1
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Braunisch MC, Mayer CC, Werfel S, Bauer A, Haller B, Lorenz G, Günthner R, Matschkal J, Bachmann Q, Thunich S, Schlegl M, Ludwig M, Holzmann-Littig C, Assali T, Pachmann M, Küchle C, Renders L, Wassertheurer S, Müller A, Schmidt G, Heemann U, Malik M, Schmaderer C. U-Shaped Association of the Heart Rate Variability Triangular Index and Mortality in Hemodialysis Patients With Atrial Fibrillation. Front Cardiovasc Med 2021; 8:751052. [PMID: 34912859 PMCID: PMC8667023 DOI: 10.3389/fcvm.2021.751052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/31/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Atrial fibrillation (AF) is common in hemodialysis patients and contributes to increased mortality. We aimed to examine heart rate variability triangular index (HRVI) in hemodialysis patients with AF as it has recently been reported to predict mortality in AF patients without kidney disease. Methods: A total of 88 patients on hemodialysis with a medical history of AF or newly diagnosed AF underwent 24-h electrocardiography recordings. The primary endpoint of cardiovascular mortality was recorded during a median follow up of 3.0 years. Risk prediction was assessed by Cox regression, both unadjusted and adjusted for the Charlson Comorbidity Index and the Cardiovascular Mortality Risk Score. Results: Median age was 76 years, median dialysis vintage was 27 months. Altogether, 22 and 44 patients died due to cardiovascular and non-cardiovascular causes. In 55% of patients AF was present during the recording. Kaplan-Meier plots of HRVI quartiles suggested a non-linear association between HRVI, cardiovascular, and all-cause mortality which was confirmed in non-linear Cox regression analysis. Adjusted linear Cox regression revealed a hazard ratio of 6.2 (95% CI: 2.1-17.7, p = 0.001) and 2.2 (95% CI: 1.3-3.8, p = 0.002) for the outer quartiles (combined first and fourth quartile) for cardiovascular and all-cause mortality, respectively. Patients in the first quartile were more likely to have sinus rhythm whereas patients in the fourth quartile were more likely to have AF. Conclusions: We found a U-shaped association between HRVI and mortality in hemodialysis AF patients. The results might contribute to risk stratification independent of known risk scores in hemodialysis AF patients.
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Affiliation(s)
- Matthias C. Braunisch
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christopher C. Mayer
- Center for Health and Bioresources, Biomedical Systems, AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | - Stanislas Werfel
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Axel Bauer
- University Hospital for Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
- Department of Cardiology, Munich University Clinic, DZHK (German Centre for Cardiovascular Research), Ludwig-Maximilians University, Munich, Germany
| | - Bernhard Haller
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
- School of Medicine, Klinikum Rechts der Isar, Institute of Medical Informatics, Statistics and Epidemiology (IMedIS), Technical University of Munich, Munich, Germany
| | - Georg Lorenz
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Roman Günthner
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Julia Matschkal
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Quirin Bachmann
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stephan Thunich
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
- School of Medicine, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Michaela Schlegl
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Maximilian Ludwig
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christopher Holzmann-Littig
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Tarek Assali
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | | | - Claudius Küchle
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lutz Renders
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Siegfried Wassertheurer
- Center for Health and Bioresources, Biomedical Systems, AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | - Alexander Müller
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
- School of Medicine, Klinik für Innere Medizin I, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Georg Schmidt
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
- School of Medicine, Klinik für Innere Medizin I, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Uwe Heemann
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Marek Malik
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Christoph Schmaderer
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
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2
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Antali F, Kulin D, Lucz KI, Szabó B, Szűcs L, Kulin S, Miklós Z. Multimodal Assessment of the Pulse Rate Variability Analysis Module of a Photoplethysmography-Based Telemedicine System. SENSORS 2021; 21:s21165544. [PMID: 34450986 PMCID: PMC8401087 DOI: 10.3390/s21165544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/06/2021] [Accepted: 08/14/2021] [Indexed: 12/25/2022]
Abstract
Alterations of heart rate variability (HRV) are associated with various (patho)physiological conditions; therefore, HRV analysis has the potential to become a useful diagnostic module of wearable/telemedical devices to support remote cardiovascular/autonomic monitoring. Continuous pulse recordings obtained by photoplethysmography (PPG) can yield pulse rate variability (PRV) indices similar to HRV parameters; however, it is debated whether PRV/HRV parameters are interchangeable. In this study, we assessed the PRV analysis module of a digital arterial PPG-based telemedical system (SCN4ALL). We used Bland–Altman analysis to validate the SCN4ALL PRV algorithm to Kubios Premium software and to determine the agreements between PRV/HRV results calculated from 2-min long PPG and ECG captures recorded simultaneously in healthy individuals (n = 33) at rest and during the cold pressor test, and in diabetic patients (n = 12) at rest. We found an ideal agreement between SCN4ALL and Kubios outputs (bias < 2%). PRV and HRV parameters showed good agreements for interbeat intervals, SDNN, and RMSSD time-domain variables, for total spectral and low-frequency power (LF) frequency-domain variables, and for non-linear parameters in healthy subjects at rest and during cold pressor challenge. In diabetics, good agreements were observed for SDNN, LF, and SD2; and moderate agreement was observed for total power. In conclusion, the SCN4ALL PRV analysis module is a good alternative for HRV analysis for numerous conventional HRV parameters.
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Affiliation(s)
- Flóra Antali
- Institute of Translational Medicine, Semmelweis University, 1094 Budapest, Hungary;
- E-Med4All Europe Ltd., 1036 Budapest, Hungary; (K.I.L.); (B.S.); (L.S.); (S.K.)
- Correspondence: (F.A.); (Z.M.); Tel.: +36-70-323-7431 (F.A.); +36-20-585-8099 (Z.M.)
| | - Dániel Kulin
- Institute of Translational Medicine, Semmelweis University, 1094 Budapest, Hungary;
- E-Med4All Europe Ltd., 1036 Budapest, Hungary; (K.I.L.); (B.S.); (L.S.); (S.K.)
| | - Konrád István Lucz
- E-Med4All Europe Ltd., 1036 Budapest, Hungary; (K.I.L.); (B.S.); (L.S.); (S.K.)
| | - Balázs Szabó
- E-Med4All Europe Ltd., 1036 Budapest, Hungary; (K.I.L.); (B.S.); (L.S.); (S.K.)
| | - László Szűcs
- E-Med4All Europe Ltd., 1036 Budapest, Hungary; (K.I.L.); (B.S.); (L.S.); (S.K.)
- Antal Bejczy Center for Intelligent Robotics, Óbuda University, 1034 Budapest, Hungary
| | - Sándor Kulin
- E-Med4All Europe Ltd., 1036 Budapest, Hungary; (K.I.L.); (B.S.); (L.S.); (S.K.)
| | - Zsuzsanna Miklós
- Institute of Translational Medicine, Semmelweis University, 1094 Budapest, Hungary;
- Correspondence: (F.A.); (Z.M.); Tel.: +36-70-323-7431 (F.A.); +36-20-585-8099 (Z.M.)
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3
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Hämmerle P, Eick C, Poli S, Blum S, Schlageter V, Bauer A, Rizas KD, Eken C, Coslovsky M, Aeschbacher S, Krisai P, Meyre P, Wuerfel J, Sinnecker T, Vesin JM, Beer JH, Moschovitis G, Bonati LH, Sticherling C, Conen D, Osswald S, Kühne M, Zuern CS. Association of Heart Rate Variability With Silent Brain Infarcts in Patients With Atrial Fibrillation. Front Cardiovasc Med 2021; 8:684461. [PMID: 34095266 PMCID: PMC8175975 DOI: 10.3389/fcvm.2021.684461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/20/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Silent brain infarcts (SBI) are frequently detected in patients with atrial fibrillation (AF), but it is unknown whether SBI are linked to autonomic dysfunction. We aimed to explore the association of autonomic dysfunction with SBI in AF patients. Methods: 1,358 AF patients without prior stroke or TIA underwent brain MRI and 5-min resting ECG. We divided our cohort into AF patients who presented in sinus rhythm (SR-group, n = 816) or AF (AF-group, n = 542). HRV triangular index (HRVI), standard deviation of normal-to-normal intervals, mean heart rate, root mean square root of successive differences of normal-to-normal intervals, 5-min total power and power in the low frequency, high frequency and very low frequency range were calculated. Primary outcome was presence of SBI in the SR group, defined as large non-cortical or cortical infarcts. Secondary outcomes were SBI volumes and topography. Results: Mean age was 72 ± 9 years, 27% were female. SBI were detected in 10.5% of the SR group and in 19.9% of the AF group (p < 0.001). HRVI <15 was the only HRV parameter associated with the presence of SBI after adjustment for clinical covariates in the SR group [odds ratio (OR) 1.67; 95% confidence interval (CI): 1.03–2.70; p = 0.037]. HRVI <15 was associated with larger brain infarct volumes [β (95% CI) −0.47 (−0.84; −0.09), p = 0.016] in the SR group and was more frequently observed in patients with right- than left-hemispheric SBI (p = 0.017). Conclusion: Impaired HRVI is associated with SBI in AF patients. AF patients with autonomic dysfunction might undergo systematic brain MRI screening to initiate intensified medical treatment. Clinical Trials Gov Identifier: NCT02105844.
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Affiliation(s)
- Peter Hämmerle
- Department of Cardiology, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Christian Eick
- Department of Cardiology, University Hospital Tübingen, Tübingen, Germany
| | - Sven Poli
- Department of Neurology & Stroke, Hertie Institute for Clinical Brain Research, Eberhard-Karls University Tübingen, Tübingen, Germany
| | - Steffen Blum
- Department of Cardiology, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Vincent Schlageter
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Axel Bauer
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Konstantinos D Rizas
- Medizinische Klinik und Poliklinik I, Munich University Clinic, Munich, Germany.,German Center for Cardiovascular Research Partner Site, Munich Heart Alliance, Munich, Germany
| | - Ceylan Eken
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Michael Coslovsky
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Stefanie Aeschbacher
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Philipp Krisai
- Department of Cardiology, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Pascal Meyre
- Department of Cardiology, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Jens Wuerfel
- Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Tim Sinnecker
- Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jean-Marc Vesin
- Institute of Electrical Engineneering, Swiss Federal Institute of Technology, Lausanne University Hospital, Lausanne, Switzerland
| | - Jürg H Beer
- Department of Internal Medicine, Cantonal Hospital Baden, Aargau, Switzerland
| | - Giorgio Moschovitis
- Division of Cardiology, Ospedale Regionale di Lugano-Civico e Italiano, Lugano, Switzerland
| | - Leo H Bonati
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - David Conen
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.,Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Christine S Zuern
- Department of Cardiology, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
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4
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Hansen CS, Jørgensen ME, Malik M, Witte DR, Brunner EJ, Tabák AG, Kivimäki M, Vistisen D. Heart Rate and Heart Rate Variability Changes Are Not Related to Future Cardiovascular Disease and Death in People With and Without Dysglycemia: A Downfall of Risk Markers? The Whitehall II Cohort Study. Diabetes Care 2021; 44:1012-1019. [PMID: 33526428 PMCID: PMC7985416 DOI: 10.2337/dc20-2490] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/27/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Higher resting heart rate (rHR) and lower heart rate variability (HRV) are associated with increased risk of cardiovascular disease (CVD) and all-cause mortality in people with and without diabetes. It is unknown whether temporal changes in rHR and HRV may contribute to this risk. We investigated associations between 5-year changes in rHR and HRV and risk of future CVD and death, taking into account participants' baseline glycemic state. RESEARCH DESIGN AND METHODS In this prospective, population-based cohort study we investigated 4,611 CVD-free civil servants (mean [SD] age, 60 [5.9] years; 70% men). We measured rHR and/or six indices of HRV. Associations of 5-year change in 5-min rHR and HRV with fatal and nonfatal CVD and all-cause mortality or the composite of the two were assessed, with adjustments made for relevant confounders. Effect modification by glycemic state was tested. RESULTS At baseline, 63% of participants were normoglycemic, 29% had prediabetes, and 8% had diabetes. During a median (interquartile range) follow-up of 11.9 (11.4; 12.3) years, 298 participants (6.5%) experienced a CVD event and 279 (6.1%) died of non-CVD-related causes. We found no association between 5-year changes in rHR and HRV and future events. Only baseline rHR was associated with all-cause mortality. A 10 bpm-higher baseline HR level was associated with an 11.4% higher rate of all-cause mortality (95% CI 1.0-22.9%; P = 0.032). Glycemic state did not modify associations. CONCLUSIONS Changes in rHR and HRV and possibly also baseline values of these measures are not associated with future CVD or death in people with or without dysglycemia.
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Affiliation(s)
- Christian S Hansen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark .,National Institute of Public Health, Southern Denmark University, Odense, Denmark
| | | | - Marek Malik
- National Heart and Lung Institute, Imperial College, London, U.K.,Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Daniel R Witte
- National Institute of Public Health, Southern Denmark University, Odense, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark.,Danish Diabetes Academy, Odense, Denmark.,Steno Diabetes Center Aarhus, Aarhus, Denmark
| | - Eric J Brunner
- Department of Epidemiology and Public Health, University College London, London, U.K
| | - Adam G Tabák
- Department of Epidemiology and Public Health, University College London, London, U.K.,Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, Budapest, Hungary.,Department of Public Health, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, U.K
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5
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Hämmerle P, Eick C, Blum S, Schlageter V, Bauer A, Rizas KD, Eken C, Coslovsky M, Aeschbacher S, Krisai P, Meyre P, Vesin JM, Rodondi N, Moutzouri E, Beer J, Moschovitis G, Kobza R, Di Valentino M, Corino VDA, Laureanti R, Mainardi L, Bonati LH, Sticherling C, Conen D, Osswald S, Kühne M, Zuern CS. Heart Rate Variability Triangular Index as a Predictor of Cardiovascular Mortality in Patients With Atrial Fibrillation. J Am Heart Assoc 2020; 9:e016075. [PMID: 32750290 PMCID: PMC7792265 DOI: 10.1161/jaha.120.016075] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Impaired heart rate variability (HRV) is associated with increased mortality in sinus rhythm. However, HRV has not been systematically assessed in patients with atrial fibrillation (AF). We hypothesized that parameters of HRV may be predictive of cardiovascular death in patients with AF. Methods and Results From the multicenter prospective Swiss‐AF (Swiss Atrial Fibrillation) Cohort Study, we enrolled 1922 patients who were in sinus rhythm or AF. Resting ECG recordings of 5‐minute duration were obtained at baseline. Standard parameters of HRV (HRV triangular index, SD of the normal‐to‐normal intervals, square root of the mean squared differences of successive normal‐to‐normal intervals and mean heart rate) were calculated. During follow‐up, an end point committee adjudicated each cause of death. During a mean follow‐up time of 2.6±1.0 years, 143 (7.4%) patients died; 92 deaths were attributable to cardiovascular reasons. In a Cox regression model including multiple covariates (age, sex, body mass index, smoking status, history of diabetes mellitus, history of hypertension, history of stroke/transient ischemic attack, history of myocardial infarction, antiarrhythmic drugs including β blockers, oral anticoagulation), a decreased HRV index ≤ median (14.29), but not other HRV parameters, was associated with an increase in the risk of cardiovascular death (hazard ratio, 1.7; 95% CI, 1.1–2.6; P=0.01) and all‐cause death (hazard ratio, 1.42; 95% CI, 1.02–1.98; P=0.04). Conclusions The HRV index measured in a single 5‐minute ECG recording in a cohort of patients with AF is an independent predictor of cardiovascular mortality. HRV analysis in patients with AF might be a valuable tool for further risk stratification to guide patient management. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02105844.
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Affiliation(s)
- Peter Hämmerle
- Department of Cardiology University Hospital Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel Basel Switzerland
| | - Christian Eick
- Department of Cardiology University Hospital Tübingen Tübingen Germany
| | - Steffen Blum
- Department of Cardiology University Hospital Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel Basel Switzerland
| | - Vincent Schlageter
- Cardiovascular Research Institute Basel University Hospital Basel Basel Switzerland
| | - Axel Bauer
- University Clinic of Internal Medicine III, Cardiology and Angiology Medical University of Innsbruck Austria
| | - Konstantinos D Rizas
- Medizinische Klinik und Poliklinik I Munich University Clinic Munich Germany.,German Center for Cardiovascular Research partner site Munich Heart Alliance Munich Germany
| | - Ceylan Eken
- Cardiovascular Research Institute Basel University Hospital Basel Basel Switzerland
| | - Michael Coslovsky
- Cardiovascular Research Institute Basel University Hospital Basel Basel Switzerland
| | - Stefanie Aeschbacher
- Department of Cardiology University Hospital Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel Basel Switzerland
| | - Philipp Krisai
- Department of Cardiology University Hospital Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel Basel Switzerland
| | - Pascal Meyre
- Department of Cardiology University Hospital Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel Basel Switzerland
| | | | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM) University of Bern Switzerland.,Department of General Internal Medicine Inselspital Bern University HospitalUniversity of Bern Switzerland
| | - Elisavet Moutzouri
- Institute of Primary Health Care (BIHAM) University of Bern Switzerland.,Department of General Internal Medicine Inselspital Bern University HospitalUniversity of Bern Switzerland
| | - Jürg Beer
- Department of Medicine Cantonal Hospital of Baden and Molecular Cardiology University Hospital of Zurich Switzerland
| | - Giorgio Moschovitis
- Department of Cardiology EOC Ospedale Regionale di Lugano Lugano Switzerland
| | - Richard Kobza
- Division of Cardiology Luzerner Kantonsspital Luzern Switzerland
| | | | - Valentina D A Corino
- Biosignals Bioimaging and Bioinformatics Laboratory (B3-Lab) Department of Electronics, Information and Bioengineering (DEIB) Politecnico di Milano Milan Italy
| | - Rita Laureanti
- Biosignals Bioimaging and Bioinformatics Laboratory (B3-Lab) Department of Electronics, Information and Bioengineering (DEIB) Politecnico di Milano Milan Italy
| | - Luca Mainardi
- Biosignals Bioimaging and Bioinformatics Laboratory (B3-Lab) Department of Electronics, Information and Bioengineering (DEIB) Politecnico di Milano Milan Italy
| | - Leo H Bonati
- Department of Neurology and Stroke Center University Hospital BaselUniversity of Basel Switzerland
| | - Christian Sticherling
- Department of Cardiology University Hospital Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel Basel Switzerland
| | - David Conen
- Cardiovascular Research Institute Basel University Hospital Basel Basel Switzerland.,Population Health Research Institute McMaster University and Hamilton Health Sciences Hamilton Canada
| | - Stefan Osswald
- Department of Cardiology University Hospital Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel Basel Switzerland
| | - Michael Kühne
- Department of Cardiology University Hospital Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel Basel Switzerland
| | - Christine S Zuern
- Department of Cardiology University Hospital Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel Basel Switzerland
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6
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Abstract
Essentially all biological processes fluctuate over the course of the day, observed at cellular (eg, transcription, translation, and signaling), organ (eg, contractility and metabolism), and whole-body (eg, physical activity and appetite) levels. It is, therefore, not surprising that both cardiovascular physiology (eg, heart rate and blood pressure) and pathophysiology (eg, onset of adverse cardiovascular events) oscillate during the 24-hour day. Chronobiological influence over biological processes involves a complex interaction of factors that are extrinsic (eg, neurohumoral factors) and intrinsic (eg, circadian clocks) to cells. Here, we focus on circadian governance of 6 fundamentally important processes: metabolism, signaling, electrophysiology, extracellular matrix, clotting, and inflammation. In each case, we discuss (1) the physiological significance for circadian regulation of these processes (ie, the good); (2) the pathological consequence of circadian governance impairment (ie, the bad); and (3) whether persistence/augmentation of circadian influences contribute to pathogenesis during distinct disease states (ie, the ugly). Finally, the translational impact of chronobiology on cardiovascular disease is highlighted.
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Affiliation(s)
- Samir Rana
- From the Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham
| | - Sumanth D Prabhu
- From the Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham
| | - Martin E Young
- From the Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham
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7
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Jung W, Jang KI, Lee SH. Heart and Brain Interaction of Psychiatric Illness: A Review Focused on Heart Rate Variability, Cognitive Function, and Quantitative Electroencephalography. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2019; 17:459-474. [PMID: 31671483 PMCID: PMC6852682 DOI: 10.9758/cpn.2019.17.4.459] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/30/2018] [Accepted: 12/19/2018] [Indexed: 12/26/2022]
Abstract
Heart rate variability (HRV) reflects beat-to-beat variability in the heart rate due to the dynamic interplay of the sympathetic and parasympathetic nervous systems. HRV is considered an index of the functional status of the autonomic nervous system. A decrease in HRV is thus observed in individuals with autonomic dysfunction. Abnormal HRV has been reported in a range of mental disorders. In this review, we give an overview of HRV in patients with major depressive disorder (MDD), schizophrenia, and posttraumatic stress disorder (PTSD), one of whose core symptoms is cognitive dysfunction. The association between HRV and cognitive function is highlighted in this review. This review consists of three main sections. In the first section, we examine how HRV in patients with MDD, schizophrenia, and PTSD is characterized, and how it is different when compared to that in healthy controls. In the second section, beyond the heart itself, we discuss the intimate connection between the heart and the brain, focusing on how HRV interacts with quantitative electroencephalography (qEEG) in the context of physiological changes in the sleep cycle. Lastly, we finish the review with the examination of the association between HRV and cognitive function. The overall findings indicate that the reduction in HRV is one of main manifestations in MDD, schizophrenia, and PTSD, and also more generally HRV is closely linked to the change in qEEG and also to individual differences in cognitive performance.
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Affiliation(s)
- Wookyoung Jung
- Department of Psychology, Keimyung University, Daegu, Korea
| | - Kuk-In Jang
- 2Department of Biomedicine and Health Sciences, College of Medicine, The Catholic University of Korea, Korea.,Institute of Biomedical Industry, The Catholic University of Korea, Seoul, Korea
| | - Seung-Hwan Lee
- Department of Psychiatry,Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.,Clinical Emotion and Cognition Research Laboratory, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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8
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Morelli D, Bartoloni L, Rossi A, Clifton DA. A computationally efficient algorithm to obtain an accurate and interpretable model of the effect of circadian rhythm on resting heart rate. Physiol Meas 2019; 40:095001. [PMID: 31437825 DOI: 10.1088/1361-6579/ab3dea] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Wrist-worn wearable devices equipped with heart rate (HR) sensors have become increasingly popular. The ability to correctly interpret the collected data is fundamental to analyse user's well-being and perform early detection of abnormal physiological data. Circadian rhythm is a strong factor of variability in HR, yet few models attempt to accurately model its effect on HR. APPROACH In this paper we present a mathematical derivation of the single-component cosinor model with multiple components that fits user data to a predetermined arbitrary function (the expected shape of the circadian effect on resting HR (RHR)), thus permitting us to predict the user's circadian rhythm component (i.e. MESOR, Acrophase and Amplitude) with a high accuracy. MAIN RESULTS We show that our model improves the accuracy of HR prediction compared to the single component cosinor model (10% lower RMSE), while retaining the readability of the fitted model of the single component cosinor. We also show that the model parameters can be used to detect sleep disruption in a qualitative experiment. The model is computationally cheap, depending linearly on the size of the data. The computation of the model does not need the full dataset, but only two surrogates, where the data is accumulated. This implies that the model can be implemented in a streaming approach, with important consequences for security and privacy of the data, that never leaves the user devices. SIGNIFICANCE The multiple component model provided in this paper can be used to approximate a user's RHR with higher accuracy than single component model, providing traditional parameters easy to interpret (i.e. the same produced by the single component cosinor model). The model we developed goes beyond fitting circadian activity on RHR, and it can be used to fit arbitrary periodic real valued time series, vectorial data, or complex data.
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Affiliation(s)
- Davide Morelli
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, OX2 6DP, United Kingdom. Biobeats Group LTD, 3 Fitzhardinge Street, London, W1H 6EF, United Kingdom
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9
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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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10
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Traunmüller C, Stefitz R, Gaisbachgrabner K, Hofmann P, Roessler A, Schwerdtfeger AR. Psychophysiological concomitants of burnout: Evidence for different subtypes. J Psychosom Res 2019; 118:41-48. [PMID: 30782353 DOI: 10.1016/j.jpsychores.2019.01.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND There is evidence that chronic stress and emotional exhaustion are related to physiological dysregulations, which could negatively impact physical and mental health. This study aimed to identify the specific physiological clusters which are most reliable and prominently associated with burnout. Emphasis was placed on variables of the autonomic nervous system and hypothalamic-pituitary-adrenal axis. Burnout was assessed using the Emotional Exhaustion subscale of the German version of the Maslach Burnout Inventory (MBI-GS). METHODS A sample of 105 individuals aged between 28 and 60 years (M = 42.7, SD = 7.75) and working under highly demanding conditions participated in this study. 46 participants reported a low risk of burnout, and 58 participants a high risk. They underwent 24 h of ECG monitoring, had cortisol awakening response collected, and had blood pressure measured two times within a week. RESULTS Compromised HRV, higher cortisol values, and higher blood pressure were found in individuals with high burnout symptoms. Furthermore, a discriminant function analysis on cardiac and neuroendocrine variables suggested two subgroups within the high burnout individuals, with only one group showing evidence for autonomic dysfunction as indicated by lower vagal efference. CONCLUSIONS Results suggest that burnout might not necessarily imply physiological disturbances, thus calling for a more differentiated and individualized view of burnout.
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Affiliation(s)
- Claudia Traunmüller
- Institute of Psychology, Health Psychology Unit, University of Graz, Graz, Austria.
| | - Rene Stefitz
- Institute of Psychology, Health Psychology Unit, University of Graz, Graz, Austria
| | | | - Peter Hofmann
- Institute of Sports Science, Exercise Physiology, Training & Training Therapy Research Group, University of Graz, Graz, Austria
| | - Andreas Roessler
- Institute of Physiology, Medical University of Graz, Graz, Austria
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11
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Yang Z, Liu H, Meng F, Guan Y, Zhao M, Qu W, Hao H, Luan G, Zhang J, Li L. The analysis of circadian rhythm of heart rate variability in patients with drug-resistant epilepsy. Epilepsy Res 2018; 146:151-159. [DOI: 10.1016/j.eplepsyres.2018.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 07/17/2018] [Accepted: 08/06/2018] [Indexed: 01/01/2023]
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12
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Witt A, Ehlers F, Luther S. Extremes of fractional noises: A model for the timings of arrhythmic heart beats in post-infarction patients. CHAOS (WOODBURY, N.Y.) 2017; 27:093942. [PMID: 28964134 DOI: 10.1063/1.5003249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We have analyzed symbol sequences of heart beat annotations obtained from 24-h electrocardiogram recordings of 184 post-infarction patients (from the Cardiac Arrhythmia Suppression Trial database, CAST). In the symbol sequences, each heart beat was coded as an arrhythmic or as a normal beat. The symbol sequences were analyzed with a model-based approach which relies on two-parametric peaks over the threshold (POT) model, interpreting each premature ventricular contraction (PVC) as an extreme event. For the POT model, we explored (i) the Shannon entropy which was estimated in terms of the Lempel-Ziv complexity, (ii) the shape parameter of the Weibull distribution that best fits the PVC return times, and (iii) the strength of long-range correlations quantified by detrended fluctuation analysis (DFA) for the two-dimensional parameter space. We have found that in the frame of our model the Lempel-Ziv complexity is functionally related to the shape parameter of the Weibull distribution. Thus, two complementary measures (entropy and strength of long-range correlations) are sufficient to characterize realizations of the two-parametric model. For the CAST data, we have found evidence for an intermediate strength of long-range correlations in the PVC timings, which are correlated to the age of the patient: younger post-infarction patients have higher strength of long-range correlations than older patients. The normalized Shannon entropy has values in the range 0.5<hLZ<1.0 which indicates a high degree of randomness in the PVC timings. For the CAST and the model data, the ranges of both measures were found to be in good accordance. The correlation between the age and the persistence strength found for the CAST data could be explained as a change of model parameters.
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Affiliation(s)
- Annette Witt
- Biomedical Physics Group, Max-Planck Institute for Dynamics and Self-Organization, Göttingen, Germany
| | - Frithjof Ehlers
- Biomedical Physics Group, Max-Planck Institute for Dynamics and Self-Organization, Göttingen, Germany
| | - Stefan Luther
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
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13
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De Nobrega AK, Mellers AP, Lyons LC. Aging and circadian dysfunction increase alcohol sensitivity and exacerbate mortality in Drosophila melanogaster. Exp Gerontol 2017; 97:49-59. [PMID: 28750752 DOI: 10.1016/j.exger.2017.07.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 07/12/2017] [Accepted: 07/24/2017] [Indexed: 11/29/2022]
Abstract
Alcohol abuse is a rising problem in middle-aged and older individuals resulting in serious health, family and economic consequences. Effective treatment necessitates the identification of factors influencing alcohol toxicity with aging. We investigated the interaction between aging, alcohol toxicity and circadian function using Drosophila as a model system. We found as wild type flies age, sensitivity to alcohol increases and circadian regulation of alcohol-induced behaviors weakens. Decreased circadian modulation is correlated with significantly greater alcohol sensitivity during the subjective day. The circadian clock modulates alcohol-induced mortality in younger flies with increased mortality following alcohol exposure at night. Older flies exhibit significantly longer recovery times following alcohol-induced sedation and increased mortality following binge-like or chronic alcohol exposure. Flies rendered arrhythmic either genetically or environmentally exhibit significantly increased alcohol sensitivity, longer recovery times and increased mortality. We hypothesize that the circadian clock phase specifically buffers behavioral and cellular alcohol sensitivity with this protection diminishing as the circadian clock weakens with age.
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Affiliation(s)
- Aliza K De Nobrega
- Department of Biological Science, Program in Neuroscience, Florida State University, Tallahassee, FL 32306, United States
| | - Alana P Mellers
- Department of Biological Science, Program in Neuroscience, Florida State University, Tallahassee, FL 32306, United States
| | - Lisa C Lyons
- Department of Biological Science, Program in Neuroscience, Florida State University, Tallahassee, FL 32306, United States.
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14
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Hospital overnight and evaluation of systems and timelines study: A point prevalence study of practice in Australia and New Zealand. Resuscitation 2016; 100:1-5. [DOI: 10.1016/j.resuscitation.2015.11.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 11/10/2015] [Accepted: 11/30/2015] [Indexed: 11/22/2022]
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Sundararajan K, Flabouris A, Thompson C. Diurnal variation in the performance of rapid response systems: the role of critical care services-a review article. J Intensive Care 2016; 4:15. [PMID: 26913199 PMCID: PMC4765019 DOI: 10.1186/s40560-016-0136-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 02/03/2016] [Indexed: 11/17/2022] Open
Abstract
The type of medical review before an adverse event influences patient outcome. Delays in the up-transfer of patients requiring intensive care are associated with higher mortality rates. Timely detection and response to a deteriorating patient constitute an important function of the rapid response system (RRS). The activation of the RRS for at-risk patients constitutes the system’s afferent limb. Afferent limb failure (ALF), an important performance measure of rapid response systems, constitutes a failure to activate a rapid response team (RRT) despite criteria for calling an RRT. There are diurnal variations in hospital staffing levels, the performance of rapid response systems and patient outcomes. Fewer ward-based nursing staff at night may contribute to ALF. The diurnal variability in RRS activity is greater in unmonitored units than it is in monitored units for events that should result in a call for an RRT. RRT events include a significant abnormality in either the pulse rate, blood pressure, conscious state or respiratory rate. There is also diurnal variation in RRT summoning rates, with most activations occurring during the day. The reasons for this variation are mostly speculative, but the failure of the afferent limb of RRT activation, particularly at night, may be a factor. The term “circadian variation/rhythm” applies to physiological variations over a 24-h cycle. In contrast, diurnal variation applies more accurately to extrinsic systems. Circadian rhythm has been demonstrated in a multitude of bodily functions and disease states. For example, there is an association between disrupted circadian rhythms and abnormal vital parameters such as anomalous blood pressure, irregular pulse rate, aberrant endothelial function, myocardial infarction, stroke, sleep-disordered breathing and its long-term consequences of hypertension, heart failure and cognitive impairment. Therefore, diurnal variation in patient outcomes may be extrinsic, and more easily modifiable, or related to the circadian variation inherent in human physiology. Importantly, diurnal variations in the implementation and performance of the RRS, as gauged by ALF, the RRT response to clinical deterioration and any variations in quality and quantity of patient monitoring have not been fully explored across a diverse group of hospitals.
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Affiliation(s)
- Krishnaswamy Sundararajan
- Intensive Care Unit, Royal Adelaide Hospital and Discipline of Acute Care Medicine, University of Adelaide, Level 4, ICU, Robert Gerard Wing, Adelaide, 5000 South Australia Australia
| | - Arthas Flabouris
- Intensive Care Unit, Royal Adelaide Hospital and Discipline of Acute Care Medicine, University of Adelaide, Level 4, ICU, Robert Gerard Wing, Adelaide, 5000 South Australia Australia
| | - Campbell Thompson
- Department of Medicine, University of Adelaide and the Royal Adelaide Hospital, Adelaide, 5000 South Australia Australia
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Corino VDA, Platonov PG, Enger S, Tveit A, Ulimoen SR. Circadian variation of variability and irregularity of heart rate in patients with permanent atrial fibrillation: relation to symptoms and rate control drugs. Am J Physiol Heart Circ Physiol 2015; 309:H2152-7. [PMID: 26497961 DOI: 10.1152/ajpheart.00300.2015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 10/22/2015] [Indexed: 11/22/2022]
Abstract
The aim of the present study was to evaluate diurnal variations of the variability and irregularity of heart rate (HR) in patients with permanent atrial fibrillation (AF) with and without rate control drugs. Thirty-eight patients with permanent AF were part of an investigator-blind crossover study comparing diltiazem, verapamil, metoprolol, and carvedilol. We analyzed five Holter recordings per patient: at baseline (no rate control drug) and with each of the four drug regimens. HR, variability (SD; percentages of interval differences of successive RR intervals of >20, 50, and 80 ms; and root of the mean squared differences of successive RR intervals), and irregularity (approximate and sample entropy) parameters were computed in 20-min long nonoverlapping segments. Circadian rhythmicity was evaluated using cosinor analysis to each parameter series, which is characterized by the 24-h mean [midline statistic of rhythm (MESOR)] and excursion over the mean (amplitude). Arrhythmia-related symptoms were assessed by a questionnaire measuring symptom severity and frequency. HR and variability parameters showed a significant circadian variation in most patients, whereas only a small minority of the patients had circadian variations of irregularity parameters. Patients with circadian approximate entropy n at baseline had more severe symptoms (symptom severity: 9 ± 4 vs. 6 ± 5, P < 0.05, circadian vs. noncircadian variations). All drugs decreased the MESOR of HR and increased the MESOR of variability parameters. Only carvedilol and metoprolol decreased the normalized amplitude over 24 h of all parameters and HR. In conclusion, HR and RR variability parameters present a circadian variation in patients with permanent AF, whereas few patients demonstrated circadian fluctuations in irregularity parameters, suggesting different physiological mechanisms.
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Affiliation(s)
- Valentina D A Corino
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy;
| | - Pyotr G Platonov
- Center for Integrative Electrocardiology at Lund University, Department of Cardiology, Clinical Sciences, Lund University and Arrhythmia Clinic, Skåne University Hospital, Lund, Sweden; and
| | - Steve Enger
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Rud, Norway
| | - Arnljot Tveit
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Rud, Norway
| | - Sara R Ulimoen
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Rud, Norway
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Verkuil B, Brosschot JF, Marques AH, Kampschroer K, Sternberg EM, Thayer JF. Gender differences in the impact of daily sadness on 24-h heart rate variability. Psychophysiology 2015; 52:1682-8. [PMID: 26338472 DOI: 10.1111/psyp.12541] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 08/13/2015] [Indexed: 11/26/2022]
Abstract
Reduced heart rate variability (HRV) is proposed to mediate the relation between depressive symptoms and cardiovascular health problems. Yet, several studies have found that in women depression is associated with higher HRV levels, whereas in men depression is associated with lower HRV levels. So far, these studies have only examined gender differences in HRV levels using a single assessment. This study aimed to test the interactive effects of gender and sadness on ambulatory-assessed HRV levels. A sample of 60 (41 women) employees participated in an ambulatory study. HRV levels (mean of successive differences; MSD) were continuously measured for 24 h. During the daytime, hourly assessments of sadness and other mood states were taken, while depressive symptoms were assessed with the Center for Epidemiologic Studies Depression scale (CES-D). Gender differences were observed when examining the impact of average daily sadness on MSD. In women, but not in men, the total amount of sadness experienced during the day was associated with higher circadian MSD levels. These findings suggest that researchers need to take gender differences into account when examining the relation between sadness, HRV, and cardiovascular problems.
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Affiliation(s)
- Bart Verkuil
- Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Jos F Brosschot
- Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Andrea H Marques
- Department of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Kevin Kampschroer
- Public Buildings Service, United States General Services Administration, Washington, District of Columbia, USA
| | - Esther M Sternberg
- Arizona Center for Integrative Medicine, University of Arizona, Tucson, Arizona, USA
| | - Julian F Thayer
- Department of Psychology, The Ohio State University, Columbus, Ohio, USA
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Brainard J, Gobel M, Bartels K, Scott B, Koeppen M, Eckle T. Circadian rhythms in anesthesia and critical care medicine: potential importance of circadian disruptions. Semin Cardiothorac Vasc Anesth 2014; 19:49-60. [PMID: 25294583 DOI: 10.1177/1089253214553066] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The rotation of the earth and associated alternating cycles of light and dark--the basis of our circadian rhythms--are fundamental to human biology and culture. However, it was not until 1971 that researchers first began to describe the molecular mechanisms for the circadian system. During the past few years, groundbreaking research has revealed a multitude of circadian genes affecting a variety of clinical diseases, including diabetes, obesity, sepsis, cardiac ischemia, and sudden cardiac death. Anesthesiologists, in the operating room and intensive care units, manage these diseases on a daily basis as they significantly affect patient outcomes. Intriguingly, sedatives, anesthetics, and the intensive care unit environment have all been shown to disrupt the circadian system in patients. In the current review, we will discuss how newly acquired knowledge of circadian rhythms could lead to changes in clinical practice and new therapeutic concepts.
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Affiliation(s)
| | - Merit Gobel
- University of Colorado Denver, Aurora, CO, USA
| | | | | | - Michael Koeppen
- University of Colorado Denver, Aurora, CO, USA Ludwig-Maximilians-University, Munich, Germany
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Kaya H, Süner A, Köroğlu S, Akçay A, Türkbeyler İH, Köleoğlu M. Heart rate variability in familial Mediterranean fever patients. Eur J Rheumatol 2014; 1:58-61. [PMID: 27708876 DOI: 10.5152/eurjrheumatol.2014.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 03/27/2014] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Familial Mediterranean fever (FMF) is an autosomal recessive autoimmune disease, presenting with the attacks of fever and inflammation of serous membranes. One of the leading causes of death in autoimmune rheumatologic diseases is cardiovascular events. The purpose of this study is to evaluate the effects of FMF on the autonomic nerve and cardiovascular systems by measuring the indices of heart rate variability (HRV). MATERIAL AND METHODS Thirty FMF patients and the same number of healthy volunteers were enrolled to the study. Standard deviation of all R-R intervals (SDNN), the square root of the sum of the square of the differences between successive R-R intervals (RMSSD), standard deviation of 5-minute mean values of R-R interval (SDANN), low frequency (LF), and high frequency (HF) were measured. RESULTS Time domain indices (SDNN, SDANN, and RMSSD) were: 124.67±40.79, 129.87±36.43 (p=0.605); 11.43±38.41, 11.23±38.98 (p=0.984); and 33.43±17.39, 38.17±12.8 (p=0.235) for FMF patients and controls, respectively, and similar in both groups. Frequency domain indices (HF, LF, and LF/HF) were: 290.41±290.25, 322.20±222.54 (p=0.639); 596.16±334.07, 805.80±471.00 (p=0.051); and 3.57±2.57, 3.05±1.40 (p=0.338) for FMF patients and controls, respectively, and similar in both groups. CONCLUSION The HRV parameters were similar in both groups. However, studies including larger populations and using different methods are required to clarify if autonomic dysfunction exists in patients with FMF.
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Affiliation(s)
- Hakan Kaya
- Department of Cardiology, Adıyaman University Faculty of Medicine, Adıyaman, Turkey
| | - Arif Süner
- Department of Cardiology, Adıyaman University Faculty of Medicine, Adıyaman, Turkey
| | - Sedat Köroğlu
- Department of Cardiology, Afşin State Hospital, Kahramanmaraş, Turkey
| | - Ahmet Akçay
- Department of Cardiology, Sütçü İmam University Faculty of Medicine, Kahramanmaraş, Turkey
| | | | - Murat Köleoğlu
- Department of Cardiology, Avicenna Hospital, İstanbul, Turkey
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Fidanci K, Gulgun M, Demirkaya E, Acikel C, Kilic A, Gok F, Ozen S. Assessment of autonomic functions in children with familial Mediterranean fever by using heart rate variability measurements. Int J Rheum Dis 2014; 20:2086-2092. [PMID: 24860912 DOI: 10.1111/1756-185x.12401] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study is to analyze possible autonomic nerve system alterations and assess the efficacy of heart rate variability (HRV) analysis in anticipation of cardiovascular risks in pediatric patients with familial Mediterranean fever (FMF). METHOD In this study, cardiac autonomic functions were investigated in children with FMF by analyzing HRV and its other probable cardiac effects by echocardiography. We studied 70 pediatric patients with FMF and 50 healthy controls. RESULTS The time-domain parameters of HRV were compared between the FMF and control groups. SDNN (standard deviation of all NN intervals) was significantly decreased in patients with FMF as compared to control subjects. The other time-domain parameters of HRV and the frequency-domain parameters of HRV were similar in both groups. Frequency-dependent HRV parameters were similar in both groups, as were conventional echocardiographic parameters. CONCLUSION HRV is a convenient and reliable technique for evaluation of autonomic functions. There are only a few studies on the assessment of autonomic functions by means of HRV in adult FMF patients but not in pediatric patients. Further studies are required to assess whether there is autonomic dysfunction in children with FMF.
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Affiliation(s)
- Kursat Fidanci
- Department of Pediatric Cardiology, Gulhane Military Medical Faculty, Ankara, Turkey
| | - Mustafa Gulgun
- Department of Pediatric Cardiology, Gulhane Military Medical Faculty, Ankara, Turkey
| | - Erkan Demirkaya
- Department of Pediatric Rheumatology, Gulhane Military Medical Faculty, Ankara, Turkey.,FMF Arthritis Vasculitis and Orphan Disease Research in Pediatric Rheumatology (FAVOR), Gulhane Military Medical Faculty, Ankara, Turkey
| | - Cengizhan Acikel
- FMF Arthritis Vasculitis and Orphan Disease Research in Pediatric Rheumatology (FAVOR), Gulhane Military Medical Faculty, Ankara, Turkey.,Department of Biostatistics, Gulhane Military Medical Faculty, Ankara, Turkey
| | - Ayhan Kilic
- Department of Pediatric Cardiology, Gulhane Military Medical Faculty, Ankara, Turkey
| | - Faysal Gok
- Department of Pediatric Rheumatology, Gulhane Military Medical Faculty, Ankara, Turkey
| | - Seza Ozen
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
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Böckelmann I. Analyse der Herzfrequenzvariabilität (HRV) — praktische Relevanz. ZENTRALBLATT FUR ARBEITSMEDIZIN ARBEITSSCHUTZ UND ERGONOMIE 2014. [DOI: 10.1007/bf03346164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lee HW, Han TH, Yi KJ, Choi MC, Lee SY, Ryu PD. Time course of diurnal rhythm disturbances in autonomic function of rats with myocardial infarction. Auton Neurosci 2013; 179:28-36. [DOI: 10.1016/j.autneu.2013.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 06/17/2013] [Accepted: 06/19/2013] [Indexed: 10/26/2022]
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Bonney S, Kominsky D, Brodsky K, Eltzschig H, Walker L, Eckle T. Cardiac Per2 functions as novel link between fatty acid metabolism and myocardial inflammation during ischemia and reperfusion injury of the heart. PLoS One 2013; 8:e71493. [PMID: 23977055 PMCID: PMC3748049 DOI: 10.1371/journal.pone.0071493] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 07/01/2013] [Indexed: 01/06/2023] Open
Abstract
Disruption of peripheral circadian rhyme pathways dominantly leads to metabolic disorders. Studies on circadian rhythm proteins in the heart indicated a role for Clock or Per2 in cardiac metabolism. In contrast to Clock−/−, Per2−/− mice have larger infarct sizes with deficient lactate production during myocardial ischemia. To test the hypothesis that cardiac Per2 represents an important regulator of cardiac metabolism during myocardial ischemia, we measured lactate during reperfusion in Per1−/−, Per2−/− or wildtype mice. As lactate measurements in whole blood indicated an exclusive role of Per2 in controlling lactate production during myocardial ischemia, we next performed gene array studies using various ischemia-reperfusion protocols comparing wildtype and Per2−/− mice. Surprisingly, high-throughput gene array analysis revealed dominantly lipid metabolism as the differentially regulated pathway in wildtype mice when compared to Per2−/−. In all ischemia-reperfusion protocols used, the enzyme enoyl-CoA hydratase, which is essential in fatty acid beta-oxidation, was regulated in wildtype animals only. Studies using nuclear magnet resonance imaging (NMRI) confirmed altered fatty acid populations with higher mono-unsaturated fatty acid levels in hearts from Per2−/− mice. Unexpectedly, studies on gene regulation during reperfusion revealed solely pro inflammatory genes as differentially regulated ‘Per2-genes’. Subsequent studies on inflammatory markers showed increasing IL-6 or TNFα levels during reperfusion in Per2−/− mice. In summary, these studies reveal an important role of cardiac Per2 for fatty acid metabolism and inflammation during myocardial ischemia and reperfusion, respectively.
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Affiliation(s)
- Stephanie Bonney
- Department of Anesthesiology and Mucosal Inflammation Program, University of Colorado Denver, Aurora, Colorado, United States of America
| | - Doug Kominsky
- Department of Anesthesiology and Mucosal Inflammation Program, University of Colorado Denver, Aurora, Colorado, United States of America
| | - Kelley Brodsky
- Department of Anesthesiology and Mucosal Inflammation Program, University of Colorado Denver, Aurora, Colorado, United States of America
| | - Holger Eltzschig
- Department of Anesthesiology and Mucosal Inflammation Program, University of Colorado Denver, Aurora, Colorado, United States of America
| | - Lori Walker
- Division of Cardiology, Department of Medicine, University of Colorado Denver, Aurora, United States of America
| | - Tobias Eckle
- Department of Anesthesiology and Mucosal Inflammation Program, University of Colorado Denver, Aurora, Colorado, United States of America
- * E-mail:
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Gaifutdinova AV, Chervyakov AV, Fokin VF. Age-related brain activity in patients after traumatic brain injury and cerebral infarction. ADVANCES IN GERONTOLOGY 2013. [DOI: 10.1134/s2079057013030041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Shusterman V, Lampert R. Role of Stress in Cardiac Arrhythmias. J Atr Fibrillation 2013; 5:834. [PMID: 28496839 DOI: 10.4022/jafib.834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 03/03/2013] [Accepted: 03/05/2013] [Indexed: 11/10/2022]
Abstract
Stress is a major trigger of cardiac arrhythmias; it exerts profound effects on electrophysiology of the cardiomyocytes and the cardiac rhythm. Psychological and physiological stressors impact the cardiovascular system through the autonomic nervous system (ANS). While stressors vary, properties of the stress response at the level of cardiovascular system (collectively referred to as the autonomic cardiovascular responses) are similar and can be studied independently from the properties of specific stressors. Here, we will review the clinical and experimental evidence linking common stressors and atrial arrhythmias. Specifically, we will describe the impact of psychological and circadian stressors on ANS activity and arrhythmogenesis. We will also review studies examining relationships between autonomic cardiovascular responses and cardiac arrhythmias in ambulatory and laboratory settings.
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Affiliation(s)
- Vladimir Shusterman
- University of Pittsburgh School of Medicine and Yale University School of Medicine
| | - Rachel Lampert
- University of Pittsburgh School of Medicine and Yale University School of Medicine
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Junqueira LF. Insights into the clinical and functional significance of cardiac autonomic dysfunction in Chagas disease. Rev Soc Bras Med Trop 2012; 45:243-52. [PMID: 22535000 DOI: 10.1590/s0037-86822012000200020] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 01/10/2012] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Exclusive or associated lesions in various structures of the autonomic nervous system occur in the chronic forms of Chagas disease. In the indeterminate form, the lesions are absent or mild, whereas in the exclusive or combined heart and digestive disease forms, they are often more pronounced. Depending on their severity these lesions can result mainly in cardiac parasympathetic dysfunction but also in sympathetic dysfunction of variable degrees. Despite the key autonomic effect on cardiovascular functioning, the pathophysiological and clinical significance of the cardiac autonomic dysfunction in Chagas disease remains unknown. METHODS Review of data on the cardiac autonomic dysfunction in Chagas disease and their potential consequences, and considerations supporting the possible relationship between this disturbance and general or cardiovascular clinical and functional adverse outcomes. RESULTS We hypothesise that possible consequences that cardiac dysautonomia might variably occasion or predispose in Chagas disease include: transient or sustained arrhythmias, sudden cardiac death, adverse overall and cardiovascular prognosis with enhanced morbidity and mortality, an inability of the cardiovascular system to adjust to functional demands and/or respond to internal or external stimuli by adjusting heart rate and other hemodynamic variables, and immunomodulatory and cognitive disturbances. CONCLUSIONS Impaired cardiac autonomic modulation in Chagas disease might not be a mere epiphenomenon without significance. Indirect evidences point for a likely important role of this alteration as a primary predisposing or triggering cause or mediator favouring the development of subtle or evident secondary cardiovascular functional disturbances and clinical consequences, and influencing adverse outcomes.
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Affiliation(s)
- Luiz Fernando Junqueira
- Laboratório Cardiovascular, Área de Clínica Médica (Cardiologia), Universidade de Brasilia, Brasilia, DF.
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Stapelberg NJ, Hamilton-Craig I, Neumann DL, Shum DHK, McConnell H. Mind and heart: heart rate variability in major depressive disorder and coronary heart disease - a review and recommendations. Aust N Z J Psychiatry 2012; 46:946-57. [PMID: 22528974 DOI: 10.1177/0004867412444624] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE There is a reciprocal association between major depressive disorder (MDD) and coronary heart disease (CHD). These conditions are linked by a causal network of mechanisms. This causal network should be quantitatively studied and it is hypothesised that the investigation of vagal function represents a promising starting point. Heart rate variability (HRV) has been used to investigate cardiac vagal control in the context of MDD and CHD. This review aims to examine the relationship of HRV to both MDD and CHD in the context of vagal function and to make recommendations for clinical practice and research. METHODS The search terms 'heart rate variability', 'depression' and 'heart disease' were entered into an electronic multiple database search engine. Abstracts were screened for their relevance and articles were individually selected and collated. RESULTS Decreased HRV is found in both MDD and CHD. Both diseases are theorized to disrupt autonomic control feedback loops on the heart and are linked to vagal function. Existing theories link vagal function to both mood and emotion as well as cardiac function. However, several factors can potentially confound HRV measures and would thus impact on a complete understanding of vagal mechanisms in the link between MDD and CHD. CONCLUSIONS The quantitative investigation of vagal function using HRV represents a reasonable starting point in the study of the relationship between MDD and CHD. Many psychotropic and cardiac medications have effects on HRV, which may have clinical importance. Future studies of HRV in MDD and CHD should consider antidepressant medication, as well as anxiety, as potential confounders.
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Affiliation(s)
- Nicolas J Stapelberg
- Behavioural Basis of Health, Griffith Health Institute and School of Applied Psychology, Griffith University, Southport, Australia.
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Stapelberg NJC, Neumann DL, Shum DHK, McConnell H, Hamilton-Craig I. A topographical map of the causal network of mechanisms underlying the relationship between major depressive disorder and coronary heart disease. Aust N Z J Psychiatry 2011; 45:351-69. [PMID: 21500954 DOI: 10.3109/00048674.2011.570427] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Major depressive disorder (MDD) and coronary heart disease (CHD) are both clinically important public health problems. Depression is linked with a higher incidence of ischaemic cardiac events and MDD is more prevalent in patients with CHD. No single comprehensive model has yet described the causal mechanisms linking MDD to CHD. Several key mechanisms have been put forward, comprising behavioural mechanisms, genetic mechanisms, dysregulation of immune mechanisms, coagulation abnormalities and vascular endothelial dysfunction, polyunsaturated omega-3 free fatty acid deficiency, and autonomic mechanisms. It has been suggested that these mechanisms form a network, which links MDD and CHD. The aim of this review is to examine the causal mechanisms underlying the relationship between MDD and CHD, with the aim of constructing a topological map of the causal network which describes the relationship between MDD and CHD. METHODS The search term 'depression and heart disease' was entered into an electronic multiple database search engine. Abstracts were screened for relevance and individually selected articles were collated. RESULTS This review introduces the first topological map of the causal network which describes the relationship between MDD and CHD. CONCLUSIONS Viewing the causal pathways as an interdependent network presents a new paradigm in this field and provides fertile ground for further research. The causal network can be studied using the methodology of systems biology, which is briefly introduced. Future research should focus on the creation of a more comprehensive topological map of the causal network and the quantification of the activity between each node of the causal network.
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Affiliation(s)
- Nicolas J C Stapelberg
- School of Psychology and Griffith Health Institute, Griffith University, Southport, Queensland 4215, Australia.
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Eryonucu B, Bilge M, Güler N. Comparison of heart rate variability and treadmill exercise score in patients with stable coronary artery disease. Int J Angiol 2011. [DOI: 10.1007/bf01616980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Rodríguez-Colón SM, Bixler EO, Li X, Vgontzas AN, Liao D. Obesity is associated with impaired cardiac autonomic modulation in children. ACTA ACUST UNITED AC 2010; 6:128-34. [PMID: 20919806 DOI: 10.3109/17477166.2010.490265] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To examine the cross-sectional association between measurements of obesity and subclinical impairment of cardiac autonomic modulation (CAM) in a population-based sample of children. METHODS Data from 616 grade K-5 children randomly selected from Central Pennsylvania were utilized. Obesity was defined using the International Obesity Task Force (IOTF) age- and sex-specific cut-off criteria and classified as normal weight, overweight, and obese. CAM was measured by heart rate variability (HRV) analysis of beat-to-beat RR intervals, including time domain measures i.e., the standard deviation of all RR intervals (SDNN), the square root of the mean of the sum of squares of differences between adjacent RR intervals (RMSSD), and mean heart rate (HR); and frequency domain measures i.e., high frequency power (HF), low frequency power (LF), and LF/HF ratio. RESULTS The prevalence of obesity and overweight in children was 12.3%, and 16.5%, respectively. Age, race, sex, and sleep disorder breathing (SDB) adjusted means (standard error, SE) of SDNN were 98 (1.24), 90.2 (2.58), and 81.9 (3.03) milliseconds (ms) in normal weight, overweight, and obese groups, respectively; and that for (log) HF were 6.83 (0.04), 6.56 (0.08), and 6.35 (0.09) ms(2), respectively. Comparing the magnitude of effects from body mass index (BMI), weight, and height percentiles, and waist circumference on HRV indices revealed that body weight was the strongest correlate of HRV indices. CONCLUSION Childhood obesity is significantly associated with lower HRV, indicative of sympathetic overflow unopposed by parasympathetic modulation. These findings support the need to target childhood-obesity before traditional "high risk age" for cardiac events.
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Affiliation(s)
- Sol M Rodríguez-Colón
- Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA 17033, USA
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Liao D, Li X, Rodriguez-Colon SM, Liu J, Vgontzas AN, Calhoun S, Bixler EO. Sleep-disordered breathing and cardiac autonomic modulation in children. Sleep Med 2010; 11:484-8. [PMID: 20362503 DOI: 10.1016/j.sleep.2009.11.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Revised: 11/17/2009] [Accepted: 11/18/2009] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To investigate the adverse cardiac autonomic effects of sleep-disordered breathing (SDB) in a large population-based sample and a clinical sample of children. METHODS Subjects included a population-based sample of 700 and a clinically diagnosed sample of 43 SDB children. SDB was defined based on an apnea hypopnea index (AHI) 1 during one night of polysomnography. Cardiac autonomic modulation was measured by heart rate variability (HRV) analysis of the beat-to-beat RR interval data collected during polysomnography. RESULTS The mean (SD) age was 112 (21) months, with 49% male and 25% non-white. About 73.0% had AHI<1 (no SDB), 25.8% had 1-5 AHI (mild SDB), and 1.2% had 5 AHI (moderate SDB). Among individuals with moderate SDB in the population-based sample and the clinically diagnosed SDB patients, the mean (SE) of HRV-high frequency power (HF) was significantly lower compared to children without SDB [6.00 (0.32) and 6.24 (0.14), respectively, vs. 6.68 (0.04) ms(2), p<0.05 and p<0.01, respectively], whereas the low frequency power to high frequency power ratio (LF/HF) was significantly higher [1.62 (0.20) and 1.74 (0.09), respectively, vs. 0.99 (0.02), both p<0.01)]. CONCLUSIONS SDB in healthy young children and in clinical patients is significantly associated with impaired cardiac autonomic modulation, i.e., sympathetic overflow and weaker parasympathetic modulation, which may contribute to increased risk of acute cardiac events in persons with SDB, even before reaching the "high risk age."
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Affiliation(s)
- Duanping Liao
- Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA 17033, USA
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Circadian Body Temperature Variability is an Indicator of Poor Prognosis in Cardiomyopathic Hamsters. J Card Fail 2010; 16:268-74. [DOI: 10.1016/j.cardfail.2009.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Revised: 10/19/2009] [Accepted: 11/23/2009] [Indexed: 12/30/2022]
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Liao D, Liu J, Vgontzas AN, Rodriguez-Colon S, Calhoun S, Li X, Bixler EO. Cardiac Autonomic Modulation and Sleep-Disordered Breathing in Children. Sleep Med Clin 2009. [DOI: 10.1016/j.jsmc.2008.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Monmeneu JV, Chorro FJ, Bodí V, Sanchis J, Llácer A, García-Civera R, Ruiz R, Sanjuán R, Burguera M, López-Merino V. Relationships between heart rate variability, functional capacity, and left ventricular function following myocardial infarction: an evaluation after one week and six months. Clin Cardiol 2009; 24:313-20. [PMID: 11303700 PMCID: PMC6655109 DOI: 10.1002/clc.4960240411] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Relationships between heart rate (HR) variability and different prognostic markers such as ejection fraction, functional capacity, and patency of the infarct-related artery, as well as the comparison of their time courses are not fully elucidated. HYPOTHESIS The aim of study was to assess prospectively the early postinfarction changes in HR variability and its evolution over a period of 6 months: the relationships between HR variability and functional capacity in exercise testing; left ventricular function in cardiac catheterization: status of the infarct-related artery; and the comparison of their time courses. METHODS In 42 patients with anterior myocardial infarction, a study was made of the early changes in HR variability analyzed by the complex demodulation method, its evolution over a period of 6 months. and the relationships between HR variability and (1) functional capacity in exercise testing, (2) left ventricular function in cardiac catheterization, and (3) status of the infarct-related artery. RESULTS At 1 week HR variability parameters correlated directly with functional capacity indicators such as METS, percent change in HR from rest to peak exercise (%deltaHR), difference between initial and peak HR (HR range), percent peak theoretical HR (% peak HR), left ventricular ejection fraction (EF), and, inversely, with end-systolic volume (ESV). Stepwise multiple regression analysis to establish HR variability parameters (recorded at 1 week) as related to functional capacity and left ventricular function at 1 week and 6 months postinfarction established the following variables: (1) At 1 week: standard deviation (SD) of the RR cycles in relation to %deltaHR (r = 0.60, p <0.0001), HR range (r = 0.43, p < 0.01), and EF (r = 0.79, p < 0.0001). (2) At 6 months, the sole accepted HR variability parameter was the SD in relation to %deltaHR (r = 0.38, p < 0.05) and HR range (r = 0.45, p < 0.01). No variability parameter was accepted in relation to METS, % peak HR, or ESV. Relationship between EF or ESV and HR variability parameters was not significant when both were evaluated at 6 months. At that time, there was a significant increase in all HR variability parameters among all surviving patients (n = 39), with the exception of the LF/HF ratio and mean RR cycle. The percent increase in HR variability between the first week and 6 months was greater among those patients with the lowest basal EF. No relation was established between HR variability and patency of the infarct-related artery. CONCLUSION The decrease in HR variability observed following myocardial infarction is associated with a diminished functional capacity and an increased alteration of the EF. This does not affect the recovery of HR variability, which was observed in all surviving patients.
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Affiliation(s)
- J V Monmeneu
- Cardiology Service, University Clinic Hospital, Valencia, Spain
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Wang CY, Wen MS, Wang HW, Hsieh IC, Li Y, Liu PY, Lin FC, Liao JK. Increased vascular senescence and impaired endothelial progenitor cell function mediated by mutation of circadian gene Per2. Circulation 2008; 118:2166-73. [PMID: 18981300 DOI: 10.1161/circulationaha.108.790469] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Alteration of the circadian rhythm and increased vascular senescence are linked to cardiovascular disease. Per2, a circadian gene, is known to regulate endothelium-dependent vasomotion. However, the mechanism by which Per2 affects endothelial function is unknown. We hypothesize that endothelial dysfunction in Per2 mutant (Per2(m/m)) mice is mediated in part by increased vascular senescence and impaired endothelial progenitor cell (EPC) function. METHODS AND RESULTS Endothelial cells from Per2(m/m) mice exhibit increased protein kinase Akt signaling, greater senescence, and impaired vascular network formation and proliferation. Indeed, Per2(m/m) mice have impaired blood flow recovery and developed autoamputation of the distal limb when subjected to hind-limb ischemia. Furthermore, matrigel implantation into Per2(m/m) mice resulted in less neovascularization. Because EPCs contribute to angiogenesis, we studied the role of Per2 in these cells using bone marrow transplantation. Basal EPC levels were similar between wild-type and Per2(m/m) mice. However, compared with wild-type bone marrow transplantation mice, EPC mobilization was impaired in Per2(m/m) bone marrow transplantation mice in response to ischemia or VEGF stimulation. Bone marrow transplantation or infusion of wild-type EPC restored blood flow recovery and prevented autoamputation in Per2(m/m) mice. CONCLUSIONS These findings indicate that mutation of Per2 causes Akt-dependent senescence and impairs ischemia-induced revascularization through the alteration of EPC function.
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Affiliation(s)
- Chao-Yung Wang
- Brigham and Women's Hospital, 65 Landsdowne St, Room 275, Cambridge, MA 02139, USA
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Analysis of heart rate variability as an index of noncardiac surgical stress. Heart Vessels 2008; 23:53-9. [PMID: 18273547 DOI: 10.1007/s00380-007-0997-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2006] [Accepted: 06/08/2007] [Indexed: 01/08/2023]
Abstract
Measurement of heart rate variability (HRV) is useful in assessing the function of the autonomic nervous system and in staging of clinical diseases. The purpose of this study is to assess a feasibility of HRV for evaluating surgical stress during the noncardiac perioperative period. Standard deviation of normal-to-normal RR intervals (SDNN) and HRV triangular index derived from 24-h Holter ECC were measured in 24 patients undergoing digestive surgery. Holter ECG was performed at 1 day before operation, the first day (postoperative day 1: POD1), and the 7th day (POD7) after operation. Indices of HRV were compared with factors influencing surgical stress, such as duration of the operation and amount of blood loss during the operation, and postoperative complications. The SDNN and HRV triangular index decreased significantly on POD1 and recovered on POD7 (P < 0.05). Heart rate variability indices correlated significantly to duration and blood loss of operation (both P < 0.05). In 7 patients with postoperative complications, HRV indices were statistically lower than those in patients without complications on POD1 (P < 0.05). Our results indicate that HRV may provide useful information with respect to surgical stress.
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Ushiyama T, Nakatsu T, Yamane S, Tokutake H, Wakabayashi H, Ishimura K, Maeta H. Heart rate variability for evaluating surgical stress and development of postoperative complications. Clin Exp Hypertens 2008; 30:45-55. [PMID: 18214733 DOI: 10.1080/10641960701813908] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Heart rate variability (HRV) has recently been used to detect autonomic nerve tone, which is affected by various stresses. To test out hypothesis that HRV can determine surgical stress, we examined perioperative HRV in 30 patients with surgical treatment. Relations between HRV and factors of surgical stresses, such as duration of the operation, amount of blood loss at the operation, and developments of complications, were evaluated. Mean heart rate (HR) increased and other HRV indices decreased postoperatively. Most indices correlated significantly to the duration of the operation and amount of blood loss at the operation on postoperative day 1. Only the standard deviation of normal to normal RR intervals (SDNN) and HRV triangular index showed significantly low values in complicated patients. HRV measurement in the perioperative period showed a significant relation to surgical stress. The present results indicated that HRV may provide useful information with respect to surgical stress.
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Affiliation(s)
- Takafumi Ushiyama
- Department of Surgery, National Hospital Organization Takamatsuhigashi National Hospital 8, Otsu, Shinden, Takamatsu, Kagawa, Japan.
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Chan HL, Lin LY, Lin MA, Fang SC, Lin CH. Nonlinear characteristics of heart rate variability during unsupervised and steady physical activities. Physiol Meas 2007; 28:277-86. [PMID: 17322592 DOI: 10.1088/0967-3334/28/3/004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The heart rate (HR) exhibits various behavior patterns in different postures and during physical activities, whereas a conventional long-term analysis of HR variability has the confounding effect whether the subject was physically active or immobilized. A specially designed ambulatory recorder that simultaneously measures the electrocardiogram and body accelerations was used to study the short-term (< or =11 beats, alpha1) fractal correlation property and the approximate entropy (ApEn) of RR interval data during sleep, sitting and standing (passive standing or mild walking) levels and immediately after rising in the morning in 15 healthy subjects. The alpha1 exponent that increased from sleep to sitting to standing implies an increased correlation of HR dynamics, which is concomitant with an increased ratio of low-frequency power to high-frequency power (LF/HF) that is usually linked with an increased sympathetic activity. A lower ApEn value during standing and after rising implies a reduced complexity of HR dynamics. Compared to the HR measures during the standing level, the LF/HF ratio showed a quick autonomic shift and alpha1 showed a rapid recruitment of fractal HR behavior after rising, whereas the ApEn value had a slower recovery of HR complexity. In conclusion, both linear and nonlinear HR behaviors during different unsupervised physical activities can be better interpreted with the aid of the recorded movement data.
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Affiliation(s)
- Hsiao-Lung Chan
- Department of Electrical Engineering, Chang Gung University, Taoyuan, Taiwan.
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Sin DD, Wong E, Mayers I, Lien DC, Feeny D, Cheung H, Gan WQ, Man SFP. Effects of Nocturnal Noninvasive Mechanical Ventilation on Heart Rate Variability of Patients With Advanced COPD. Chest 2007; 131:156-63. [PMID: 17218570 DOI: 10.1378/chest.06-1423] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Cardiovascular comorbidities have a negative impact on the health status and prognosis of patients with COPD. We determined whether nocturnal noninvasive (positive) mechanical ventilation (NIMV) can improve heart rate variability (HRV), decrease circulating natriuretic peptide levels, and improve functional performance of patients with very advanced COPD. METHODS A randomized, double-blind, parallel controlled trial was conducted in 23 participants with stable but advanced COPD. Participants received standard medical therapy plus nocturnal NIMV or standard medical therapy plus sham NIMV for 3 months. RESULTS After 3 months of NIMV therapy, the 24-h triangular interpolation of N-N intervals increased from 322 to 473 ms (p = 0.034), the 24-h HRV index (HRVI) increased from 21.8 to 29.9 ms (p = 0.035), nocturnal HRVI increased from 6.1 to 8.0 ms (p = 0.026), and the SD of the average N-N interval increased from 37 to 41 ms (p = 0.020). None of these indexes changed significantly in the control group. Additionally, compared with the control group, the pro-atrial natriuretic peptide levels declined significantly in the NIMV group (p = 0.013). CONCLUSIONS NIMV applied nocturnally over 3 months may improve HRV, reduce circulating natriuretic peptide levels, and enhance the functional performance of patients with advanced but stable COPD. While not definitive due to small sample size, these data suggest that nocturnal NIMV may reduce the impact of cardiac comorbidities in COPD patients.
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Affiliation(s)
- Don D Sin
- Pulmonary Division, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.
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Suhrbier A, Heringer R, Walther T, Malberg H, Wessel N. Comparison of three methods for beat-to-beat-interval extraction from continuous blood pressure and electrocardiogram with respect to heart rate variability analysis. BIOMED ENG-BIOMED TE 2006; 51:70-6. [PMID: 16915768 DOI: 10.1515/bmt.2006.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In recent years the analysis of heart rate variability (HRV) has become a suitable method for characterizing autonomous cardiovascular regulation. The aim of this study was to investigate the differences in HRV estimated from continuous blood pressure (BP) measurement by different methods in comparison to electrocardiogram (ECG) signals. The beat-to-beat intervals (BBI) were simultaneously extracted from the ECG and blood pressure of 9 cardiac patients (10 min, Colin system, 1000-Hz sampling frequency). For both data types, slope, peak, and correlation detection algorithms were applied. The short-term variability was calculated using concurrent 10-min BP and ECG segments. The root mean square errors in comparison to ECG slope detection were: 1.74 ms for ECG correlation detection; 5.42 ms for ECG peak detection; 5.45 ms for BP slope detection; 5.75 ms for BP correlation detection; and 11.96 ms for BP peak detection. Our results show that the variability obtained with ECG is the most reliable. Moreover, slope detection is superior to peak detection and slightly superior to correlation detection. In particular, for ECG signals with higher frequency characteristics, peak detection often exhibits more artificial variability. Besides measurement noise, respiratory modulation and pulse transit time play an important role in determining BBI. The slope detection method applied to ECG should be preferred, because it is more robust as regards morphological changes in the signals, as well as physiological properties. As the ECG is not recorded in most animal studies, distal pulse wave measurement in combination with correlation or slope detection may be considered an acceptable alternative.
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Chan HL, Fang SC, Ko YL, Lin MA, Huang HH, Lin CH. Heart Rate Variability Characterization in Daily Physical Activities Using Wavelet Analysis and Multilayer Fuzzy Activity Clustering. IEEE Trans Biomed Eng 2006; 53:133-9. [PMID: 16402613 DOI: 10.1109/tbme.2005.859811] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A portable data recorder was developed to parallel measure the electrocardiogram and body accelerations. A multilayer fuzzy clustering algorithm was proposed to classify the physical activity based on body accelerations. Discrete wavelet transform was incorporated to retrieve time-varying characteristics of heart rate variability under different physical activities. Nine healthy subjects were included to investigate activity-related heart rate variability during 24 h. The results showed that the heartbeat fluctuations in high frequencies were the greatest during lying and the smallest during standing. Moreover, very-low-frequency heartbeat fluctuations during low activity level (lying) were greater than during high activity level (nonlying).
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Affiliation(s)
- Hsiao-Lung Chan
- Department of Electrical Engineering, Chang Gung University, Taoyuan, Taiwan.
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42
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Ronkainen E, Ansakorpi H, Huikuri HV, Myllylä VV, Isojärvi JIT, Korpelainen JT. Suppressed circadian heart rate dynamics in temporal lobe epilepsy. J Neurol Neurosurg Psychiatry 2005; 76:1382-6. [PMID: 16170081 PMCID: PMC1739357 DOI: 10.1136/jnnp.2004.053777] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To measure interictal circadian rhythm of heart rate (HR) variability in patients with temporal lobe epilepsy (TLE) using a 24 hour ECG recording. METHODS Various conventional and dynamic fractal measures of HR variability were analysed in 17 patients with refractory TLE, 20 patients with well controlled TLE, and 37 healthy age and sex matched control subjects. RESULTS The SD of all RR intervals (p < 0.01), the measured power spectral components of HR variability (low frequency power (p < 0.01), high frequency power (p < 0.05)), and the SD1 (p < 0.05) and SD2 (p < 0.01) Poincaré two dimensional vector analysis measurements were suppressed in the patients. This suppression was observed during both day and night time; however, it was more pronounced at night, and nocturnal increase in HR variability usually seen in the normal population could not be detected in the patients. The HR variability measures did not correlate with the duration of epilepsy, the age of the patients, or with the anti-epileptic drugs used. CONCLUSION TLE was associated with reduced HR variability, which was more pronounced during night than day, and the nocturnal increase in HR variability was abolished in patients with TLE. The alteration in autonomic regulation of HR variability was similar in patients with both refractory and well controlled TLE.
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Affiliation(s)
- E Ronkainen
- Department of Neurology, P.O.Box 5000, FIN-90014 University of Oulu, Finland.
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D'Negri CE, Marelich L, Vigo D, Acunzo RS, Girotti LA, Cardinali DP, Siri LN. Circadian periodicity of heart rate variability in hospitalized angor patients. Clin Auton Res 2005; 15:223-32. [PMID: 15944873 DOI: 10.1007/s10286-005-0280-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2004] [Accepted: 03/21/2005] [Indexed: 10/25/2022]
Abstract
The relationship between unstable angor (angina) and circadian periodicity of heart rate variability (HRV) was explored in a group of patients hospitalized in a coronary care unit (CCU). Patients were classified as normal (whose symptoms had non-cardiovascular origin, n=8), moderate angor (n=13) and severe angor (n=11). A fourth group of ambulatory healthy volunteers (n=12) was included. Individual 24 h Holter records were analyzed, mean RR and standard deviation of RR (SDNN) being obtained from 1 h-length windows. For frequency domain analysis, 5 min-length windows were employed. The spectral components analyzed were total power (spectral power between 0.01 and 0.5 Hz), low frequency power (LF: power between 0.04 and 0.15 Hz), and high frequency power (HF: power between 0.15 and 0.4 Hz). In addition, LF to HF areas ratio (L/H) was computed. Mesor, amplitude and acrophase for every 24 h rhythm were calculated by cosinor analysis. As compared to ambulatory controls, admission to the CCU diminished amplitude and phase-delayed the circadian oscillation of most HRV parameters, except for SDNN. Moderate angor patients showed decreased amplitude of RR and L/H and augmented amplitude of SDNN when compared to normal hospitalized subjects. A phase delay of about 1.5 h for RR intervals and a phase advance of 3.5-6 h for LFA and SDNN were found in the moderate angor group when compared to normal. Amplitude of 24 h variation of total power decreased in severely angor patients and the circadian oscillation of HF (an indicator of vagal control on the heart) became free running. A phase delay of 2.5 h in SDNN acrophase was found in severely affected patients when compared to moderate. The results indicate that severity of unstable angor correlates with desynchronization of parasympathetic control of heart rate.
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Affiliation(s)
- Carlos E D'Negri
- Instituto de Investigaciones, Médicas Alfredo Lanari, Laboratorio de Neumonología, Combatientes de Malvinas 3150, 1427 Buenos Aires, Argentina.
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Olesen RM, Thomsen PEB, Saermark K, Glikson M, Feldman S, Lewkowicz M, Levitan J. Statistical analysis of the DIAMOND MI study by the multipole method. Physiol Meas 2005; 26:591-8. [PMID: 16088054 DOI: 10.1088/0967-3334/26/5/002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We present a new method to describe the dynamics of the beat-to-beat RR time series. The classification of the phase-space plots obtained from RR time series is performed by a calculation of parameters which describe the features of the two-dimensional plot. We demonstrate that every parameter has its specific consequence on the evaluation of the state of the cardiac function. By applying the method to the DIAMOND MI study we demonstrate that these parameters have more prognostic power than previously suggested risk markers. The results suggest that the RR intervals constitute a highly complex time series which necessitates the use of refined mathematical-statistical methods in order to reveal pathologies in the heart rate.
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Affiliation(s)
- R M Olesen
- Department of Cardiology, Amtssygehuset i Gentofte, Copenhagen University Hospital, Denmark
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Cygankiewicz I, Wranicz JK, Bolinska H, Zaslonka J, Zareba W. Circadian changes in heart rate turbulence parameters. J Electrocardiol 2004; 37:297-303. [PMID: 15484158 DOI: 10.1016/j.jelectrocard.2004.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Heart rate turbulence is a novel method to identify patients at risk of cardiac death, and to date, there are no data concerning its circadian changes. In 46 coronary patients (mean age 63 +/- 8 years) with at least 100 ventricular premature beats in 24-hour Holter monitoring, turbulence onset, turbulence slope, and heart rate variability parameters were calculated in 3 equal 4-hour periods during morning, afternoon, and night. No circadian changes in turbulence onset values were found, while TS displayed significantly lower values during afternoon than during morning or night hours (5.08, vs. 7.08 and 7.99 ms/RR, respectively). Some heart rate variability parameters also showed lower values in the afternoon, not in the morning hours. In conclusion, in hospitalized patients with stable coronary artery disease, turbulence slope shows circadian pattern with lowest values observed in the afternoon when compared to morning and night hours.
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Schroeder EB, Whitsel EA, Evans GW, Prineas RJ, Chambless LE, Heiss G. Repeatability of heart rate variability measures. J Electrocardiol 2004; 37:163-72. [PMID: 15286929 DOI: 10.1016/j.jelectrocard.2004.04.004] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Due to the sparse data on the repeatability of short and ultra-short term heart rate variability (HRV) measures, we measured the repeatability of common HRV measures derived from 10-second, 2-minute, and 6-minute recordings in 63 healthy men and women, aged 45-64, in Chapel Hill, North Carolina. Three 10-second and 2 six-minute heart rate recordings were obtained during each of 2 visits, separated by 1 to 2 weeks. We partitioned the measurement error into components and computed intraclass correlation coefficients using nested, random effects models. Repeatability improved with the length of recording: intraclass correlation coefficients were greater than 0.7 for 6-minute measures and 2-minute time domain measures and greater than 0.5 for 2-minute frequency domain measures. Repeatability of measures from 10-second records was lower, but improved considerably when the mean from 2 or 3 records was used. Correlations between the same measures from different length recordings were quite high. Our findings support the use of records of at least 5 minutes in length in epidemiological studies, in accordance with previous guidelines. Researchers using 10-second records should consider taking the mean of several recordings, when possible, or using statistical methods to correct for measurement error.
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Ahlbom A, Feychting M, Gustavsson A, Hallqvist J, Johansen C, Kheifets L, Olsen JH. Occupational Magnetic Field Exposure and Myocardial Infarction Incidence. Epidemiology 2004; 15:403-8. [PMID: 15232399 DOI: 10.1097/01.ede.0000129516.92192.60] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Studies on healthy volunteers have seen reduced heart rate variability after exposure to extremely low-frequency electric and magnetic fields (EMF). Because reduced heart rate variability has been linked to cardiovascular disease risk, it has been hypothesized that exposure to EMF might increase the risk of cardiovascular disease. One epidemiologic study has shown increased mortality from cardiovascular conditions in utility workers with elevated exposure to magnetic fields, but several other epidemiologic studies have failed to confirm this result. We tested the hypothesis that occupational EMF exposure increases the risk of myocardial infarction in a large population-based case-control study of myocardial infarction, with detailed information on potential confounders. METHODS We used data from the SHEEP study, which is a population-based case-control study of acute myocardial infarction in Stockholm. Occupational EMF exposure was based on job titles 1, 5, and 10 years before diagnosis. We used 2 approaches to classify exposure: first, specific individual job titles with presumed elevated EMF exposure, and second, classification of subjects according to a job-exposure matrix. RESULTS We found no increased risk of myocardial infarction in subjects classified as having elevated EMF exposure. For the highest exposure category of > or = 0.3 microT according to the job-exposure matrix, the adjusted relative risk was = 0.57 (95% confidence interval = 0.36-0.89). CONCLUSIONS The results of this study do not support the hypothesis that occupational EMF exposure increases the risk of myocardial infarction.
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Affiliation(s)
- Anders Ahlbom
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
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Cuomo S, Marciano F, Migaux ML, Finizio F, Pezzella E, Losi MA, Betocchi S. Abnormal QT interval variability in patients with hypertrophic cardiomyopathy. J Electrocardiol 2004; 37:113-9. [PMID: 15127378 DOI: 10.1016/j.jelectrocard.2004.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We sought to determine QT variability pattern in patients with hypertrophic cardiomyopathy (HCM) and its relationship with the risk of syncope. QT interval variability was assessed from 24-hour Holter monitoring in 10 HCM patients with history of syncope, 10 HCM patients without history of syncope, and 10 healthy subjects. QT variability was higher in patients with HCM, in particular in those with history of syncope, than in healthy controls. Time domain QT variability did not vary between waking and sleeping hours in HCM patients, whereas it was significantly shorter while asleep in the control group. Increased QT SDANN identified HCM patients with history of syncope with an accuracy of 75%. Our data show that QT variability is abnormal in HCM patients and indirectly support the concept that arrhythmia-related syncope in these patients may be, at least in part, related to an altered control of repolarization.
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Affiliation(s)
- Sergio Cuomo
- Division of Cardiology, Pellegrini's Hospital, Naples, Italy.
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Migliaro ER, Canetti R, Contreras P, Hakas M. Heart rate variability: short-term studies are as useful as holter to differentiate diabetic patients from healthy subjects. Ann Noninvasive Electrocardiol 2004; 8:313-20. [PMID: 14516288 PMCID: PMC7313231 DOI: 10.1046/j.1542-474x.2003.08409.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The definitive incorporation of heart rate variability (HRV) as a clinical tool depends on the development of more confident techniques of measurement. The length of the studies is a critical issue. Whereas Holter studies allow the monitorization at different hours and activities, short-term recordings allow the control of environmental conditions. Recording length is also strongly related to the procedure of analysis; for instance, some time-domain indexes are strongly affected by the duration of the study. Meanwhile, spectral analyses require stationary conditions, only achieved in short-term studies. Our main goal was to determine if HRV indexes obtained from short-term analyses were as useful as those from Holter monitoring for diagnosis of reduced HRV in diabetes. METHODS We studied two groups: one with impaired HRV (15 diabetic patients) and another with normal HRV (15 healthy subjects). HRV indexes obtained from 24-hour Holter recordings (SDNN, rMSSD, and the power of LF and HF bands), were correlated with analog indexes obtained from 10-minute digital acquired studies within each group. Besides, we compared the diabetic and control groups using the indexes obtained with both methodologies. RESULTS The correlation was high (0.70<or=r <or= 0.85, P <or= 0.0032) in the diabetic group, but was poor in the control group. HRV values were significantly lower in the diabetic group either for 24-hour or short-term studies (P <or= 0.0113). CONCLUSION We conclude that short-term studies are at least as powerful as Holter to differentiate the diabetic group (impaired HRV) from the control group.
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Affiliation(s)
| | - Rafael Canetti
- Departamento de Control, Instituto de Ingeniería Eléctrica, Facultad de Ingeniería, Universidad de la República, Montevideo, Uruguay
| | | | - Michel Hakas
- Departamento de Control, Instituto de Ingeniería Eléctrica, Facultad de Ingeniería, Universidad de la República, Montevideo, Uruguay
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Sorahan T, Nichols L. Mortality from cardiovascular disease in relation to magnetic field exposure: findings from a study of UK electricity generation and transmission workers, 1973-1997. Am J Ind Med 2004; 45:93-102. [PMID: 14691973 DOI: 10.1002/ajim.10314] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Experimental and epidemiological studies have indicated that magnetic field exposure might influence heart rate variability and consequent risks of arrhythmia related deaths. METHODS The mortality experience of a cohort of 83,997 employees of the former Central Electricity Generating Board (CEGB) of England and Wales was investigated for the period 1973-1997. Cohort members were employed for at least 6 months from 1973 to 1982. Computerized work histories were available for 79,972 study subjects for the period 1971-1993. Detailed calculations had been performed by others to enable a novel assessment to be made of exposures to magnetic fields. Two analytical approaches were used, indirect standardization (n = 83,997) and Poisson regression (n = 79,972). RESULTS Based on serial mortality rates for England and Wales, deaths from four categories of cardiovascular disease were below expectation: arrhythmia-related disease (ICD-9 426-7), observed (obs) 32, expected (exp) 43.5, standardized mortality ratio (SMR) 74; acute myocardial infarction (ICD-9 410), obs 3,320, exp 3878.3, SMR 86; atherosclerosis (ICD-9 440), obs 25, exp 39.2, SMR 64; chronic/sub-acute coronary disease (ICD-9 411-414), obs 1,552, exp 2021.7, SMR 77). No statistically significant trends were shown for risks of any of these four disease groupings to increase either with lifetime cumulative exposure to magnetic fields or with such exposures received in the most recent 5 years. CONCLUSIONS There are no discernible excess risks of mortality from cardiovascular diseases as a consequence of occupational exposure to magnetic fields in UK electricity generation and transmission workers.
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Affiliation(s)
- Tom Sorahan
- Institute of Occupational Health, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
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