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Gathright EC, Hughes JW, Sun S, Storlazzi LE, DeCosta J, Balletto BL, Carey MP, Scott-Sheldon LAJ, Salmoirago-Blotcher E. Effects of stress management interventions on heart rate variability in adults with cardiovascular disease: a systematic review and meta-analysis. J Behav Med 2024; 47:374-388. [PMID: 38478157 DOI: 10.1007/s10865-024-00468-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 01/15/2024] [Indexed: 04/19/2024]
Abstract
Meta-analysis was used to investigate the potential benefits of stress management interventions (SMIs) on vagally-mediated heart rate variability (HRV) in adults with cardiovascular disease. Electronic bibliographic databases were searched through August 2022. Randomized controlled trials and quasi-experimental studies assessing effects of SMIs on HRV were included. Methodological quality was assessed with a standardized checklist. A pooled effect size was calculated for vagally-mediated HRV indices (standard deviation of normal-to-normal intervals, root mean square of the successive differences, and high frequency power) using random effects models. Fourteen studies (1202 participants, Mage: 59 ± 6.25 years; 25% ± 16% women; 61% ± 22% White) were included. Ten studies (11 effects) reported short-term HRV assessment; a small between-group difference emerged for vagally-mediated HRV (d+ = .27, 95% confidence interval [CI] 0.01-0.52, k = 11). Most interventions examined biofeedback; these studies yielded a small between-group difference on vagally-mediated HRV (d+ = 0.31, 95% CI 0.09-0.53, k = 7, Q [6] = 3.82, p = .70, I2 = 11%). This is the first systematic examination of the effect of SMIs on HRV in adults with CVD. Findings suggest a small effect of SMIs on vagally-mediated HRV, with biofeedback likely driving the effect. More research is required to fully understand whether this benefit on vagally-mediated HRV applies to other SMIs.
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Affiliation(s)
- Emily C Gathright
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA.
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA.
| | - Joel W Hughes
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Shufang Sun
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Laurie E Storlazzi
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
| | - Julie DeCosta
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
| | - Brittany L Balletto
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
| | - Michael P Carey
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Lori A J Scott-Sheldon
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Elena Salmoirago-Blotcher
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA
- Department of Medicine, Alpert School of Medicine, Brown University, Providence, RI, USA
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Hermans L, van Meulen F, Anderer P, Ross M, Cerny A, van Gilst M, Overeem S, Fonseca P. Performance of cardiorespiratory-based sleep staging in patients using beta blockers. J Clin Sleep Med 2024; 20:575-581. [PMID: 38063156 PMCID: PMC10985295 DOI: 10.5664/jcsm.10938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 04/04/2024]
Abstract
STUDY OBJECTIVES Automatic sleep staging based on cardiorespiratory signals from home sleep monitoring devices holds great clinical potential. Using state-of-the-art machine learning, promising performance has been reached in patients with sleep disorders. However, it is unknown whether performance would hold in individuals with potentially altered autonomic physiology, for example under the influence of medication. Here, we assess an existing sleep staging algorithm in patients with sleep disorders with and without the use of beta blockers. METHODS We analyzed a retrospective dataset of sleep recordings of 57 patients with sleep disorders using beta blockers and 57 age-matched patients with sleep disorders not using beta blockers. Sleep stages were automatically scored based on electrocardiography and respiratory effort from a thoracic belt, using a previously developed machine-learning algorithm (CReSS algorithm). For both patient groups, sleep stages classified by the model were compared to gold standard manual polysomnography scoring using epoch-by-epoch agreement. Additionally, for both groups, overall sleep parameters were calculated and compared between the two scoring methods. RESULTS Substantial agreement was achieved for four-class sleep staging in both patient groups (beta blockers: kappa = 0.635, accuracy = 78.1%; controls: kappa = 0.660, accuracy = 78.8%). No statistical difference in epoch-by-epoch agreement was found between the two groups. Additionally, the groups did not differ on agreement of derived sleep parameters. CONCLUSIONS We showed that the performance of the CReSS algorithm is not deteriorated in patients using beta blockers. Results do not indicate a fundamental limitation in leveraging autonomic characteristics to obtain a surrogate measure of sleep in this clinically relevant population. CITATION Hermans L, van Meulen F, Anderer P, et al. Performance of cardiorespiratory-based sleep staging in patients using beta blockers. J Clin Sleep Med. 2024;20(4):575-581.
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Affiliation(s)
- Lieke Hermans
- Philips Research, Eindhoven, The Netherlands
- Department of Electrical Engineering, TU/e Eindhoven, Eindhoven, The Netherlands
| | - Fokke van Meulen
- Department of Electrical Engineering, TU/e Eindhoven, Eindhoven, The Netherlands
- Sleep Medicine Center Kempenhaeghe, Heeze, The Netherlands
| | - Peter Anderer
- Philips Sleep and Respiratory Care, Vienna, Austria
- The Siesta Group Schlafanalyse GmbH, Vienna, Austria
| | - Marco Ross
- Department of Electrical Engineering, TU/e Eindhoven, Eindhoven, The Netherlands
- Philips Sleep and Respiratory Care, Vienna, Austria
- The Siesta Group Schlafanalyse GmbH, Vienna, Austria
| | | | - Merel van Gilst
- Department of Electrical Engineering, TU/e Eindhoven, Eindhoven, The Netherlands
- Sleep Medicine Center Kempenhaeghe, Heeze, The Netherlands
| | - Sebastiaan Overeem
- Department of Electrical Engineering, TU/e Eindhoven, Eindhoven, The Netherlands
- Sleep Medicine Center Kempenhaeghe, Heeze, The Netherlands
| | - Pedro Fonseca
- Philips Research, Eindhoven, The Netherlands
- Department of Electrical Engineering, TU/e Eindhoven, Eindhoven, The Netherlands
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Marino FR, Wu HT, Etzkorn L, Rooney MR, Soliman EZ, Deal JA, Crainiceanu C, Spira AP, Wanigatunga AA, Schrack JA, Chen LY. Associations of Physical Activity and Heart Rate Variability from a Two-Week ECG Monitor with Cognitive Function and Dementia: the ARIC Neurocognitive Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.01.24303633. [PMID: 38496423 PMCID: PMC10942521 DOI: 10.1101/2024.03.01.24303633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
BACKGROUND Low physical activity (PA) measured from accelerometers and low heart rate variability (HRV) measured from short-term ECG recordings are associated with worse cognitive function. Wearable long-term ECG monitors are now widely used. These monitors can provide long-term HRV data and, if embedded with an accelerometer, they can also provide PA data. Whether PA or HRV measured from long-term ECG monitors is associated with cognitive function among older adults is unknown. METHODS Free-living PA and HRV were measured simultaneously over 14-days using the Zio ® XT Patch among 1590 participants in the Atherosclerosis Risk in Communities Study [aged 72-94 years, 58% female, 32% Black]. Total amount of PA was estimated by total mean amplitude deviation (TMAD) from the 14-day accelerometry raw data. HRV indices (SDNN and rMSSD) were measured from the 14-day ECG raw data. Cognitive factor scores for global cognition, executive function, language, and memory were derived using latent variable methods. Dementia or mild cognitive impairment (MCI) status was adjudicated. Linear or multinomial regression models examined whether higher PA or higher HRV was cross-sectionally associated with higher factor scores or lower odds of MCI/dementia. Models were adjusted for demographic and medical comorbidities. RESULTS Each 1-unit higher in total amount of PA was significantly associated with 0.30 higher global cognition factor scores (95% CI: 0.16-0.44), 0.38 higher executive function factor scores (95% CI: 0.22-0.53), and 62% lower odds of MCI (OR: 0.38, 95% CI: 0.22-0.67) or 75% lower odds of dementia (OR: 0.25, 95% CI: 0.08-0.74) versus unimpaired cognition. Neither HRV measure was significantly associated with cognitive function or dementia. CONCLUSIONS PA derived from a 2-week ECG monitor with an embedded accelerometer was significantly associated with higher cognitive test performance and lower odds of MCI/dementia among older adults. By contrast, HRV indices measured over 2 weeks were not significantly associated with cognitive outcomes. More research is needed to define the role of wearable ECG monitors as a tool for digital phenotyping of dementia. CLINICAL PERSPECTIVE What Is New?: This cross-sectional study evaluated associations between physical activity (PA) and heart rate variability (HRV) measured over 14 days from a wearable ECG monitor with cognitive function.Higher total amount of PA was associated with higher global cognition and executive function, as well as lower odds of mild cognitive impairment or dementia.HRV indices measured over 2 weeks were not significantly associated with cognitive outcomes.What Are the Clinical Implications?: These findings replicate positive associations between PA and cognitive function using accelerometer data from a wearable ECG monitor with an embedded accelerometer.These findings raise the possibility of using wearable ECG monitors (with embedded accelerometers) as a promising tool for digital phenotyping of dementia.
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Kanniainen M, Pukkila T, Kuisma J, Molkkari M, Lajunen K, Räsänen E. Estimation of physiological exercise thresholds based on dynamical correlation properties of heart rate variability. Front Physiol 2023; 14:1299104. [PMID: 38179139 PMCID: PMC10765723 DOI: 10.3389/fphys.2023.1299104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/30/2023] [Indexed: 01/06/2024] Open
Abstract
Aerobic and anaerobic thresholds of the three-zone exercise model are often used to evaluate the exercise intensity and optimize the training load. Conventionally, these thresholds are derived from the respiratory gas exchange or blood lactate concentration measurements. Here, we introduce and validate a computational method based on the RR interval (RRI) dynamics of the heart rate (HR) measurement, which enables a simple, yet reasonably accurate estimation of both metabolic thresholds. The method utilizes a newly developed dynamical detrended fluctuation analysis (DDFA) to assess the real-time changes in the dynamical correlations of the RR intervals during exercise. The training intensity is shown to be in direct correspondence with the time- and scale-dependent changes in the DDFA scaling exponent. These changes are further used in the definition of an individual measure to estimate the aerobic and anaerobic threshold. The results for 15 volunteers who participated in a cyclo-ergometer test are compared to the benchmark lactate thresholds, as well as to the ventilatory threshods and alternative HR-based estimates based on the maximal HR and the conventional detrended fluctuation analysis (DFA). Our method provides the best overall agreement with the lactate thresholds and provides a promising, cost-effective alternative to conventional protocols, which could be easily integrated in wearable devices. However, detailed statistical analysis reveals the particular strengths and weaknessess of each method with respect to the agreement and consistency with the thresholds-thus underlining the need for further studies with more data.
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Affiliation(s)
- Matias Kanniainen
- Computational Physics Laboratory, Tampere University, Tampere, Finland
| | - Teemu Pukkila
- Computational Physics Laboratory, Tampere University, Tampere, Finland
| | - Joonas Kuisma
- Computational Physics Laboratory, Tampere University, Tampere, Finland
| | - Matti Molkkari
- Computational Physics Laboratory, Tampere University, Tampere, Finland
| | | | - Esa Räsänen
- Computational Physics Laboratory, Tampere University, Tampere, Finland
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Lundström A, Wiklund U, Winbo A, Eliasson H, Karlsson M, Rydberg A. Cardiac response to water activities in children with Long QT syndrome type 1. PLoS One 2023; 18:e0295431. [PMID: 38060596 PMCID: PMC10703314 DOI: 10.1371/journal.pone.0295431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Swimming is a genotype-specific trigger in long QT syndrome type 1 (LQT1). OBJECTIVE To examine the autonomic response to water activities in children and adolescents with LQT1. METHODS In this cross-sectional study, LQT1 patients were age and sex matched to one healthy control subject. Electrocardiograms (ECGs) were recorded during face immersion (FI), swimming, diving, and whole-body submersion (WBS). Heart rate (HR) and heart rate variability (HRV) was measured. The high frequency (HF) component of HRV was interpreted to reflect parasympathetic activity, while the low frequency (LF) component was interpreted as reflecting the combined influence of sympathetic and parasympathetic activity on autonomic nervous modulation of the heart. RESULTS Fifteen LQT1 patients (aged 7-19 years, all on beta-blocker therapy) and fifteen age and sex matched non-medicated controls were included. No significant ventricular arrhythmias were observed in the LQT1 population during the water activities. Out of these 15 matched pairs, 12 pairs managed to complete FI and WBS for more than 10 seconds and were subsequently included in HR and HRV analyses. In response to FI, the LQT1 group experienced a drop in HR of 48 bpm, compared to 67 bpm in the control group (p = 0.006). In response to WBS, HR decreased by 48 bpm in the LQT1 group and 70 bpm in the control group (p = 0.007). A significantly lower PTOT (p < 0.001) and HF (p = 0.011) component was observed before, during and after FI in LQT1 patients compared with the controls. Before, during and after WBS, a significantly lower total power (p < 0.001), LF (p = 0.002) and HF (p = 0.006) component was observed in the LQT1 patients. CONCLUSION A significantly lower HR decrease in response to water activities was observed in LQT1 subjects on beta-blocker therapy, compared to matched non-medicated controls. The data suggests an impaired parasympathetic response in LQT1 children and adolescents. An aberrant autonomic nervous system (ANS) response may cause an autonomic imbalance in this patient group.
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Affiliation(s)
- Anna Lundström
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Urban Wiklund
- Department of Radiation Sciences, Radiation Physics, Biomedical Engineering, Umeå University, Umeå, Sweden
| | - Annika Winbo
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Håkan Eliasson
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Marcus Karlsson
- Department of Radiation Sciences, Radiation Physics, Biomedical Engineering, Umeå University, Umeå, Sweden
| | - Annika Rydberg
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
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Baumeister-Lingens L, Rothe R, Wolff L, Gerlach AL, Koenig J, Sigrist C. Vagally-mediated heart rate variability and depression in children and adolescents - A meta-analytic update. J Affect Disord 2023; 339:237-255. [PMID: 37437729 DOI: 10.1016/j.jad.2023.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/09/2023] [Accepted: 07/08/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Depression is one of the most common mental disorders and a leading cause of disability worldwide. In adults, depression is characterized by decreased vagal activity (vagally-mediated heart rate variability; vmHRV), while vmHRV is inversely correlated with depressive symptoms. In children/adolescents, a 2016 synthesis (4 studies, 259 individuals) found similarly decreased vmHRV in clinical depression, but no significant association between depressive symptoms and vmHRV (6 studies, 2625 individuals). Given the small number of studies previously considered for synthesis and the rapidly growing evidence base in this area, a meta-analytic update was warranted. METHOD A previous review was updated by a systematic literature search to identify studies that (a) compared vmHRV in clinically depressed children/adolescents with non-depressed controls and (b) reported associations between vmHRV and depression severity. RESULTS The search update identified 5 additional studies for group comparison (k = 9 studies in total, n = 608 individuals in total) and 15 additional studies for correlational meta-analysis (k = 21 studies in total, n = 4224 individuals in total). Evidence was found for lower resting-state vmHRV in clinically depressed children/adolescents compared to healthy controls (SMD = -0.593, 95 % CI [-1.1760; -0.0101], I2 = 90.92 %) but not for a significant association between vmHRV and depressive symptoms (r = -0.053, 95 % CI [-0.118; 0.012], I2 = 65.77 %). Meta-regression revealed a significant association between depressive symptoms and vmHRV as a function of sex. LIMITATIONS The samples considered are highly heterogeneous. Data on the longitudinal association between vmHRV and depression are currently lacking. CONCLUSION The present findings support the use of vmHRV as a biomarker for clinical depression in children/adolescents.
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Affiliation(s)
- Luise Baumeister-Lingens
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany
| | - Roxana Rothe
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany
| | - Lena Wolff
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany
| | - Alexander L Gerlach
- Department of Psychology, Institute of Clinical Psychology and Psychotherapy, University of Cologne, Cologne, Germany
| | - Julian Koenig
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany
| | - Christine Sigrist
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany.
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Gillett L, Johnson-Sasso C, Miller B, Shakowski C, Walker LA, Tompkins C. Arrhythmic Effects of Cannabis in Ischemic Heart Disease. Cannabis Cannabinoid Res 2023; 8:867-876. [PMID: 35353598 PMCID: PMC10589466 DOI: 10.1089/can.2021.0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Rationale: Cannabis use is increasing worldwide, especially among older individuals at risk for chronic ischemic heart disease (IHD). However, little is known about the arrhythmic effects of cannabis use in IHD. Accordingly, we prospectively assessed the relationship between cannabis use, heart rate (HR), and arrhythmias in healthy age-matched controls and subjects with IHD. Methods: Healthy controls (n=37, 57% men) and subjects with IHD (myocardial infarction ≥3 months ago; n=24, 58% men) who used cannabis wore a Zio® (iRhythm Technologies) monitor for 14 days. Noncannabis using ischemic subjects (n=35, 51% males) wore Zio monitors for standard clinical indications. Baseline HR was compared with average HR measured for 4 h following consumption and changes in HR and frequency of arrhythmias were correlated with cannabis use. Results: In controls, HR increased 20 min (4.99±6.7 bpm, p=0.08) after use, then declined 4 h following use (-7.4±7.7, p<0.001). Conversely, subjects with IHD showed minimal HR increase (1.6±3.9 bpm) and blunted HR decline (-3.4±5.6 bpm, p<0.001). Supraventricular tachycardia (SVT) (29.7% vs. 58.3%; p=0.04) and nonsustained ventricular tachycardia (NSVT) (5.6% vs. 47.8%, p=0.01) were the most frequently occurring arrhythmias in controls and IHD subjects, respectively. Incidence of SVT decreased as cannabis use increased in both groups. Conversely, NSVT tended to increase with increased use in controls, and was significantly more prevalent in IHD. However, overall arrhythmia burden did not differ between cannabis users and nonusers with IHD. Conclusion: Our findings demonstrate that chronic cannabis use is associated with only mild HR changes, which are blunted in IHD. In addition, our data suggest that among cannabis users, arrhythmias are more frequent in IHD subjects that in healthy subjects.
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Affiliation(s)
- Leah Gillett
- Continuing Medical Education, University of Colorado Boulder, Boulder, Colorado, USA
| | - Cecelia Johnson-Sasso
- Department of Medicine, Northwestern University School of Medicine, Chicago, Illinois, USA
| | - Brian Miller
- Department of Medicine/Cardiology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Courtney Shakowski
- Department of Medicine/Cardiology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Lori A. Walker
- Department of Medicine/Cardiology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Christine Tompkins
- Department of Medicine/Cardiology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Medicine/Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
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Krause E, Vollmer M, Wittfeld K, Weihs A, Frenzel S, Dörr M, Kaderali L, Felix SB, Stubbe B, Ewert R, Völzke H, Grabe HJ. Evaluating heart rate variability with 10 second multichannel electrocardiograms in a large population-based sample. Front Cardiovasc Med 2023; 10:1144191. [PMID: 37252117 PMCID: PMC10213655 DOI: 10.3389/fcvm.2023.1144191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/27/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Heart rate variability (HRV), defined as the variability of consecutive heart beats, is an important biomarker for dysregulations of the autonomic nervous system (ANS) and is associated with the development, course, and outcome of a variety of mental and physical health problems. While guidelines recommend using 5 min electrocardiograms (ECG), recent studies showed that 10 s might be sufficient for deriving vagal-mediated HRV. However, the validity and applicability of this approach for risk prediction in epidemiological studies is currently unclear to be used. Methods This study evaluates vagal-mediated HRV with ultra-short HRV (usHRV) based on 10 s multichannel ECG recordings of N = 4,245 and N = 2,392 participants of the Study of Health in Pomerania (SHIP) from two waves of the SHIP-TREND cohort, additionally divided into a healthy and health-impaired subgroup. Association of usHRV with HRV derived from long-term ECG recordings (polysomnography: 5 min before falling asleep [N = 1,041]; orthostatic testing: 5 min of rest before probing an orthostatic reaction [N = 1,676]) and their validity with respect to demographic variables and depressive symptoms were investigated. Results High correlations (r = .52-.75) were revealed between usHRV and HRV. While controlling for covariates, usHRV was the strongest predictor for HRV. Furthermore, the associations of usHRV and HRV with age, sex, obesity, and depressive symptoms were similar. Conclusion This study provides evidence that usHRV derived from 10 s ECG might function as a proxy of vagal-mediated HRV with similar characteristics. This allows the investigation of ANS dysregulation with ECGs that are routinely performed in epidemiological studies to identify protective and risk factors for various mental and physical health problems.
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Affiliation(s)
- Elischa Krause
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Marcus Vollmer
- Institute of Bioinformatics, University Medicine Greifswald, Greifswald, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
| | - Katharina Wittfeld
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Partner Site Rostock/Greifswald, Greifswald, Germany
| | - Antoine Weihs
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Stefan Frenzel
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Marcus Dörr
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Lars Kaderali
- Institute of Bioinformatics, University Medicine Greifswald, Greifswald, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
| | - Stephan B. Felix
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Beate Stubbe
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Ralf Ewert
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Hans J. Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Partner Site Rostock/Greifswald, Greifswald, Germany
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Saleem S, Khandoker AH, Alkhodari M, Hadjileontiadis LJ, Jelinek HF. Investigating the effects of beta-blockers on circadian heart rhythm using heart rate variability in ischemic heart disease with preserved ejection fraction. Sci Rep 2023; 13:5828. [PMID: 37037871 PMCID: PMC10086029 DOI: 10.1038/s41598-023-32963-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/05/2023] [Indexed: 04/12/2023] Open
Abstract
Heart failure is characterized by sympathetic activation and parasympathetic withdrawal leading to an abnormal autonomic modulation. Beta-blockers (BB) inhibit overstimulation of the sympathetic system and are indicated in heart failure patients with reduced ejection fraction. However, the effect of beta-blocker therapy on heart failure with preserved ejection fraction (HFpEF) is unclear. ECGs of 73 patients with HFpEF > 55% were recruited. There were 56 patients in the BB group and 17 patients in the without BB (NBB) group. The HRV analysis was performed for the 24-h period using a window size of 1,4 and 8-h. HRV measures between day and night for both the groups were also compared. Percentage change in the BB group relative to the NBB group was used as a measure of difference. RMSSD (13.27%), pNN50 (2.44%), HF power (44.25%) and LF power (13.53%) showed an increase in the BB group relative to the NBB group during the day and were statistically significant between the two groups for periods associated with high cardiac risk during the morning hours. LF:HF ratio showed a decrease of 3.59% during the day. The relative increase in vagal modulated RMSSD, pNN50 and HF power with a decrease in LF:HF ratio show an improvement in the parasympathetic tone and an overall decreased risk of a cardiac event especially during the morning hours that is characterized by a sympathetic surge.
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Affiliation(s)
- Shiza Saleem
- Department of Biomedical Engineering, Khalifa University, 127788, Abu Dhabi, United Arab Emirates.
| | - Ahsan H Khandoker
- Department of Biomedical Engineering, Khalifa University, 127788, Abu Dhabi, United Arab Emirates
- Healthcare Engineering Innovation Center, Khalifa University, 127788, Abu Dhabi, United Arab Emirates
| | - Mohanad Alkhodari
- Healthcare Engineering Innovation Center, Khalifa University, 127788, Abu Dhabi, United Arab Emirates
- Cardiovascular Clinical Research Facility, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Leontios J Hadjileontiadis
- Department of Biomedical Engineering, Khalifa University, 127788, Abu Dhabi, United Arab Emirates
- Healthcare Engineering Innovation Center, Khalifa University, 127788, Abu Dhabi, United Arab Emirates
| | - Herbert F Jelinek
- Department of Biomedical Engineering, Khalifa University, 127788, Abu Dhabi, United Arab Emirates
- Healthcare Engineering Innovation Center, Khalifa University, 127788, Abu Dhabi, United Arab Emirates
- Biotechnology Center, Khalifa University, 127788, Abu Dhabi, United Arab Emirates
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10
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Mirowsky JE, Carraway MS, Dhingra R, Tong H, Neas L, Diaz-Sanchez D, Cascio WE, Case M, Crooks JL, Hauser ER, Dowdy ZE, Kraus WE, Devlin RB. Exposures to low-levels of fine particulate matter are associated with acute changes in heart rate variability, cardiac repolarization, and circulating blood lipids in coronary artery disease patients. ENVIRONMENTAL RESEARCH 2022; 214:113768. [PMID: 35780850 DOI: 10.1016/j.envres.2022.113768] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/16/2022] [Accepted: 06/24/2022] [Indexed: 06/15/2023]
Abstract
Exposure to air pollution is a major risk factor for cardiovascular disease, disease risk factors, and mortality. Specifically, particulate matter (PM), and to some extent ozone, are contributors to these effects. In addition, exposures to these pollutants may be especially dangerous for susceptible populations. In this repeated-visit panel study, cardiovascular markers were collected from thirteen male participants with stable coronary artery disease. For 0-4 days prior to the health measurement collections, daily concentrations of fine PM (PM2.5) and ozone were obtained from local central monitoring stations located near the participant's homes. Then, single (PM2.5) and two-pollutant (PM2.5 and ozone) models were used to assess whether there were short-term changes in cardiovascular health markers. Per interquartile range increase in PM2.5, there were decrements in several heart rate variability metrics, including the standard deviation of the normal-to-normal intervals (lag 3, -5.8%, 95% confidence interval (CI) = -11.5, 0.3) and root-mean squared of successive differences (five day moving average, -8.1%, 95% CI = -15.0, -0.7). In addition, increases in PM2.5 were also associated with changes in P complexity (lag 1, 4.4%, 95% CI = 0.5, 8.5), QRS complexity (lag 1, 4.9%, 95% CI = 1.4, 8.5), total cholesterol (five day moving average, -2.1%, 95% CI = -4.1, -0.1), and high-density lipoprotein cholesterol (lag 2, -1.6%, 95% CI = -3.1, -0.1). Comparisons to our previously published work on ozone were conducted. We found that ozone affected inflammation and endothelial function, whereas PM2.5 influenced heart rate variability, repolarization, and lipids. All the health changes from these two studies were found at concentrations below the United States Environmental Protection Agency's National Ambient Air Quality Standards. Our results imply clear differences in the cardiovascular outcomes observed with exposure to the two ubiquitous air pollutants PM2.5 and ozone; this observation suggests different mechanisms of toxicity for these exposures.
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Affiliation(s)
- Jaime E Mirowsky
- Department of Chemistry, SUNY College of Environmental Science and Forestry, Syracuse, NY, USA; Curriculum in Toxicology, University of North Carolina, Chapel Hill, NC, USA.
| | - Martha Sue Carraway
- Department of Medicine, Pulmonary and Critical Care Medicine, Durham VA Medical Center, Durham, NC, USA
| | - Radhika Dhingra
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency, Chapel Hill, NC, USA; Department of Environmental Sciences and Engineering, University of North Carolina, Chapel Hill, NC, USA
| | - Haiyan Tong
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency, Chapel Hill, NC, USA
| | - Lucas Neas
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency, Chapel Hill, NC, USA
| | - David Diaz-Sanchez
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency, Chapel Hill, NC, USA
| | - Wayne E Cascio
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency, Chapel Hill, NC, USA
| | - Martin Case
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency, Chapel Hill, NC, USA
| | - James L Crooks
- Department of Immunology and Genomic Medicine, National Jewish Health, Denver, CO, USA; Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Elizabeth R Hauser
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA; Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Z Elaine Dowdy
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - William E Kraus
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA; Division of Cardiology, Department of Medicine, School of Medicine, Duke University, Durham, NC, USA
| | - Robert B Devlin
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency, Chapel Hill, NC, USA
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11
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Cardiac Autonomic Neuropathy in Type 1 and 2 Diabetes: Epidemiology, Pathophysiology, and Management. Clin Ther 2022; 44:1394-1416. [DOI: 10.1016/j.clinthera.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 07/23/2022] [Accepted: 09/06/2022] [Indexed: 11/21/2022]
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12
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Role of the autonomic nervous system and premature atrial contractions in short-term paroxysmal atrial fibrillation forecasting: Insights from machine learning models. Arch Cardiovasc Dis 2022; 115:377-387. [DOI: 10.1016/j.acvd.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 02/01/2023]
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13
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Valente HB, Silva VEDS, Barros TRM, Vanderlei FM, Laurino MJL, Botta AFB, Vanzella LM, Bongiovani AC, Vanderlei LCM. Relationship between the number of comorbidities, quality of life, and cardiac autonomic modulation in patients with coronary disease: a cross-sectional study. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2022; 68:450-455. [PMID: 35649066 DOI: 10.1590/1806-9282.20210919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 01/15/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate if there is a relationship between the number of comorbidities, autonomic modulation, and quality of life in patients diagnosed with coronary artery disease. METHODS A cross-sectional study was conducted at an outpatient rehabilitation center in Presidente Prudente-SP, Brazil. A total of 27 participants (65.33±9.23 years) diagnosed with coronary artery disease were assessed, from a cardiac rehabilitation program, independent of sex or age. The number of comorbidities was evaluated using the Self-Administered Comorbidity Questionnaire, and quality of life was evaluated using the Medical Outcome Study 36-Item Short Form Health Survey (SF-36) (eight domains: functional capacity, physical aspects, pain, general health status, vitality, social aspects, emotional aspects, and mental health). To evaluate the cardiac autonomic modulation, the heart rate was registered beat to beat using an heart rate monitor in the supine position during rest for 30 min. A total of 1000 RR intervals were considered to calculate linear (time domain: RMSSD, SDNN; frequency domain: LF, HF, LF/HF) and nonlinear indices (SD1, SD2, SD1/SD2) of heart rate variability. RESULTS A negative correlation was observed between the aggregation of comorbidities and the pain domain of the SF-36 (r=-0.427; p=0.03). No significant correlations were observed between other variables (p>0.05). CONCLUSION The number of comorbidities is inversely related to the pain domain of the SF-36, suggesting that a higher pain level is related to a higher number of comorbidities in coronary artery disease patients.
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Affiliation(s)
- Heloisa Balotari Valente
- Universidade Estadual Paulista, School of Technology and Sciences - Presidente Prudente (SP), Brazil
| | | | | | | | - Maria Júlia Lopez Laurino
- Universidade Estadual Paulista, School of Technology and Sciences - Presidente Prudente (SP), Brazil
| | - Ana Flavia Balotari Botta
- Universidade Estadual Paulista, School of Technology and Sciences - Presidente Prudente (SP), Brazil
| | - Laís Manata Vanzella
- University Health Network, Toronto Rehabilitation Institute - East York (ON), Canada
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Amoabeng Nti AA, Robins TG, Mensah JA, Dwomoh D, Kwarteng L, Takyi SA, Acquah A, Basu N, Batterman S, Fobil JN. Personal exposure to particulate matter and heart rate variability among informal electronic waste workers at Agbogbloshie: a longitudinal study. BMC Public Health 2021; 21:2161. [PMID: 34823492 PMCID: PMC8613947 DOI: 10.1186/s12889-021-12241-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 11/15/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Informal electronic waste recycling activities are major contributors to ambient air pollution, yet studies assessing the effects or relationship between direct/continuous exposure of informal e-waste workers to particulate matter and cardiovascular function are rare. METHODS Repeated measurements of fractions of PM2.5, PM10-2.5, and PM10 in personal air of informal e-waste workers, (n = 142) and a comparable group (n = 65) were taken over a period of 20 months (March 2017 to November, 2018). Concurrently, 5-min resting electrocardiogram was performed on each participant to assess resting heart rate variability indices. Linear mixed-effects models were used to assess the association between PM fractions and cardiac function. RESULTS SDNN, RMSSD, LF, HF and LH/HF ratio were all associated with PM. Significant associations were observed for PM2.5 and Mean NN (p = 0.039), PM10 and SDNN (p = 0.035) and PM 10-2.5 and LH/HF (p = 0.039). A 10 μg/m3 increase in the concentrations of PM 2.5, PM10-2.5, and PM10 in personal air was associated with reduced HRV indices and increased resting HR. A 10 μg/m3 per interquartile (IQR) increase in PM10-2.5 and PM10, decreased SDNN by 11% [(95% CI: - 0.002- 0.000); (p = 0.187)] and 34% [(95% CI: - 0.002-0.001); (p = 0.035)] respectively. However, PM2.5 increased SDNN by 34% (95% CI: - 1.32-0.64); (p = 0.493). Also, 10 μg/m3 increase in PM2.5, PM10-2.5 and PM10 decreased RMSSD by 27% [(- 1.34-0.79); (p = 0.620)], 11% [(- 1.73, 0.95); (p = 0.846)] and 0.57% [(- 1.56-0.46); (p = 0.255%)]. CONCLUSION Informal e-waste workers are at increased risk of developing cardiovascular disease from cardiac autonomic dysfunction as seen in reduced HRV and increased heart rate.
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Affiliation(s)
- Afua A. Amoabeng Nti
- grid.8652.90000 0004 1937 1485Department of Biological, Environmental & Occupational Health Sciences, School of Public Health, University of Ghana, P.O. Box LG13, Accra, Ghana
| | - Thomas G. Robins
- grid.214458.e0000000086837370Department of Environmental Health Sciences, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109 USA
| | - John Arko Mensah
- grid.8652.90000 0004 1937 1485Department of Biological, Environmental & Occupational Health Sciences, School of Public Health, University of Ghana, P.O. Box LG13, Accra, Ghana
| | - Duah Dwomoh
- grid.8652.90000 0004 1937 1485Department of Biostatistics, School of Public Health, University of Ghana, P.O. Box LG13, Accra, Ghana
| | - Lawrencia Kwarteng
- grid.8652.90000 0004 1937 1485Department of Biological, Environmental & Occupational Health Sciences, School of Public Health, University of Ghana, P.O. Box LG13, Accra, Ghana
| | - Sylvia A. Takyi
- grid.8652.90000 0004 1937 1485Department of Biological, Environmental & Occupational Health Sciences, School of Public Health, University of Ghana, P.O. Box LG13, Accra, Ghana
| | - Augustine Acquah
- grid.8652.90000 0004 1937 1485Department of Biological, Environmental & Occupational Health Sciences, School of Public Health, University of Ghana, P.O. Box LG13, Accra, Ghana
| | - Niladri Basu
- grid.14709.3b0000 0004 1936 8649Faculty of Agricultural and Environmental Sciences, McGill University, Montréal, QC H9X 3V9 Canada
| | - Stuart Batterman
- grid.214458.e0000000086837370Department of Environmental Health Sciences, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109 USA
| | - Julius N. Fobil
- grid.8652.90000 0004 1937 1485Department of Biological, Environmental & Occupational Health Sciences, School of Public Health, University of Ghana, P.O. Box LG13, Accra, Ghana
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15
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Vuoti AO, Tulppo MP, Ukkola OH, Junttila MJ, Huikuri HV, Kiviniemi AM, Perkiömäki JS. Prognostic value of heart rate variability in patients with coronary artery disease in the current treatment era. PLoS One 2021; 16:e0254107. [PMID: 34214132 PMCID: PMC8253412 DOI: 10.1371/journal.pone.0254107] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/18/2021] [Indexed: 12/19/2022] Open
Abstract
Coronary artery disease (CAD) mortality has declined substantially over the past decades thanks to advancing medical and interventional/surgical treatments; therefore, the prognostic value of the heart rate variability in CAD in the current treatment era is not well established. We evaluated the prognostic significance of baseline heart rate variability in 1,757 ARTEMIS study patients with angiographically verified CAD. During an average follow-up time of 8.7 ± 2.2 years, a total of 285 (16.2%) patients died. Of the patients, 63 (3.6%) suffered sudden cardiac death or were resuscitated from sudden cardiac arrest (SCD/SCA), 60 (3.4%) experienced non-sudden cardiac death (NSCD), and death attributable to non-cardiac causes (NCD) occurred in 162 (9.2%) patients. For every 10 ms decrease in standard deviation of normal to normal intervals the risk for SCD/SCA, NSCD and NCD increased significantly: HR 1.153 (95% CI 1.075–1.236, p<0.001), HR 1.187 (95% CI 1.102–1.278, p<0.001) and HR 1.080 (95% CI 1.037–1.125, p<0.001), respectively. The natural logarithm of the low-frequency component of the power spectrum and the short-term scaling exponent of the detrended fluctuation analysis also had significant association with all modes of death (p<0.001). After relevant adjustment, standard deviation of normal-to-normal intervals retained its association with NSCD and NCD (p<0.01), the natural logarithm of the low-frequency component of the power spectrum with all modes of death (p from <0.05 to <0.01), and the short-term scaling exponent of the detrended fluctuation analysis with SCD/SCA (p<0.05) and NCD (p<0.001). In conclusion, impairment of many measures of heart rate variability predicts mortality but is not associated with any specific mode of death in patients with stable CAD during the current treatment era, limiting the clinical applicability of heart rate variability to targeting therapy.
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Affiliation(s)
- Antti O Vuoti
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Mikko P Tulppo
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Olavi H Ukkola
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - M Juhani Junttila
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.,Biocenter Oulu, University of Oulu, Oulu, Finland
| | - Heikki V Huikuri
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Antti M Kiviniemi
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Juha S Perkiömäki
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
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16
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Cardiovascular Events After Partner Bereavement, What is the Role of Low Dose Aspirin and Beta-Blockers? Curr Probl Cardiol 2021; 47:100883. [PMID: 34103192 DOI: 10.1016/j.cpcardiol.2021.100883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/02/2021] [Indexed: 11/20/2022]
Abstract
Bereavement due to loss of a partner is one of the most stressful life events, often leading to adverse physiological responses. Spousal loss has been associated with an increased morbidity and mortality, particularly from cardiovascular disease. Use of aspirin and/or beta adrenergic blockers have previously been suggested to play a role in cardiovascular risk associated with early bereavement. However, the available literature regarding this topic is limited. In this review article, we explore the potential beneficial role of aspirin and beta blockers in early bereavement. Our systematic review suggests that most studies have found aspirin and beta blockers to be beneficial in preventing adverse cardiovascular outcomes associated with early bereavement. Further randomized controlled long-term studies are warranted with adequate sample size to clearly establish the role of these medications on cardiovascular disease in late bereavement.
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17
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Tan Q, Ma J, Zhou M, Wang D, Wang B, Nie X, Mu G, Zhang X, Chen W. Heavy metals exposure, lipid peroxidation and heart rate variability alteration: Association and mediation analyses in urban adults. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2020; 205:111149. [PMID: 32829210 DOI: 10.1016/j.ecoenv.2020.111149] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/04/2020] [Accepted: 08/10/2020] [Indexed: 06/11/2023]
Abstract
Exposure to heavy metals was reported to be associated with heart rate variability (HRV) alteration. However, possible pathway of such association remains unclear. In this research, we investigated the possible role of lipid peroxidation in the associations between urinary heavy metals and HRV. We performed a cross-sectional study using baseline data of Wuhan-Zhuhai cohort. Urinary heavy metals (including lead, barium, antimony, cadmium, zinc, copper, iron and manganese), urinary 8-iso-prostaglandin-F2α levels (common biomarker for lipid peroxidation) and HRV indices (SDNN, r-MSSD, low frequency, high frequency and total power) were measured among 3022 participants. We conducted multivariable linear regression models to quantify associations between urinary 8-iso-prostaglandin-F2α (8-iso-PGF2α) and heavy metals or HRV indices. The potential role of 8-iso-PGF2α in the association of urinary heavy metals with HRV was evaluated through mediation analyses. After adjusting for potential confounders, urinary manganese, iron, copper, zinc, cadmium, antimony and barium were identified to be negatively associated with one or more HRV parameters. Each one-unit growth of log-transformed levels of urinary manganese, iron, copper, zinc, antimony and barium was associated with a 1.9%, 1.5%, 4.7%, 4.0%, 2.7% and 1.3% decrease in SDNN, respectively. We observed positive dose-response relationships between all eight urinary heavy metals and 8-iso-PGF2α, as well as negative association of urinary 8-iso-PGF2α with SDNN and total power (all P trend<0.05). The proportions mediated by 8-iso-PGF2α on SDNN were 4.6% for manganese, 9.3% for iron, 19.8% for antimony and 11.0% for barium. The proportions mediated by 8-iso-PGF2α on total power were 6.9% for manganese and 10.1% for cadmium (all P value < 0.05). This study suggested that urinary manganese, iron, copper, zinc, cadmium, antimony and barium were negatively associated with HRV indices. Lipid peroxidation may partly mediate the associations of urinary manganese, iron, cadmium, antimony and barium with specific HRV indices.
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Affiliation(s)
- Qiyou Tan
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, And State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Jixuan Ma
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, And State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Min Zhou
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, And State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Dongming Wang
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, And State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Bin Wang
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, And State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Xiuquan Nie
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, And State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Ge Mu
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, And State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Xiaomin Zhang
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, And State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Weihong Chen
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, And State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China.
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18
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Natarajan A, Pantelopoulos A, Emir-Farinas H, Natarajan P. Heart rate variability with photoplethysmography in 8 million individuals: a cross-sectional study. LANCET DIGITAL HEALTH 2020; 2:e650-e657. [PMID: 33328029 DOI: 10.1016/s2589-7500(20)30246-6] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/15/2020] [Accepted: 09/21/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Heart rate variability, or the variation in the time interval between consecutive heart beats, is a non-invasive dynamic metric of the autonomic nervous system and an independent risk factor for cardiovascular death. Consumer wrist-worn tracking devices using photoplethysmography, such as Fitbit, now provide the unique potential of continuously measuring surrogates of sympathetic and parasympathetic nervous system activity through the analysis of interbeat intervals. We aimed to leverage wrist-worn trackers to derive and describe diverse measures of cardiac autonomic function among Fitbit device users. METHODS In this cross-sectional study, we collected interbeat interval data that are sent to a central database from Fitbit devices during a randomly selected 24 h period. Age, sex, body-mass index, and steps per day in the 90 days preceding the measurement were extracted. Interbeat interval data were cleaned and heart rate variability features were computed. We analysed heart rate variability metrics across the time (measured via the root mean square of successive RR interval differences [RMSSD] and SD of the RR interval [SDRR]), frequency (measured by high-frequency and low-frequency power), and graphical (measured by Poincare plots) domains. We considered 5 min windows for the time and frequency domain metrics and 60 min measurements for graphical domain metrics. Data from participants were analysed to establish the correlation between heart rate variability metrics and age, sex, time of day, and physical activity. We also determined benchmarks for heart rate variability (HRV) metrics among the users. FINDINGS We included data from 8 203 261 Fitbit users, collected on Sept 1, 2018. HRV metrics decrease with age, and parasympathetic function declines faster than sympathetic function. We observe a strong diurnal variation in the heart rate variability. SDRR, low-frequency power, and Poincare S2 show a significant variation with sex, whereas such a difference is not seen with RMSSD, high-frequency power, and Poincare S1. For males, when measured from 0600 h to 0700 h, the mean low-frequency power decreased by a factor of 66·5% and high-frequency power decreased by a factor of 82·0% from the age of 20 years to 60 years. For females, the equivalent factors were 69·3% and 80·9%, respectively. Comparing low-frequency power between males and females at the ages of 40-41 years, measured from 0600 h to 0700 h, we found excess power in males, with a Cohen's d effect size of 0·33. For high-frequency power, the equivalent effect size was -0·04. Increased daily physical activity, across age and sex, was highly correlated with improvement in diverse measures of heart rate variability in a dose-dependent manner. We provide benchmark tables for RMSSD, SDRR, high and low frequency powers, and Poincare S1 and S2, separately for different ages and sex and computed at two times of the day. INTERPRETATION Diverse metrics of cardiac autonomic health can be derived from wrist-worn trackers. Empirical distributions of heart rate variability can potentially be used as a framework for individual-level interpretation. Increased physical activity might yield improvement in heart rate variability and requires prospective trials for confirmation. FUNDING Fitbit.
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Affiliation(s)
| | | | | | - Pradeep Natarajan
- Center for Genomic Medicine and Cardiovascular Research, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA, USA.
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19
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Tofler GH, Morel-Kopp MC, Spinaze M, Dent J, Ward C, McKinley S, Mihailidou AS, Havyatt J, Whitfield V, Bartrop R, Fethney J, Prigerson HG, Buckley T. The effect of metoprolol and aspirin on cardiovascular risk in bereavement: A randomized controlled trial. Am Heart J 2020; 220:264-272. [PMID: 31923768 DOI: 10.1016/j.ahj.2019.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 11/10/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Bereavement is associated with an increased risk of cardiovascular disease; however, no reports exist of interventions to reduce risk. In a randomized, double-blind, placebo-controlled trial of 85 recently bereaved participants, we determined whether β-blocker (metoprolol 25 mg) and aspirin (100 mg) reduce cardiovascular risk markers and anxiety, without adversely affecting bereavement intensity. METHODS Participants were spouses (n = 73) or parents (n = 12) of deceased from 5 hospitals in Sydney, Australia, 55 females, 30 males, aged 66.1 ± 9.4 years. After assessment within 2 weeks of bereavement, subjects were randomized to 6 weeks of daily treatment or placebo, and the effect evaluated using ANCOVA, adjusted for baseline values (primary analysis). RESULTS Participants on metoprolol and aspirin had lower levels of home systolic pressure (P = .03), 24-hour average heart rate (P < .001) and anxiety (P = .01) platelet response to arachidonic acid (P < .001) and depression symptoms (P = .046) than placebo with no difference in standard deviation of NN intervals index (SDNNi), von Willebrand Factor antigen, platelet-granulocyte aggregates or bereavement intensity. No significant adverse safety impact was observed. CONCLUSIONS In early bereavement, low dose metoprolol and aspirin for 6 weeks reduces physiological and psychological surrogate measures of cardiovascular risk. Although further research is needed, results suggest a potential preventive benefit of this approach during heightened cardiovascular risk associated with early bereavement.
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Affiliation(s)
- Geoffrey H Tofler
- Royal North Shore Hospital, St Leonards, NSW, Autralia; University of Sydney, Sydney, NSW, Autralia.
| | - Marie-Christine Morel-Kopp
- Royal North Shore Hospital, St Leonards, NSW, Autralia; University of Sydney, Sydney, NSW, Autralia; Kolling Institute, St Leonards, NSW, Autralia
| | - Monica Spinaze
- Royal North Shore Hospital, St Leonards, NSW, Autralia; University of Sydney, Sydney, NSW, Autralia
| | - Jill Dent
- Royal North Shore Hospital, St Leonards, NSW, Autralia; University of Sydney, Sydney, NSW, Autralia
| | - Christopher Ward
- Royal North Shore Hospital, St Leonards, NSW, Autralia; University of Sydney, Sydney, NSW, Autralia
| | | | - Anastasia S Mihailidou
- Royal North Shore Hospital, St Leonards, NSW, Autralia; Kolling Institute, St Leonards, NSW, Autralia; Macquarie University, Sydney, NSW, Autralia
| | - Jennifer Havyatt
- Royal North Shore Hospital, St Leonards, NSW, Autralia; University of Sydney, Sydney, NSW, Autralia
| | - Victoria Whitfield
- Royal North Shore Hospital, St Leonards, NSW, Autralia; University of Sydney, Sydney, NSW, Autralia
| | - Roger Bartrop
- Royal North Shore Hospital, St Leonards, NSW, Autralia; University of Sydney, Sydney, NSW, Autralia
| | | | | | - Thomas Buckley
- Royal North Shore Hospital, St Leonards, NSW, Autralia; University of Sydney, Sydney, NSW, Autralia; Weill Cornell Medicine, New York, NY, U.S.A
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Chan KS, Lai KPL, Chan PF, Luk MHM, Chao VKD. Evaluation of the applicability of deep breathing test in the diagnosis of hypertension with white-coat effect in Chinese patients in primary care. Clin Hypertens 2019; 25:2. [PMID: 30774977 PMCID: PMC6357457 DOI: 10.1186/s40885-018-0106-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/19/2018] [Indexed: 01/01/2023] Open
Abstract
Purpose The current gold standard for the diagnosis of white-coat effect is by the 24-h ambulatory blood pressure monitoring (ABPM) which may not be readily available in every primary care setting. Previous studies had shown that deep breathing, through modulating the baroreceptor reflex sensitivity to vagal stimulation over 30 to 60 s, was useful in detection of the white-coat effect. The aim of our study was to evaluate the diagnostic accuracy of the deep breathing test (DBT) as compared with the gold standard of ABPM in the diagnosis of hypertension with white-coat effect in Chinese patients in primary care. Methods This cross sectional study recruited 178 consecutive, eligible, consented, hypertensive patients receiving treatment at a local public primary care Hypertension Clinic. The diagnostic accuracy of the DBT in all recruited patients, patients not taking beta-adrenergic blockers and patients with different clinic SBP cut-off before the DBT by means of area under the receiver operating characteristic (ROC) curve, sensitivity, specificity, positive and negative predictive values was evaluated. Results The results for the ROC curves for systolic and diastolic BP changes after the DBT were statistically insignificant. The ROC curve was statistically significant for SBP change in patients not taking beta-adrenergic blockers and with pre-DBT clinic SBP ≥ 165 mmHg (ROC curve area of 0.719, 95% CI 0.53 to 0.91, p = 0.04). The corresponding sensitivity and specificity of the DBT were 40.9 and 90.9% respectively if SBP drop was > 30 mmHg. Conclusion The DBT, even though could not be clinically applied to all patients, was proven to be a potential screening and diagnostic test for white-coat effect in Chinese hypertensive patients with a pre-test SBP of ≥165 mmHg and who were not taking beta-adrenergic blockers. Trial registration This study was approved by Kowloon East Cluster/ Kowloon Central Cluster Research Ethics Committee/Institutional Review Board of Hospital Authority of Hong Kong under the registration KC/KE-16-0084/ER-3.
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Affiliation(s)
- Kam Sum Chan
- Department of Family Medicine and Primary Health Care, United Christian Hospital and Tseung Kwan O Hospital, Kowloon East Cluster, Hospital Authority, Tseung Kwan O, Hong Kong, China
| | - Kit Ping Loretta Lai
- Department of Family Medicine and Primary Health Care, United Christian Hospital and Tseung Kwan O Hospital, Kowloon East Cluster, Hospital Authority, Tseung Kwan O, Hong Kong, China
| | - Pang Fai Chan
- Department of Family Medicine and Primary Health Care, United Christian Hospital and Tseung Kwan O Hospital, Kowloon East Cluster, Hospital Authority, Tseung Kwan O, Hong Kong, China
| | - Man Hei Matthew Luk
- Department of Family Medicine and Primary Health Care, United Christian Hospital and Tseung Kwan O Hospital, Kowloon East Cluster, Hospital Authority, Tseung Kwan O, Hong Kong, China
| | - Vai Kiong David Chao
- Department of Family Medicine and Primary Health Care, United Christian Hospital and Tseung Kwan O Hospital, Kowloon East Cluster, Hospital Authority, Tseung Kwan O, Hong Kong, China
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Wilson D, Ermentrout B. Stochastic Pacing Inhibits Spatially Discordant Cardiac Alternans. Biophys J 2017; 113:2552-2572. [PMID: 29212008 DOI: 10.1016/j.bpj.2017.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 09/28/2017] [Accepted: 10/02/2017] [Indexed: 12/19/2022] Open
Abstract
Depressed heart rate variability is a well-established risk factor for sudden cardiac death in survivors of acute myocardial infarction and for those with congestive heart failure. Although measurements of heart rate variability provide a valuable prognostic tool, it is unclear whether reduced heart rate variability itself is proarrhythmic or if it simply correlates with the severity of autonomic nervous system dysfunction. In this work, we investigate a possible mechanism by which heart rate variability could protect against cardiac arrhythmia. Specifically, in numerical simulations, we observe an inverse relationship between the variance of stochastic pacing and the occurrence of spatially discordant alternans, an arrhythmia that is widely believed to facilitate the development of cardiac fibrillation. By analyzing the effects of conduction velocity restitution, cellular dynamics, electrotonic coupling, and stochastic pacing on the nodal dynamics of spatially discordant alternans, we provide intuition for this observed behavior and propose control strategies to inhibit discordant alternans.
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Affiliation(s)
- Dan Wilson
- Department of Mathematics, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Bard Ermentrout
- Department of Mathematics, University of Pittsburgh, Pittsburgh, Pennsylvania
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22
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Mirowsky JE, Carraway MS, Dhingra R, Tong H, Neas L, Diaz-Sanchez D, Cascio W, Case M, Crooks J, Hauser ER, Elaine Dowdy Z, Kraus WE, Devlin RB. Ozone exposure is associated with acute changes in inflammation, fibrinolysis, and endothelial cell function in coronary artery disease patients. Environ Health 2017; 16:126. [PMID: 29157250 PMCID: PMC5697214 DOI: 10.1186/s12940-017-0335-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 10/23/2017] [Indexed: 05/21/2023]
Abstract
BACKGROUND Air pollution is a major risk factor for cardiovascular disease, of which ozone is a major contributor. Several studies have found associations between ozone and cardiovascular morbidity, but the results have been inconclusive. We investigated associations between ozone and changes across biological pathways associated with cardiovascular disease. METHODS Using a panel study design, 13 participants with coronary artery disease were assessed for markers of systemic inflammation, heart rate variability and repolarization, lipids, blood pressure, and endothelial function. Daily measurements of ozone and particulate matter (PM2.5) were obtained from central monitoring stations. Single (ozone) and two-pollutant (ozone and PM2.5) models were used to assess percent changes in measurements per interquartile ranges of pollutants. RESULTS Per interquartile increase in ozone, changes in tissue plasminogen factor (6.6%, 95% confidence intervals (CI) = 0.4, 13.2), plasminogen activator inhibitor-1 (40.5%, 95% CI = 8.7, 81.6), neutrophils (8.7% 95% CI = 1.5, 16.4), monocytes (10.2%, 95% CI = 1.0, 20.1), interleukin-6 (15.9%, 95% CI = 3.6, 29.6), large-artery elasticity index (-19.5%, 95% CI = -34.0, -1.7), and the baseline diameter of the brachial artery (-2.5%, 95% CI = -5.0, 0.1) were observed. These associations were robust in the two-pollutant model. CONCLUSIONS We observed alterations across several pathways associated with cardiovascular disease in 13 coronary artery disease patients following ozone exposures, independent of PM2.5. The results support the biological plausibility of ozone-induced cardiovascular effects. The effects were found at concentrations below the EPA National Ambient Air Quality Standards for both ozone and PM2.5.
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Affiliation(s)
- Jaime E. Mirowsky
- Department of Chemistry, SUNY College of Environmental Science and Forestry, 1 Forestry Drive, Syracuse, NY 13210 USA
- Curriculum in Toxicology, University of North Carolina, Chapel Hill, NC USA
| | - Martha Sue Carraway
- Department of Medicine, Pulmonary and Critical Care Medicine, Durham VA Medical Center, Durham, NC USA
| | - Radhika Dhingra
- National Health and Environmental Effects Laboratory, US Environmental Protection Agency, Chapel Hill, NC USA
| | - Haiyan Tong
- National Health and Environmental Effects Laboratory, US Environmental Protection Agency, Chapel Hill, NC USA
| | - Lucas Neas
- National Health and Environmental Effects Laboratory, US Environmental Protection Agency, Chapel Hill, NC USA
| | - David Diaz-Sanchez
- National Health and Environmental Effects Laboratory, US Environmental Protection Agency, Chapel Hill, NC USA
| | - Wayne Cascio
- National Health and Environmental Effects Laboratory, US Environmental Protection Agency, Chapel Hill, NC USA
| | - Martin Case
- National Health and Environmental Effects Laboratory, US Environmental Protection Agency, Chapel Hill, NC USA
| | - James Crooks
- Department of Biomedical Research, National Jewish Health, Denver, CO USA
- Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, CO USA
- Department of Epidemiology, Colorado School of Public Health, Denver, CO USA
| | - Elizabeth R. Hauser
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC USA
- Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Medical Center, Durham, NC USA
| | - Z. Elaine Dowdy
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC USA
| | - William E. Kraus
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC USA
- Division of Cardiology, Department of Medicine, School of Medicine, Duke University, Durham, NC USA
| | - Robert B. Devlin
- National Health and Environmental Effects Laboratory, US Environmental Protection Agency, Chapel Hill, NC USA
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Medeiros WM, de Luca FA, de Figueredo Júnior AR, Mendes FAR, Gun C. Heart rate recovery improvement in patients following acute myocardial infarction: exercise training, β-blocker therapy or both. Clin Physiol Funct Imaging 2017; 38:351-359. [DOI: 10.1111/cpf.12420] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 01/30/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Wladimir M. Medeiros
- Laboratory of Exercise Physiology and Cardiac Rehabilitation (GERFE); Department of Medicine and Physiotherapy; Santo Amaro University (UNISA); São Paulo Brazil
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE); Respiratory Division; Department of Medicine; Federal University of São Paulo (UNIFESP); São Paulo Brazil
- Department of Rehabilitation and Functional Capacity; School of Physiotherapy; Ibirapuera University (UNIB); São Paulo Brazil
| | - Fabio A. de Luca
- Laboratory of Exercise Physiology and Cardiac Rehabilitation (GERFE); Department of Medicine and Physiotherapy; Santo Amaro University (UNISA); São Paulo Brazil
| | - Alcides R. de Figueredo Júnior
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE); Respiratory Division; Department of Medicine; Federal University of São Paulo (UNIFESP); São Paulo Brazil
| | - Felipe A. R. Mendes
- Department of Rehabilitation and Functional Capacity; School of Physiotherapy; Ibirapuera University (UNIB); São Paulo Brazil
| | - Carlos Gun
- Laboratory of Exercise Physiology and Cardiac Rehabilitation (GERFE); Department of Medicine and Physiotherapy; Santo Amaro University (UNISA); São Paulo Brazil
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Braga LM, Prado GF, Umeda IIK, Kawauchi TS, Taboada AMF, Azevedo RS, Pereira Filho HG, Grupi CJ, Souza HCC, Moreira DAR, Nakagawa NK. Reproducibility for Heart Rate Variability Analysis during 6-Min Walk Test in Patients with Heart Failure and Agreement between Devices. PLoS One 2016; 11:e0167407. [PMID: 27936043 PMCID: PMC5147870 DOI: 10.1371/journal.pone.0167407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 11/14/2016] [Indexed: 01/08/2023] Open
Abstract
Heart rate variability (HRV) analysis is a useful method to assess abnormal functioning in the autonomic nervous system and to predict cardiac events in patients with heart failure (HF). HRV measurements with heart rate monitors have been validated with an electrocardiograph in healthy subjects but not in patients with HF. We explored the reproducibility of HRV in two consecutive six-minute walk tests (6MW), 60-minute apart, using a heart rate monitor (PolarS810i) and a portable electrocardiograph (called Holter) in 50 HF patients (mean age 59 years, NYHA II, left ventricular ejection fraction ~35%). The reproducibility for each device was analysed using a paired t-test or the Wilcoxon signed-rank test. Additionally, we assessed the agreement between the two devices based on the HRV indices at rest, during the 6MW and during recovery using concordance correlation coefficients (CCC), 95% confidence intervals and Bland-Altman plots. The test-retest for the HRV analyses was reproducible using Holter and PolarS810i at rest but not during recovery. In the second 6MW, patients showed significant increases in rMSSD and walking distance. The PolarS810i measurements had remarkably high concordance correlation [0.86
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Affiliation(s)
- Lays Magalhães Braga
- Department of Physiotherapy, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Gustavo Faibischew Prado
- Pulmonary Division of Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Tatiana Satie Kawauchi
- Department of Physiotherapy, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Horacio Gomes Pereira Filho
- Cardiology Division of Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - César José Grupi
- Cardiology Division of Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Naomi Kondo Nakagawa
- Department of Physiotherapy, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Bailey JJ, Hodges M, Church TR. Decision to Implant a Cardioverter Defibrillator after Myocardial Infarction: The Role of Ejection Fraction v. Other Risk Factor Markers. Med Decis Making 2016; 27:151-60. [PMID: 17409365 DOI: 10.1177/0272989x06297392] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background . The Multicenter Automatic Defibrillator Implantation Trial showed that in post—myocardial infarction patients with a left ventricular ejection fraction (EF) ≤ 0.30, an implantable cardioverter defibrillator (ICD) resulted in a 31% relative reduction in the risk of death when compared with a conventional therapy group. Whether further refinement in risk estimation could be achieved with additional clinical testing to qualify patients for primary prevention with ICDs remains problematic. Methods . The authors analyzed Cardiac Arrhythmia Suppression Trial registry data to estimate sensitivity and specificity of EF, ventricular premature frequency, and nonsustained ventricular tachycardia for predicting death. They combined the results with similar data from the literature and used summarizing receiver operating characteristic (meta-ROC) curves to estimate overall operational values for sensitivity and specificity for each clinical test. They estimated aggregate values for prior probability to project risks when tests were used singly and in combination. Results . The authors used arrhythmia markers and heart rate variability to further stratify low-EF patients (prior risk = 20.3%); proportionately, 20.4% were predicted at high risk (> 30%) and 40.5% at low risk (< 10%). When heart rate variability is normal, those at high risk reduced proportionately to 9.2%, and those at low risk increased to 51.6%. Conclusions . The combined use of noninvasive markers for arrhythmia substrate and altered autonomic tone can improve risk stratification in low EF without optimal beta-block therapy, whereas for those with optimal beta-block therapy, markers for arrhythmia substrate alone work. Ancillary use of electrophysiologic stimulation can improve results.
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Affiliation(s)
- James J Bailey
- Center for Information Technology, National Institutes of Health, Bethesda, Maryland 20892-5620, USA.
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Quintana DS, Alvares GA, Heathers JAJ. Guidelines for Reporting Articles on Psychiatry and Heart rate variability (GRAPH): recommendations to advance research communication. Transl Psychiatry 2016; 6:e803. [PMID: 27163204 PMCID: PMC5070064 DOI: 10.1038/tp.2016.73] [Citation(s) in RCA: 222] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 03/18/2016] [Accepted: 03/23/2016] [Indexed: 12/11/2022] Open
Abstract
The number of publications investigating heart rate variability (HRV) in psychiatry and the behavioral sciences has increased markedly in the last decade. In addition to the significant debates surrounding ideal methods to collect and interpret measures of HRV, standardized reporting of methodology in this field is lacking. Commonly cited recommendations were designed well before recent calls to improve research communication and reproducibility across disciplines. In an effort to standardize reporting, we propose the Guidelines for Reporting Articles on Psychiatry and Heart rate variability (GRAPH), a checklist with four domains: participant selection, interbeat interval collection, data preparation and HRV calculation. This paper provides an overview of these four domains and why their standardized reporting is necessary to suitably evaluate HRV research in psychiatry and related disciplines. Adherence to these communication guidelines will help expedite the translation of HRV research into a potential psychiatric biomarker by improving interpretation, reproducibility and future meta-analyses.
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Affiliation(s)
- D S Quintana
- Division of Mental Health and Addiction, NORMENT, KG Jebsen Centre for Psychosis Research, University of Oslo, Oslo University Hospital, Oslo, Norway,Division of Mental Health and Addiction, NORMENT, KG Jebsen Centre for Psychosis Research, University of Oslo, Oslo University Hospital, Building 49, Oslo University Hospital, Ullevål, Kirkeveien 166, PO Box 4956, Nydalen, Oslo N-0424, Norway. E-mail:
| | - G A Alvares
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia,Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, QLD, Australia
| | - J A J Heathers
- School of Psychology, University of Sydney, Sydney, NSW, Australia,Department of Cardiology and Intensive Therapy, Poznań University of Medical Sciences, Poznań, Poland
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Naunheim M, Yung KC, Courey M. Timing of hemodynamic changes during transnasal endoscopic surgery. Laryngoscope 2015; 126:2047-50. [PMID: 26536668 DOI: 10.1002/lary.25758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 09/23/2015] [Accepted: 10/02/2015] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS Although considered less invasive and therefore less morbid than laryngoscopy under general anesthesia, prior research shows that transnasal flexible endoscopic (TNFE) procedures are associated with a significant increase in heart rate and blood pressure. The purpose of this review was to identify the most stimulating portion of the procedure to potentially provide a target for directed pharmacotherapy to ensure hemodynamic stability. STUDY DESIGN Retrospective chart review. METHODS Retrospective chart review of adult patients who underwent upper airway intervention in the larynx and trachea by TNFE. Vital signs recorded at 5-minute intervals throughout the procedure were examined and analyzed by Wilcoxon signed rank test and Wilcoxon rank sum test. RESULTS For heart rate and systolic and diastolic blood pressure, the median change in value was 13 beats per minute (P < 0.0001), 27 mm of mercury (P < 0.0001), and 26.5 mm of mercury (P < 0.0001), respectively. The most significant change in heart rate and saturation was during the application of nasal and laryngeal anesthetic, as well as during the positioning of the scope. Blood pressures were elevated during the procedure itself. With respect to comorbidities, underlying asthma and coronary artery disease were associated with a greater percent change in the heart rate (P = 0.05 for both). CONCLUSION There are significant vital sign changes during transnasal endoscopic procedures. Changes in heart rate and oxygen saturation tended to occur during preparation, whereas blood pressure was elevated during the laryngeal intervention. For patients with asthma, the percent change was greater, and perhaps a more controlled environment is warranted. LEVEL OF EVIDENCE 4. Laryngoscope, 126:2047-2050, 2016.
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Affiliation(s)
- Molly Naunheim
- Department of Otolaryngology-Head and Neck Surgery, Division of Laryngology, University of California-San Francisco Medical Center, San Francisco, California, U.S.A
| | - Katherine C Yung
- Department of Otolaryngology-Head and Neck Surgery, Division of Laryngology, University of California-San Francisco Medical Center, San Francisco, California, U.S.A
| | - Mark Courey
- Department of Otolaryngology-Head and Neck Surgery, Division of Laryngology, University of California-San Francisco Medical Center, San Francisco, California, U.S.A
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Feng W, He X, Chen M, Deng S, Qiu G, Li X, Liu C, Li J, Deng Q, Huang S, Wang T, Dai X, Yang B, Yuan J, He M, Zhang X, Chen W, Kan H, Wu T. Urinary metals and heart rate variability: a cross-sectional study of urban adults in Wuhan, China. ENVIRONMENTAL HEALTH PERSPECTIVES 2015; 123:217-22. [PMID: 25356836 PMCID: PMC4348740 DOI: 10.1289/ehp.1307563] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 10/28/2014] [Indexed: 05/03/2023]
Abstract
BACKGROUND Epidemiological studies have suggested an association between external estimates of exposure to metals in air particles and altered heart rate variability (HRV). However, studies on the association between internal assessments of metals exposure and HRV are limited. OBJECTIVES The purpose of this study was to examine the potential association between urinary metals and HRV among residents of an urban community in Wuhan, China. METHODS We performed a cross-sectional analysis of 23 urinary metals and 5-min HRV indices (SDNN, standard deviation of normal-to-normal intervals; r-MSSD, root mean square of successive differences in adjacent normal-to-normal intervals; LF, low frequency; HF, high frequency; TP, total power) using baseline data on 2,004 adult residents of Wuhan. RESULTS After adjusting for other metals, creatinine, and other covariates, natural log-transformed urine titanium concentration was positively associated with all HRV indices (all p < 0.05). Moreover, we estimated negative associations between cadmium and r-MSSD, LF, HF, and TP; between lead and r-MSSD, HF, and TP; and between iron, copper, and arsenic and HF, SDNN, and LF, respectively, based on models adjusted for other metals, creatinine, and covariates (all p < 0.10). Several associations differed according to cardiovascular disease risk factors. For example, negative associations between cadmium and r-MSSD were stronger among participants ≤ 52 years of age (vs. > 52), current smokers (vs. nonsmokers), body mass index < 25 kg/m2 (vs. ≥ 25), and among those who were not hypertensive. CONCLUSIONS Urine concentrations of several metals were associated with HRV parameters in our cross-sectional study population. These findings need replication in other studies with adequate sample sizes.
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Affiliation(s)
- Wei Feng
- Department of Occupational and Environmental Health, and Ministry of Education Key Lab for Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Grung B, Hansen AL, Berg M, Møen-Knudseth MP, Olson G, Thornton D, Dahl L, Thayer JF. Exploratory multivariate analysis of the effect of fatty fish consumption and medicinal use on heart rate and heart rate variability data. Front Psychol 2015; 6:135. [PMID: 25741303 PMCID: PMC4330718 DOI: 10.3389/fpsyg.2015.00135] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 01/26/2015] [Indexed: 01/27/2023] Open
Abstract
The overall aim of the present study was to explore the relationship between medicinal use and fatty fish consumption on heart rate variability (HRV) and heart rate (HR) in a group of forensic inpatients on a variety of medications. A total of 49 forensic inpatients, randomly assigned to a fish group (n = 27) or a control group (n = 22) were included in the present study. Before and by the end of the food intervention period HR and HRV were measured during an experimental test procedure. An additional aim of this paper is to show how multivariate data analysis can highlight differences and similarities between the groups, thus being a valuable addition to traditional statistical hypothesis testing. The results indicate that fish consumption may have a positive effect on both HR and HRV regardless of medication, but that the influence of medication is strong enough to mask the true effect of fish consumption. Without correcting for medication, the fish group and control group become indistinguishable (p = 0.0794, Cohen’s d = 0.60). The effect of medication is demonstrated by establishing a multivariate regression model that estimates HR and HRV in a recovery phase based on HR and HRV data recorded during psychological tests. The model performance is excellent for HR data, but yields poor results for HRV when employed on participants undergoing the more severe medical treatments. This indicates that the HRV behavior of this group is very different from that of the participants on no or lower level of medication. When focusing on the participants on a constant medication regime, a substantial improvement in HRV and HR for the fish group compared to the control group is indicated by a principal component analysis and t-tests (p = 0.00029, Cohen’s d = 2.72). In a group of psychiatric inpatients characterized by severe mental health problems consuming different kinds of medication, the fish diet improved HR and HRV, indices of both emotional regulation and physical health.
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Affiliation(s)
- Bjørn Grung
- Department of Chemistry, University of Bergen Bergen, Norway
| | - Anita L Hansen
- Department of Psychosocial Science, University of Bergen Bergen, Norway ; Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital Bergen, Norway
| | - Mari Berg
- Department of Chemistry, University of Bergen Bergen, Norway
| | | | - Gina Olson
- Sand Ridge Secure Treatment Centre Mauston, WI USA
| | | | - Lisbeth Dahl
- National Institute of Nutrition and Seafood Research Bergen, Norway
| | - Julian F Thayer
- Department of Psychology, The Ohio State University Columbus, OH, USA
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Seeck A, Rademacher W, Fischer C, Haueisen J, Surber R, Voss A. Prediction of atrial fibrillation recurrence after cardioversion—Interaction analysis of cardiac autonomic regulation. Med Eng Phys 2013; 35:376-82. [DOI: 10.1016/j.medengphy.2012.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 05/21/2012] [Accepted: 06/03/2012] [Indexed: 11/27/2022]
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Currie KD, Rosen LM, Millar PJ, McKelvie RS, MacDonald MJ. Heart rate recovery and heart rate variability are unchanged in patients with coronary artery disease following 12 weeks of high-intensity interval and moderate-intensity endurance exercise training. Appl Physiol Nutr Metab 2013; 38:644-50. [PMID: 23724882 DOI: 10.1139/apnm-2012-0354] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Decreased heart rate variability and attenuated heart rate recovery following exercise are associated with an increased risk of mortality in cardiac patients. This study investigated the effects of 12 weeks of moderate-intensity endurance exercise (END) and a novel low-volume high-intensity interval exercise protocol (HIT) on measures of heart rate recovery and heart rate variability in patients with coronary artery disease (CAD). Fourteen males with CAD participated in 12 weeks of END or HIT training, each consisting of 2 supervised exercise sessions per week. END consisted of 30-50 min of continuous cycling at 60% peak power output (PPO). HIT involved ten 1-min intervals at 88% PPO separated by 1-min intervals at 10% PPO. Heart rate recovery at 1 min and 2 min was measured before and after training (pre- and post-training, respectively) using a submaximal exercise bout. Resting time and spectral and nonlinear domain measures of heart rate variability were calculated. Following 12 weeks of END and HIT, there was no change in heart rate recovery at 1 min (END, 40 ± 12 beats·min(-1) vs. 37 ± 19 beats·min(-1); HIT, 31 ± 8 beats·min(-1) vs. 35 ± 8 beats·min(-1); p ≥ 0.05 for pre- vs. post-training) or 2 min (END, 44 ± 18 beats·min(-1) vs. 43 ± 19 beats·min(-1); HIT, 42 ± 10 beats·min(-1) vs. 50 ± 6 beats·min(-1); p ≥ 0.05 for pre- vs. post-training). All heart rate variability indices were unchanged following END and HIT training. In conclusion, neither END nor HIT exercise programs elicited training-induced improvements in cardiac autonomic function in patients with CAD. The absence of improvements with training may be attributed to the optimal medical management and normative pretraining state of our sample.
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Affiliation(s)
- Katharine D Currie
- Department of Kinesiology, McMaster University, Ivor Wynne Centre, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
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Katarzynska-Szymanska A, Ochotny R, Oko-Sarnowska Z, Wachowiak-Baszynska H, Krauze T, Piskorski J, Gwizdala A, Mitkowski P, Guzik P. Shortening baroreflex delay in hypertrophic cardiomyopathy patients -- an unknown effect of β-blockers. Br J Clin Pharmacol 2012; 75:1516-24. [PMID: 23126403 DOI: 10.1111/bcp.12027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 10/31/2012] [Indexed: 12/15/2022] Open
Abstract
AIMS Hypertrophic cardiomyopathy (HCM) is characterized by left ventricular hypertrophy and impaired diastolic and systolic function. Abnormal sympathetic-parasympathetic balance is a potential stimulus for left ventricular hypertrophy in HCM patients. β-Blockers are routinely used in HCM for their strong negative inotropic effect; however, these drugs also influence the sympathetic-parasympathetic balance. This study aimed to determine the autonomic control of the cardiovascular system and the autonomic effects of β-blockers in HCM patients treated or untreated with β-blockers. METHODS Among 51 HCM outpatients (18-70 years old; 29 men) there were 19 individuals with no medication and 32 subjects treated with a β-blocker. Fourteen age- and gender-matched (23-70 years old; nine men) healthy volunteers were enrolled in the control group. Continuous, non-invasive finger blood pressure was recorded during supine rest for 30 min. Autonomic regulation of the cardiovascular system was measured by heart rate variability and spontaneous baroreflex function (cross-correlation sequence method). RESULTS The mean pulse interval, time domain and spectral measures of heart rate variability and baroreflex sensitivity were comparable between HCM patients, treated or not with β-blockers, and the control group. However, the delay of the baroreflex was significantly longer in HCM patients who were not treated with β-blockers [2.0 (1.6-2.3) s] in comparison with HCM patients receiving β-blockers [1.4 (1.1-1.8) s; P = 0.0072] or control subjects [1.2 (0.8-1.8) s; P = 0.0025]. This delay did not differ between HCM patients treated with β-blockers and the control group. CONCLUSIONS Hypertrophic cardiomyopathy not treated with β-blockers is accompanied by prolonged baroreflex delay. The use of β-blockers normalizes this delay.
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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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Battes LC, Pedersen SS, Oemrawsingh RM, van Geuns RJ, Al Amri I, Regar E, de Jaegere PPT, Serruys P, van Domburg RT. Beta blocker therapy is associated with reduced depressive symptoms 12 months post percutaneous coronary intervention. J Affect Disord 2012; 136:751-7. [PMID: 22032873 DOI: 10.1016/j.jad.2011.09.047] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 09/30/2011] [Accepted: 09/30/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Beta blocker therapy may induce depressive symptoms, although current evidence is conflicting. We examined the association between beta blocker therapy and depressive symptoms in percutaneous coronary intervention (PCI) patients and the extent to which there is a dose-response relationship between beta blocker dose and depressive symptoms. METHODS Patients treated with PCI (N=685) completed the depression scale of the Hospital Anxiety and Depression Scale 1 and 12 months post PCI. Information about type and dose of beta blocker use was extracted from medical records. RESULTS Of all patients, 68% (466/685) were on beta blocker therapy at baseline. In adjusted analysis, beta blocker use at 1 month post PCI (OR: 0.82; 95% CI: 0.53-1.26) was not significantly associated with depressive symptoms. At 12 months post PCI, there was a significant relationship between beta blocker use and depressive symptoms (OR: 0.51; 95% CI: 0.31-0.84), with beta blocker therapy associated with a 49% risk reduction in depressive symptoms. There was a dose-response relationship between beta blocker dose and depressive symptoms 12 months post PCI, with the risk reduction in depressive symptoms in relation to a low dose being 36% (OR: 0.64; 95% CI: 0.37-1.10) and 58% (OR: 0.42; 95% CI: 0.24-0.76) in relation to a high dose. CONCLUSIONS Patients treated with beta blocker therapy were less likely to experience depressive symptoms 12 months post PCI, with there being a dose-response relationship with a higher dose providing a more pronounced protective effect.
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Affiliation(s)
- Linda C Battes
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
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Li X, Shaffer ML, Rodríguez-Colón SM, He F, Bixler EO, Vgontzas AN, Wolbrette DL, Wu C, Ball RW, Liao D. Systemic inflammation and circadian rhythm of cardiac autonomic modulation. Auton Neurosci 2011; 162:72-6. [PMID: 21444250 DOI: 10.1016/j.autneu.2011.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 02/23/2011] [Accepted: 03/01/2011] [Indexed: 12/19/2022]
Abstract
Systemic inflammation (SI) is associated with impairment of cardiac autonomic modulation (CAM), which is associated with cardiac disease. However, there is limited data about SI on CAM circadian pattern, which this study aimed to investigate in a middle-aged sample. C-reactive protein (CRP) was used as a SI marker. We performed HRV analysis on each 5-min segment RRs from a 24-h 12-lead ECG to obtain time and frequency domain HRV indices as measures of CAM. The circadian pattern of CAM was analyzed by a two-stage modeling. Stage one, for each individual we fit a cosine periodic model based on the 288 segments of 5-min HRV data to produce three individual-level cosine parameters that quantity the circadian pattern: mean (M), amplitude (Â), and acrophase time (θ), measure the overall average, the amplitude of the oscillation, and the timing of the highest oscillation, respectively. Stage two, we used random-effects-meta-analysis to summarize the effects of CRP on the three circadian parameters obtained in stage one. CRP was adversely associated with lower M of log-HF, log-LF, SDNN, and RMSSD [β (SE): -0.22 (0.07) ms(2), -0.20 (0.06) ms(2), -3.62 (0.99) ms, and -2.32 (0.73) ms, respectively, with all p-values <0.01]. More importantly, CRP was also adversely associated with lower  of SDNN and RMSSD [β (SE): -0.84 (0.44) ms and -0.86 (0.38) ms, respectively, both p-values <0.05]. SI is adversely associated with circadian pattern of CAM, suggesting that the cardiac risk associated with SI may be partially mediated via inflammation-related changes in CAM.
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Affiliation(s)
- Xian Li
- Department of Public Health Sciences, Penn State University College of Medicine, 600 Centerview Drive, Hershey, PA 17033, USA
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de Montmollin E, Annane D. Nouvelles pistes dans le traitement du sepsis — Modulation β-adrénergique au cours du sepsis. MEDECINE INTENSIVE REANIMATION 2011. [DOI: 10.1007/s13546-010-0133-y] [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]
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de Montmollin E, Aboab J, Mansart A, Annane D. Bench-to-bedside review: Beta-adrenergic modulation in sepsis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2009; 13:230. [PMID: 19863760 PMCID: PMC2784350 DOI: 10.1186/cc8026] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Sepsis, despite recent therapeutic progress, still carries unacceptably high mortality rates. The adrenergic system, a key modulator of organ function and cardiovascular homeostasis, could be an interesting new therapeutic target for septic shock. β-Adrenergic regulation of the immune function in sepsis is complex and is time dependent. However, β2 activation as well as β1 blockade seems to downregulate proinflammatory response by modulating the cytokine production profile. β1 blockade improves cardiovascular homeostasis in septic animals, by lowering myocardial oxygen consumption without altering organ perfusion, and perhaps by restoring normal cardiovascular variability. β-Blockers could also be of interest in the systemic catabolic response to sepsis, as they oppose epinephrine which is known to promote hyperglycemia, lipid and protein catabolism. The role of β-blockers in coagulation is less clear cut. They could have a favorable role in the septic pro-coagulant state, as β1 blockade may reduce platelet aggregation and normalize the depressed fibrinolytic status induced by adre-nergic stimulation. Therefore, β1 blockade as well as β2 activation improves sepsis-induced immune, cardiovascular and coagulation dysfunctions. β2 blocking, however, seems beneficial in the metabolic field. Enough evidence has been accumulated in the literature to propose β- adrenergic modulation, β1 blockade and β2 activation in particular, as new promising therapeutic targets for septic dyshomeostasis, modulating favorably immune, cardiovascular, metabolic and coagulation systems.
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Affiliation(s)
- Etienne de Montmollin
- Service de Réanimation Polyvalente de l'Hôpital Raymond Poincaré, 92380 Garches, France.
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Association between symptoms of depression and anxiety with heart rate variability in patients with implantable cardioverter defibrillators. Psychosom Med 2009; 71:821-7. [PMID: 19661191 PMCID: PMC2794038 DOI: 10.1097/psy.0b013e3181b39aa1] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This study investigated whether depression and anxiety symptoms are associated with measures of autonomic nervous system dysfunction in patients with implantable cardioverter defibrillators who are at high risk of cardiac rhythm disturbances. Depression and anxiety are associated with autonomic nervous system dysfunction, which may promote the risk of malignant cardiac arrhythmias. METHODS Patients with an implantable cardioverter defibrillator (ICD) underwent ambulatory electrocardiographic (ECG) monitoring (n = 44, mean age = 62.1 +/- 9.3 years). Depression was assessed using the Beck Depression Inventory and anxiety was evaluated using the Taylor Manifest Anxiety Scale. Heart rate variability was assessed using time (RMSSD, pNN50, and SDNN) and frequency domain measures derived from 24-hour R-R intervals. Multivariate models were adjusted for age, sex, hypertension, diabetes, and smoking status. RESULTS Defibrillator patients with elevated depression symptoms (n = 12) had significantly lower RMSSD (15.25 +/- 1.66 ms versus 24.97 +/- 2.44 ms, p = .002) and pNN50 (1.83 +/- 0.77 versus 5.61 +/- 1.04, p = .006) than defibrillator patients with low depression symptoms (n = 32). These associations remained significant after multivariate adjustment for covariates. ICD patients with high anxiety levels (n = 10) displayed lower RMSSD (p = .013), which became marginally significant when adjusting for covariates (p = .069). CONCLUSIONS Depression and anxiety in defibrillator patients are associated with autonomic nervous system dysfunction indices of reduced parasympathetic control. Autonomic nervous system dysfunction may partially explain the association between depression and anxiety with life-threatening cardiac outcomes in vulnerable patients.
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Abstract
Heart rate variability (HRV) has recently become a popular noninvasive research tool in cardiology. Clinical assessment of HRV is frequently based on standard long-term ambulatory electrocardiograms, whereas physiologic studies employ spectral analysis of short-term recordings under controlled conditions. From a general point of view, HRV can be used in clinical practice to estimate (1) the integrity of cardiac autonomic innervation, (2) the physiologic status of cardiac autonomic activity, and (3) the vulnerability to various cardiac arrhythmias resulting from autonomic imbalance. Clinical relevance of HRV has been clearly demonstrated in only two clinical conditions: (1) impaired HRV can be used alone or in a combination with other factors to predict risk of arrhythmic events after acute myocardial infarction, and (2) decrease in HRV is a useful clinical marker for evolving diabetic neuropathy. Substantial advances of our knowledge are required to establish and promote clinical applications in other areas of clinical medicine. To accomplish this task, proper hypotheses should be studied and appropriate techniques selected.
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Affiliation(s)
- J Kautzner
- Department of Cardiological Sciences, St George's Hospital Medical School, London, UK
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Tiainen M, Parikka HJ, Mäkijärvi MA, Takkunen OS, Sarna SJ, Roine RO. Arrhythmias and heart rate variability during and after therapeutic hypothermia for cardiac arrest*. Crit Care Med 2009; 37:403-9. [DOI: 10.1097/ccm.0b013e31819572c4] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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de Hartog JJ, Lanki T, Timonen KL, Hoek G, Janssen NAH, Ibald-Mulli A, Peters A, Heinrich J, Tarkiainen TH, van Grieken R, van Wijnen JH, Brunekreef B, Pekkanen J. Associations between PM2.5 and heart rate variability are modified by particle composition and beta-blocker use in patients with coronary heart disease. ENVIRONMENTAL HEALTH PERSPECTIVES 2009; 117:105-11. [PMID: 19165395 PMCID: PMC2627852 DOI: 10.1289/ehp.11062] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Accepted: 08/25/2008] [Indexed: 05/03/2023]
Abstract
BACKGROUND It has been hypothesized that ambient particulate air pollution is able to modify the autonomic nervous control of the heart, measured as heart rate variability (HRV). Previously we reported heterogeneous associations between particulate matter with aerodynamic diameter < 2.5 microm (PM2.5) and HRV across three study centers. OBJECTIVES We evaluated whether exposure misclassification, effect modification by medication, or differences in particle composition could explain the inconsistencies. METHODS Subjects with coronary heart disease visited clinics biweekly in Amsterdam, the Netherlands; Erfurt, Germany; and Helsinki, Finland for 6-8 months. The standard deviation (SD) of NN intervals on an electrocardiogram (ECG; SDNN) and high frequency (HF) power of HRV was measured with ambulatory ECG during paced breathing. Outdoor levels of PM2.5 were measured at a central site. In Amsterdam and Helsinki, indoor and personal PM2.5 were measured during the 24 hr preceding the clinic visit. PM2.5 was apportioned between sources using principal component analyses. We analyzed associations of indoor/personal PM2.5, elements of PM2.5, and source-specific PM2.5 with HRV using linear regression. RESULTS Indoor and personal PM2.5 were not associated with HRV. Increased outdoor PM2.5 was associated with decreased SDNN and HF at lags of 2 and 3 days only among persons not using beta-blocker medication. Traffic-related PM2.5 was associated with decreased SDNN, and long-range transported PM2.5 with decreased SDNN and HF, most strongly among persons not using beta blockers. Indicators for PM2.5 from traffic and long-range transport were also associated with decreased HRV. CONCLUSIONS Our results suggest that differences in the composition of particles, beta-blocker use, and obesity of study subjects may explain some inconsistencies among previous studies on HRV.
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Affiliation(s)
- Jeroen J de Hartog
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
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Effects of drug, biobehavioral and exercise therapies on heart rate variability in coronary artery disease: a systematic review. ACTA ACUST UNITED AC 2008; 15:386-96. [DOI: 10.1097/hjr.0b013e3283030a97] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nuttall SL, Langford NJ, Kendall MJ. Beta-blockers in heart failure. 2. Mode of action. J Clin Pharm Ther 2008. [DOI: 10.1111/j.1365-2710.2001.00316.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Michaels AD, Bart BA, Pinto T, Lafferty J, Fung G, Kennard ED. The effects of enhanced external counterpulsation on time- and frequency-domain measures of heart rate variability. J Electrocardiol 2007; 40:515-21. [PMID: 17532337 DOI: 10.1016/j.jelectrocard.2007.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Accepted: 04/24/2007] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE We hypothesized that symptom improvement from enhanced external counterpulsation (EECP) is related to improved heart rate variability (HRV). METHODS This prospective, multicenter study enrolled 27 patients with angina who underwent 48-hour ambulatory electrocardiogram monitoring at baseline, immediately after 35 hours of EECP, and at 1 month. Primary end points included change in time-domain (SD of normal-to-normal intervals) and frequency-domain HRV. RESULTS Twenty-four patients completed the full course of EECP therapy and 3 ambulatory electrocardiograms. There were no significant changes in time-domain HRV measures after EECP. Patients younger than 65 years and those with heart failure had improved SD of normal-to-normal interval after EECP (P = .02). Although frequency-domain HRV measures did not change in the overall cohort, patients with diabetes had improved daytime low-frequency power (P = .016). CONCLUSIONS There was no significant change in the time- or frequency-domain HRV measures after EECP. In diabetic individuals, there was an increase in low-frequency HRV, which has been associated with reduced mortality.
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Affiliation(s)
- Andrew D Michaels
- Division of Cardiology, University of Utah, Salt Lake City, UT, USA.
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Hamaad A, Lip GYH, Nicholls D, MacFadyen RJ. Comparative Dose Titration Responses to the Introduction of Bisoprolol or Carvedilol in Stable Chronic Systolic Heart Failure. Cardiovasc Drugs Ther 2007; 21:437-44. [PMID: 17896170 DOI: 10.1007/s10557-007-6055-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Several beta blocking drugs (BB) reduce mortality in systolic heart failure (LVSD). We have compared the initial response to introduction of carvedilol and bisoprolol during the standard dose titration protocols for each drug. METHODS Approximately 31 unselected patients with stable LVSD were randomised to either carvedilol or bisoprolol measuring blood pressure, heart rate responses and both time and frequency domain heart rate variability (HRV). RESULTS One subject died; five withdrew due to intolerable BB related side effects. Carvedilol (n = 13) and bisoprolol (n = 12) attained similar maximal heart rate reduction and induced comparable falls in systolic and diastolic blood pressure. Higher carvedilol doses were associated with lower blood pressure compared to baseline. Individual time domain HRV indices remained unchanged over the initial titration period. Significant increases in triangular Index (TI) were seen with both BB. Carvedilol demonstrated greater (but non-significant) rises in TI compared to Bisoprolol. CONCLUSIONS In this study we found similar degrees and rate of onset of HR, HRV and BP response to both carvedilol and bisoprolol in treated LVSD patients. Carvedilol appears to show superior HRV rises compared to bisoprolol during initial titration. Any significant increases in HRV attributable to carvedilol compared to bisoprolol may emerge over a longer treatment interval in LVSD.
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Affiliation(s)
- Ali Hamaad
- University Department of Medicine, City Hospital, Dudley Road, Birmingham, B18 7QH, UK
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Ridha M, Mäkikallio TH, Lopera G, Pastor J, de Marchena E, Chakko S, Huikuri HV, Castellanos A, Myerburg RJ. Effects of carvedilol on heart rate dynamics in patients with congestive heart failure. Ann Noninvasive Electrocardiol 2006; 7:133-8. [PMID: 12049685 PMCID: PMC7027650 DOI: 10.1111/j.1542-474x.2002.tb00154.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Patients with congestive heart failure (CHF) have alterations in the traditional and nonlinear indices of heart rate (HR) dynamics, which have been associated with an increased risk of mortality. This study was designed to test the effects of carvedilol, a nonselective beta-blocker with alpha-1 blocking properties, on HR dynamics in patients with CHF. METHODS We studied 15 patients with CHF secondary to ischemic or idiopathic cardiomyopathy who met the following inclusion criteria: NYHA functional class II-III, optimal conventional medical therapy, normal sinus rhythm, left ventricular ejection fraction (LVEF) of < 40%, and resting systolic blood pressure greater than 100 mmHg. The 6-minute corridor walk test, estimation of LVEF, and 24-hour Holter recording were performed at baseline and after 12 weeks of therapy with carvedilol. Traditional time and frequency domain measures and short-term fractal scaling exponent of HR dynamics were analyzed. RESULTS After 12 weeks of therapy with carvedilol, the mean LVEF improved significantly (from 0.27 +/- 0.08 to 0.38 +/- 0.08, P < 0.001). The average HR decreased significantly (from 86 +/- 11 to 70 +/- 8 beats/min, P < 0.001). The mean distance traveled in the 6-minute walk test increased significantly (from 177 +/- 44 to 273 +/- 55 m, P < 0.01). The frequency-domain indices (HF and LF), the time domain indices (rMSSD and PNN5 ), and the short-term fractal scaling exponent increased significantly. The scaling exponent increased particularly among the patients with the lowest initial values (< 1.0), and the change in the fractal scaling exponent correlated with the change in ejection fraction (r = 0.63, P < 0.01). CONCLUSION Carvedilol improves time and frequency domain indices of HR variability and corrects the altered scaling properties of HR dynamics in patients with CHF. It also improves LVEF and functional capacity. These specific changes in HR behavior caused by carvedilol treatment may reflect the normalization of impaired cardiovascular neural regulation of patients with CHF.
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Affiliation(s)
- Mustafa Ridha
- Cardiology (111-A), V.A. Medical Center, 1201 NW 16th Street, Miami, FL 33125, USA
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Aronson D, Burger AJ. Effect of beta-blockade on autonomic modulation of heart rate and neurohormonal profile in decompensated heart failure. Ann Noninvasive Electrocardiol 2006; 6:98-106. [PMID: 11333166 PMCID: PMC7027697 DOI: 10.1111/j.1542-474x.2001.tb00093.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND One of the putative mechanisms for the salutary effects of beta-blockers in patients with congestive heart failure (CHF) is their ability to improve autonomic dysfunction. However, patients with profound neurohumoral abnormalities derive little survival benefit from beta-blockers. The purpose of the current study was to evaluate the effect of beta-blockers on heart rate variability (HRV) in decompensated CHF. METHODS Time and frequency domain HRV indices were obtained from 24-hour Holter recordings and compared to assess the role of beta-blockade in 199 patients (mean age 60 +/- 14 years) with decompensated CHF. Neurohormonal differences were assessed by measuring norepinephrine, endothelin-1, tumor necrosis factor-alpha, and interleukin-6 in a subset of 64 patients. RESULTS All HRV indices were markedly suppressed but were substantially higher in patients who were on beta-blockers. Time domain measures of parasympathetic cardiac activity, the percentage of R-R intervals with > 50 ms variation (4.9 +/- 0.6 vs 7.7 +/- 1.2%, P = 0.006) and the square root of mean squared differences of successive R-R intervals (22.7 +/- 2.0 vs 31.6 +/- 4.1 ms, P = 0.004), were higher in the beta-blocker group. Spectral analysis revealed that the total power and the ultra-low frequency power were significantly higher in patients on beta-blockers (82% and 59%, respectively). The high frequency power, a spectral index of parasympathetic modulation, was 41% higher in the beta-blocker group (121 +/- 25 vs 171 +/- 27 ms(2), P = 0.02). Norepinephrine and interleukin-6 levels were substantially lower in patients on beta-blockers (28% and 61%, respectively). However, these differences did not reach statistical significance. CONCLUSIONS Beta-blockers improve the impaired cardiac autonomic regulation during high sympathetic stress of decompensated CHF. This effect may play an important role in protecting the myocardium and preventing arrhythmias during transient increases in sympathetic activity.
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Affiliation(s)
- D Aronson
- Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
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Furukawa Y, Shimizu H, Hiromoto K, Kanemori T, Masuyama T, Ohyanagi M. Circadian variation of beat-to-beat QT interval variability in patients with prior myocardial infarction and the effect of beta-blocker therapy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2006; 29:479-86. [PMID: 16689842 DOI: 10.1111/j.1540-8159.2006.00379.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recent studies have demonstrated that increased QT interval variability (QTV) is associated with a greater susceptibility to ventricular arrhythmias and that patients with prior myocardial infarction (MI) were prone to ventricular arrhythmias during the daytime. The goal of the present study was to investigate the circadian variation of the QTV and to determine whether beta-blocker therapy improves the temporal fluctuation of the ventricular repolarization in patients with MI. METHODS The study population consisted of 15 MI patients who had not received beta-blocker therapy, 11 MI patients who had received beta-blocker therapy, and 12 healthy subjects. Twenty-four hour Holter monitoring was obtained, and the RR and QT intervals were calculated automatically from 512 consecutive sinus beats for every 2 hours. RESULTS In the daytime, the QT-SD was significantly greater in the MI group than in the healthy subjects (P<0.01), but there was no difference in the QT-SD when comparing the beta-blocker group to the control group. Moreover, the QT variability index and the QT variance normalized for the mean QT were similar pattern with QT-SD. The heart rate variability did not significantly differ when compared between the three study groups. CONCLUSION These data indicate that the QTV increases during the daytime in patients with MI and that this circadian effect is prevented by beta-blocker therapy. Thus, beta-blocker therapy may reverse the maladaptation of the ventricular repolarization to the change in the heart rate and may thereby reduce the ventricular arrhythmias and decrease the mortality in patients with MI.
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Affiliation(s)
- Yoshio Furukawa
- Department of Internal Medicine, Division of Coronary Heart Disease, Hyogo College of Medicine, Nishinomiya, Japan
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Yamanaka H, Suzuki T, Kishida H, Nagasawa K, Takano T. Relationship between the mismatch of 123I-BMIPP and 201Tl myocardial single-photon emission computed tomography and autonomic nervous system activity in patients with acute myocardial infarction. Int Heart J 2006; 47:193-207. [PMID: 16607047 DOI: 10.1536/ihj.47.193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to elucidate the relationship between the mismatch of thallium-201(Tl) and iodine-123-beta-methyl-iodophenyl-pentadecanoic acid (BMIPP) myocardial single-photon emission computed tomography (SPECT) and autonomic nervous system activity in myocardial infarction (MI) patients. The subjects were 40 patients (34 males, 6 females) who underwent examinations by 123I-BMIPP and 201Tl myocardial SPECT imaging and 24-hour Holter monitoring within a 3-day period 3 weeks after the onset of their first MI. R-R intervals were analyzed every hour over a period of 24 hours by fast Fourier transformation (FFT). High frequency (HF) and low frequency (LF) were defined as markers of cardiac vagal activity in the former and the LF/HF ratio as sympathetic activity. Greater or more extensive decreases in the BMIPP image than that in the Tl image were defined as a positive mismatch. Patients were divided into positive and negative mismatch groups of 20 patients each. There were no significant differences between the 2 groups in age, sex, site of infarction, max CK (creatine kinase), max CK-MB, or left ventricular ejection fraction. The incidences of clinical signs suggesting residual myocardial ischemia were significantly greater in the positive than in the negative mismatch group (P < 0.05). The mean values for HF over the entire 24-hour period and over the 5-hour nocturnal period (0-5 AM) in the positive mismatch group were both significantly lower than those in the negative mismatch group (P < 0.001 in both groups). The 24-hour mean HF and mean nighttime HF in patients with signs of residual ischemia were both significantly lower than in those without signs of residual ischemia in the positive mismatch group (P < 0.05 in both groups). The mean LF/HF ratio for both the entire 24-hour and the nocturnal period in the positive mismatch group were significantly higher than those in the negative mismatch group (P < 0.001, P < 0.05, respectively). The daily profile of hourly HF measurements was significantly lower in the positive mismatch group than in the negative mismatch group (P < 0.02). The mean values of HF for 24-hour and 5-hour periods were significantly lower in patients with signs of residual ischemia in the positive mismatch group than in those with signs of residual ischemia in the negative mismatch group (P < 0.01, P < 0.02, respectively). There were no significant differences between the patients with signs of residual ischemia in the negative mismatch group and those without signs of residual ischemia in the positive and negative mismatch group with regard to the mean values of HF and the LF/HF ratio measured every hour for 24 hours and 5 hours. It is concluded from the present study that the findings of a mismatch on 123I-BMIPP and 201Tl myocardial SPECT 3 weeks after a first acute myocardial infarction with uncomplicated moderate or severe heart failure and decreased heart rate variability are related to residual myocardial ischemia. A combined assessment of heart rate variability in 24-hour Holter ECG monitoring and perfusion-metabolism mismatch in 123I-BMIPP and 201Tl myocardial SPECT is useful for determining residual myocardial ischemia in the follow-up of those with acute myocardial infarction.
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Affiliation(s)
- Hiroyuki Yamanaka
- First Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
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