIVE To investigate the temporal association between depression and HRV. DESIGN, SETTINGS, AND PARTICIPANTS A longitudinal, cross-lagged twin difference study, with baseline assessments from March 2002 to March 2006 (visit 1) and a 7-year follow-up (visit 2) at an academic research center with participants recruited from a national twin registry. Twins (n = 166) from the Vietnam Era Twin Registry, who served in the US military during the Vietnam War, and were discordant for depression at baseline were recruited. MAIN OUTCOMES AND MEASURES At both visits, depressive symptoms were measured using the Beck Depression Inventory-II (BDI-II), and HRV was measured through 24-hour electrocardiogram monitoring. To assess the direction of the association, within-pair differences in multivariable mixed-effects regression models were examined, and standardized β coefficients for both pathways were calculated. The associations were evaluated separately in monozygotic and dizygotic twins. RESULTS In the final analytic sample (N = 146), all participants were men, 138 (95%) were white, and the mean (SD) age was 54 (3) years at baseline. Results showed consistent associations between visit 1 HRV and visit 2 BDI score across all HRV domains and models (β coefficients ranging from -0.14 to -0.29), which were not explained by antidepressants or other participant characteristics. The magnitude of the association was similar in the opposite pathway linking visit 1 BDI score to visit 2 HRV, with β coefficients ranging from 0.05 to -0.30, but it was largely explained by antidepressant use. In stratified analysis by zygosity, significant associations were observed in monozygotic and dizygotic twins for the path linking visit 1 HRV to visit 2 BDI score, although the associations were slightly stronger in dizygotic twins. CONCLUSIONS AND RELEVANCE The association between depression and autonomic dysregulation, indexed by HRV, is bidirectional, with stronger evidence suggesting that autonomic function affects depression risk rather than vice versa. The opposite causal pathway from depression to lower HRV is mostly driven by antidepressant use. These findings highlight an important role of autonomic nervous system in the risk of depression and contribute new understanding of the mechanisms underlying the comorbidity of depression and cardiovascular disease.
Collapse
Affiliation(s)
- Minxuan Huang
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Amit Shah
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia,Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Shaoyong Su
- Department of Pediatrics, Georgia Prevention Institute, Augusta University, Augusta, Georgia
| | - Jack Goldberg
- Vietnam Era Twin Registry, Seattle Epidemiologic Research and Information Center, US Department of Veterans Affairs, Seattle, Washington,Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington
| | - Rachel J. Lampert
- Division of Cardiology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Oleksiy M. Levantsevych
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Lucy Shallenberger
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Pratik Pimple
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - J. Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia,Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
| | - Viola Vaccarino
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia,Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
50
|
Sugrue A, Mahowald J, Asirvatham SJ. Hey Goglexiri, Do I Have Coronary Artery Disease? Mayo Clin Proc 2018; 93:818-820. [PMID: 29976371 DOI: 10.1016/j.mayocp.2018.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 05/29/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Alan Sugrue
- Department of Cardiovascular Diseases, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN
| | - Jillian Mahowald
- Department of Cardiovascular Diseases, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN
| | - Samuel J Asirvatham
- Department of Cardiovascular Diseases, Division of Heart Rhythm Services, Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN.
| |
Collapse
|