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Pichot V, Corbier C, Chouchou F. The contribution of granger causality analysis to our understanding of cardiovascular homeostasis: from cardiovascular and respiratory interactions to central autonomic network control. FRONTIERS IN NETWORK PHYSIOLOGY 2024; 4:1315316. [PMID: 39175608 PMCID: PMC11338816 DOI: 10.3389/fnetp.2024.1315316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 07/18/2024] [Indexed: 08/24/2024]
Abstract
Homeostatic regulation plays a fundamental role in maintenance of multicellular life. At different scales and in different biological systems, this principle allows a better understanding of biological organization. Consequently, a growing interest in studying cause-effect relations between physiological systems has emerged, such as in the fields of cardiovascular and cardiorespiratory regulations. For this, mathematical approaches such as Granger causality (GC) were applied to the field of cardiovascular physiology in the last 20 years, overcoming the limitations of previous approaches and offering new perspectives in understanding cardiac, vascular and respiratory homeostatic interactions. In clinical practice, continuous recording of clinical data of hospitalized patients or by telemetry has opened new applicability for these approaches with potential early diagnostic and prognostic information. In this review, we describe a theoretical background of approaches based on linear GC in time and frequency domains applied to detect couplings between time series of RR intervals, blood pressure and respiration. Interestingly, these tools help in understanding the contribution of homeostatic negative feedback and the anticipatory feedforward mechanisms in homeostatic cardiovascular and cardiorespiratory controls. We also describe experimental and clinical results based on these mathematical tools, consolidating previous experimental and clinical evidence on the coupling in cardiovascular and cardiorespiratory studies. Finally, we propose perspectives allowing to complete the understanding of these interactions between cardiovascular and cardiorespiratory systems, as well as the interplay between brain and cardiac, and vascular and respiratory systems, offering a high integrative view of cardiovascular and cardiorespiratory homeostatic regulation.
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Affiliation(s)
- Vincent Pichot
- Department of Clinical and Exercise Physiology, SAINBIOSE, Inserm U1059, Saint-Etienne Jean Monnet University, CHU Saint-Etienne, Saint-Etienne, France
| | - Christophe Corbier
- LASPI EA3059, Saint-Etienne Jean Monnet University, Roanne Technology University Institute, Roanne, France
| | - Florian Chouchou
- IRISSE Laboratory EA4075, University of La Réunion, UFR Science de ’Homme et de l’Environnement, Le Tampon, France
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Chao-Écija A, López-González MV, Dawid-Milner MS. CardioRVAR: A New R Package and Shiny Application for the Evaluation of Closed-Loop Cardiovascular Interactions. BIOLOGY 2023; 12:1438. [PMID: 37998037 PMCID: PMC10669071 DOI: 10.3390/biology12111438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 11/25/2023]
Abstract
CardioRVAR is a new R package designed for the complete evaluation of closed-loop cardiovascular interactions and baroreflex sensitivity estimated from continuous non-invasive heart rate and blood pressure recordings. In this work, we highlight the importance of this software tool in the context of human cardiovascular and autonomic neurophysiology. A summary of the main algorithms that CardioRVAR uses are reviewed, and the workflow of this package is also discussed. We present the results obtained from this tool after its application in three clinical settings. These results support the potential clinical and scientific applications of this tool. The open-source tool can be downloaded from a public GitHub repository, as well as its specific Shiny application, CardioRVARapp. The open-source nature of the tool may benefit the future continuation of this work.
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Affiliation(s)
- Alvaro Chao-Écija
- Autonomic Nervous System Unit, CIMES, School of Medicine, University of Málaga, 29071 Malaga, Spain; (A.C.-É.); (M.V.L.-G.)
| | - Manuel Víctor López-González
- Autonomic Nervous System Unit, CIMES, School of Medicine, University of Málaga, 29071 Malaga, Spain; (A.C.-É.); (M.V.L.-G.)
- Biomedical Research Institute of Málaga (IBIMA), 29590 Malaga, Spain
| | - Marc Stefan Dawid-Milner
- Autonomic Nervous System Unit, CIMES, School of Medicine, University of Málaga, 29071 Malaga, Spain; (A.C.-É.); (M.V.L.-G.)
- Biomedical Research Institute of Málaga (IBIMA), 29590 Malaga, Spain
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Corbier C, Chouchou F, Roche F, Barthélémy JC, Pichot V. Causal analyses to study autonomic regulation during acute head-out water immersion, head-down tilt and supine position. Exp Physiol 2020; 105:1216-1222. [PMID: 32436624 DOI: 10.1113/ep088640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/18/2020] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? Can Granger causality analysis of R-R intervals, systolic blood pressure and respiration provide evidence for the different physiological mechanisms induced during thermoneutral water immersion, 6 deg head-down tilt and supine position tests that are not accessible using traditional heart rate variability and baroreflex methods? What is the main finding and its importance? The Granger analysis demonstrated a significant difference in the causal link from R-R intervals to respiration between water immersion and head-down tilt. The underlying physiological mechanism explaining this difference could be the variation in peripheral resistances. ABSTRACT Thermoneutral head-out water immersion (WI) and 6 deg head-down tilt (HDT) are used to simulate SCUBA diving, swimming and microgravity, because these models induce an increase in central blood volume. Standard methods to analyse autonomic regulation have demonstrated an increase in parasympathetic activity and baroreflex sensitivity during these experimental conditions. However, such methods are not adapted to quantify all closed-loop interactions involved in respiratory and cardiovascular regulation. To overcome this limitation, we used Granger causality analysis between R-R intervals (RR), systolic blood pressure (SBP) and respiration (RE) in eight young, healthy subjects, recorded during 30 min periods in the supine position, WI and HDT. For all experimental conditions, we found a bidirectional causal relationship between RE and RR and between RR and SBP, with a dominant direction from RR to SBP, and a unidirectional causality from RE to SBP. These causal relationships remained unchanged for the three experimental tests. Interestingly, there was a lower causal relationship from RR to RE during WI compared with HDT. This causal link from RR to RE could be modulated by peripheral resistances. These results highlight differences in cardiovascular regulation during WI and HDT and confirm that Granger causality might reveal physiological mechanisms not accessible with standard methods.
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Affiliation(s)
- Christophe Corbier
- Saint-Etienne Jean Monnet University, Roanne Technology University Institute, University of Lyon, LASPI (EA3059), Roanne, F-42334, France
| | - Florian Chouchou
- University of La Réunion, UFRSHE, IRISSE Laboratory (EA4075), Le Tampon, F-97430, France
| | - Frédéric Roche
- Saint-Etienne Jean Monnet University, CHU de Saint-Etienne, Department of Clinical and Exercise Physiology, University of Lyon, SNA-EPIS (EA4607), Saint-Etienne, F-42055, France
| | - Jean-Claude Barthélémy
- Saint-Etienne Jean Monnet University, CHU de Saint-Etienne, Department of Clinical and Exercise Physiology, University of Lyon, SNA-EPIS (EA4607), Saint-Etienne, F-42055, France
| | - Vincent Pichot
- Saint-Etienne Jean Monnet University, CHU de Saint-Etienne, Department of Clinical and Exercise Physiology, University of Lyon, SNA-EPIS (EA4607), Saint-Etienne, F-42055, France
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Bari V, Vaini E, De Maria B, Cairo B, Pistuddi V, Ranucci M, Porta A. Comparison of Different Strategies to Assess Cardiac Baroreflex Sensitivity Based on Transfer Function Technique in Patients Undergoing General Anesthesia. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:2780-2783. [PMID: 30440978 DOI: 10.1109/embc.2018.8512782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Baroreflex sensitivity (BRS) can be noninvasively assessed from heart period (HP) and arterial pressure (AP) variability series via the estimation of the gain of the transfer function (TF) in the low frequency (LF, 0.04-0.15 Hz) band. However, different strategies can be adopted to pick the value of the TF gain and different fiducial AP values can be considered. In this study we compared different strategies to reduce the TF gain into a unique maker: i) sampling the TF gain in correspondence of the maximum of the HP-AP squared coherence; ii) sampling the TF gain at the weighted average of the central frequencies of AP spectral components; iii) calculating the average of the TF gain in the LF band. Indexes were computed using alternatively systolic AP (SAP) or diastolic AP (DAP) series in combination with HP. Results were obtained in 129 patients undergoing coronary artery bypass graft surgery before (PRE) and after (POST) the induction of general anesthesia with propofol and remifentanil. The reduction of BRS during general anesthesia is expected as a result of overall depression of the cardiovascular control even in this group of pathological subjects already featuring a low BRS before general anesthesia induction. We found that the expected decrease of BRS was observed regardless of the strategy using DAP. Moreover, regardless of series (i.e., SAP or DAP), the sampling of TF gain at the weighted average of the central frequencies of the AP spectral components has the greatest statistical power in distinguishing the two experimental conditions. We recommend the use of this strategy in assessing BRS via TF analysis and a more frequent exploitation of the DAP series.
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Bari V, Ranucci M, Marchi A, De Maria B, Pistuddi V, Porta A. Cardiovascular interactions assessed via conditional joint transfer entropy in patients developing atrial fibrillation after coronary artery bypass graft surgery. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:2937-2940. [PMID: 28268929 DOI: 10.1109/embc.2016.7591345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Assigned the universe of knowledge Ω as composed by one target and two exogenous signals, the conditional joint transfer entropy (CJTE), assessing the amount of information jointly transferred from the two sources to the target that can be uniquely linked to one of the two sources, was found useful to study cardiovascular control. We propose the assessment of CJTE from systolic arterial pressure (SAP) and respiration (R) to heart period (HP) conditioned on R (CJTESAP, R→HP|R) along the baroreflex, and from HP and R to SAP conditioned on R (CJTEHP, R→SAP|R) along the feedforward mechanical pathway, in 134 patients undergoing coronary artery bypass graft surgery before (PRE) and after (POST) the induction of general anesthesia. In this group 38 patients developed atrial fibrillation (AF) after surgery, while the remaining individuals did not (noAF, n=96). Both CJTESAP, R→HP|R and CJTEHP, R→SAP|R distinguished AF from noAF individuals in the PRE condition, suggesting an impairment of HP-SAP closed-loop regulation in AF group and the possibility to identify subjects at higher risk to develop post-surgery AF.
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Huang D, Zhou J, Su D, Yu W, Chen J. Variations of perioperative baroreflex sensitivity in hypertensive and normotensive patients. Clin Exp Hypertens 2017; 39:74-79. [PMID: 28060537 DOI: 10.1080/10641963.2016.1210624] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Impaired baroreflex sensitivity (BRS) is a marker of autonomous dysfunction, which may play an important role in the long-term development of hypertension. Perioperative patients with hypertension are rapidly increasing in all populations worldwide. OBJECTIVE To estimate the value of BRS for hypertension in a surgery cohort. METHODS An observational and cross-sectional study was performed, involving 96 patients who underwent video-assisted thoracoscopic pulmonary lobectomy or segmentectomy. Invasive blood pressure and heart rate before and after giving nitroglycerin were measured in 48 normotensive patients and 48 hypertensive patients (25 and 23 undergoing regular treatment hypertensive [HR] and irregular treatment hypertensive [HI], respectively) while entering the operation room, 30 minutes after skin incision, and 10 minutes after skin suture. RESULTS BRSpreoperative of hypertensive group (Group H) was lower than normotensive group (Group N) (3.49 ± 1.55 vs. 5.75 ± 4.15 ms/mmHg; P < 0.05). BRSintraoperative of Group H was lower than Group N (1.70 ± 1.18 vs. 2.84 ± 1.11 ms/mmHg; P < 0.05). BRSpreoperative of patients in irregular-treated group (Group HI) was lower than regular-treated group (Group HR) (2.92 ± 1.36 vs. 4.31 ± 1.87 ms/mmHg; P < 0.05). BRSintraoperative of Group HI was lower than Group HR (1.45 ± 0.90 vs. 2.08 ± 1.82 ms/mmHg; P < 0.05). BRSintraoperative and BRSpostoperative were lower than BRSpreoperative in each group (P < 0.01). CONCLUSION The perioperative autonomic nerve function was significantly impaired in hypertensive patients. This effect was less pronounced for those who were on regular antihypertensive treatment. Attention should be paid to maintain the stability of cardiovascular function, to ensure patients can go through perioperative period safely.
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Affiliation(s)
- Dan Huang
- a Department of Anesthesiology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Jie Zhou
- a Department of Anesthesiology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Diansan Su
- a Department of Anesthesiology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Weifeng Yu
- a Department of Anesthesiology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Jie Chen
- a Department of Anesthesiology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
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Bassi GS, Brognara F, Castania JA, Talbot J, Cunha TM, Cunha FQ, Ulloa L, Kanashiro A, Dias DPM, Salgado HC. Baroreflex activation in conscious rats modulates the joint inflammatory response via sympathetic function. Brain Behav Immun 2015; 49:140-7. [PMID: 25986215 PMCID: PMC7023897 DOI: 10.1016/j.bbi.2015.05.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 05/07/2015] [Accepted: 05/10/2015] [Indexed: 12/19/2022] Open
Abstract
The baroreflex is a critical physiological mechanism controlling cardiovascular function by modulating both the sympathetic and parasympathetic activities. Here, we report that electrical activation of the baroreflex attenuates joint inflammation in experimental arthritis induced by the administration of zymosan into the femorotibial cavity. Baroreflex activation combined with lumbar sympathectomy, adrenalectomy, celiac subdiaphragmatic vagotomy or splenectomy dissected the mechanisms involved in the inflammatory modulation, highlighting the role played by sympathetic inhibition in the attenuation of joint inflammation. From the immunological standpoint, baroreflex activation attenuates neutrophil migration and the synovial levels of inflammatory cytokines including TNF, IL-1β and IL-6, but does not affect the levels of the anti-inflammatory cytokine IL-10. The anti-inflammatory effects of the baroreflex system are not mediated by IL-10, the vagus nerve, adrenal glands or the spleen, but by the inhibition of the sympathetic drive to the knee. These results reveal a novel physiological neuronal network controlling peripheral local inflammation.
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Affiliation(s)
- Gabriel S. Bassi
- Departments of Immunology from the Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Fernanda Brognara
- Departments of Physiology from the Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Jaci A. Castania
- Departments of Physiology from the Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Jhimmy Talbot
- Departments of Pharmacology from the Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Thiago M. Cunha
- Departments of Immunology from the Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil,Departments of Pharmacology from the Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Fernando Q. Cunha
- Departments of Immunology from the Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil,Departments of Pharmacology from the Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Luis Ulloa
- Rutgers University – New Jersey Medical School, Newark, NJ 07103, USA
| | - Alexandre Kanashiro
- Departments of Pharmacology from the Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Daniel P. Martins Dias
- Departments of Physiology from the Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Helio C. Salgado
- Departments of Physiology from the Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil,Corresponding author at: Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes 3900, 14049-900 Ribeirão Preto, SP, Brazil. Tel.: +55 16 33153201. (H.C. Salgado)
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Guzzetti S, Marchi A, Bassani T, Citerio G, Porta A. Univariate and bivariate symbolic analyses of cardiovascular variability differentiate general anesthesia procedures. Physiol Meas 2015; 36:715-26. [PMID: 25798537 DOI: 10.1088/0967-3334/36/4/715] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
General anesthesia attenuates autonomic function and baroreflex control. This side effect should be prevented as much as possible because it limits the subject's ability in responding to physiological challenges during surgery (e.g. arterial pressure and ventricular contractility drops). This study is designed to rank two of the most commonly exploited general anesthesia treatments, i.e. intravenous anesthesia (IA) based on a propofol-opioid combination and volatile anesthesia (VA) based on a sevoflurane-opioid combination, according to their ability to maintain autonomic nervous system activity and baroreflex control. Univariate and bivariate symbolic techniques were applied to spontaneous heart period (HP) and systolic arterial pressure (SAP) variability series recorded during IA and VA procedures in 19 and 18 patients undergoing elective intracranial neurosurgery. Traditional linear univariate and bivariate frequency domain markers of the autonomic nervous system state and baroreflex control were evaluated as well. We found that: (i) univariate symbolic analysis of HP series suggests a better preservation of vagal modulation in VA than in IA; (ii) bivariate symbolic markers assessing the degree of HP-SAP association differentiate IA from VA, while baroreflex sensitivity and squared coherence function cannot; (iii) bivariate symbolic analysis indicates a better preservation of the HP-SAP association at slow frequencies in IA than in VA, thus suggesting a more active baroreflex control in IA. We conclude that symbolic indexes can be fruitfully exploited to rank general anesthesia treatments, and their performance appears to be superior to that of more traditional linear markers.
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Bonyhay I, Risk M, Freeman R. High-pass filter characteristics of the baroreflex--a comparison of frequency domain and pharmacological methods. PLoS One 2013; 8:e79513. [PMID: 24244518 PMCID: PMC3828383 DOI: 10.1371/journal.pone.0079513] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 10/01/2013] [Indexed: 11/22/2022] Open
Abstract
Pharmacological methods to assess baroreflex sensitivity evoke supra-physiological blood pressure changes whereas computational methods use spontaneous fluctuations of blood pressure. The relationships among the different baroreflex assessment methods are still not fully understood. Although strong advocates for each technique exist, the differences between these methods need further clarification. Understanding the differences between pharmacological and spontaneous baroreflex methods could provide important insight into the baroreflex physiology. We compared the modified Oxford baroreflex gain and the transfer function modulus between spontaneous RR interval and blood pressure fluctuations in 18 healthy subjects (age: 39±10 yrs., BMI: 26±4.9). The transfer function was calculated over the low-frequency range of the RR interval and systolic blood pressure oscillations during random-frequency paced breathing. The average modified Oxford baroreflex gain was lower than the average transfer function modulus (15.7±9.2 ms/mmHg vs. 19.4±10.5 ms/mmHg, P<0.05). The difference between the two baroreflex measures within the individual subjects comprised a systematic difference (relative mean difference: 20.7%) and a random variance (typical error: 3.9 ms/mmHg). The transfer function modulus gradually increased with the frequency within the low-frequency range (LF), on average from 10.4±7.3 ms/mmHg to 21.2±9.8 ms/mmHg across subjects. Narrowing the zone of interest within the LF band produced a decrease in both the systematic difference (relative mean difference: 0.5%) and the random variance (typical error: 2.1 ms/mmHg) between the modified Oxford gain and the transfer function modulus. Our data suggest that the frequency dependent increase in low-frequency transfer function modulus between RR interval and blood pressure fluctuations contributes to both the systematic difference (bias) and the random variance (error) between the pharmacological and transfer function baroreflex measures. This finding suggests that both methodological and physiological factors underlie the observed disagreement between the pharmacological and the transfer function method. Thus both baroreflex measures contribute complementary information and can be considered valid methods for baroreflex sensitivity assessment.
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Affiliation(s)
- Istvan Bonyhay
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Marcelo Risk
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
- Instituto Tecnologico de Buenos Aires (ITBA) and Consejo Nacional de Investigaciones Cientificas y Tecnicas (CONICET), Buenos Aires, Argentina
| | - Roy Freeman
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
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Porta A, Żebrowski J. Inferring cardiovascular control from spontaneous variability. Auton Neurosci 2013; 178:1-3. [PMID: 23746470 DOI: 10.1016/j.autneu.2013.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Indexed: 11/25/2022]
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Porta A, Bari V, Bassani T, Marchi A, Pistuddi V, Ranucci M. Model-based causal closed-loop approach to the estimate of baroreflex sensitivity during propofol anesthesia in patients undergoing coronary artery bypass graft. J Appl Physiol (1985) 2013; 115:1032-42. [DOI: 10.1152/japplphysiol.00537.2013] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cardiac baroreflex is a fundamental component of the cardiovascular control. The continuous assessment of baroreflex sensitivity (BRS) from spontaneous heart period (HP) and systolic arterial pressure (SAP) variations during general anesthesia provides relevant information about cardiovascular regulation in physiological conditions. Unfortunately, several difficulties including unknown HP-SAP causal relations, negligible SAP changes, small BRS values, and confounding influences due to mechanical ventilation prevent BRS monitoring from HP and SAP variabilities during general anesthesia. We applied a model-based causal closed-loop approach aiming at BRS assessment during propofol anesthesia in 34 patients undergoing coronary artery bypass graft (CABG) surgery. We found the following: 1) traditional time and frequency domain approaches (i.e., baroreflex sequence, cross-correlation, spectral, and transfer function techniques) exhibited irremediable methodological limitations preventing the assessment of the BRS decrease during propofol anesthesia; 2) Granger causality approach proved that the methodological caveats were linked to the decreased presence of bidirectional closed-loop HP-SAP interactions and to the increased incidence of the HP-SAP uncoupling; 3) our model-based closed-loop approach detected the significant BRS decrease during propofol anesthesia as a likely result of accounting for the influences of mechanical ventilation and causal HP-SAP interactions; and 4) the model-based closed-loop approach found also a diminished gain of the relation from HP to SAP linked to vasodilatation and reduced ventricular contractility during propofol anesthesia. The proposed model-based causal closed-loop approach is more effective than traditional approaches in monitoring cardiovascular control during propofol anesthesia and indicates an overall depression of the HP-SAP closed-loop regulation.
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Affiliation(s)
- Alberto Porta
- Department of Biomedical Sciences for Health, Galeazzi Orthopedic Institute, University of Milan, Milan, Italy
| | - Vlasta Bari
- Gruppo Ospedaliero San Donato Foundation, Milan, Italy
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Tito Bassani
- Humanitas Clinical and Research Center, Rozzano, Italy; and
| | - Andrea Marchi
- Humanitas Clinical and Research Center, Rozzano, Italy; and
| | - Valeria Pistuddi
- Department of Anesthesia and Intensive Care, Policlinico San Donato, San Donato Milanese, Italy
| | - Marco Ranucci
- Department of Anesthesia and Intensive Care, Policlinico San Donato, San Donato Milanese, Italy
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