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Silva LRB, Gentil P, Seguro CS, de Oliveira GT, Silva MS, Zamunér AR, Beltrame T, Rebelo ACS. High Fasting Glycemia Predicts Impairment of Cardiac Autonomic Control in Adults With Type 2 Diabetes: A Case-Control Study. Front Endocrinol (Lausanne) 2021; 12:760292. [PMID: 34858333 PMCID: PMC8630737 DOI: 10.3389/fendo.2021.760292] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/22/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Type 2 diabetes (T2D) is characterized by a metabolic disorder that elevates blood glucose concentration. Chronic hyperglycemia has been associated with several complications in patients with T2D, one of which is cardiac autonomic dysfunction that can be assessed from heart rate variability (HRV) and heart rate recovery (HRR) response, both associated with many aspects of health and fitness, including severe cardiovascular outcomes. OBJECTIVE To evaluate the effects of T2D on cardiac autonomic modulation by means of HRV and HRR measurements. MATERIALS AND METHODS This study has an observational with case-control characteristic and involved ninety-three middle-aged adults stratified into two groups (control group - CG, n = 34; diabetes group - DG, n = 59). After signing the free and informed consent form, the patients were submitted to the evaluation protocols, performed biochemical tests to confirm the diagnosis of T2D, collection of R-R intervals for HRV analysis and cardiopulmonary effort test to quantify HRR. RESULTS At rest, the DG showed a reduction in global HRV (SDNN= 19.31 ± 11.72 vs CG 43.09 ± 12.74, p < 0.0001), lower parasympathetic modulation (RMSSD= 20.49 ± 14.68 vs 52.41 ± 19.50, PNN50 = 4.76 ± 10.53 vs 31.24 ± 19.24, 2VD%= 19.97 ± 10.30 vs 28.81 ± 9.77, p < 0.0001 for both indices) and higher HRrest when compared to CG. After interruption of physical exercise, a slowed heart rate response was observed in the DG when compared to the CG. Finally, a simple linear regression showed that fasting glycemia was able to predict cardiac autonomic involvement in volunteers with T2D. CONCLUSION Patients with T2D presented lower parasympathetic modulation at rest and slowed HRR after physical exercise, which may be associated with higher cardiovascular risks. The findings show the glycemic profile as an important predictor of impaired cardiac autonomic modulation.
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Affiliation(s)
- Lucas Raphael Bento Silva
- Department of Physical Education, Araguaia University Center, Goiânia, Brazil
- Post-Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Goias, Goiânia, Brazil
- *Correspondence: Lucas Raphael Bento Silva,
| | - Paulo Gentil
- Post-Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Goias, Goiânia, Brazil
- Faculty of Physical Education and Dance, Federal University of Goias, Goiânia, Brazil
- Hypertension League, Federal University of Goias, Goiânia, Brazil
| | - Camila Simões Seguro
- Post-Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Goias, Goiânia, Brazil
| | | | - Maria Sebastiana Silva
- Post-Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Goias, Goiânia, Brazil
- Faculty of Physical Education and Dance, Federal University of Goias, Goiânia, Brazil
| | - Antônio Roberto Zamunér
- Laboratory of Clinical Research in Kinesiology, Department of Kinesiology, Universidad Católica del Maule, Talca, Chile
| | - Thomas Beltrame
- Institute of Computing, University of Campinas, São Paulo, Brazil
- Department of Physical Therapy, Federal University of São Carlos, São Paulo, Brazil
| | - Ana Cristina Silva Rebelo
- Post-Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Goias, Goiânia, Brazil
- Faculty of Physical Education and Dance, Federal University of Goias, Goiânia, Brazil
- Department of Morphology, Institute of Biological Sciences, Federal University of Goias, Goiânia, Brazil
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152
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Lin X, Chen C, Liu Y, Peng Y, Chen Z, Huang H, Xu L. Peripheral Nerve Conduction And Sympathetic Skin Response Are Reliable Methods to Detect Diabetic Cardiac Autonomic Neuropathy. Front Endocrinol (Lausanne) 2021; 12:709114. [PMID: 34621241 PMCID: PMC8490774 DOI: 10.3389/fendo.2021.709114] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/31/2021] [Indexed: 11/23/2022] Open
Abstract
AIM This study aimed to investigate the role of nerve conduction studies (NCS) and sympathetic skin response (SSR) in evaluating diabetic cardiac autonomic neuropathy (DCAN). METHODS DCAN was diagnosed using the Ewing test combined with heart rate variability analysis. NCS and SSR were assessed by electrophysiological methods. The association between NCS/SSR and DCAN was assessed via multivariate regression and receiver-operating characteristic analyses. RESULTS The amplitude and conduction velocity of the motor/sensory nerve were found to be significantly lower in the DCAN+ group (all P < 0.05). A lower amplitude of peroneal nerve motor fiber was found to be associated with increased odds for DCAN (OR 2.77, P < 0.05). The SSR amplitude was lower while the SSR latency was longer in the DCAN+ group than in the DCAN- group. The receiver-operating characteristic analysis revealed that the optimal cutoff points of upper/lower limb amplitude of SSR to indicate DCAN were 1.40 mV (sensitivity, 61.9%; specificity, 66.3%, P < 0.001) and 0.85 mV (sensitivity, 66.7%; specificity, 68.5%, P < 0.001), respectively. The optimal cutoff points of upper/lower limb latency to indicate DCAN were 1.40 s (sensitivity, 61.9%; specificity, 62%, P < 0.05) and 1.81 s (sensitivity, 69.0%; specificity, 52.2%, P < 0.05), respectively. CONCLUSIONS NCS and SSR are reliable methods to detect DCAN. Abnormality in the peroneal nerve (motor nerve) is crucial in predicting DCAN. SSR may help predict DCAN.
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Affiliation(s)
- Xiaopu Lin
- Department of Huiqiao Building, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chuna Chen
- Department of Endocrinology, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yingshan Liu
- Department of Endocrinology, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yu Peng
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhenguo Chen
- Department of Endocrinology, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Haishan Huang
- Department of Endocrinology, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Lingling Xu
- Department of Endocrinology, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
- *Correspondence: Lingling Xu,
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153
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Dutheil F, de Saint Vincent S, Pereira B, Schmidt J, Moustafa F, Charkhabi M, Bouillon-Minois JB, Clinchamps M. DHEA as a Biomarker of Stress: A Systematic Review and Meta-Analysis. Front Psychiatry 2021; 12:688367. [PMID: 34295276 PMCID: PMC8290065 DOI: 10.3389/fpsyt.2021.688367] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/28/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Psychosocial stress is a significant public health problem inducing consequences for quality of life. Results about the use of dehydroepiandrosterone (DHEA) as a biomarker of acute stress are conflicting. We conducted a systematic review and meta-analysis to demonstrate that DHEA levels could be a biomarker of stress. Methods: PubMed, Cochrane Library, Embase, and ScienceDirect databases were searched on March 19, 2021 using the keywords "acute stress" AND "DHEA" OR "Dehydroepiandrosterone." Articles needed to describe our primary outcome, i.e., induction of acute stress and at least two measures of DHEA. Results: We included 14 studies, with a total of 631 participants, in our meta-analysis. The DHEA levels increased overtime after acute stress [standardized mean difference (SMD) = 1.56, 95%CI = 1.13-1.99]. Stratification by time showed a main peak at the end of stress (SMD = 2.43, 95%CI = 1.59-3.27), followed by a progressive decrease (coefficient = -0.11, 95%CI = -0.19 to -0.17, p = 0.020). There was no significant change 1 h after the end of acute stress. Metaregressions showed an impact of mental stress (SMD = 2.04, 95%CI = 1.43-2.65), sex (SMD = 0.02, 95%CI = 0.00-0.04), age (SMD = -0.12, 95%CI = -0.2 to -0.05), and obesity (SMD = 0.31, 95%CI = -0.00 to 0.63). There was no difference whatever the type of fluid (blood or saliva) and the measurement technique used. Conclusions: DHEA is a biomarker of acute stress, with a short-term increase (1 h). DHEA increases following acute mental stress, whatever the type and duration of mental stress. Women, young people, and obese individuals had a higher response. Blood and saliva measures were comparable.
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Affiliation(s)
- Frédéric Dutheil
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, CHU Clermont-Ferrand, Occupational and Environmental Medicine, Wittyfit, Clermont-Ferrand, France
| | - Sarah de Saint Vincent
- Université Clermont Auvergne, Occupational and Environmental Medicine, Clermont-Ferrand, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, CHU Clermont-Ferrand, Clinical Research and Innovation Direction, Clermont-Ferrand, France
| | - Jeannot Schmidt
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, CHU Clermont-Ferrand, Emergency Department, Clermont-Ferrand, France
| | - Farès Moustafa
- Université Clermont Auvergne, CHU Clermont-Ferrand, Emergency Department, Clermont-Ferrand, France
| | - Morteza Charkhabi
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, Clermont-Ferrand, France
| | - Jean-Baptiste Bouillon-Minois
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, CHU Clermont-Ferrand, Emergency Department, Clermont-Ferrand, France
| | - Maëlys Clinchamps
- CHU Clermont-Ferrand, CHU Clermont-Ferrand, Occupational and Environmental Medicine, Clermont-Ferrand, France
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154
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Marstrand SD, Buch-Larsen K, Andersson M, Jensen LT, Schwarz P. Heart rate variability and vibration perception threshold to assess chemotherapy-induced neuropathy in women with breast cancer - a systematic review. Cancer Treat Res Commun 2020; 26:100295. [PMID: 33387870 DOI: 10.1016/j.ctarc.2020.100295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 12/20/2020] [Accepted: 12/22/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND It is well known that breast cancer (BC) patients often suffer from chemotherapy-induced peripheral neuropathy (CIPN). However, it is not always recognized that they have higher risk of falling, dizziness and other signs of dysfunctional autonomous nervous system. We performed a systematic review of the literature on vibration perception threshold (VPT) and heart rate variability (HRV) as methods to objectively assess (CIPN) in BC-patients. Could VPT and HRV describe coexisting sensory and autonomic nerve damage? MATERIALS AND METHODS PubMed was searched in September 2019. The included studies had to address HRV and/or VPT in BC-patients who received chemotherapy. RESULTS Seven studies assessed VPT and six studies assessed HRV in BC-patients. Studies showed lowered perception of vibrations after chemotherapy reflected in higher VPT and no changes in HRV after taxane-based chemotherapy. No studies evaluated VPT and HRV at the same time. CONCLUSION The results were limited by short follow-up, small sample sizes, and different chemotherapy regimens which makes generalizability problematic. A standard assessment method of CIPN is still missing and further research is needed to evaluate if VPT and HRV could contribute to an objective assessment of CIPN. With higher survival rates for BC-patients autonomous and sensory nerve damage will be an increasing task. However, our literature review showed that no one have focused on the combination of autonomous and sensory affection measured by the simple methods VPT and HRV. Therefore, we encourage the development of international guidelines for the objective measure of nerve damage in BC-patients.
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Affiliation(s)
- Simone Diedrichsen Marstrand
- Diabetes and bone-metabolic research unit, Department of Endocrinology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Kristian Buch-Larsen
- Diabetes and bone-metabolic research unit, Department of Endocrinology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Michael Andersson
- Department of Oncology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Lars Thorbjørn Jensen
- Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, Borgmester Ib Juuls Vej 71, 2730 Herlev, Denmark; Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen, Denmark
| | - Peter Schwarz
- Diabetes and bone-metabolic research unit, Department of Endocrinology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen, Denmark
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155
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Badrov MB, Mak S, Floras JS. Cardiovascular Autonomic Disturbances in Heart Failure With Preserved Ejection Fraction. Can J Cardiol 2020; 37:609-620. [PMID: 33310140 DOI: 10.1016/j.cjca.2020.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 02/09/2023] Open
Abstract
In heart failure with reduced ejection fraction (HFrEF), diminished tonic and reflex vagal heart rate modulation and exaggerated sympathetic outflow and neural norepinephrine release are evident from disease inception. Each of these disturbances of autonomic regulation has been independently associated with shortened survival, and β-adrenoceptor antagonism and therapeutic autonomic modulation by other means have been demonstrated, in clinical trials, to lessen symptoms and prolong survival. In contrast, data concerning the autonomic status of patients with heart failure with preserved ejection fraction (HFpEF) are comparatively sparse. Little is known concerning the prognostic consequences of autonomic dysregulation in such individuals, and therapies applied with success in HFrEF have in most trials failed to improve symptoms or survival of those with HFpEF. A recent HFpEF Expert Scientific Panel report emphasised that without a deeper understanding of the pathophysiology of HFpEF, establishing effective treatment will be challenging. One aspect of such pathology may be cardiovascular autonomic disequilibrium, often worsened by acute exercise or routine daily activity. This review aims to summarise existing knowledge concerning parasympathetic and sympathetic function of patients with HFpEF, consider potential mechanisms and specific consequences of autonomic disturbances that have been identified, and propose hypotheses for future investigation.
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Affiliation(s)
- Mark B Badrov
- Division of Cardiology, Department of Medicine, University Health Network and Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Susanna Mak
- Division of Cardiology, Department of Medicine, University Health Network and Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - John S Floras
- Division of Cardiology, Department of Medicine, University Health Network and Sinai Health System, University of Toronto, Toronto, Ontario, Canada.
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156
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Medeiros AR, Leicht AS, Michael S, Boullosa D. Weekly vagal modulations and their associations with physical fitness and physical activity. Eur J Sport Sci 2020; 21:1326-1336. [PMID: 33070741 DOI: 10.1080/17461391.2020.1838619] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The root mean square of successive differences (RMSSD) of R-R intervals, the most robust vagal modulation parameter of heart rate variability (HRV), has been proposed as a marker of global health and training adaptations. The weekly averaging of RMSSD and its natural logarithm (LnRMSSD) has been adopted to enhance detection of training-induced adaptations. We assessed measures of aerobic fitness, body composition, objective physical activity (PA), and daily LnRMSSD recordings during different conditions, such as supine rest, seated rest, standing and walking at 5 km/h, over a week in 34 healthy young individuals of both sexes (age: 22 ± 4 yr; body fatness: 20 ± 8%; estimated VO2max: 40 ± 8 mL·kg-1·min-1). The day-to-day reliability and agreement among LnRMSSD averages over 5, 4, 3, 2 and a single-day value per condition were assessed, while correlations between LnRMSSD, aerobic fitness, body composition, and PA were also examined. Poor to good day-to-day reliability, and moderate to excellent agreement were observed for LnRMSSD recordings for diverse conditions with a minimum of two daily recordings in the supine condition, and three in the other conditions achieving excellent agreement for weekly HRV assessment. Several correlations between LnRMSSD, aerobic fitness, body composition, and PA were revealed, with stronger observed associations during walking. Utilisation of weekly HRV (average of 2-3 daily recordings), as described in the current study, may provide practitioners with a tool to assess weekly vagal modulations for health and performance purposes. Walking HRV recordings may be a practical alternative to other conditions for the investigation of cardiac autonomic function.
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Affiliation(s)
| | - Anthony S Leicht
- Sport & Exercise Science, James Cook University, Townsville, Australia
| | - Scott Michael
- Centre for Human and Applied Physiology, University of Wollongong, Wollongong, Australia
| | - Daniel Boullosa
- Sport & Exercise Science, James Cook University, Townsville, Australia.,Graduate Program in Movement Sciences, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
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157
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Hoshi RA, Santos IS, Dantas EM, Andreão RV, Mill JG, Duncan BB, Schmidt MI, Lotufo PA, Bensenor I. Diabetes and subclinical hypothyroidism on heart rate variability. Eur J Clin Invest 2020; 50:e13349. [PMID: 32654127 DOI: 10.1111/eci.13349] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/29/2020] [Accepted: 07/07/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND We aimed to analyse if the effects of coexistent diabetes and subclinical hypothyroidism extend to the cardio autonomic nervous system, using heart rate variability baseline data from the Brazilian Longitudinal Study of Adult Health. MATERIALS AND METHODS Heart rate variability analyses were performed by linear time and frequency domains in 5-minute time series collected in the supine position. The associations of diabetes and subclinical hypothyroidism with the lowest quartile group for heart rate and the highest quartile group for each heart rate variability parameter were analysed using additive and multiplicative terms in logistic models. For the first approach, the subsample was categorized into four groups: subjects without diabetes and normal thyroid function (controls); subjects without diabetes and subclinical hypothyroidism; patients with diabetes and normal thyroid function; and patients with diabetes and subclinical hypothyroidism. For the interaction alnalysis, diabetes and subclinical hypothyroidism diagnoses were included in separate, along with a multiplicative interaction term between them. RESULTS Point odds ratio estimates for the 4th quartiles of heart rate, and 1st quartiles of all heart rate variability measurements were higher for subjects with combined diabetes and subclinical hypothyroidism than for diabetes only, independently of main sociodemographic and clinical variables (HR: 8.33 vs 2.63; SDNN: 2.59 vs 1.61; RMSSD: 2.37 vs 1.42; LF: 2.83 vs 1.71; HF: 3.06 vs 1.39), but not independently of HbA1c and TSH. Only the interaction term for the association with heart rate, adjusted for sociodemographic and clinical variables, had borderline statistical significance. CONCLUSION Diabetes and subclinical hypothyroidism exert a potential joint impact on cardiac autonomic control, showed by additive effects between diabetes and subclinical hypothyroidism, as well as a significant interaction term for the association with heart rate.
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Affiliation(s)
- Rosangela A Hoshi
- Center for Clinical and Epidemiological Research of University Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Itamar S Santos
- Center for Clinical and Epidemiological Research of University Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Eduardo M Dantas
- Department of Biological Sciences, Federal University of Vale do Sao Francisco, Petrolina, Brazil
| | - Rodrigo V Andreão
- Department of Electrical Engineering, Federal Institute of Espirito Santo, Vitória, Brazil
| | - José G Mill
- Department of Physiological Sciences, Federal University of Espírito Santo, Vitória, Brazil
| | - Bruce B Duncan
- Department of Social Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria I Schmidt
- Postgraduate Programme in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Paulo A Lotufo
- Center for Clinical and Epidemiological Research of University Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Isabela Bensenor
- Center for Clinical and Epidemiological Research of University Hospital, University of Sao Paulo, Sao Paulo, Brazil
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158
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Aggarwal Y, Das J, Mazumder PM, Kumar R, Sinha RK. Heart rate variability time domain features in automated prediction of diabetes in rat. Phys Eng Sci Med 2020; 44:45-52. [PMID: 33252718 DOI: 10.1007/s13246-020-00950-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
Diabetes is a very common occurring disease, diagnosed by hyperglycemia. The established mode of diagnosis is the analysis of blood glucose level with the help of a hand-held glucometer. Nowadays, it is also known for affecting multi-organ functions, particularly the microvasculature of the cardiovascular system. In this work, an alternative diagnostic system based on the heart rate variability (HRV) analysis and artificial neural network (ANN) and support vector machine (SVM) have been proposed. The experiment and data recording has been performed on male Wister rats of 10-12 week of age and 200 ± 20 gm of weight. The digital lead-I electrocardiogram (ECG) data are recorded from control (n = 5) and Streptozotocin-induced diabetic rats (n = 5). Nine time-domain linear HRV parameters are computed from 60 s of ECG data epochs and used for the training and testing of backpropagation ANN and SVM. Total 526 (334 Control and 192 diabetics) such datasets are computed for the testing of ANN for the identification of the diabetic conditions. The ANN has been optimized for architecture 9:5:1 (Input: hidden: output neurons, respectively) with the optimized learning rate parameter at 0.02. With this network, a very good classification accuracy of 96.2% is achieved. While similar accuracy of 95.2% is attained using SVM. Owing to the successful implementation of HRV parameters based automated classifiers for diabetic conditions, a non-invasive, ECG based online prognostic system can be developed for accurate and non-invasive prediction of the diabetic condition.
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Affiliation(s)
- Yogender Aggarwal
- Department of Bio-Engineering, Birla Institute of Technology, Mesra, Ranchi, Jharkhand, India
| | - Joyani Das
- Department of Pharmaceutical Science and Technology, Birla Institute of Technology, Mesra, Ranchi, Jharkhand, India
| | - Papiya Mitra Mazumder
- Department of Pharmaceutical Science and Technology, Birla Institute of Technology, Mesra, Ranchi, Jharkhand, India
| | - Rohit Kumar
- Department of Mathematics, Birla Institute of Technology, Mesra, Ranchi, Jharkhand, India
| | - Rakesh Kumar Sinha
- Department of Bio-Engineering, Birla Institute of Technology, Mesra, Ranchi, Jharkhand, India.
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159
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Shah AS, Jaiswal M, Dabelea D, Divers J, Isom S, Liese AD, Lawrence JM, Kim G, Urbina EM. Cardiovascular risk and heart rate variability in young adults with type 2 diabetes and arterial stiffness: The SEARCH for Diabetes in Youth Study. J Diabetes Complications 2020; 34:107676. [PMID: 32713707 PMCID: PMC7502460 DOI: 10.1016/j.jdiacomp.2020.107676] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 07/06/2020] [Accepted: 07/09/2020] [Indexed: 02/07/2023]
Abstract
AIMS To evaluate cardiovascular risk factors and heart rate variability (HRV) in young adults with type 2 diabetes and arterial stiffness and to explore the relationship between HRV and arterial stiffness. METHODS We studied 185 young adults with youth-onset T2D enrolled in the SEARCH for Diabetes in Youth Study. Cardiovascular risk factors and HRV were compared between individuals with and without type 2 diabetes and arterial stiffness (defined as a pulse wave velocity greater than the 90th percentile of healthy controls, >6.767 m/s). Semiparametric regression evaluated the independent relationship between HRV and PWV. RESULTS Participants with T2D and arterial stiffness were more likely to be older, non-Hispanic Black, have higher systolic and diastolic blood pressure, greater adiposity and obesity-related dyslipidemia (higher triglycerides and lower HDLC). Participants with T2D and arterial stiffness also had lower overall HRV (lower SDNN) with parasympathetic loss (lower RMSSD and PNN50), p < 0.05. Lower HRV tended to be but was not significantly associated with arterial stiffness after adjustment for age, race/ethnicity, sex and cardiovascular risk factors (beta coefficient = -1.11, p = 0.08). CONCLUSIONS Youth with T2D and arterial stiffness have a worse cardiovascular risk profile, specifically risk factors related to the metabolic syndrome and lower HRV.
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Affiliation(s)
- Amy Sanghavi Shah
- Cincinnati Children's Hospital Medical Center and the University of Cincinnati, United States of America.
| | - Mamta Jaiswal
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States of America
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, United States of America
| | - Jasmin Divers
- Division of Health Services Research, NYU Long Island School of Medicine, Mineola, NY, United States of America
| | - Scott Isom
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Angela D Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
| | - Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America
| | - Grace Kim
- Seattle Children's Hospital, Seattle, WA, United States of America
| | - Elaine M Urbina
- Cincinnati Children's Hospital Medical Center and the University of Cincinnati, United States of America
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160
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Hur MH, Lee MK, Seong K, Hong JH. Deterioration of Sleep Quality According to Glycemic Status. Diabetes Metab J 2020; 44:679-686. [PMID: 32431108 PMCID: PMC7643591 DOI: 10.4093/dmj.2019.0125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 08/20/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a progressive disease with multiple complications. The present study aimed to determine the effects of glycemic status on sleep quality in individuals with T2DM, prediabetes, and normal glucose tolerance (NGT). METHODS A total of 90 participants were categorized into three groups, T2DM (n=30), prediabetes (n=30), and NGT (n=30). Objective sleep quality was measured with the actigraph wrist-worn device over 3 nights and subjective sleep quality was evaluated with a questionnaire. RESULTS The duration of diabetes in the T2DM group was 2.23 years and the glycosylated hemoglobin (HbA1c) levels in the T2DM, prediabetes, and NGT groups were 7.83%, 5.80%, and 5.31%, respectively. Sleep efficiency decreased across the T2DM, prediabetes, and NGT groups (86.25%, 87.99%, and 90.22%, respectively; P=0.047). Additionally, HbA1c levels revealed a significant negative correlation with sleep efficiency (r=-0.348, P=0.001). The sleep quality questionnaire results were similar among the three groups. CONCLUSION Although the participants in the present study were not necessarily conscious of their sleep disturbances, deterioration in sleep quality progressed according to glycemic status.
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Affiliation(s)
| | | | - Kayeon Seong
- Eulji University College of Nursing, Daejeon, Korea
| | - Jun Hwa Hong
- Division of Endocrinology, Department of Internal Medicine, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
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161
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Kochli-Hailovski T, Marai I, Lorber A, Cohen M. Providing regular grandchild care: Grandparents' psychological and physical health. Geriatr Nurs 2020; 42:173-180. [PMID: 32950275 DOI: 10.1016/j.gerinurse.2020.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/11/2020] [Accepted: 07/14/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To examine the associations between intensity of providing regular grandchild care and positive affect (PA) and negative affect (NA), heart rate variability (HRV) and somatic symptoms. METHODS This was a cross-sectional study involving 104 individuals (aged 59-82) who provide at least 5 h a week of regular care for their grandchildren. The study model was assessed using structural equation modeling. RESULTS Intensity of regular care (mean hours per week: M = 14.8, SD = 11.2) was associated with higher PA and lower NA. Higher perceived role overload, higher NA and lower PA were associated with lower HRV and somatic symptoms. The fit indices indicated a good model fit. CONCLUSIONS The results suggest that healthcare professionals should be aware of the positive and negative implications of caring for grandchildren on their older patients, including the increased risk of future morbidity, as indicated by lower HRV.
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Affiliation(s)
| | - Ibrahim Marai
- Cardiology Department, The Baruch Padeh Medical Center, Poriya, Israel.
| | - Abraham Lorber
- Department of Pediatric Cardiology & Congenital Heart Disease in Adults, Rambam Health Care Campus, Haifa, Israel.
| | - Miri Cohen
- School of Social Work, University of Haifa, Haifa, Israel.
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162
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Abstract
Adaption to changes of external environment or internal health, the body-mind connection, or autonomic nervous system must be flexible and healthy. Population health studies with wearable technology and remote monitoring will lead to paradigm shifts in how to approach the physiology of emotion. Heart rate variability as a whole health biomarker could emerge as a foundation for a process beginning with objective habits and skills of real-time modulation with focused breathing for healthier decision making and autonomic health trajectory change. Physical medicine and rehabilitation is uniquely poised to refine an autonomic rehabilitation process in an integrative manner to help individuals adapt.
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Affiliation(s)
- Raouf S Gharbo
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, 109 Elizabeth Meriwether, Williamsburg, VA 23185, USA.
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163
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Abstract
Neuropathy is the most prevalent microvascular complication of diabetes mellitus; it encompasses distal symmetric polyneuropathy, autonomic neuropathy, radiculoplexus neuropathy, mononeuropathy, and treatment-induced neuropathy. The prevalence rate of diabetic neuropathy in Korea was reported to be approximately 43%, which is similar to rates in other countries. However, the precise pathogenic mechanism underlying diabetic neuropathy is still obscure, and many clinical trials have failed to develop methods to prevent or reduce the progression of diabetic neuropathy. Nevertheless, early diagnosis and proper management of diabetic neuropathy are essential to alleviate disabling symptoms and to improve the quality of life of patients. This review discusses clinical manifestations and classification of diabetic neuropathies, bedside neurological examination, and electrophysiological tests.
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Affiliation(s)
- Jeeyoung Oh
- Department of Neurology, Konkuk University Medical Center, Seoul, Korea
- Correspondence to Jeeyoung Oh, M.D. Department of Neurology, Konkuk University Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, Korea Tel: +82-2-2030-7564 Fax: +82-2-2030-5169 E-mail:
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164
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Patron E, Munafò M, Messerotti Benvenuti S, Stegagno L, Palomba D. Not All Competitions Come to Harm! Competitive Biofeedback to Increase Respiratory Sinus Arrhythmia in Managers. Front Neurosci 2020; 14:855. [PMID: 32982665 PMCID: PMC7487422 DOI: 10.3389/fnins.2020.00855] [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] [Received: 05/13/2020] [Accepted: 07/22/2020] [Indexed: 11/17/2022] Open
Abstract
Despite the positive impact on achievement, competition has been associated with elevated psychophysiological activation, potentially leading to a greater risk of cardiovascular diseases. Competitive biofeedback (BF) can be used to highlight the effects of competition on the same physiological responses that are going to be controlled through BF. However, it is still unknown whether competition could enhance the effects of respiratory sinus arrhythmia (RSA)-BF training in improving cardiac vagal control. The present study explored whether competitive RSA-BF could be more effective than non-competitive RSA-BF in increasing RSA in executive managers, who are at higher cardiovascular risk of being commonly exposed to highly competitive conditions. Thirty managers leading outstanding private or public companies were randomly assigned to either a Competition (n = 14) or a Control (n = 16) RSA-BF training lasting five weekly sessions. Managers in the Competition group underwent the RSA-BF in couples and each participant was requested to produce a better performance (i.e., higher RSA) than the paired challenger. After the training, results showed that managers in the Competition group succeeded in increasing cardiac vagal control, as supported by the specific increase in RSA (p < 0.001), the standard deviation of R-R wave intervals (SDNN; p < 0.001), and root mean square of the successive differences between adjacent heartbeats (rMSSD; p < 0.001). A significant increase in the percentage of successive normal sinus beat to beat intervals more than 50 ms (pNN50; p = 0.023; η2 p = 0.17), low frequency (p = ≤ 0.001; η2 p = 0.44), and high frequency power (p = 0.005; η2 p = 0.25) emerged independently from the competitive condition. Intriguingly, managers who compete showed the same reduction in resting heart rate (HR; p = 0.003, η2 p = 0.28), systolic blood pressure (SBP; p = 0.013, η2 p = 0.20), respiration rate (p < 0.001; η2 p = 0.46), and skin conductance level (SCL; p = 0.001, η2 p = 0.32) as non-competitive participants. Also, the same reduction in social anxiety (p = 0.005; η2 p = 0.25), state (p = 0.038, η2 p = 0.14) and trait anxiety (p = 0.001, η2 p = 0.31), and depressive symptoms (p = 0.023, η2 p = 0.17) emerged in the two groups. The present results showed that managers competing for increasing RSA showed a greater improvement in their parasympathetic modulation than non-competing managers. Most importantly, competition did not lead to the classic pattern of increased psychophysiological activation under competitive RSA-BF. Therefore, competition could facilitate the use of self-regulation strategies, especially in highly competitive individuals, to promote adaptive responses to psychological stress.
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Affiliation(s)
| | - Marianna Munafò
- Department of General Psychology, University of Padua, Padua, Italy
| | - Simone Messerotti Benvenuti
- Department of General Psychology, University of Padua, Padua, Italy
- Padova Neuroscience Center, University of Padua, Padua, Italy
| | - Luciano Stegagno
- Department of General Psychology, University of Padua, Padua, Italy
| | - Daniela Palomba
- Department of General Psychology, University of Padua, Padua, Italy
- Padova Neuroscience Center, University of Padua, Padua, Italy
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165
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Barnett MP, Bangalore S. Cardiovascular Risk Factors: It's Time to Focus on Variability! J Lipid Atheroscler 2020; 9:255-267. [PMID: 32821735 PMCID: PMC7379092 DOI: 10.12997/jla.2020.9.2.255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/28/2020] [Accepted: 04/02/2020] [Indexed: 12/19/2022] Open
Abstract
Atherosclerotic heart disease remains a leading cause of morbidity and mortality worldwide. While extensive research supports cardiovascular risk factor reduction in the form of achieving evidence-based blood pressure, lipid, glucose, and body weight targets as a means to improve cardiovascular outcomes, residual risk remains. Emerging data have demonstrated that the intraindividual variability of these risk factor targets potentially contribute to this residual risk. It may therefore be time to define risk factor by not only its magnitude and duration as done traditionally, but perhaps also by the variability of that particular risk factor over time.
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Affiliation(s)
- Mallory P Barnett
- The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY, USA
| | - Sripal Bangalore
- The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY, USA
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166
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Avram R, Olgin JE, Kuhar P, Hughes JW, Marcus GM, Pletcher MJ, Aschbacher K, Tison GH. A digital biomarker of diabetes from smartphone-based vascular signals. Nat Med 2020; 26:1576-1582. [PMID: 32807931 DOI: 10.1038/s41591-020-1010-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 07/06/2020] [Indexed: 12/11/2022]
Abstract
The global burden of diabetes is rapidly increasing, from 451 million people in 2019 to 693 million by 20451. The insidious onset of type 2 diabetes delays diagnosis and increases morbidity2. Given the multifactorial vascular effects of diabetes, we hypothesized that smartphone-based photoplethysmography could provide a widely accessible digital biomarker for diabetes. Here we developed a deep neural network (DNN) to detect prevalent diabetes using smartphone-based photoplethysmography from an initial cohort of 53,870 individuals (the 'primary cohort'), which we then validated in a separate cohort of 7,806 individuals (the 'contemporary cohort') and a cohort of 181 prospectively enrolled individuals from three clinics (the 'clinic cohort'). The DNN achieved an area under the curve for prevalent diabetes of 0.766 in the primary cohort (95% confidence interval: 0.750-0.782; sensitivity 75%, specificity 65%) and 0.740 in the contemporary cohort (95% confidence interval: 0.723-0.758; sensitivity 81%, specificity 54%). When the output of the DNN, called the DNN score, was included in a regression analysis alongside age, gender, race/ethnicity and body mass index, the area under the curve was 0.830 and the DNN score remained independently predictive of diabetes. The performance of the DNN in the clinic cohort was similar to that in other validation datasets. There was a significant and positive association between the continuous DNN score and hemoglobin A1c (P ≤ 0.001) among those with hemoglobin A1c data. These findings demonstrate that smartphone-based photoplethysmography provides a readily attainable, non-invasive digital biomarker of prevalent diabetes.
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Affiliation(s)
- Robert Avram
- Division of Cardiology, Department of Medicine and Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Jeffrey E Olgin
- Division of Cardiology, Department of Medicine and Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, USA
| | | | - J Weston Hughes
- Department of Computer Science, University of California, Berkeley, Berkeley, CA, USA
| | - Gregory M Marcus
- Division of Cardiology, Department of Medicine and Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Mark J Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Kirstin Aschbacher
- Division of Cardiology, Department of Medicine and Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, USA.,Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, USA.,Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Geoffrey H Tison
- Division of Cardiology, Department of Medicine and Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, USA. .,Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, USA.
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167
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Shambrook P, Kingsley MI, Taylor NF, Wundersitz DW, Wundersitz CE, Gordon BA. Multiple short bouts of exercise are better than a single continuous bout for cardiometabolic health: a randomised crossover trial. Eur J Appl Physiol 2020; 120:2361-2369. [PMID: 32776220 DOI: 10.1007/s00421-020-04461-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/04/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare cardiometabolic responses to five consecutive days of daily postprandial exercise accumulated in three 10-min bouts or a single 30-min bout to a no-exercise control. METHODS Ten insufficiently active adults completed three trials in a randomised order. Each trial comprised five consecutive days of 30 min of exercise either accumulated in three separate 10-min bouts (ACC) after main meals; a single 30-min bout after dinner (CONT); or a no-exercise control (NOEX). Glucose regulation was assessed from an oral glucose tolerance test. Applanation tonometry was used to assess pulse wave velocity approximately 12 h following completion of the final trial. RESULTS Area under the 2-h glucose curve was similar for CONT (mean; 95% CI 917 mmol L-1 2 h-1; 815 to 1019) and ACC (931 mmol L-1 2 h-1; 794 to 1068, p = 0.671). Area under the 2-h insulin curve was greater following NOEX (70,328 pmol L-1 2 h-1; 30,962 to 109,693) than ACC (51,313 pmol L-1 2 h-1: 21,822 to 80,806, p = 0.007). Pulse wave velocity was lower for ACC (5.96 m s-1: 5.38 to 6.53) compared to CONT (6.93 m s-1: 5.92 to 7.94, p = 0.031) but not significantly lower for ACC compared to NOEX (6.52 m s-1: 5.70 to 7.34, p = 0.151). CONCLUSION Accumulating 30 min of moderate-intensity walking in three bouts throughout the day is more effective at reducing markers of cardiometabolic health risk in insufficiently active, apparently healthy adults than a single daily bout. Both accumulated and single-bout walking were equally as effective at reducing postprandial glucose concentrations compared to a no-exercise control. Therefore, accumulating exercise in short bouts after each main meal might be more advantageous for overall cardiometabolic health.
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Affiliation(s)
- Philip Shambrook
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, P.O. Box 199, Bendigo, VIC, 3552, Australia
| | - Michael I Kingsley
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, P.O. Box 199, Bendigo, VIC, 3552, Australia.,Department of Exercise Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Daniel W Wundersitz
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, P.O. Box 199, Bendigo, VIC, 3552, Australia
| | - Claire E Wundersitz
- Angliss Hospital Community Rehabilitation Programme, Eastern Health, Melbourne, Australia
| | - Brett A Gordon
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, P.O. Box 199, Bendigo, VIC, 3552, Australia.
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168
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Zandstra T, Kiès P, Man SC, Maan A, Bootsma M, Vliegen H, Egorova A, Holman E, Schalij M, Jongbloed M. QT interval variability and heart rate turbulence are associated with clinical characteristics in congenital heart disease patients with a systemic right ventricle. J Cardiol 2020; 76:514-520. [PMID: 32665161 DOI: 10.1016/j.jjcc.2020.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/09/2020] [Accepted: 05/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND QT interval variability (QTV) and heart rate turbulence (HRT) are measures of cardiac autonomic function, which, when abnormal, are correlated with ventricular arrhythmias and worse clinical outcome. This study aims to evaluate QTV and HRT in patients with a systemic right ventricle (RV) and to assess correlations with clinical characteristics. METHODS In a retrospective cohort study, QTV and HRT were derived from 24-h Holter registrations of patients with a systemic RV and healthy controls. QTV and HRT were compared between groups. In patients, the association between QTV, HRT, and clinical characteristics was assessed. RESULTS Holter recordings from 40 patients (mean age 40 years, 16 females) and 37 healthy controls (mean age 42 years, 21 females) were analyzed. Groups were comparable in terms of age and sex. QTV was increased in patients compared with controls (p < 0.001), HRT did not differ significantly between the groups. Increased QTV and decreased HRT correlated with medication use, especially of diuretics, and with clinical events, particularly supraventricular arrhythmias. Increased QTV correlated with reduced systemic RV function. Decreased HRT was independently associated with a larger number of past clinical events (estimate -0.33, 95% CI -0.63 to -0.02, p = 0.037). QTV was higher in women in both patients and controls (p = 0.041 and p = 0.034, respectively). CONCLUSIONS QTV and HRT are associated with clinical factors and events in patients with a systemic RV. Further studies are mandatory to confirm their prognostic value.
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Affiliation(s)
- Tjitske Zandstra
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Philippine Kiès
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sum-Che Man
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arie Maan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marianne Bootsma
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hubert Vliegen
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anastasia Egorova
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Eduard Holman
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique Jongbloed
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands.
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169
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Aggarwal Y, Das J, Mazumder PM, Kumar R, Sinha RK. Heart rate variability features from nonlinear cardiac dynamics in identification of diabetes using artificial neural network and support vector machine. Biocybern Biomed Eng 2020. [DOI: 10.1016/j.bbe.2020.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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170
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Macartney MJ, Notley SR, Herry CL, Seely AJE, Sigal RJ, Kenny GP. Diminished heart rate variability in type 2 diabetes is exacerbated during exercise-heat stress. Acta Diabetol 2020; 57:899-901. [PMID: 32008160 DOI: 10.1007/s00592-020-01482-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/11/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | - Sean R Notley
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, 125 University, Room 367, Montpetit Hall, Ottawa, ON, K1N 6N5, Canada
| | - Christophe L Herry
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Andrew J E Seely
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Thoracic Surgery and Critical Care Medicine, The Ottawa Hospital, Ottawa, Canada
| | - Ronald J Sigal
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, 125 University, Room 367, Montpetit Hall, Ottawa, ON, K1N 6N5, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Departments of Medicine, Cardiac Sciences and Community Health Sciences, Cumming School of Medicine, Faculties of Medicine and Kinesiology, University of Calgary, Calgary, Canada
| | - Glen P Kenny
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, 125 University, Room 367, Montpetit Hall, Ottawa, ON, K1N 6N5, Canada.
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
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171
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Zandstra T, Kiès P, Maan A, Man SC, Bootsma M, Vliegen H, Egorova A, Mertens B, Holman E, Schalij M, Jongbloed M. Association between reduced heart rate variability components and supraventricular tachyarrhythmias in patients with a systemic right ventricle. Auton Neurosci 2020; 227:102696. [PMID: 32623323 DOI: 10.1016/j.autneu.2020.102696] [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] [Received: 09/16/2019] [Revised: 05/24/2020] [Accepted: 06/23/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Patients with a systemic right ventricle are prone to develop heart failure. Abnormal heart rate variability (HRV), a measure of autonomic dysfunction, is associated with morbidity and mortality in patients with left ventricular failure. The association between HRV and supraventricular arrhythmias (SVTs), which are associated with adverse events in this population, was assessed. METHODS 24-Hour Holter recordings of patients with a systemic right ventricle and healthy controls were analysed in a retrospective cohort study. HRV was calculated and compared between groups. Correlation coefficients were determined for HRV variables and clinical characteristics. The relation between HRV and SVTs was investigated with linear regression. RESULTS The patient group included 29 patients (69%) late after Mustard or Senning correction for transposition of the great arteries, and 13 patients with congenitally corrected transposition of the great arteries (31%). The control group included 38 subjects. HRV was significantly lower in patients compared with controls. In the patient group, lower SDANN (standard deviation of the average NN intervals calculated over 5-minute intervals) was independently associated with a higher number of supraventricular arrhythmias (95% CI -0.03 to -0.0004, p = 0.045). In exploratory correlation analysis, several HRV variables correlated with echocardiographic systemic right ventricular function (rho = 0.36, p = 0.02 for SDANN), and exercise capacity (rho = 0.39, p = 0.05 for SDANN). CONCLUSION In patients with a systemic right ventricle, HRV is lower compared with controls and (SDANN) is independently associated with supraventricular arrhythmias.
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Affiliation(s)
- Tjitske Zandstra
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Philippine Kiès
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Arie Maan
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Sum-Che Man
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Marianne Bootsma
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Hubert Vliegen
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Anastasia Egorova
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Bart Mertens
- Department of Statistics, Leiden University Medical Center, Leiden, the Netherlands.
| | - Eduard Holman
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Martin Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Monique Jongbloed
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, the Netherlands.
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172
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Motoki H, Masuda I, Yasuno S, Oba K, Shoin W, Usami S, Saito Y, Waki M, Komatsu M, Ueshima K, Nakagawa Y, Son C, Yonemitsu S, Hiramitsu S, Konda M, Onishi K, Kuwahara K. Rationale and design of the EMPYREAN study. ESC Heart Fail 2020; 7:3134-3141. [PMID: 32578353 PMCID: PMC7524086 DOI: 10.1002/ehf2.12825] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/12/2020] [Accepted: 05/21/2020] [Indexed: 12/31/2022] Open
Abstract
Aims A sodium glucose cotransporter 2 (SGLT2) inhibitor was recently found to reduce heart failure hospitalization in the EMPA‐REG OUTCOME trial. We have hypothesized that autonomic nerve activity may be modulated by SGLT2 inhibition. The current study aims to investigate the impact of empagliflozin on sympathetic and parasympathetic nerve activity in patients with type 2 diabetes mellitus. Methods and results This ongoing study is a prospective, randomized, open‐label, multicentre investigation of 134 patients with type 2 diabetes mellitus. The patients are randomly allocated to receive either empagliflozin or sitagliptin with the treatment goal of the Japan Diabetes Society guidelines. Ambulatory electrocardiographic monitoring is performed at the baseline and at 12 and 24 weeks of treatment. Analyses of heart rate variability are conducted using the MemCalc method, which is a combination of the maximum entropy method for spectral analysis and the non‐linear least squares method for square analysis. The primary endpoint is the change in the low‐frequency (0.04–0.15 Hz)/high‐frequency (0.15–0.4 Hz) ratio from baseline to 24 weeks. Conclusions This investigation on the effect of EMPagliflozin on cardiac sYmpathetic and parasympathetic neRve activity in JapanEse pAtieNts with type 2 diabetes (EMPYREAN study) offers an important opportunity to understand the impact of SGLT2 inhibition on autonomic nerve activity in patients with type 2 diabetes.
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Affiliation(s)
- Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Izuru Masuda
- Medical Examination Center, Takeda Hospital, Kyoto, Japan
| | - Shinji Yasuno
- Clinical Research Support Center, The Jikei University School of Medicine, Tokyo, Japan
| | - Koji Oba
- Department of Biostatistics, School of Public Health, The University of Tokyo, Tokyo, Japan.,Interfaculty Initiative in Information Studies, The University of Tokyo, Tokyo, Japan
| | - Wataru Shoin
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Satoru Usami
- Department of Internal Medicine, Taigenkai Hospital, Ichinomiya, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Masako Waki
- Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Mitsuhisa Komatsu
- Division of Diabetes, Endocrinology and Metabolism, Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kenji Ueshima
- Department of EBM Research, Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan
| | - Yasuaki Nakagawa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Cheol Son
- Division of Endocrinology and Metabolism, National Cerebral and Cardiovascular Center, Suita, Japan.,Omics Research Center, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Shin Yonemitsu
- Department of Diabetes and Endocrinology, Osaka Red Cross Hospital, Osaka, Japan
| | | | - Manako Konda
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | | | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
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173
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Franco OS, Júnior AOS, Signori LU, Prietsch SOM, Zhang L. Cardiac autonomic modulation assessed by heart rate variability in children with asthma. Pediatr Pulmonol 2020; 55:1334-1339. [PMID: 32119199 DOI: 10.1002/ppul.24714] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 02/22/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To assess cardiac autonomic modulation, measured by short-term frequency domain analysis of heart rate variability (HRV), in children with asthma. METHODS We conducted an observational study at a tertiary care teaching hospital. The sample consisted of 119 children aged 7 to 15 years with asthma and 56 age-matched healthy controls. Frequency domain HRV measures included low-frequency (LF; 0.04-0.15 Hz), high-frequency (HF; 0.15-0.4 Hz), and LF/HF ratio. The LF and HF components were expressed in both absolute values of power (ms2 ) and in normalized units (nu). RESULTS Compared with healthy controls, asthmatic children had significantly higher value of HF (nu) (mean ± standard deviation: 45.9 ± 14.6 vs 40.7 ± 13.6; P = .02), and lower values of LF (nu) (54.1 ± 14.6 vs 59.3 ± 13.6; P = .02) and LF/HF ratio (median, interquartile range: 1.12, 0.82-1.88 vs 1.59, 1.02-2.08; P = .03). We did not find significant differences between children with persistent and intermittent asthma, and between children with well-controlled and partially-controlled or uncontrolled asthma, in terms of HRV measures. CONCLUSIONS Children with stable chronic asthma may have a cardiac autonomic imbalance with a possible enhanced parasympathetic modulation, as assessed by short-term frequency domain analysis of HRV. Neither asthma severity nor asthma control was significantly associated with HRV measures, but the study did not have enough power to draw a firm conclusion on this point.
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Affiliation(s)
- Ozeia S Franco
- Pediatric Pulmonology Division, Postgraduate Program in Health Sciences and Postgraduate Program in Public Health, Faculty of Medicine, Federal University of Rio Grande, Rio Grande, Rio Grande do Sul, Brazil
| | - Abelardo O S Júnior
- Physical Therapy Division, Anhanguera College of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Luis U Signori
- Department of Physical Therapy and Rehabilitation, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Silvio O M Prietsch
- Pediatric Pulmonology Division, Postgraduate Program in Health Sciences and Postgraduate Program in Public Health, Faculty of Medicine, Federal University of Rio Grande, Rio Grande, Rio Grande do Sul, Brazil
| | - Linjie Zhang
- Pediatric Pulmonology Division, Postgraduate Program in Health Sciences and Postgraduate Program in Public Health, Faculty of Medicine, Federal University of Rio Grande, Rio Grande, Rio Grande do Sul, Brazil
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174
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Atrial Fibrillation and Diabetes Mellitus: JACC Review Topic of the Week. J Am Coll Cardiol 2020; 74:1107-1115. [PMID: 31439220 DOI: 10.1016/j.jacc.2019.07.020] [Citation(s) in RCA: 197] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/29/2019] [Accepted: 07/02/2019] [Indexed: 12/12/2022]
Abstract
Diabetes mellitus is one of the most common chronic medical conditions, and is a risk factor for the development of atrial fibrillation (AF). The presence of diabetes in patients with AF is associated with increased symptom burden and increased cardiovascular and cerebrovascular mortality. The pathophysiology of diabetes-related AF is not fully understood, but is related to structural, electrical, electromechanical, and autonomic remodeling. This paper reviews the complex interaction between diabetes and AF, and explores its effect on the prevention and treatment of AF.
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175
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Cardoso R, Meneses RF, Lumini-Oliveira J, Pestana P. Associations Between Teachers' Autonomic Dysfunction and Voice Complaints. J Voice 2020; 35:843-851. [PMID: 32345502 DOI: 10.1016/j.jvoice.2020.03.013] [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: 12/29/2019] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This investigation aimed to verify if there were any differences in autonomic nervous system function and voice parameters of teachers with and without voice complaints. STUDY DESIGN Cross-sectional study. METHODS The Questionnaire of Autonomic Dysfunction was answered by 24 teachers, 6 males, and 18 females, whose heart rate variability was also assessed. Aerodynamic assessment of voice, acoustic and auditory-perceptual analysis of voice were done. Participants were divided into two groups: without voice complaints (WVCG; n = 11) and with voice complaints (VCG; n = 13) based on the completion of the Sociodemographic and Clinical Questionnaire. RESULTS For auditory-perceptual analysis, VCG showed significantly higher values on GRBASH subscales Grade (P < 0.001) and Roughness (P = 0.011). Regarding the heart rate variability, it was found that in the VCG, the square root of the mean squared difference of successive RR intervals (RMSSD) and the percentage of adjacent NN intervals differing by more than 50 milliseconds (pNN50) were significantly lower than in the WVCG (P = 0.023 and P = 0.032, respectively). The VCG presented a higher occurrence of neurovegetative symptoms directly related to voice, namely in fluctuating nose obstruction (P = 0.011), neck pain (while or after speaking) (P = 0.017) and in fatigability when speaking (P = 0.004). Concerning the aerodynamic assessment of voice, acoustic analysis of voice and neurovegetative symptoms not directly related to voice, no statistically significant differences between groups were found. CONCLUSIONS Findings indicated significantly lower values in RMSSD and pNN50 of teachers VCG when compared with teachers WVCG and that the teachers VCG presented a higher occurrence of neurovegetative symptoms directly related to voice than the ones WVCG.
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Affiliation(s)
- Ricardo Cardoso
- Fernando Pessoa University, Porto, Portugal; Transdisciplinary Center of Consciousness Studies of Fernando Pessoa University, Porto, Portugal; FP-B2S - Behaviour and Social Sciences Research Center of Fernando Pessoa University, Porto, Portugal.
| | - Rute F Meneses
- Fernando Pessoa University, Porto, Portugal; Transdisciplinary Center of Consciousness Studies of Fernando Pessoa University, Porto, Portugal; FP-B2S - Behaviour and Social Sciences Research Center of Fernando Pessoa University, Porto, Portugal; Longevity and Development Observatory of Fernando Pessoa University, Porto, Portugal
| | - José Lumini-Oliveira
- Fernando Pessoa University, Porto, Portugal; CIAFEL - Research Centre in Physical Activity, Health and Leisure, Porto University, Porto, Portugal; LABIOMEP - Porto Biomechanics Laboratory, Porto University, Porto, Portugal
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176
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Risk Factor Variability and Cardiovascular Outcome: JACC Review Topic of the Week. J Am Coll Cardiol 2020; 73:2596-2603. [PMID: 31118154 DOI: 10.1016/j.jacc.2019.02.063] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/15/2019] [Accepted: 02/21/2019] [Indexed: 02/08/2023]
Abstract
Until recently, intraindividual visit-to-visit variability of cardiovascular risk factors has been dismissed as random fluctuation. This simplistic concept was challenged by demonstrating that visit-to-visit blood pressure variability, independent of average blood pressure, was a powerful risk factor for stroke. Subsequently, variability of other cardiovascular risk factors such as cholesterol, glycemia, and body weight was documented to increase risk independent of their absolute values. Variability of these risk factors has been demonstrated to be a powerful predictor for all-cause and cardiovascular mortality, stroke, coronary artery disease, heart failure, end-stage renal disease, and dementia. With the notable exception of heart rate, cardiovascular risk factors must now be defined by 2 components: the magnitude and duration of sustained risk factor elevation and, equally important, the variability of the same risk factor over time.
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177
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Smith TW, Deits‐Lebehn C, Williams PG, Baucom BRW, Uchino BN. Toward a social psychophysiology of vagally mediated heart rate variability: Concepts and methods in self‐regulation, emotion, and interpersonal processes. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2020. [DOI: 10.1111/spc3.12516] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
| | | | | | | | - Bert N. Uchino
- Department of PsychologyUniversity of Utah Salt Lake City Utah
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178
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Dutheil F, Zaragoza-Civale L, Pereira B, Mermillod M, Baker JS, Schmidt J, Moustafa F, Navel V. Prostate Cancer and Asbestos: A Systematic Review and Meta-Analysis. Perm J 2020; 24:19.086. [PMID: 32097115 DOI: 10.7812/tpp/19.086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Asbestos-related diseases and cancers represent a major public health concern. OBJECTIVE To conduct a systematic review and meta-analysis to demonstrate that asbestos exposure increases the risk of prostate cancer. METHODS The PubMed, Cochrane Library, Embase, and ScienceDirect databases were searched using the keywords (prostate cancer OR prostatic neoplasm) AND (asbestos* OR crocidolite* OR chrysotile* OR amphibole* OR amosite*). To be included, articles needed to describe our primary outcome: Risk of prostate cancer after any asbestos exposure. RESULTS We included 33 studies with 15,687 cases of prostate cancer among 723,566 individuals. Asbestos exposure increased the risk of prostate cancer (effect size = 1.10, 95% confidence interval [CI] = 1.05-1.15). When we considered mode of absorption, respiratory inhalation increased the risk of prostate cancer (1.10, 95% CI = 1.05-1.14). Both environmental and occupational exposure increased the risk of prostate cancer (1.25, 95% CI = 1.01-1.48; and 1.07, 1.04-1.10, respectively). For type of fibers, the amosite group had an increased risk of prostate cancer (1.12, 95% CI = 1.05-1.19), and there were no significant results for the chrysotile/crocidolite group. The risk was higher in Europe (1.12, 95% CI = 1.05-1.19), without significant results in other continents. DISCUSSION Asbestos exposure seems to increase prostate cancer risk. The main mechanism of absorption was respiratory. Both environmental and occupational asbestos exposure were linked to increased risk of prostate cancer. CONCLUSION Patients who were exposed to asbestos should possibly be encouraged to complete more frequent prostate cancer screening.
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Affiliation(s)
- Frédéric Dutheil
- Physiological and Psychosocial Stress, Université Clermont Auvergne, CNRS, LaPSCo, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Occupational and Preventive Medicine, WittyFit, France.,Faculty of Health, School of Exercise Science, Australian Catholic University, Melbourne, Victoria
| | - Laetitia Zaragoza-Civale
- Occupational and Preventive Medicine, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Unit, the Clinical Research and Innovation Direction, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, France
| | - Martial Mermillod
- Université Grenoble Alpes, Université, Savoie Mont Blanc, CNRS, LPNC, Grenoble.,Institut Universitaire de France, Paris
| | - Julien S Baker
- Department of Sport, Physical Education, and Health, Centre for Health and Exercise Science Research, Hong Kong Baptist University, Kowloon Tong
| | - Jeannot Schmidt
- Physiological and Psychosocial Stress, Université Clermont Auvergne, CNRS, LaPSCo, CHU Clermont-Ferrand, Emergency Medicine, University Hospital of Clermont-Ferrand, France
| | - Fares Moustafa
- Emergency Medicine, Université Clermont Auvergne, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, France
| | - Valentin Navel
- Ophthalmology, Université Clermont Auvergne, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, France
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179
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Sekercioglu N, Lovblom LE, Bjornstad P, Lovshin JA, Lytvyn Y, Boulet G, Farooqi MA, Orszag A, Lai V, Tse J, Cham L, Keenan HA, Brent MH, Paul N, Bril V, Perkins BA, Cherney DZI. Risk factors for diabetic kidney disease in adults with longstanding type 1 diabetes: results from the Canadian Study of Longevity in Diabetes. Ren Fail 2020; 41:427-433. [PMID: 31162987 PMCID: PMC6566893 DOI: 10.1080/0886022x.2019.1614057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objectives: Diabetic kidney disease (DKD) is an independent predictor of cardiovascular morbidity and mortality in type 1 diabetes (T1D). We aimed to explore clinical and biochemical factors, including the achievement of American Diabetes Association (ADA) recommended targets associated with DKD in people living with T1D for ≥50 years. Methods: This was a post hoc analysis of a cross-sectional study of 75 participants enrolled in the Canadian Study of Longevity in T1D. We explored diabetes-related complications, including neuropathy, retinopathy, cardiovascular disease, and DKD. Study participants were dichotomized based on the achievement of ADA recommended targets as the low-target group (achieving ≤4 targets, n = 31) and high-target group (achieving >4 targets, n = 44). The outcome of interest was DKD defined by estimated glomerular filtration rate (eGFR) values <60/mL/min/1.73 m2 and/or 24-h albumin excretion >30 mg. Multivariable logistic regression models were employed to estimate odds ratios (ORs) for DKD with 95% confidence intervals (CIs). Results: Of the 75 participants with prolonged T1D duration (45% male, mean age 66 years), 25 participants had DKD and 50 did not. There was no statistical difference between the high- and low-target groups in terms of age and body mass index. eGFR was significantly higher and the prevalence of diabetic retinopathy was significantly lower in the high-target group. Older age at diagnosis of T1D and lower frequency component to high-frequency component ratio increased the odds of having DKD. Conclusions: In adults with prolonged T1D duration, older age at diagnosis and lower heart rate variability may be associated with DKD.
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Affiliation(s)
- Nigar Sekercioglu
- a Department of Medicine, Division of Nephrology , University of Toronto , Toronto , Canada.,b Department of Health Research Methods, Evidence, and Impact , McMaster University , Hamilton , Canada
| | - Leif Erik Lovblom
- c Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital , Toronto , Canada
| | - Petter Bjornstad
- d Department of Pediatrics, Division of Endocrinology and Department of Medicine, Division of Nephrology , University of Colorado School of Medicine , Aurora , CO , USA
| | - Julie A Lovshin
- e Department of Medicine, Division of Endocrinology and Metabolism , Sunnybrook Health Sciences Centre, University of Toronto , Toronto , Canada
| | - Yuliya Lytvyn
- a Department of Medicine, Division of Nephrology , University of Toronto , Toronto , Canada
| | - Geneviève Boulet
- c Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital , Toronto , Canada
| | - Mohammed A Farooqi
- c Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital , Toronto , Canada
| | - Andrej Orszag
- c Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital , Toronto , Canada
| | - Vesta Lai
- a Department of Medicine, Division of Nephrology , University of Toronto , Toronto , Canada
| | - Josephine Tse
- a Department of Medicine, Division of Nephrology , University of Toronto , Toronto , Canada
| | - Leslie Cham
- a Department of Medicine, Division of Nephrology , University of Toronto , Toronto , Canada
| | - Hillary A Keenan
- f Research Division , Joslin Diabetes Center , Boston , MA , USA
| | - Michael H Brent
- g Department of Ophthalmology and Vision Sciences Faculty of Medicine , University of Toronto , Toronto , Canada
| | - Narinder Paul
- h Joint Department of Medical Imaging, University of Toronto, Toronto, Canada and Department of Medical Imaging , Western University , London , Canada
| | - Vera Bril
- i Department of Medicine, Division of Neurology , University Health Network, University of Toronto , Toronto , Canada
| | - Bruce A Perkins
- c Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital , Toronto , Canada.,j Department of Medicine, Division of Endocrinology and Metabolism , Mount Sinai Hospital, University of Toronto , Toronto , Canada
| | - David Z I Cherney
- a Department of Medicine, Division of Nephrology , University of Toronto , Toronto , Canada.,k Department of Physiology , University of Toronto , Toronto , Canada.,l Department of Physiology and Banting and Best Diabetes Centre , University of Toronto , Toronto , Canada
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180
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Hoshi RA, Santos IS, Dantas EM, Andreão RV, Mill JG, Goulart AC, Lotufo PA, Bensenor I. Relationship between heart rate variability and carotid intima-media thickness in the Brazilian Longitudinal Study of Adult Health - ELSA-Brasil. Clin Physiol Funct Imaging 2019; 40:122-130. [PMID: 31821714 DOI: 10.1111/cpf.12613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 12/06/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Both increased carotid intima-media thickness (cIMT) and low heart rate variability (HRV) have been associated with cardiovascular mortality and morbidity. Thus, the aim of this study was to investigate whether cardio autonomic alterations are accompanied or not by subclinical atherosclerosis in participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). METHODS cIMT measures and 5-min HRV analyses were performed in apparently healthy adults. Heart rate variability was evaluated by linear time and frequency domain analyses. cIMT was defined as the average between the mean left and mean right cIMT values and was analysed as continuous and categorized variables (P≥75 or P<75). Multiple linear models using continuous variables and multivariate logistic regression with categorized cIMT and HRV quartiles were performed. RESULTS Out of 7256 participants eligible for analyses, 23·4% presented cIMT ≥ 75th percentile. Heart rate variability variables were reduced in cIMT ≥ P75 in comparison with cIMT < P75: SDNN 33·0 versus 37·0 ms, P<0·001; RMSSD 22·0 versus 26·0 ms, P<0·001; LF 191·0 versus 260·0 ms2 , P<0·001; HF 164·0 versus 238·5 ms2 , P<0·001. In crude analysis, an increased odds ratio for cIMT ≥ P75 was verified within the lowest two quartiles of LF and HF, but significances did not remain after adjustments for anthropometric and clinical variables. CONCLUSIONS Considering the entire sample, subjects with cIMT ≥ P75 presented lower HRV values, but no independent relationships were detected between cIMT and HRV after multivariate adjustment.
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Affiliation(s)
- Rosangela A Hoshi
- Center for Clinical and Epidemiological Research of University Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Itamar S Santos
- Center for Clinical and Epidemiological Research of University Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Eduardo M Dantas
- Department of Biological Sciences, Federal University of Vale do Sao Francisco, Petrolina, Brazil
| | - Rodrigo V Andreão
- Department of Electrical Engineering, Federal Institute of Espirito Santo, Vitória, Brazil
| | - José G Mill
- Department of Physiological Sciences, Federal University of Espirito Santo, Vitória, Brazil
| | - Alessandra C Goulart
- Center for Clinical and Epidemiological Research of University Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Paulo A Lotufo
- Center for Clinical and Epidemiological Research of University Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Isabela Bensenor
- Center for Clinical and Epidemiological Research of University Hospital, University of Sao Paulo, Sao Paulo, Brazil
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181
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The Effect of Marine n-3 Polyunsaturated Fatty Acids on Heart Rate Variability in Renal Transplant Recipients: A Randomized Controlled Trial. Nutrients 2019; 11:nu11122847. [PMID: 31757095 PMCID: PMC6950630 DOI: 10.3390/nu11122847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/15/2019] [Accepted: 11/16/2019] [Indexed: 12/21/2022] Open
Abstract
Resting heart rate (rHR) and heart rate variability (HRV) are non-invasive measurements that predict the risk of sudden cardiac death (SCD). Marine n-3 polyunsaturated fatty acid (PUFA) supplementation may decrease rHR, increase HRV, and reduce the risk of SCD. To date, no studies have investigated the effect of marine n-3 PUFA on HRV in renal transplant recipients. In a randomized controlled trial, 132 renal transplant recipients were randomized to receive either three 1 g capsules of marine n-3 PUFA, each containing 460 mg/g EPA and 380 mg/g DHA, or control (olive oil) for 44 weeks. HRV was calculated in the time and frequency domains during a conventional cardiovascular reflex test (response to standing, deep breathing, and Valsalva maneuver) and during 2 min of resting in the supine position. There was no significant effect of marine n-3 PUFA supplementation on time-domain HRV compared with controls. rHR decreased 3.1 bpm (± 13.1) for patients receiving marine n-3 PUFA compared to 0.8 (± 11.0) in controls (p = 0.28). In the frequency domain HRV analyses, there was a significant change in response to standing in both high and low frequency measures, 2.9 (p = 0.04, 95% CI (1.1;8)) and 2.7 (p = 0.04, 95% CI (1.1;6.5)), respectively. In conclusion, 44 weeks of supplemental marine n-3 PUFAs in renal transplant recipients significantly improved the cardiac autonomic function, assessed by measuring HRV during conventional cardiovascular reflex tests.
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182
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Ravichandran S, Srivastav S, Kamble PH, Chambial S, Shukla R, Sharma P, Sharma RK. VEGF-A and cardiac autonomic function in newly diagnosed type 2 diabetes mellitus: A cross-sectional study at a tertiary care center. J Family Med Prim Care 2019; 8:3185-3190. [PMID: 31742140 PMCID: PMC6857358 DOI: 10.4103/jfmpc.jfmpc_537_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/22/2019] [Accepted: 09/19/2019] [Indexed: 11/26/2022] Open
Abstract
Introduction: Cardiac autonomic neuropathy (CAN) is a key complication of type 2 diabetes mellitus (Ty2DM). Vascular endothelial-derived growth factor (VEGF-A) plays a key role in diabetic macrovascular and microvascular complications. It is shown to be elevated in diabetic neuropathy and has the potential to serve as a biomarker in Ty2DM. We evaluated VEGF-A levels and cardiac autonomic function in newly diagnosed Ty2DM patients. Materials and Methods: Forty-four newly diagnosed patients (with symptoms within 1 year from the date of recruitment) were included in the study. Cardiac autonomic function was assessed using heart rate variability (HRV) and Ewing's battery tests. Ewing's scores were computed and tabulated. VEGF-A levels were estimated using enzyme-linked immunosorbent assay (ELISA). Results: The patients demonstrated normal responses to the reactivity tests. Ewing's scores were 0 (0-0) and 0 (0-0) for sympathetic and parasympathetic parameters, respectively. The autonomic tone was impaired as assessed by HRV parameters. VEGF-A levels were elevated (308.3 ± 167.2 pg/mL) when compared with the previous literature. Discussion: Impaired tone with normal reactivity was suggestive of early stage of autonomic neuropathy. Elevated VEGF-A levels may be attributed to a protective action of the factor seen in early stages of neuropathy in Ty2DM. Serial VEGF-A estimation in large cohorts of newly diagnosed diabetics may validate it as a biomarker in CAN seen in Ty2DM.
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Affiliation(s)
- Suresh Ravichandran
- Department of Physiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Shival Srivastav
- Department of Physiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Shailja Chambial
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ravindra Shukla
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Praveen Sharma
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Rajesh Kumar Sharma
- Department of Physiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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183
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Kaneko K, Chikamoto A, Hsu JCN, Tochinai R, Sekizawa SI, Yamamoto M, Kuwahara M. Effects of environmental enrichment on autonomic nervous activity in NSY mice. Exp Anim 2019; 69:161-167. [PMID: 31735765 PMCID: PMC7220714 DOI: 10.1538/expanim.19-0103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Environmental enrichment (EE) can reduce anxiety and stress in experimental animals,
while little is known about the influence on autonomic nervous activity especially in
disease animal models. Diabetes mellitus (DM) is associated with cardiovascular autonomic
dysfunction, which can be characterized by a higher resting heart rate and a lower heart
rate variability (HRV). We hypothesized that EE can enhance parasympathetic nervous
activity while reducing disease progression in type 2 diabetic mice. A telemetry
transmitter was implanted in NSY mice to continuously record electrocardiograms (ECG).
Animals were kept in a cage with or without a nest box as EE. The autonomic nervous
activity was evaluated using power spectral analysis of HRV. Four weeks of EE could
increase high frequency (HF) power, but no change was observed in the absence of EE.
Although animals showed impaired glucose tolerance at 48 weeks of age regardless of EE, a
worsen case was observed in control. These results indicate that EE can be necessary for
long-term housing of experimental animals and may reduce the risk of impaired glucose
tolerance in NSY mice by enhancing parasympathetic nervous activity. In future, it is
demanded whether increasing parasympathetic nervous activity, whatever the method is, can
prevent diabetes from worsening.
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Affiliation(s)
- Kentaro Kaneko
- Laboratory of Veterinary Pathophysiology and Animal Health, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan.,School of Nursing, Ibaraki Christian University, 6-11-1 Omika, Hitachi, Ibaraki 319-1295, Japan.,Graduate School of Nursing, Ibaraki Christian University, 6-11-1 Omika, Hitachi, Ibaraki 319-1295, Japan
| | - Akitoshi Chikamoto
- Laboratory of Veterinary Pathophysiology and Animal Health, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
| | - Julia Chu-Ning Hsu
- Laboratory of Veterinary Pathophysiology and Animal Health, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
| | - Ryota Tochinai
- Laboratory of Veterinary Pathophysiology and Animal Health, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
| | - Shin-Ichi Sekizawa
- Laboratory of Veterinary Pathophysiology and Animal Health, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
| | - Machiko Yamamoto
- School of Nursing, Ibaraki Christian University, 6-11-1 Omika, Hitachi, Ibaraki 319-1295, Japan.,Graduate School of Nursing, Ibaraki Christian University, 6-11-1 Omika, Hitachi, Ibaraki 319-1295, Japan
| | - Masayoshi Kuwahara
- Laboratory of Veterinary Pathophysiology and Animal Health, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
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184
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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.
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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
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185
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Chang WL, Lee JT, Li CR, Davis AHT, Yang CC, Chen YJ. Effects of Heart Rate Variability Biofeedback in Patients With Acute Ischemic Stroke: A Randomized Controlled Trial. Biol Res Nurs 2019; 22:34-44. [PMID: 31635477 DOI: 10.1177/1099800419881210] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Autonomic dysfunction, cognitive impairment, and psychological distress are associated with poorer prognosis in patients with acute ischemic stroke (AIS). Heart rate variability (HRV) biofeedback (BF) improves autonomic dysfunction, cognitive impairment, and psychological distress in other patient populations, but its effect in patients with AIS is still unclear. OBJECTIVE This study investigated the effects of an HRVBF intervention on autonomic function, cognitive impairment, and psychological distress in patients with AIS. METHOD In this randomized, controlled, single-blind trial, patients with AIS were randomly assigned to the experimental or control group. The experimental group received four HRVBF training sessions. The control group received usual care. Repeated measures of HRV, mini-mental status examination (MMSE), and Hospital Anxiety and Depression Scales (HADS) were collected prior to and at 1 and 3 months postintervention. RESULTS A total of 35 patients completed the study (19 experimental, 16 control). HRV and HADS significantly improved in the experimental group (p < .001) but not in the control group. Likewise, only the experimental group showed significant improvements in HRV, MMSE, and HADS over time (p < .05). CONCLUSION HRVBF is a promising intervention for improving autonomic function, cognitive impairment, and psychological distress in patients with AIS. More studies of HRVBF interventions are needed to further optimize the effects of HRVBF on autonomic, cognitive, and psychological function in patients with AIS.
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Affiliation(s)
- Wan-Ling Chang
- Department of Nursing, Fu Jen Catholic University Hospital, New Taipei City
| | - Jiunn-Tay Lee
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Chi-Rong Li
- Department of Teaching and Research, Taichung Hospital, Ministry of Health and Welfare, Taichung
| | - Amy H T Davis
- College of Health and Society, Hawaii Pacific University, Kaneohe, HI, USA
| | - Chia-Chen Yang
- School of Nursing, National Defense Medical Center, Taipei
| | - Yu-Ju Chen
- School of Nursing, National Defense Medical Center, Taipei
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186
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Navel V, Mulliez A, Benoist d’Azy C, Baker JS, Malecaze J, Chiambaretta F, Dutheil F. Efficacy of treatments for Demodex blepharitis: A systematic review and meta-analysis. Ocul Surf 2019; 17:655-669. [DOI: 10.1016/j.jtos.2019.06.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/21/2019] [Accepted: 06/17/2019] [Indexed: 02/06/2023]
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187
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Noronha Osório D, Viana-Soares R, Marto JP, Mendonça MD, Silva HP, Quaresma C, Viana-Baptista M, Gamboa H, Vieira HLA. Autonomic nervous system response to remote ischemic conditioning: heart rate variability assessment. BMC Cardiovasc Disord 2019; 19:211. [PMID: 31500561 PMCID: PMC6734354 DOI: 10.1186/s12872-019-1181-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 08/12/2019] [Indexed: 11/17/2022] Open
Abstract
Background Remote ischemic conditioning (RIC) is a procedure applied in a limb for triggering endogenous protective pathways in distant organs, namely brain or heart. The underlying mechanisms of RIC are still not fully understood, and it is hypothesized they are mediated either by humoral factors, immune cells and/or the autonomic nervous system. Herein, heart rate variability (HRV) was used to evaluate the electrophysiological processes occurring in the heart during RIC and, in turn to assess the role of autonomic nervous system. Methods Healthy subjects were submitted to RIC protocol and electrocardiography (ECG) was used to evaluate HRV, by assessing the variability of time intervals between two consecutive heart beats. This is a pilot study based on the analysis of 18 ECG from healthy subjects submitted to RIC. HRV was characterized in three domains (time, frequency and non-linear features) that can be correlated with the autonomic nervous system function. Results RIC procedure increased significantly the non-linear parameter SD2, which is associated with long term HRV. This effect was observed in all subjects and in the senior (> 60 years-old) subset analysis. SD2 increase suggests an activation of both parasympathetic and sympathetic nervous system, namely via fast vagal response (parasympathetic) and the slow sympathetic response to the baroreceptors stimulation. Conclusions RIC procedure modulates both parasympathetic and sympathetic autonomic nervous system. Furthermore, this modulation is more pronounced in the senior subset of subjects. Therefore, the autonomic nervous system regulation could be one of the mechanisms for RIC therapeutic effectiveness. Electronic supplementary material The online version of this article (10.1186/s12872-019-1181-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniel Noronha Osório
- LIBPhys-UNL - Laboratorio de Instrumentação, Engenharia Biomédica e Física da Radiação (LIBPhys-UNL), Departamento de Física, Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa, Monte da Caparica, 2892-516, Caparica, Portugal.,PLUX - Wireless Biosignals, S.A, Lisboa, Portugal
| | - Ricardo Viana-Soares
- CEDOC - NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria, 130, 1169-056, Lisboa, Portugal
| | - João Pedro Marto
- CEDOC - NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria, 130, 1169-056, Lisboa, Portugal.,Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Marcelo D Mendonça
- CEDOC - NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria, 130, 1169-056, Lisboa, Portugal.,Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal.,Champalimaud Research, Champalimaud Centre for the Unknown, Lisboa, 7IT - Instituto de Telecomunicações, Lisboa, Portugal
| | - Hugo P Silva
- PLUX - Wireless Biosignals, S.A, Lisboa, Portugal.,EST/IPS - Escola Superior de Tecnologia do Instituto Politécnico de Setúbal, Setúbal, Portugal.,iBET - Instituto de Biologia Experimental e Tecnológica, Oeiras, Portugal
| | - Cláudia Quaresma
- LIBPhys-UNL - Laboratorio de Instrumentação, Engenharia Biomédica e Física da Radiação (LIBPhys-UNL), Departamento de Física, Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa, Monte da Caparica, 2892-516, Caparica, Portugal
| | - Miguel Viana-Baptista
- CEDOC - NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria, 130, 1169-056, Lisboa, Portugal.,Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Hugo Gamboa
- LIBPhys-UNL - Laboratorio de Instrumentação, Engenharia Biomédica e Física da Radiação (LIBPhys-UNL), Departamento de Física, Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa, Monte da Caparica, 2892-516, Caparica, Portugal.
| | - Helena L A Vieira
- CEDOC - NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria, 130, 1169-056, Lisboa, Portugal.
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188
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Karey E, Pan S, Morris AN, Bruun DA, Lein PJ, Chen CY. The Use of Percent Change in RR Interval for Data Exclusion in Analyzing 24-h Time Domain Heart Rate Variability in Rodents. Front Physiol 2019; 10:693. [PMID: 31244671 PMCID: PMC6562196 DOI: 10.3389/fphys.2019.00693] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 05/16/2019] [Indexed: 11/13/2022] Open
Abstract
While epidemiological data support the link between reduced heart rate variability (HRV) and a multitude of pathologies, the mechanisms underlying changes in HRV and disease progression are poorly understood. Even though we have numerous rodent models of disease for mechanistic studies, not being able to reliably measure HRV in conscious, freely moving rodents has hindered our ability to extrapolate the role of HRV in the progression from normal physiology to pathology. The sheer number of heart beats per day (>800,000 in mice) makes data exclusion both time consuming and daunting. We sought to evaluate an RR interval exclusion method based on percent (%) change of adjacent RR intervals. Two approaches were evaluated: % change from “either” and “both” adjacent RR intervals. The data exclusion method based on standard deviation (SD) was also evaluated for comparison. Receiver operating characteristic (ROC) curves were generated to determine the performance of each method. Results showed that exclusion based on % change from “either” adjacent RR intervals was the most accurate method in identifying normal and abnormal RR intervals, with an overall accuracy of 0.92–0.99. As the exclusion value increased (% change or SD), the sensitivity (correctly including normal RR intervals) increased exponentially while the specificity (correctly rejecting abnormal RR intervals) decreased linearly. Compared to the SD method, the “either” approach had a steeper rise in sensitivity and a more gradual decrease in specificity. The intersection of sensitivity and specificity where the exclusion criterion had the same accuracy in identifying normal and abnormal RR intervals was 10–20% change for the “either” approach and ∼ 1 SD for the SD-based exclusion method. Graphically (tachogram and Lorenz plot), 20% change from either adjacent RR interval resembled the data after manual exclusion. Finally, overall (SDNN) and short-term (rMSSD) indices of HRV generated using 20% change from “either” adjacent RR intervals as the exclusion criterion were closer to the manual exclusion method with lower subject-to-subject variability than those generated using the 2 SD exclusion criterion. Thus, 20% change from “either” adjacent RR intervals is a good criterion for data exclusion for reliable 24-h time domain HRV analysis in rodents.
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Affiliation(s)
- Emma Karey
- Department of Pharmacology, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Shiyue Pan
- Department of Pharmacology, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Amber N Morris
- Department of Pharmacology, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Donald A Bruun
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Pamela J Lein
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Chao-Yin Chen
- Department of Pharmacology, School of Medicine, University of California, Davis, Davis, CA, United States
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189
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Lundqvist MH, Almby K, Abrahamsson N, Eriksson JW. Is the Brain a Key Player in Glucose Regulation and Development of Type 2 Diabetes? Front Physiol 2019; 10:457. [PMID: 31133864 PMCID: PMC6524713 DOI: 10.3389/fphys.2019.00457] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/01/2019] [Indexed: 01/08/2023] Open
Abstract
Ever since Claude Bernards discovery in the mid 19th-century that a lesion in the floor of the third ventricle in dogs led to altered systemic glucose levels, a role of the CNS in whole-body glucose regulation has been acknowledged. However, this finding was later overshadowed by the isolation of pancreatic hormones in the 20th century. Since then, the understanding of glucose homeostasis and pathology has primarily evolved around peripheral mechanism. Due to scientific advances over these last few decades, however, increasing attention has been given to the possibility of the brain as a key player in glucose regulation and the pathogenesis of metabolic disorders such as type 2 diabetes. Studies of animals have enabled detailed neuroanatomical mapping of CNS structures involved in glucose regulation and key neuronal circuits and intracellular pathways have been identified. Furthermore, the development of neuroimaging techniques has provided methods to measure changes of activity in specific CNS regions upon diverse metabolic challenges in humans. In this narrative review, we discuss the available evidence on the topic. We conclude that there is much evidence in favor of active CNS involvement in glucose homeostasis but the relative importance of central vs. peripheral mechanisms remains to be elucidated. An increased understanding of this field may lead to new CNS-focusing pharmacologic strategies in the treatment of type 2 diabetes.
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Affiliation(s)
| | - Kristina Almby
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Jan W Eriksson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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190
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Breder ISS, Sposito AC. Cardiovascular autonomic neuropathy in type 2 diabetic patients. ACTA ACUST UNITED AC 2019; 65:56-60. [PMID: 30758421 DOI: 10.1590/1806-9282.65.1.56] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 10/26/2018] [Indexed: 02/07/2023]
Abstract
Diabetes is one of the most common chronic pathologies around the world, involving treatment with general clinicians, endocrinologists, cardiologists, ophthalmologists, nephrologists and a multidisciplinary team. Patients with type 2 Diabetes Mellitus (T2DM) can be affected by cardiac autonomic neuropathy, leading to increased mortality and morbidity. In this review, we will present current concepts, clinical features, diagnosis, prognosis, and possible treatment. New drugs recently developed to reduce glycemic level presented a pleiotropic effect of reducing sudden death, suggesting a potential use in patients at risk.
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Affiliation(s)
- Ikaro Soares Santos Breder
- Endocrinologist - Doctorate Student at the Laboratory of Vascular Biology and Atherosclerosis. -Faculty of medical Sciences (FCM) - State University of Campinas (Unicamp) - Campinas (SP) - Brasil
| | - Andrei C Sposito
- Full Professor - Department of Cardiology - Laboratory of Vascular Biology and Atherosclerosis - FCM - Unicamp - São Paulo (SP) - Brasil
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191
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Vukomanovic V, Suzic-Lazic J, Celic V, Cuspidi C, Petrovic T, Ilic S, Skokic D, Armando Morris D, Tadic M. Association between functional capacity and heart rate variability in patients with uncomplicated type 2 diabetes. Blood Press 2019; 28:184-190. [DOI: 10.1080/08037051.2019.1586431] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Vladan Vukomanovic
- Department of Cardiology, University Clinical Hospital Center “Dr. Dragisa Misovic - Dedinje”, Belgrade, Serbia
| | - Jelena Suzic-Lazic
- Department of Cardiology, University Clinical Hospital Center “Dr. Dragisa Misovic - Dedinje”, Belgrade, Serbia
| | - Vera Celic
- Department of Cardiology, University Clinical Hospital Center “Dr. Dragisa Misovic - Dedinje”, Belgrade, Serbia
| | - Cesare Cuspidi
- Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Meda, Italy
| | - Tijana Petrovic
- Department of Cardiology, University Clinical Hospital Center “Dr. Dragisa Misovic - Dedinje”, Belgrade, Serbia
| | - Sanja Ilic
- Department of Cardiology, University Clinical Hospital Center “Dr. Dragisa Misovic - Dedinje”, Belgrade, Serbia
| | - Dusan Skokic
- Department of Cardiology, University Clinical Hospital Center “Dr. Dragisa Misovic - Dedinje”, Belgrade, Serbia
| | - Daniel Armando Morris
- Department of Internal Medicine and, Cardiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Marijana Tadic
- Department of Cardiology, University Clinical Hospital Center “Dr. Dragisa Misovic - Dedinje”, Belgrade, Serbia
- Department of Internal Medicine and, Cardiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
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192
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Heart rate variability in patients presenting with neurally mediated syncope in an emergency department. Am J Emerg Med 2019; 38:211-216. [PMID: 30765277 DOI: 10.1016/j.ajem.2019.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/03/2019] [Accepted: 02/05/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Neurally mediated syncope (NMS) is a disorder of autonomic nervous system (ANS) regulation. Orthostatic stress is one of the most common causative factors seen in clinical practice. Analysis of heart rate variability (HRV) is a non-invasive method that is used to assess ANS regulation. In this study, we investigated the pathophysiology of NMS using HRV in our emergency department. METHODS The subjects were 19 patients (age 25.8 ± 6.2 years old) who presented with NMS and 20 healthy individuals (age 26.6 ± 2.7 years old) who served as controls. HRV was measured in supine, sitting and standing positions. Heart rate (HR), low frequency (LF 0.04-0.15 Hz), high frequency (HF > 0.15 Hz), and coefficient of variation of the R-R interval (CVRR) were determined. RESULTS LF and HF in the supine position were significantly lower in the patients with NMS (p < 0.05). HR was higher in all positions in patients with NMS than in healthy individuals (p < 0.05). CVRR in the supine position was lower in the patients with NMS (p < 0.001), and it was significantly lower in patients who were positive in an orthostatic test (p = 0.0017). Area under the curve was calculated to be 0.824, and at the cutoff value of 4.997 of CVRR in supine, the sensitivity and the specificity were 78.9% and 85.0%. CONCLUSION The sympathetic and parasympathetic nervous systems were both suppressed in patients with NMS. In post-syncope, parasympathetic withdrawal, rather than sympathetic reactivation, was responsible for the increased HR after syncope. CVRR may serve as a new clinical biomarker in the emergency department.
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193
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López-Cano C, Gutiérrez-Carrasquilla L, Sánchez E, González J, Yeramian A, Martí R, Hernández M, Cao G, Ribelles M, Gómez X, Barril S, Barbé F, Hernández C, Simó R, Lecube A. Sympathetic Hyperactivity and Sleep Disorders in Individuals With Type 2 Diabetes. Front Endocrinol (Lausanne) 2019; 10:752. [PMID: 31736881 PMCID: PMC6839128 DOI: 10.3389/fendo.2019.00752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 10/17/2019] [Indexed: 12/27/2022] Open
Abstract
Introduction: Many studies on the impact of type 2 diabetes mellitus (T2DM) on sleep breathing have shown a higher prevalence and severity of sleep apnea-hypopnea syndrome (SAHS) in those with T2DM. Moreover, an increased activity of the sympathetic nervous system has been described in both pathologies. This cross-sectional study aimed to assess sympathetic activity in patients with T2DM, and to investigate the relationship between sympathetic activity and polysomnographic parameters. Materials and Methods: Thirty-six patients with T2DM without known clinical macrovascular nor pulmonary disease and 11 controls underwent respiratory polygraphy, and their cardiac variability and 24-h urine total metanephrines were measured. Results: SAHS was highly prevalent with a mean apnea-hypopnea index (AHI) in the range of moderate SAHS. In patients with T2DM, the nocturnal concentration of total metanephrines in urine were higher than diurnal levels [247.0 (120.0-1375.0) vs. 210.0 (92.0-670.0), p = 0.039]. The nocturnal total metanephrine concentration was positively and significantly associatedwith the percentage of sleeping time spent with oxygen saturation <90%(CT90). In the entire population and in subjects with T2DM, the multivariate regression analysis showed a direct interaction between the nocturnal concentration of urine metanephrines and the CT90. Conclusion: These findings suggest that the increase in sympathetic activity previously described in patients with T2DM could be mediated through nocturnal breathing disturbances. The diagnosis and treatment of SAHS may influence sympathetic activity disorders and may contribute to an improvement in T2DM and cardiovascular risk.
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Affiliation(s)
- Carolina López-Cano
- Endocrinology and Nutrition Department, Institut de Recerca Biomèdica de Lleida (IRBLleida), Hospital Universitari Arnau de Vilanova, Obesity, Diabetes and Metabolism Research Group (ODIM), Universitat de Lleida (UdL), Lleida, Spain
| | - Liliana Gutiérrez-Carrasquilla
- Endocrinology and Nutrition Department, Institut de Recerca Biomèdica de Lleida (IRBLleida), Hospital Universitari Arnau de Vilanova, Obesity, Diabetes and Metabolism Research Group (ODIM), Universitat de Lleida (UdL), Lleida, Spain
| | - Enric Sánchez
- Endocrinology and Nutrition Department, Institut de Recerca Biomèdica de Lleida (IRBLleida), Hospital Universitari Arnau de Vilanova, Obesity, Diabetes and Metabolism Research Group (ODIM), Universitat de Lleida (UdL), Lleida, Spain
| | - Jessica González
- Respiratory Department, Institut de Recerca Biomèdica de Lleida (IRBLleida), Hospital Universitari Arnau de Vilanova-Santa María, Translational Research in Respiratory Medicine, Universitat de Lleida (UdL), Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Andree Yeramian
- Endocrinology and Nutrition Department, Institut de Recerca Biomèdica de Lleida (IRBLleida), Hospital Universitari Arnau de Vilanova, Obesity, Diabetes and Metabolism Research Group (ODIM), Universitat de Lleida (UdL), Lleida, Spain
| | - Raquel Martí
- Endocrinology and Nutrition Department, Institut de Recerca Biomèdica de Lleida (IRBLleida), Hospital Universitari Arnau de Vilanova, Obesity, Diabetes and Metabolism Research Group (ODIM), Universitat de Lleida (UdL), Lleida, Spain
| | - Marta Hernández
- Endocrinology and Nutrition Department, Institut de Recerca Biomèdica de Lleida (IRBLleida), Hospital Universitari Arnau de Vilanova, Obesity, Diabetes and Metabolism Research Group (ODIM), Universitat de Lleida (UdL), Lleida, Spain
| | - Gonzalo Cao
- Section of Hormones, Clinic Laboratory, Hospital Universitari Arnau de Vilanova, Universitat de Lleida (UdL), Lleida, Spain
| | - Mercè Ribelles
- Clinic Laboratory, Hospital Universitari Arnau de Vilanova, Universitat de Lleida (UdL), Lleida, Spain
| | - Xavier Gómez
- Clinic Laboratory, Department of Laboratory Medicine, Hospital Universitari Arnau de Vilanova, Universitat de Lleida (UdL), Lleida, Spain
| | - Silvia Barril
- Respiratory Department, Institut de Recerca Biomèdica de Lleida (IRBLleida), Hospital Universitari Arnau de Vilanova-Santa María, Translational Research in Respiratory Medicine, Universitat de Lleida (UdL), Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Ferran Barbé
- Respiratory Department, Institut de Recerca Biomèdica de Lleida (IRBLleida), Hospital Universitari Arnau de Vilanova-Santa María, Translational Research in Respiratory Medicine, Universitat de Lleida (UdL), Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Cristina Hernández
- Diabetes and Metabolism Research Unit, Endocrinology and Nutrition Department, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación en Red en Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Rafael Simó
- Diabetes and Metabolism Research Unit, Endocrinology and Nutrition Department, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación en Red en Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Albert Lecube
- Endocrinology and Nutrition Department, Institut de Recerca Biomèdica de Lleida (IRBLleida), Hospital Universitari Arnau de Vilanova, Obesity, Diabetes and Metabolism Research Group (ODIM), Universitat de Lleida (UdL), Lleida, Spain
- Centro de Investigación en Red en Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- *Correspondence: Albert Lecube
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Okada M, Okada K, Fujii K. Influence of polypharmacy on heart rate variability in older adults at the Hiroshima Atomic Bomb Survivors Recuperation Research Center, Japan. PLoS One 2018; 13:e0209081. [PMID: 30540860 PMCID: PMC6291139 DOI: 10.1371/journal.pone.0209081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 11/28/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Many studies have identified the risk of polypharmacy, but physiological evidence and methods of evaluation in these studies were poor. The relationship between polypharmacy and heart rate variability in older adults remains unclear. We investigated the relationship between polypharmacy in older adults, including atomic bomb survivors, and heart rate variability. METHODS We surveyed 56 older adults who did not need nursing care assistance in the Hiroshima Atomic Bomb Survivors Recuperation Center. Chronic diseases, types of medication, and lifestyle were assessed, and heart rate variability at rest was measured. We calculated heart rate variability indices including standard deviation of normal-to-normal RR intervals (SDNN), total power (TP), and very low frequency (VLF) and analyzed the relationship between the number of daily medication types and heart rate variability indices in older adults. The differences in heart rate variability indices were analyzed using six medications as a cut-off point. RESULTS Participants included 36 atomic bomb survivors and 20 non-atomic bomb survivors. The mean number of medication types was 3.6±3.4 (mean±standard deviation). SDNN, TP, and VLF decreased with an increased number of medications in all participants (P<0.01). When the standard of polypharmacy was set to more than six types of medications, SDNN, TP, and VLF were significantly lower in older adults who took six or more medications. Additionally, the mean number of medication types among atomic bomb survivors was higher than that of non-atomic bomb survivors (P = 0.008). The SDNN was significantly lower when atomic bomb survivors took six or more medications (P<0.001). CONCLUSIONS We found that a lower heart rate variability in older adults, including atomic bomb survivors, is associated with polypharmacy. We showed physiological evidence of the influence of polypharmacy, which may be important for the healthy life expectancy and prognosis in older adults.
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Affiliation(s)
- Masahiro Okada
- Department of Food and Dietetics, Hiroshima Bunka Gakuen Two-Year College, 3-5-1 Nagatsukanishi, Asaminami-ku, Hiroshima, Japan
- * E-mail:
| | - Kosuke Okada
- Department of Internal Medicine COOP Saeki Hospital, 3-11-29 Yahata-higashi, Saeki-ku, Hiroshima, Japan
| | - Kohyu Fujii
- Department of Food and Dietetics, Hiroshima Bunka Gakuen Two-Year College, 3-5-1 Nagatsukanishi, Asaminami-ku, Hiroshima, Japan
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Rodrigues TS, Quarto LJG. Body Mass Index May Influence Heart Rate Variability. Arq Bras Cardiol 2018; 111:640-642. [PMID: 30365689 PMCID: PMC6199506 DOI: 10.5935/abc.20180201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 09/12/2018] [Indexed: 11/29/2022] Open
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196
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Renal sympathetic denervation induces changes in heart rate variability and is associated with a lower sympathetic tone. Clin Res Cardiol 2018; 108:22-30. [DOI: 10.1007/s00392-018-1307-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/15/2018] [Indexed: 10/28/2022]
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Tai HC, Chou YS, Tzeng IS, Wei CY, Su CH, Liu WC, Kung WM. Effect of Tai Chi Synergy T1 Exercise on Autonomic Function, Metabolism, and Physical Fitness of Healthy Individuals. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2018; 2018:6351938. [PMID: 30050592 PMCID: PMC6040286 DOI: 10.1155/2018/6351938] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/16/2018] [Accepted: 05/31/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Tai Chi synergy T1 exercise is an aerobic exercise derived mainly from Tai Chi exercise. It is also derived from the Eight Trigrams Palms, form and will boxing, mantis boxing, Qigong, and Yoga, with a total of 16 sessions in 63 minutes. In this study, we investigated its effects on autonomic modulation, metabolism, immunity, and physical function in healthy practitioners. METHOD We recruited a total of 26 volunteers and 23 control participants. Heart rate variability (HRV), blood pressure, and body mass index (BMI) were recorded before and after practicing Tai Chi synergy T1 exercise and regular walking for 10 weeks, respectively. Serum glucose, cholesterol, and peripheral blood including B and T cell counts were also measured. They underwent one-minute bent-knee sit-ups, sit and reach test, and three-minute gradual step test. RESULTS Tai Chi synergy T1 exercise enhanced parasympathetic modulation and attenuated sympathetic nerve control with increased very low frequency (VLF) and high frequency (HF) but decreased low frequency (LF) compared to the control group. Metabolic profiles including serum glucose, cholesterol, and BMI significantly improved after exercise. The exercise enhanced innate and adaptive immunity by increasing the counts of CD3+ T cells, CD19+ B cells, and CD16+CD56+ NK cells but decreasing the CD3+ cytotoxic T cell count. All monitored parameters including physical fitness and physical strength improved after the exercise. CONCLUSION Tai Chi synergy T1 exercise improves autonomic modulation, body metabolism, physical fitness, and physical strength after 10 weeks of practice.
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Affiliation(s)
- Hsu-Chih Tai
- 1Department of Exercise and Health Promotion, College of Education, Chinese Culture University, Taipei, Taiwan
| | - Yi-Sheng Chou
- 2Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- 3Division of Hematology and Oncology, Department of Medicine, Taipei City Hospital, Renai Branch, Taipei, Taiwan
| | - I-Shiang Tzeng
- 4Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Cheng-Yu Wei
- 1Department of Exercise and Health Promotion, College of Education, Chinese Culture University, Taipei, Taiwan
- 5Department of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Chun-Hsien Su
- 1Department of Exercise and Health Promotion, College of Education, Chinese Culture University, Taipei, Taiwan
| | - Wen-Chen Liu
- 6Department of Leisure and Sports Management, College of Life and Creativity, Cheng Shiu University, Kaohsiung, Taiwan
| | - Woon-Man Kung
- 1Department of Exercise and Health Promotion, College of Education, Chinese Culture University, Taipei, Taiwan
- 7Division of Neurosurgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- 8Department of Surgery, School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
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