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Kimata M, Hashimoto K, Harada N, Kawamura Y, Kimizuka Y, Fujikura Y, Kaneko M, Kiriu N, Sekine Y, Iwabuchi N, Kiyozumi T, Kawana A, Matsukuma S, Tanaka Y. Noninvasive Ambulatory Electrocardiographic Markers from Patients with COVID-19 Pneumonia: A Report of Three Cases. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:655. [PMID: 38674301 PMCID: PMC11052239 DOI: 10.3390/medicina60040655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/05/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024]
Abstract
Coronavirus disease 2019 (COVID-19) has affected medical practice. More than 7,000,000 patients died worldwide after being infected with COVID-19; however, no specific laboratory markers have yet been established to predict death related to this disease. In contrast, electrocardiographic changes due to COVID-19 include QT prolongation and ST-T changes; however, there have not been studies on the ambulatory electrocardiographic markers of COVID-19. We encountered three patients diagnosed as having COVID-19 who did not have a prior history of significant structural heart diseases. All patients had abnormalities in ambulatory echocardiogram parameters detected by high-resolution 24 h electrocardiogram monitoring: positive late potentials (LPs) and T-wave alternans (TWA), abnormal heart rate variability (HRV), and heart rate turbulence (HRT). Case 1 involved a 78-year-old woman with a history of chronic kidney disease, Case 2 involved a 76-year-old man with hypertension and diabetes, and Case 3 involved a 67-year-old man with renal cancer, lung cancer, and diabetes. None of them had a prior history of significant structural heart disease. Although no significant consistent increases in clinical markers were observed, all three patients died, mainly because of respiratory failure with mild heart failure. The LP, TWA, HRV, and HRT were positive in all three cases with no significant structural cardiac disease at the initial phase of admission. The further accumulation of data regarding ambulatory electrocardiographic markers in patients with COVID-19 is needed. Depending on the accumulation of data, the LP, TWA, HRV, and HRT could be identified as potential risk factors for COVID-19 pneumonia in the early phase of admission.
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Affiliation(s)
- Motohiro Kimata
- Department of General Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (M.K.); (N.H.); (Y.T.)
| | - Kenichi Hashimoto
- Department of General Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (M.K.); (N.H.); (Y.T.)
| | - Naomi Harada
- Department of General Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (M.K.); (N.H.); (Y.T.)
| | - Yusuke Kawamura
- Department of General Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (M.K.); (N.H.); (Y.T.)
- Department of Integrative Physiology and Bio-Nano Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan
| | - Yoshifumi Kimizuka
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (Y.K.); (Y.F.); (A.K.)
| | - Yuji Fujikura
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (Y.K.); (Y.F.); (A.K.)
| | - Mayuko Kaneko
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (M.K.); (N.K.); (Y.S.); (T.K.)
| | - Nobuaki Kiriu
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (M.K.); (N.K.); (Y.S.); (T.K.)
| | - Yasumasa Sekine
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (M.K.); (N.K.); (Y.S.); (T.K.)
| | - Natsumi Iwabuchi
- Department of Laboratory Medicine, National Defense Medical College Hospital, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (N.I.); (S.M.)
| | - Tetsuro Kiyozumi
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (M.K.); (N.K.); (Y.S.); (T.K.)
- Department of Defense Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan
| | - Akihiko Kawana
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (Y.K.); (Y.F.); (A.K.)
| | - Susumu Matsukuma
- Department of Laboratory Medicine, National Defense Medical College Hospital, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (N.I.); (S.M.)
- Department of Pathology and Laboratory Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan
| | - Yuji Tanaka
- Department of General Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (M.K.); (N.H.); (Y.T.)
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Michou V, Liakopoulos V, Roumeliotis S, Roumeliotis A, Anifanti M, Tsamos G, Papagianni A, Zempekakis P, Deligiannis A, Kouidi E. Effects of Home-Based Exercise Training on Cardiac Autonomic Neuropathy and Metabolic Profile in Diabetic Hemodialysis Patients. Life (Basel) 2023; 13:life13010232. [PMID: 36676181 PMCID: PMC9866875 DOI: 10.3390/life13010232] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/26/2022] [Accepted: 01/12/2023] [Indexed: 01/17/2023] Open
Abstract
Background: This study aimed to investigate the effects of a home-based exercise training program on Cardiac Autonomic Neuropathy (CAN) and metabolic profile in Diabetic Kidney Disease (DKD) patients undergoing maintenance hemodialysis (HD). Method: Twenty-eight DKD patients undergoing hemodialysis were randomly assigned into two groups. The exercise (EX) group followed a 6-month combined exercise training program at home, while the control (CO) group remained untrained. All participants at baseline and the end of the study underwent cardiopulmonary exercise testing (CPET), biochemical tests for glucose and lipid profile, and 24-h electrocardiographic monitoring for heart rate variability (HRV) analysis and heart rate turbulence (HRT). Results: At the end of the study, compared to the CO, the EX group showed a significant increase in serum high-density lipoprotein (HDL) by 27.7% (p = 0.01), peak oxygen uptake (VO2peak) by 9.3% (p < 0.05), the standard deviation of R-R intervals (SDNN) by 34.3% (p = 0.03), percentage of successive RR intervals higher than 50ms (pNN50) by 51.1% (p = 0.02), turbulence slope (TS) index by 18.4% (p = 0.01), and decrease in (glycated hemoglobin) HbA1c by 12.5% (p = 0.04) and low-frequency power LF (ms2) by 29.7% (p = 0.01). Linear regression analysis after training showed that VO2peak was correlated with SDNN (r = 0.55, p = 0.03) and HF (r = 0.72, p = 0.02). Multiple regression analysis indicated that the improvement of sympathovagal balance and aerobic capacity depended on patients’ participation in exercise training. Conclusion: In conclusion, a 6-month home-based mixed-type exercise program can improve cardiac autonomic function and metabolic profile in DKD patients on HD.
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Affiliation(s)
- Vassiliki Michou
- Sports Medicine Laboratory, School of Physical Education & Sport Science, Aristotle University, 57001 Thessaloniki, Greece
| | - Vassilios Liakopoulos
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, Medical School, AHEPA Hospital, Aristotle University, 57001 Thessaloniki, Greece
| | - Stefanos Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, Medical School, AHEPA Hospital, Aristotle University, 57001 Thessaloniki, Greece
| | - Athanasios Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, Medical School, AHEPA Hospital, Aristotle University, 57001 Thessaloniki, Greece
| | - Maria Anifanti
- Sports Medicine Laboratory, School of Physical Education & Sport Science, Aristotle University, 57001 Thessaloniki, Greece
| | - Georgios Tsamos
- Laboratory of Hygiene, Department of Internal Medicine, Agios Dimitrios Hospital, Aristotle University, 57001 Thessaloniki, Greece
| | - Aikaterini Papagianni
- Department of Nephrology, Hippokration Hospital, Aristotle University, 57001 Thessaloniki, Greece
| | - Pantelis Zempekakis
- Sports Medicine Laboratory, School of Physical Education & Sport Science, Aristotle University, 57001 Thessaloniki, Greece
| | - Asterios Deligiannis
- Sports Medicine Laboratory, School of Physical Education & Sport Science, Aristotle University, 57001 Thessaloniki, Greece
| | - Evangelia Kouidi
- Sports Medicine Laboratory, School of Physical Education & Sport Science, Aristotle University, 57001 Thessaloniki, Greece
- Correspondence: ; Tel.: +30-69-3704-0265
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Blesius V, Schölzel C, Ernst G, Dominik A. Comparability of Heart Rate Turbulence Methodology: 15 Intervals Suffice to Calculate Turbulence Slope – A Methodological Analysis Using PhysioNet Data of 1074 Patients. Front Cardiovasc Med 2022; 9:793535. [PMID: 35463773 PMCID: PMC9019151 DOI: 10.3389/fcvm.2022.793535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/07/2022] [Indexed: 11/24/2022] Open
Abstract
Heart rate turbulence (HRT) is a characteristic heart rate pattern triggered by a ventricular premature contraction (VPC). It can be used to assess autonomic function and health risk for various conditions, e.g., coronary artery disease or cardiomyopathy. While comparability is essential for scientific analysis, especially for research focusing on clinical application, the methodology of HRT still varies widely in the literature. Particularly, the ECG measurement and parameter calculation of HRT differs, including the calculation of turbulence slope (TS). In this article, we focus on common variations in the number of intervals after the VPC that are used to calculate TS (#TSRR) posing two questions: 1) Does a change in #TSRR introduce noticeable changes in HRT parameter values and classification? and 2) Do larger values of turbulence timing (TT) enabled by a larger #TSRR still represent distinct HRT? We compiled a free-access data set of 1,080 annotated long-term ECGs provided by Physionet. HRT parameter values and risk classes were determined both with #TSRR 15 and 20. A standard local tachogram was created by averaging the tachograms of only the files with the best heart rate variability values. The shape of this standard VPC sequence was compared to all VPC sequences grouped by their TT value using dynamic time warping (DTW) in order to identify HRT shapes. When calculated with different #TSRR, our results show only a little difference between the number of files with enough valid VPC sequences to calculate HRT (<1%) and files with different risk classes (5 and 6% for HRT0-2 and HRTA-C, respectively). In the DTW analysis, the difference between averaged sequences with a specific TT and the standard sequence increased with increasing TT. Our analysis suggests that HRT occurs in the early intervals after the VPC and TS calculated from late intervals reflects common heart rate variability rather than a distinct response to the VPC. Even though the differences in classification are marginal, this can lead to problems in clinical application and scientific research. Therefore, we recommend uniformly using #TSRR 15 in HRT analysis.
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Affiliation(s)
- Valeria Blesius
- Life Science Informatics Group, Department of Mathematics, Natural Sciences and Informatics, Technische Hochschule Mittelhessen (THM) University of Applied Sciences, Giessen, Germany
- *Correspondence: Valeria Blesius
| | - Christopher Schölzel
- Life Science Informatics Group, Department of Mathematics, Natural Sciences and Informatics, Technische Hochschule Mittelhessen (THM) University of Applied Sciences, Giessen, Germany
| | - Gernot Ernst
- Department of Anaesthesiology, Kongsberg Hospital, Vestre Viken Hospital Trust, Kongsberg, Norway
- Psychological Institute, University of Oslo, Oslo, Norway
| | - Andreas Dominik
- Life Science Informatics Group, Department of Mathematics, Natural Sciences and Informatics, Technische Hochschule Mittelhessen (THM) University of Applied Sciences, Giessen, Germany
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Yalim Z, Alan Yalim S, Eroğul Ö, Doğan M. The role of heart rate variability and heart rate turbulence in diabetic retinopathy. Minerva Endocrinol (Torino) 2022; 47:172-180. [PMID: 35142481 DOI: 10.23736/s2724-6507.20.03346-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AIMS The aim of this study was to evaluate the cardiac autonomic functions of individuals with asymptomatic diabetic retinopathy (DR) and no obvious heart disease by heart rate turbulence (HRT) and heart rate variability (HRV) analysis. METHODS A total of 72 patients with Type II Diabetes Mellitus: 20 non-retinopathic (NRDM), 26 non-proliferative retinopathic patients (NPDR) and 26 proliferative retinopathic patients (PDR) were enrolled in this cross-sectional study. RESULTS The HRV parameters of Standard deviation of NN intervals (SDNN) (119.8±11.7, 101.1±20.2, 100.6±17.04), Standard deviation of the average NN intervals (SDANN) (108.3±10.8, 91.2±17.5, 93.6±18.4), SDNN Index (49.5±5.1, 40.1±13.4, 38.6±12.7), Root mean square of successive RR interval differences (RMSSD) (28.3±5.1, 22.3±7.5, 26±9.2) and Triangular index (34.4±4.3, 29.7±8.8, 27.3±6.7) were significantly lower in the NPDR and PDR groups than in the NRDM group (for all p<0.05). Also, there was a statistically significant higher Turbulence Onset (-1.80±0.7, -1.1±0.9, -0.43±0.81) and lower Turbulence Slope (8.05±2.59, 5.82±3.39, 4.53±2.07) in HRT parameters in patients in the NPDR and PDR groups than in the NRDM group (respectively, NRDM, NPDM, PDM, for all p<0.001). CONCLUSIONS We found that HRV and HRT parameters had a significant deterioration in retinopathic individuals compared to the group without retinopathy. We think that HRV and HRT analysis can have an important role in the evaluation of these patients.
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Affiliation(s)
- Zafer Yalim
- Department of Cardiology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey -
| | - Sümeyra Alan Yalim
- Department of İnternal Medicine, Afyonkarahisar State Hospital, Afyonkarahisar, Turkey
| | - Özgür Eroğul
- Department of Ophthalmology, Afyonkarahisar Health Sciences University Hospital, Afyonkarahisar, Turkey
| | - Mustafa Doğan
- Department of Ophthalmology, Afyonkarahisar Health Sciences University Hospital, Afyonkarahisar, Turkey
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Yagcioglu P, Ari S, Ari H, Melek M. Comparison of the effects of ticagrelor and clopidogrel on heart rate variability and heart rate turbulence in patients with percutaneous coronary interventions. J Saudi Heart Assoc 2020; 32:166-173. [PMID: 33154911 PMCID: PMC7640560 DOI: 10.37616/2212-5043.1048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction Clopidogrel and ticagrelor are commonly used, antiplatelet agents. Ticagrelor has an effect of enhancing the plasma level of adenosine that may alter the autonomic function. The aim of this study is to compare the effects of ticagrelor and clopidogrel on heart rate variability (HRV) and heart rate turbulence (HRT). Methods Thirty subjects who performed percutaneous coronary intervention (PCI) were included in the randomized, crossover study. These patients were divided into two groups. Clopidogrel or ticagrelor was administered in two different testing sessions (1-month treatment for each session). In group 1, clopidogrel and ticagrelor treatment were used while in group 2, ticagrelor and clopidogrel treatment were used respectively. Three times rhythm Holter recording (baseline, 1st and 2nd month) was performed. The HRV (time domain and frequency domain) and HRT (turbulence onset (TO) and turbulence slope (TS)) parameters were analyzed from the Holter recordings. Results According to baseline Holter recording, pNN50 (5.82 ± 5.83 vs 10.56 ± 8.28; p = 0.03) and HF(nu) (6.85 ± 9.33 vs 9.53 ± 7.41; p = 0.04) parameters were higher in group 2 than in group 1, while TO(0.004 ± 0.02 vs −0.01 ± 0.02; p = 0.01) parameter was positive and higher in group 1 than in group 2. In the second month, the LF/HF ratio (4.47 ± 2.43 vs 3.18 ± 2.45; p = 0.04) was higher in group 1 than in group 2. However, when the evaluation was done within the groups themselves, there were no statistically significant differences in HRV and HRT parameters obtained before and after clopidogrel and ticagrelor administration in group 1 and group 2. Conclusion Ticagrelor and clopidogrel treatments did not have a significant effect on HRV and HRT parameters.
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Affiliation(s)
- Pinar Yagcioglu
- Bursa Postgraduate Hospital, Departments of Cardiology, Bursa, Turkey
| | - Selma Ari
- Bursa Postgraduate Hospital, Departments of Cardiology, Bursa, Turkey
| | - Hasan Ari
- Bursa Postgraduate Hospital, Departments of Cardiology, Bursa, Turkey
| | - Mehmet Melek
- Bursa Postgraduate Hospital, Departments of Cardiology, Bursa, Turkey
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Yalım Z, Demir ME, Yalım SA, Alp Ç. Investigation of heart rate variability and heart rate turbulence in chronic hypotensive hemodialysis patients. Int Urol Nephrol 2020; 52:775-782. [PMID: 32157616 DOI: 10.1007/s11255-020-02429-7] [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: 09/16/2019] [Accepted: 02/23/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sudden cardiac death is the leading cause of cardiac-related death in hemodialysis patients. Hypotensive episodes in pre-, intra-, and post-dialytic periods can present serious clinical challenges that affect a patient's quality of life and prognosis. The aim of the present study was to evaluate cardiac autonomic control and arrhythmogenic risk by analyzing 24-h heart rate variability (HRV) and heart rate turbulence (HRT) in hypotensive hemodialysis patients. METHODS A total of 79 patients on maintenance hemodialysis treatment, 39 normotensive and 40 with frequent hypotension episodes during non-dialysis periods, were included in the study. Dialysis-free periods were recorded with a 24-h Holter rhythm and ambulatory blood pressure monitor device. The time-domain parameters of HRV and HRT, including turbulence onset (TO) and turbulence slope (TS), were calculated. RESULTS Values for SDNN (105.5 ± 7.02, 127.6 ± 6.2 p < 0.001), SDANN (95.1 ± 5.9, 111.8 ± 5.01 p < 0.001), and SDNN index (50.04 ± 2.7, 55.6 ± 3.7 p = 0.03), in the hypotensive group were significantly lower than in the normotensive group, respectively. Values for RMSSD (26.5 ± 2.5, 27.3 ± 2.7 p = 0.178), pNN50 (17 ± 1.7, 55.6 ± 3.7 p = 0.03), and Tİ (35.1 ± 3.1, 34.7 ± 2.6 p = 0.542) in both groups were not significantly different; however, there was a significant difference between HRT parameters, TO (- 1.8 ± 0.37, - 2.4 ± 0.39 p < 0.001) and TS (6.9 ± 0.71, 8.2 ± 0.97 p < 0.001), respectively, hypotensive and normotensive group. CONCLUSION Dialysis patients that experience frequent hypotensive episodes may also undergo significant changes in HRT and HRV which may be indicative of serious cardiac sequela. Thus, in such cases, a complete cardiologic evaluation is warranted.
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Affiliation(s)
- Zafer Yalım
- Department of Cardiology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey.
| | | | - Sümeyra Alan Yalım
- Department of İnternal Medicine, Afyonkarahisar State Hospital, Afyonkarahisar, Turkey
| | - Çağlar Alp
- Department of Cardiology, Kırıkkale University, Kırıkkale, Turkey
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Poliwczak AR, Białkowska J, Woźny J, Koziróg M, Bała A, Jabłkowski M. Cardiovascular risk assessment by electrocardiographic Holter monitoring in patients with chronic hepatitis C. Arch Med Sci 2020; 16:1031-1039. [PMID: 32863991 PMCID: PMC7444696 DOI: 10.5114/aoms.2020.96600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 03/05/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Cardiovascular diseases are ranked as the third cause of mortality among people infected with hepatitis C virus (HCV), but the relationship of infection with cardiovascular risk remains disputable. We have focused on the comprehensive use of parameters obtainable during long-term electrocardiographic (ECG) Holter monitoring. MATERIAL AND METHODS Heart rate variability and turbulence (HRV and HRT), deceleration/acceleration capacity (DC/AC), corrected QT interval (QTc) and late potential (LP) were used. 36 persons were included, and 30 healthy subjects formed a control group. All were submitted to 24-hour Holter ECG-monitoring. RESULTS The studied groups were not statistically significantly different with regards to basic anthropometric parameters. Statistically significantly higher medium and maximum heart rhythm and aminotransferase activities were recorded in patients with hepatitis C. The HRV parameters r-MSSD, p50NN, HF, and absolute DC/AC values were significantly lower in the subjects with hepatitis C than those in the control group. The QTc interval, measured for nocturnal hours, was also significantly longer in that group. There were no differences in the albumin level or basic echocardiographic parameters, including left ventricle ejection fraction. Nor was there any difference in the HRT parameters, or LP. The most interesting observation was the positive correlation among the number of viral RNA copies and DC, and LF. CONCLUSIONS We confirmed the presence of autonomic disorders with prevalence of sympathetic system activity and prolonged QTc interval in patients with chronic hepatitis C. Those parameters significantly correlated with infection intensity. Our results suggest that HCV infection could be an independent cardiovascular risk factor, not associated with the lipid profile. Further prospective studies are needed.
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Affiliation(s)
- Adam R. Poliwczak
- Department of Human Physiology, Medical University of Lodz, Lodz, Poland
| | - Jolanta Białkowska
- Department of Infectious and Liver Diseases, Medical University of Lodz, Lodz, Poland
| | - Joanna Woźny
- Department of Infectious and Liver Diseases, Medical University of Lodz, Lodz, Poland
| | - Marzena Koziróg
- Department of Internal Diseases and Cardiac Rehabilitation, Medical University of Lodz, Lodz, Poland
| | - Agnieszka Bała
- Department of Internal Diseases and Clinical Pharmacology, Medical University of Lodz, Lodz, Poland
| | - Maciej Jabłkowski
- Department of Infectious and Liver Diseases, Medical University of Lodz, Lodz, Poland
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Abnormalities of heart rate turbulence and heart rate variability as indicators of increased cardiovascular risk in patients with systemic sclerosis. Postepy Dermatol Alergol 2019; 36:707-713. [PMID: 31997999 PMCID: PMC6986290 DOI: 10.5114/ada.2019.83134] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 07/15/2018] [Indexed: 01/16/2023] Open
Abstract
Introduction Systemic sclerosis (SSc) is a connective tissue disease manifested by progressive fibrosis of many internal organs including the cardiovascular system and development of autonomic disorders with sympathetic predominance. These abnormalities can increase cardiovascular mortality. Aim To evaluate heart rate turbulence (HRT) and variability (HRV) parameters (indicator of autonomic imbalance) obtained from 24-hour ECG Holter monitoring, as predictors of the increased cardiovascular risk in patients with scleroderma. Material and methods Thirty-twoscleroderma patients and 30 healthy people were included. After clinical examination, ECG, routine laboratory tests and echocardiography, participants performed 24-hour Holter-ECG at home. For HRT assessment, turbulence onset (To) and turbulence slope (Ts) parameters were used. Both time and frequency domain analysis of HRV was used. The HRV circadian rhythm was also evaluated. Results Time domain: SDNN, SDNN-ix, SDANN and frequency domain: LF, VLF, ULF, NHF, NLF, parameters were lower, while p50NN was higher in SSc as compared to the control group. There was also a loss of the circadian rhythm for r-MSSD and p50NN present in the control group. Abnormal HRT parameters To and/or Ts occurred in the SSc group only. The median value of To = –1.24% and Ts = 11.13 ms/RR did not differ significantly as compared to the control group. Conclusions The study confirmed the presence of HRV disturbances, including HRV circadian rhythm, as it may seem at an early stage of SSc. The HRT disorders may be characterized by the increasing changes with advancing disease. This indicates the presence of autonomic imbalance and an increased cardiovascular risk.
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Jansen C, Al-Kassou B, Lehmann J, Pohlmann A, Chang J, Praktiknjo M, Nickenig G, Strassburg CP, Schrickel JW, Andrié R, Linhart M, Trebicka J. Severe abnormal Heart Rate Turbulence Onset is associated with deterioration of liver cirrhosis. PLoS One 2018; 13:e0195631. [PMID: 29634776 PMCID: PMC5892926 DOI: 10.1371/journal.pone.0195631] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/25/2018] [Indexed: 02/06/2023] Open
Abstract
Background In patients with liver cirrhosis, cardiac dysfunction is frequent and is associated with increased morbidity and mortality. Cardiac dysfunction in cirrhosis seems to be linked to autonomic dysfunction. This study investigates the role of autonomic dysfunction assessed by Heart Rate Turbulence (HRT) analyses in patients with liver cirrhosis. Methods and patients Inclusion criteria was (1) diagnosis of cirrhosis by clinical, imaging or biopsy and (2) evaluation by standard 12-lead-ECG and 24h holter monitoring and (3) at least 3 premature ventricular contractions. The exclusion criterion was presence of cardiac diseases, independent of liver cirrhosis. Biochemical parameters were analysed using standard methods. HRT was assessed using Turbulence onset (TO) and slope (TS). The endpoint was deterioration of liver cirrhosis defined as increased MELD and readmission for complications of liver cirrhosis. Results Out of 122 cirrhotic patients, 82 patients (63% male) with median Child score of 6 (range 5–12) and median MELD score of 10 (range 6–32) were included. Increasing Child score, INR and decreasing albumin were correlated with TO. In addition, decompensated patients with ascites showed more abnormal TO and TS. During the observation period, patients with more abnormal TO showed significantly higher rate of rising MELD Score at 6 months (p = 0.03). Nevertheless, at least in our collective HRT-parameters were not independent predictors of deterioration of cirrhosis. Conclusion Parameters of HRT are closely associated with deterioration of cirrhosis and might be helpful in its prediction.
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Affiliation(s)
- Christian Jansen
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - Baravan Al-Kassou
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - Jennifer Lehmann
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | | | - Johannes Chang
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | | | - Georg Nickenig
- Department of Internal Medicine II, University of Bonn, Bonn, Germany
| | | | - Jan W. Schrickel
- Department of Internal Medicine II, University of Bonn, Bonn, Germany
| | - René Andrié
- Department of Internal Medicine II, University of Bonn, Bonn, Germany
| | - Markus Linhart
- Department of Internal Medicine II, University of Bonn, Bonn, Germany
- Cardiology Department, Hospital Clínic, Barcelona, Spain
| | - Jonel Trebicka
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
- European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Institute for Bioengineering of Catalonia, Barcelona, Spain
- * E-mail:
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Bui AH, Waks JW. Risk Stratification of Sudden Cardiac Death After Acute Myocardial Infarction. J Innov Card Rhythm Manag 2018; 9:3035-3049. [PMID: 32477797 PMCID: PMC7252689 DOI: 10.19102/icrm.2018.090201] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/02/2017] [Indexed: 01/20/2023] Open
Abstract
Despite advances in the diagnosis and treatment of acute coronary syndromes and an overall improvement in outcomes, mortality after myocardial infarction (MI) remains high. Sudden death, which is most frequently due to ventricular tachycardia or ventricular fibrillation, is the cause of death in 25% to 50% of patients with prior MI, and therefore represents an important public health problem. Use of the implantable cardioverter-defibrillator (ICD), which is the primary method of reducing the chance of arrhythmic sudden death after MI, is costly to the medical system and is associated with procedural and long-term risks. Additionally, assessment of left ventricular ejection fraction (LVEF), which is the primary method of assessing a patient's post-MI sudden death risk and appropriateness for ICD implantation, lacks both sensitivity and specificity for sudden death, and may not be the optimal way to select the subgroup of post-MI patients who are most likely to benefit from ICD implantation. To optimally utilize ICDs, it is therefore critical to develop and prospectively validate sudden death risk stratification methods beyond measuring LVEF. A variety of tests that assess left ventricular systolic function/morphology, potential triggers for ventricular arrhythmias, ventricular conduction/repolarization, and autonomic tone have been proposed as sudden death risk stratification tools. Multivariable models have also been developed to assess the competing risks of arrhythmic and non-arrhythmic death so that ICDs can be utilized more effectively. This manuscript will review the epidemiology of sudden death after MI, and will discuss the current state of sudden death risk stratification in this population.
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Affiliation(s)
- An H. Bui
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jonathan W. Waks
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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11
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Poliwczak AR, Waszczykowska E, Dziankowska-Bartkowiak B, Koziróg M, Dworniak K. The use of heart rate turbulence and heart rate variability in the assessment of autonomic regulation and circadian rhythm in patients with systemic lupus erythematosus without apparent heart disease. Lupus 2017; 27:436-444. [PMID: 28795655 DOI: 10.1177/0961203317725590] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Systemic lupus erythematosus is a progressive autoimmune disease. There are reports suggesting that patients even without overt signs of cardiovascular complications have impaired autonomic function. The aim of this study was to assess autonomic function using heart rate turbulence and heart rate variability parameters indicated in 24-hour ECG Holter monitoring. Methods Twenty-six women with systemic lupus erythematosus and 30 healthy women were included. Twenty-four hour ambulatory ECG-Holter was performed in home conditions. The basic parameters of heart rate turbulence and heart rate variability were calculated. The analyses were performed for the entire day and separately for daytime activity and night time rest. Results There were no statistically significant differences in the basic anthropometric parameters. The mean duration of disease was 11.52 ± 7.42. There was a statistically significant higher turbulence onset (To) value in patients with systemic lupus erythematosus, median To = -0.17% (minimum -1.47, maximum 3.0) versus To = -1.36% (minimum -4.53, maximum -0.41), P < 0.001. There were no such differences for turbulence slope (Ts). In the 24-hour analysis almost all heart rate variability parameters were significantly lower in the systemic lupus erythematosus group than in the healthy controls, including SDANN and r-MSSD and p50NN. Concerning the morning activity and night resting periods, the results were similar as for the whole day. In the control group, higher values in morning activity were noted for parameters that characterise sympathetic activity, especially SDANN, and were significantly lower for parasympathetic parameters, including r-MSSD and p50NN, which prevailed at night. There were no statistically significant changes for systemic lupus erythematosus patients for p50NN and low and very low frequency. There was a positive correlation between disease duration and SDNN, R = 0.417; P < 0.05 and SDANN, R = 0.464; P < 0.05, a negative correlation between low/high frequency ratio and r-MSSD, R = -0.454; P < 0.05; p50NN, R = -0.435; P < 0.05 and high frequency, R = -0.478; P < 0.05. In contrast, there was no statistically significant correlation between heart rate turbulence and other variables evaluated, including disease duration and the type of autoantibodies. CONCLUSION Our study confirms the presence of autonomic disorders with respect to both heart rate variability and heart rate turbulence parameters and the presence of diurnal disturbances of sympathetic-parasympathetic balance. Further studies are required.
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Affiliation(s)
- A R Poliwczak
- 1 Department of Internal Diseases and Clinical Pharmacology, 37808 Medical University of Lodz , Lodz, Poland
| | - E Waszczykowska
- 2 Department of Dermatology and Venereology, 37808 Medical University of Lodz , Lodz, Poland
| | | | - M Koziróg
- 3 Department of Internal Medicine and Cardiologic Rehabilitation, 37808 Medical University of Lodz , Lodz, Poland
| | - K Dworniak
- 4 Department of Internal Medicine and Geriatrics, Regional Specialized Hospital in Zgierz, Zgierz, Poland
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Barquero-Perez O, Figuera C, Goya-Esteban R, Mora-Jimenez I, Gimeno-Blanes FJ, Laguna P, Martinez JP, Gil E, Sornmo L, Garcia-Alberola A, Rojo-Alvarez JL. On the Influence of Heart Rate and Coupling Interval Prematurity on Heart Rate Turbulence. IEEE Trans Biomed Eng 2016; 64:302-309. [PMID: 27101595 DOI: 10.1109/tbme.2016.2554614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Heart rate turbulence (HRT) has been successfully explored for cardiac risk stratification. While HRT is known to be influenced by the heart rate (HR) and the coupling interval (CI), nonconcordant results have been reported on how the CI influences HRT. The purpose of this study is to investigate HRT changes in terms of CI and HR by means of an especially designed protocol. METHODS A dataset was acquired from 11 patients with structurally normal hearts for which CI was altered by different pacing trains and HR by isoproterenol during electrophysiological study (EPS). The protocol was designed so that, first, the effect of HR changes on HRT and, second, the combined effect of HR and CI could be explored. As a complement to the EPS dataset, a database of 24-h Holters from 61 acute myocardial infarction (AMI) patients was studied for the purpose of assessing risk. Data analysis was performed by using different nonlinear ridge regression models, and the relevance of model variables was assessed using resampling methods. The EPS subjects, with and without isoproterenol, were analyzed separately. RESULTS The proposed nonlinear regression models were found to account for the influence of HR and CI on HRT, both in patients undergoing EPS without isoproterenol and in low-risk AMI patients, whereas this influence was absent in high-risk AMI patients. Moreover, model coefficients related to CI were not statistically significant, p > 0.05, on EPS subjects with isoproterenol. CONCLUSION The observed relationship between CI and HRT, being in agreement with the baroreflex hypothesis, was statistically significant ( ), when decoupling the effect of HR and normalizing the CI by the HR. SIGNIFICANCE The results of this study can help to provide new risk indicators that take into account physiological influence on HRT, as well as to model how this influence changes in different cardiac conditions.
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13
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Gimeno-Blanes FJ, Blanco-Velasco M, Barquero-Pérez Ó, García-Alberola A, Rojo-Álvarez JL. Sudden Cardiac Risk Stratification with Electrocardiographic Indices - A Review on Computational Processing, Technology Transfer, and Scientific Evidence. Front Physiol 2016; 7:82. [PMID: 27014083 PMCID: PMC4780431 DOI: 10.3389/fphys.2016.00082] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 02/19/2016] [Indexed: 11/22/2022] Open
Abstract
Great effort has been devoted in recent years to the development of sudden cardiac risk predictors as a function of electric cardiac signals, mainly obtained from the electrocardiogram (ECG) analysis. But these prediction techniques are still seldom used in clinical practice, partly due to its limited diagnostic accuracy and to the lack of consensus about the appropriate computational signal processing implementation. This paper addresses a three-fold approach, based on ECG indices, to structure this review on sudden cardiac risk stratification. First, throughout the computational techniques that had been widely proposed for obtaining these indices in technical literature. Second, over the scientific evidence, that although is supported by observational clinical studies, they are not always representative enough. And third, via the limited technology transfer of academy-accepted algorithms, requiring further meditation for future systems. We focus on three families of ECG derived indices which are tackled from the aforementioned viewpoints, namely, heart rate turbulence (HRT), heart rate variability (HRV), and T-wave alternans. In terms of computational algorithms, we still need clearer scientific evidence, standardizing, and benchmarking, siting on advanced algorithms applied over large and representative datasets. New scenarios like electronic health recordings, big data, long-term monitoring, and cloud databases, will eventually open new frameworks to foresee suitable new paradigms in the near future.
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Affiliation(s)
| | - Manuel Blanco-Velasco
- Department of Signal Theory and Communications, University of de Alcalá Alcalá de Henares, Spain
| | - Óscar Barquero-Pérez
- Department of Signal Theory and Communications, Rey Juan Carlos University Fuenlabrada, Spain
| | | | - José L Rojo-Álvarez
- Department of Signal Theory and Communications, Rey Juan Carlos University Fuenlabrada, Spain
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14
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Dursun H, Onrat E, Ercan E, Demirdal US, Avsar A, Dundar U, Solak O, Toktas H. Heart rate turbulence analysis in female patients with fibromyalgia. Clinics (Sao Paulo) 2015; 70:296-300. [PMID: 26017798 PMCID: PMC4418374 DOI: 10.6061/clinics/2015(04)13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 02/03/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Fibromyalgia is characterized by diffuse musculoskeletal pain and discomfort. There are several reports regarding autonomic nervous system dysfunction in patients with fibromyalgia. Heart rate turbulence is expressed as ventriculophasic sinus arrhythmia and has been considered to reflect cardiac autonomic activity. Heart rate turbulence has been shown to be an independent and powerful predictor of sudden cardiac death in various cardiac abnormalities. The aim of this study is to determine whether heart rate turbulence is changed in female patients with fibromyalgia compared with healthy controls. METHODS Thirty-seven female patients (mean age, 40±11 years) with fibromyalgia, and 35 age- and sex-matched healthy female control subjects (mean age, 42±9 years) were included. Twenty-four hours of ambulatory electrocardiography recordings were collected for all subjects, and turbulence onset and turbulence slope values were automatically calculated. RESULTS The baseline clinical characteristics of the two groups were similar. There were no significant differences in turbulence onset and turbulence slope measures between patients and control subjects (turbulence onset: -1.648±1.568% vs. -1.582±1.436%, p ϝ 0.853; turbulence slope: 12.933±5.693 ms/RR vs. 13.639±2.505 ms/RR, p ϝ 0.508). Although body mass index was negatively correlated with turbulence slope (r ϝ -0.258, p ϝ 0.046), no significant correlation was found between body mass index and turbulence onset (r ϝ 0.228, p ϝ 0.054). CONCLUSION To the best of our knowledge, this is the first study to evaluate heart rate turbulence in patients with fibromyalgia. It appears that heart rate turbulence parameters reflecting cardiac autonomic activity are not changed in female patients with fibromyalgia.
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Affiliation(s)
- Huseyin Dursun
- Dokuz Eylul University, Faculty of Medicine, Department of Cardiology, Izmir, Turkey
- E-mail:
| | - Ersel Onrat
- Afyon Kocatepe University, Faculty of Medicine, Department of Cardiology, Afyonkarahisar, Turkey
| | - Emine Ercan
- Afyon Kocatepe University, Faculty of Medicine, Department of Cardiology, Afyonkarahisar, Turkey
| | - Umit Secil Demirdal
- Katip Celebi University, Department of Physical Medicine and Rehabilitation, Izmir, Turkey
| | - Alaettin Avsar
- Afyon Kocatepe University, Faculty of Medicine, Department of Cardiology, Afyonkarahisar, Turkey
| | - Umit Dundar
- Afyon Kocatepe University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Afyonkarahisar, Turkey
| | - Ozlem Solak
- Afyon Kocatepe University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Afyonkarahisar, Turkey
| | - Hasan Toktas
- Afyon Kocatepe University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Afyonkarahisar, Turkey
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Drenjancevic I, Grizelj I, Harsanji-Drenjancevic I, Cavka A, Selthofer-Relatic K. The interplay between sympathetic overactivity, hypertension and heart rate variability (review, invited). ACTA ACUST UNITED AC 2014; 101:129-42. [PMID: 24901074 DOI: 10.1556/aphysiol.101.2014.2.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The control of arterial pressure is a complex interaction of the long- and short-term influences of hormones, local vascular factors, and neural mechanisms. The autonomic nervous system and its sympathetic arm play important roles in the regulation of blood pressure, and overactivity of sympathetic nerves may have an important role in the development of hypertension and related cardiovascular disorders. The baroreceptor system opposes either increases or decreases in arterial pressure, and the primary purpose of the arterial baroreflex is to keep blood pressure close to a particular set point over a relatively short period of time. The ability of the baroreflex to powerfully buffer acute changes in arterial pressure is well established, but the role of the arterial baroreceptor reflex in long-term control of arterial pressure has been a topic of many debate and controversy for decades. The sympathetic nervous system and arterial baroreceptor reflex control of renal sympathetic nerve activity has been proposed to play a role in long-term control of arterial pressure. The aim of this paper has been to review the postulated role of sympathetic activation.
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Affiliation(s)
- Ines Drenjancevic
- University of Osijek Department of Physiology and Immunology, Faculty of Medicine J. Huttlera 4 31000 Osijek Croatia University of Pécs Pécs Hungary
| | - I Grizelj
- University of Osijek Department of Physiology and Immunology, Faculty of Medicine J. Huttlera 4 31000 Osijek Croatia
| | - I Harsanji-Drenjancevic
- Clinical Hospital Center Osijek Department of Anesthesiology, Reanimatology and Intensive Care Unit Osijek Croatia
| | - A Cavka
- University of Osijek Department of Physiology and Immunology, Faculty of Medicine J. Huttlera 4 31000 Osijek Croatia
| | - K Selthofer-Relatic
- Clinical Hospital Center Osijek Department of Cardiology, Clinic of Internal Medicine Osijek Croatia University of Osijek Department of Internal Medicine, Medical Ethic and History of Medicine, Faculty of Medicine Osijek Croatia
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16
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Gil E, Laguna P, Martinez JP, Barquero-Perez O, Garcia-Alberola A, Sornmo L. Heart Rate Turbulence Analysis Based on Photoplethysmography. IEEE Trans Biomed Eng 2013; 60:3149-55. [DOI: 10.1109/tbme.2013.2270083] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Sörnmo L, Sandberg F, Gil E, Solem K. Noninvasive techniques for prevention of intradialytic hypotension. IEEE Rev Biomed Eng 2013; 5:45-59. [PMID: 23231988 DOI: 10.1109/rbme.2012.2210036] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Episodes of hypotension during hemodialysis treatment constitutes an important clinical problem which has received considerable attention in recent years. Despite the fact that numerous approaches to reducing the frequency of intradialytic hypotension (IDH) have been proposed and evaluated, the problem has not yet found a definitive solution--an observation which, in particular, applies to episodes of acute, symptomatic hypotension. This overview covers recent advances in methodology for predicting and preventing IDH. Following a brief overview of well-established hypotension-related variables, including blood pressure, blood temperature, relative blood volume, and bioimpedance, special attention is given to electrocardiographic and photoplethysmographic (PPG) variables and their significance for IDH prediction. It is concluded that cardiovascular variables which reflect heart rate variability, heart rate turbulence, and baroreflex sensitivity are important to explore in feedback control hemodialysis systems so as to improve their performance. The analysis of hemodialysis-related changes in PPG pulse wave properties hold considerable promise for improving prediction.
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Affiliation(s)
- Leif Sörnmo
- Department of Electrical and Information Technology and Center for Integrative Electrocardiology, Lund University, Lund, Sweden.
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18
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Soguero-Ruiz C, Lechuga-Suárez L, Mora-Jiménez I, Ramos-López J, Barquero-Pérez Ó, García-Alberola A, Rojo-Álvarez JL. Ontology for heart rate turbulence domain from the conceptual model of SNOMED-CT. IEEE Trans Biomed Eng 2013; 60:1825-33. [PMID: 23372067 DOI: 10.1109/tbme.2013.2243147] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Electronic health record (EHR) automates the clinician workflow, allowing evidence-based decision support and quality management. We aimed to start a framework for domain standardization of cardiovascular risk stratification into the EHR, including risk indices whose calculation involves ECG signal processing. We propose the use of biomedical ontologies completely based on the conceptual model of SNOMED-CT, which allows us to implement our domain in the EHR. In this setting, the present study focused on the heart rate turbulence (HRT) domain, according to its concise guidelines and clear procedures for parameter calculations. We used 289 concepts from SNOMED-CT, and generated 19 local extensions (new concepts) for the HRT specific concepts not present in the current version of SNOMED-CT. New concepts included averaged and individual ventricular premature complex tachograms, initial sinus acceleration for turbulence onset, or sinusal oscillation for turbulence slope. Two representative use studies were implemented: first, a prototype was inserted in the hospital information system for supporting HRT recordings and their simple follow up by medical societies; second, an advanced support for a prospective scientific research, involving standard and emergent signal processing algorithms in the HRT indices, was generated and then tested in an example database of 27 Holter patients. Concepts of the proposed HRT ontology are publicly available through a terminology server, hence their use in any information system will be straightforward due to the interoperability provided by SNOMED-CT.
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Affiliation(s)
- Cristina Soguero-Ruiz
- Department of Signal Theory and Communications, Universidad Rey Juan Carlos, Fuenlabrada 28943, Spain.
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Cebula S, Sredniawa B, Kowalczyk J, Musialik-Lydka A, Wozniak A, Sedkowska A, Swiatkowski A, Kalarus Z. The significance of heart rate turbulence in predicting major cardiovascular events in patients after myocardial infarction treated invasively. Ann Noninvasive Electrocardiol 2012; 17:230-40. [PMID: 22816542 DOI: 10.1111/j.1542-474x.2012.00510.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The role of heart rate turbulence (HRT) related to baroreflex sensitivity in predicting mortality after myocardial infarction (MI) has been confirmed by several investigators. However, the significance of HRT in predicting major adverse cardiovascular events (MACE) following acute MI is unknown. PURPOSE To analyze the prognostic value of HRT and other independent risk factors associated with autonomic regulation of MACE. METHODS HRT was assessed based on 24-hour Holter recordings in 500 patients (pts) with acute MI treated invasively (352 M, aged 60.58 years). Turbulence onset (TO,%), slope (TS, ms/RR interval) and timing (TT) were calculated. TO ≥ 0, TS ≤ 2.5 and TT ≥ 10 were considered abnormal; classic and own categories were defined. Time domain heart rate variability (HRV) parameters were also calculated. Within 30.1 ± 15.1 months of follow-up, MACE occurred in 116 pts. RESULTS Abnormal TO, TS, and TT were significantly more frequent in patients with MACE (P < 0.05 for each parameter, classic and own categories). In long-term follow-up, the largest differences in MACE were observed in patients with own category comprising abnormal TO, TS, and TT. Combining HRT parameters with SDNN (total HRV index) augmented their predictive value. Independent risk factors for MACE were TT, SDNN and rMSSD (a parasympathetic activity index) (HR 2.44, 1.71 and 1.69 respectively; P < 0.05). CONCLUSION Abnormal HRT distinguishes patients at risk of MACE after MI. Own category encompassing three abnormal HRT parameters best differentiates patients at risk of MACE. Turbulence timing is a strong independent risk factor for MACE following MI.
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Affiliation(s)
- Sylwia Cebula
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland
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NICOLINI PAOLA, CIULLA MICHELEM, ASMUNDIS CARLODE, MAGRINI FABIO, BRUGADA PEDRO. The Prognostic Value of Heart Rate Variability in the Elderly, Changing the Perspective: From Sympathovagal Balance to Chaos Theory. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:622-38. [DOI: 10.1111/j.1540-8159.2012.03335.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Celik A, Aytan P, Dursun H, Koc F, Ozbek K, Sagcan M, Kadi H, Ceyhan K, Onalan O, Onrat E. Heart rate variability and heart rate turbulence in hypothyroidism before and after treatment. Ann Noninvasive Electrocardiol 2012; 16:344-50. [PMID: 22008489 DOI: 10.1111/j.1542-474x.2011.00461.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Cardiac autonomic dysfunction may develop in patients with clinical or subclinical thyroid hormone deficiency. Heart rate variability (HRV) and heart rate turbulence (HRT) are used for evaluating changes in cardiac autonomic functions and also used to provide risk stratification in cardiac and noncardiac diseases. The aim of this study is to evaluate cardiac autonomic functions before and 6 months after thyroid replacement therapy in patients with thyroid hormone deficiency. METHODS Forty hypothyroid patients (mean age 48 ± 13, four male) and 31 healthy controls (mean age 51 ± 12, three male) were included in the study. Twenty-four hour ambulatory electrocardiogram recordings were taken using Pathfinder Software Version V8.255 (Reynolds Medical). The time domain parameters of HRV analysis were performed using the Heart Rate Variability Software (version 4.2.0, Norav Medical Ltd, Israel). HRT parameters, Turbulence Onset (TO), and Turbulence Slope (TS) were calculated with HRT! View Version 0.60-0.1 software. RESULTS HRV and HRT parameters were decreased in the patient group (SDNN; P < 0.001, SDANN; P < 0.009, RMSSD; P = 0.049, TO; P = 0.035, TS; P < 0.001). After 6 months of thyroid replacement therapy, there were no significant changes observed in either HRV or HRT. CONCLUSIONS Hypothyroidism may cause cardiac autonomic dysfunction. Treating hypothyroidism with L-thyroxine therapy does not effectively restore cardiac autonomic function. HRV and HRT can be used as to help monitor cardiovascular-related risk in this population.
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Affiliation(s)
- Atac Celik
- Cardiology Department, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey.
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22
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Fam JM, Ching CK. Review on Non-Invasive Risk Stratification of Sudden Cardiac Death. PROCEEDINGS OF SINGAPORE HEALTHCARE 2011. [DOI: 10.1177/201010581102000404] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Sudden cardiac death (SCD) is one of the most significant and challenging problems facing modern medicine today given its unpredictable nature. The evaluation of the patient at risk for sudden cardiac death still remains a complex task. The use of ICDs (implantable cardioverter defibrillators) remains the mainstay of primary prevention of sudden cardiac death. However, much remains to be determined on how best to identify patients at high risk of sudden cardiac death who would most benefit from ICD implantations. This paper will review the current issues in the risk assessment of sudden cardiac death and non-invasive markers of sudden death.
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Affiliation(s)
- Jiang Ming Fam
- Department of Cardiovascular Medicine, National Heart Centre, Singapore
| | - Chi Keong Ching
- Department of Cardiovascular Medicine, National Heart Centre, Singapore
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Teixeira ARL, Hecht MM, Guimaro MC, Sousa AO, Nitz N. Pathogenesis of chagas' disease: parasite persistence and autoimmunity. Clin Microbiol Rev 2011; 24:592-630. [PMID: 21734249 PMCID: PMC3131057 DOI: 10.1128/cmr.00063-10] [Citation(s) in RCA: 147] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Acute Trypanosoma cruzi infections can be asymptomatic, but chronically infected individuals can die of Chagas' disease. The transfer of the parasite mitochondrial kinetoplast DNA (kDNA) minicircle to the genome of chagasic patients can explain the pathogenesis of the disease; in cases of Chagas' disease with evident cardiomyopathy, the kDNA minicircles integrate mainly into retrotransposons at several chromosomes, but the minicircles are also detected in coding regions of genes that regulate cell growth, differentiation, and immune responses. An accurate evaluation of the role played by the genotype alterations in the autoimmune rejection of self-tissues in Chagas' disease is achieved with the cross-kingdom chicken model system, which is refractory to T. cruzi infections. The inoculation of T. cruzi into embryonated eggs prior to incubation generates parasite-free chicks, which retain the kDNA minicircle sequence mainly in the macrochromosome coding genes. Crossbreeding transfers the kDNA mutations to the chicken progeny. The kDNA-mutated chickens develop severe cardiomyopathy in adult life and die of heart failure. The phenotyping of the lesions revealed that cytotoxic CD45, CD8(+) γδ, and CD8α(+) T lymphocytes carry out the rejection of the chicken heart. These results suggest that the inflammatory cardiomyopathy of Chagas' disease is a genetically driven autoimmune disease.
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Affiliation(s)
- Antonio R L Teixeira
- Chagas Disease Multidisciplinary Research Laboratory, University of Brasilia, Federal District, Brazil.
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Poliwczak AR, Białkowska J, Broncel M, Koziróg M, Dworniak K, Kotecka K, Jabłkowski M. Heart rhythm turbulence and NT-proBNP in decompensated liver cirrhosis--a pilot study. Med Sci Monit 2011; 17:PR5-11. [PMID: 21629202 PMCID: PMC3539552 DOI: 10.12659/msm.881788] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 02/23/2011] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Heart rhythm turbulence (HRT) is a novel tool for evaluation of cardiovascular mortality. Liver cirrhosis is associated with hemodynamic and myocardial disturbances termed cirrhotic cardiomyopathy. In the stable stage of liver cirrhosis, systolic and myocardial dysfunction is correlated with brain natriuretic peptide (BNP). The aim was to evaluate HRT and its correlation with NT-proBNP, echocardiographic and biochemical parameters in patients with decompensation of liver cirrhosis. MATERIAL/METHODS The study included 18 patients with decompensated liver cirrhosis and 18 healthy volunteers. Participants underwent echocardiography and 24-hour ECG monitoring. Serum NT-proBNP and other biochemical parameters were measured. Turbulence onset (TO) and turbulence slope (TS) were used to indicate HRT. RESULTS Mean HR (87/min vs. 75/min), TO (-0.385% vs. -0.92%), NT-proBNP (304.85 pg/ml vs. 83.2 pg/ml), LAd (42.5 mm vs. 34.5 mm), RVdd (29.5 mm vs. 25 mm), SPAP (36.5 mmHg vs. 22.5 mmHg) were significantly (p<0.05) higher in patients with liver cirrhosis. Patients with normal TO and TS had better stage in Child-Pugh classification (P=0.04) than patients with abnormal values. Significant negative correlation was found between creatinine and TO, and between mean HR and TS, and significant positive correlation was found between LAd and TS. LV diastolic dysfunction was noted in a majority of cirrhotic patients (n=16). CONCLUSIONS Patients with decompensated cirrhosis had elevated levels of NT-proBNP and LV diastolic dysfunction. TO values in cirrhotic patients differed significantly from the control group. These findings can indicate risk of symptomatic heart failure development and may be a marker of cirrhotic cardiomyopathy. HRT parameters seem not to be appropriate death predicators.
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Affiliation(s)
- Adam Rafał Poliwczak
- Department of Internal Diseases and Clinical Pharmacology, Medical University of Lodz, Lodz, Poland.
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Stein PK, Barzilay JI. Relationship of abnormal heart rate turbulence and elevated CRP to cardiac mortality in low, intermediate, and high-risk older adults. J Cardiovasc Electrophysiol 2010; 22:122-7. [PMID: 21134026 DOI: 10.1111/j.1540-8167.2010.01967.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION We examined whether heart rate turbulence (HRT) and C-reactive protein (CRP) add to traditional risk factors for cardiac mortality in older adults at low, intermediate, and high risk. METHODS AND RESULTS One thousand two hundred and seventy-two individuals, age ≥ 65 years, with 24-hour Holter recordings were studied. HRT, which quantifies heart rate response to ventricular premature contractions, was categorized as: both turbulence onset (TO) and turbulence slope (TS) normal; TO abnormal; TS abnormal; or both abnormal. Independent risks for cardiac mortality associated with HRT or, for comparison, elevated CRP (>3.0 mg/L), were calculated using Cox regression analysis adjusted for traditional cardiovascular disease risk factors and stratified by the presence of no, isolated subclinical (i.e., intermediate risk) or clinical cardiovascular disease. Having TS + TO abnormal compared to both normal was associated with cardiac mortality in the low-risk group [HR 7.9, 95% confidence interval (CI) 2.8-22.5, (P < 0.001)]. In the high and intermediate risk groups, abnormal TS and TS + TO ([HR 2.2, 95% CI 1.5-4.0, P = 0.016] and [HR 2.7, 95% CI 1.2-5.9, P = 0.012]), respectively, were also significantly associated with cardiac mortality. In contrast, elevated CRP was associated with increased cardiac mortality risk only in low-risk individuals [HR 2.5, 95% CI 1.3-5.1, P = 0.009]. Among low risk, the c-statistic was 0.706 for the base model, 0.725 for the base model with CRP, and 0.767 for the base model with HRT. CONCLUSIONS Abnormal HRT independently adds to risk stratification of low, intermediate and high-risk individuals, but HRT and CRP appear to both add to stratification of those considered low risk.
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Affiliation(s)
- Phyllis K Stein
- Washington University School of Medicine, St. Louis, Missouri, USA.
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Desai MY, Watanabe MA, Laddu AA, Hauptman PJ. Pharmacologic modulation of parasympathetic activity in heart failure. Heart Fail Rev 2010; 16:179-93. [DOI: 10.1007/s10741-010-9195-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Role of Heart Rate Variability in Non-Invasive Electrophysiology: Prognostic Markers of Cardiovascular Disease. J Arrhythm 2010. [DOI: 10.1016/s1880-4276(10)80021-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Smith D, Solem K, Laguna P, Martínez JP, Sörnmo L. Model-based detection of heart rate turbulence using mean shape information. IEEE Trans Biomed Eng 2009; 57:334-42. [PMID: 19709950 DOI: 10.1109/tbme.2009.2030669] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A generalized likelihood ratio test (GLRT) statistic is proposed for detection of heart rate turbulence (HRT), where a set of Karhunen-LoEve basis functions models HRT. The detector structure is based on the extended integral pulse frequency modulation model that accounts for the presence of ectopic beats and HRT. This new test statistic takes a priori information regarding HRT shape into account, whereas our previously presented GLRT detector relied solely on the energy contained in the signal subspace. The spectral relationship between heart rate variability (HRV) and HRT is investigated for the purpose of modeling HRV "noise" present during the turbulence period, the results suggesting that the white noise assumption is feasible to pursue. The performance was studied for both simulated and real data, leading to results which show that the new GLRT detector is superior to the original one as well as to the commonly used parameter turbulence slope (TS) on both types of data. Averaging ten ventricular ectopic beats, the estimated detection probability of the new detector, the previous detector, and TS were found to be 0.83, 0.35, and 0.41, respectively, when the false alarm probability was held fixed at 0.1.
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Affiliation(s)
- Danny Smith
- Signal Processing Group, Department of Electrical and Information Technology, Lund University, and Center of Integrative Electrocardiology, Lund University (CIEL), 22100 Lund, Sweden.
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Stein PK, Barzilay JI, Chaves PHM, Mistretta SQ, Domitrovich PP, Gottdiener JS, Rich MW, Kleiger RE. Novel measures of heart rate variability predict cardiovascular mortality in older adults independent of traditional cardiovascular risk factors: the Cardiovascular Health Study (CHS). J Cardiovasc Electrophysiol 2009; 19:1169-74. [PMID: 18631274 DOI: 10.1111/j.1540-8167.2008.01232.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
UNLABELLED Novel HRV Predicts CV Mortality in the Elderly. BACKGROUND It is unknown whether abnormal heart rate turbulence (HRT) and abnormal fractal properties of heart rate variability identify older adults at increased risk of cardiovascular death (CVdth). METHODS Data from 1,172 community-dwelling adults, ages 72 +/- 5 (65-93) years, who participated in the Cardiovascular Health Study (CHS), a study of risk factors for CV disease in people >or=65 years. HRT and the short-term fractal scaling exponent (DFA1) derived from 24-hour Holter recordings. HRT categorized as: normal (turbulence slope [TS] and turbulence onset [TO] normal) or abnormal (TS and/or TO abnormal). DFA1 categorized as low (<or=1) or high (>1). Cox regression analyses stratified by Framingham Risk Score (FRS) strata (low = <10, mid = 10-20, and high >20) and adjusted for prevalent clinical cardiovascular disease (CVD), diabetes, and quartiles of ventricular premature beat counts (VPCs). RESULTS CVdths (N = 172) occurred over a median follow-up of 12.3 years. Within each FRS stratum, low DFA1 + abnormal HRT predicted risk of CVdth (RR = 7.7 for low FRS; 3.6, mid FRS; 2.8, high FRS). Among high FRS stratum participants, low DFA1 alone also predicted CVdth (RR = 2.0). VPCs in the highest quartile predicted CVdth, but only in the high FRS group. Clinical CV disease predicted CVdth at each FRS stratum (RR = 2.9, low; 2.6, mid; and 1.9, high). Diabetes predicted CVdth in the highest FRS group only (RR = 2.2). CONCLUSIONS The combination of low DFA1 + abnormal HRT is a strong risk factor for CVdth among older adults even after adjustment for conventional CVD risk measures and the presence of CVD.
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Affiliation(s)
- Phyllis K Stein
- Washington University School of Medicine, St Louis, Missouri 63108, USA.
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Solem K, Laguna P, Martínez JP, Sörnmo L. Model-based detection of heart rate turbulence. IEEE Trans Biomed Eng 2009; 55:2712-22. [PMID: 19126450 DOI: 10.1109/tbme.2008.2002113] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In this study, the integral pulse frequency modulation model is extended to account for the presence of ectopic beats and heart rate turbulence (HRT). Based on this model, a new statistical approach to the detection and characterization of HRT is presented. The detector structure involves a set of Karhunen-LoEve basis functions and a generalized likelihood ratio test statistic T(x) . The three most significant basis functions reflect the difference in heart rate prior to a ventricular ectopic beat (VEB) compared to after HRT, the "average" HRT, and a delayed contribution to HRT, respectively. Detector performance was studied on both simulated and ECG signals. Three different simulations were performed for the purpose of studying the influence of SNR, QRS jitter, and ECG sampling rate. The results show that the HRT test statistic T(x) performs better in all simulations than do the commonly used parameters known as turbulence onset (TO) and turbulence slope (TS). In order to attain the same performance as T(x), TS needs at least twice the amount of VEBs for averaging, and TO at least four times. The detector performance was also studied on ECGs acquired from eight patients who underwent hemodialysis treatment with the goal to discriminate between patients considered to be hypotension-resistant (HtR) and hypotension-prone (HtP). The results show that T(x) exhibits larger mean values in HtR patients than in HtP, suggesting that HRT is mostly present in HtR patients. The overlap between the two groups was larger for TO and TS than for T(x).
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Affiliation(s)
- Kristian Solem
- Signal Processing Group, Department of Electrical and Information Technology, Lund University, S-221 00 Lund, Sweden.
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Bauer A, Malik M, Schmidt G, Barthel P, Bonnemeier H, Cygankiewicz I, Guzik P, Lombardi F, Müller A, Oto A, Schneider R, Watanabe M, Wichterle D, Zareba W. Heart rate turbulence: standards of measurement, physiological interpretation, and clinical use: International Society for Holter and Noninvasive Electrophysiology Consensus. J Am Coll Cardiol 2008; 52:1353-65. [PMID: 18940523 DOI: 10.1016/j.jacc.2008.07.041] [Citation(s) in RCA: 260] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Revised: 06/18/2008] [Accepted: 07/10/2008] [Indexed: 01/09/2023]
Abstract
This consensus statement has been compiled on behalf of the International Society for Holter and Noninvasive Electrophysiology. It reviews the topic of heart rate turbulence (HRT) and concentrates on technologies for measurement, physiologic background and interpretation, and clinical use of HRT. It also lists suggestions for future research. The phenomenon of HRT refers to sinus rhythm cycle-length perturbations after isolated premature ventricular complexes. The physiologic pattern of HRT consists of brief heart rate acceleration (quantified by the so-called turbulence onset) followed by more gradual heart rate deceleration (quantified by the so-called turbulence slope) before the rate returns to a pre-ectopic level. Available physiologic investigations confirm that the initial heart rate acceleration is triggered by transient vagal inhibition in response to the missed baroreflex afferent input caused by hemodynamically inefficient ventricular contraction. A sympathetically mediated overshoot of arterial pressure is responsible for the subsequent heart rate deceleration through vagal recruitment. Hence, the HRT pattern is blunted in patients with reduced baroreflex. The HRT pattern is influenced by a number of factors, provocations, treatments, and pathologies reviewed in this consensus. As HRT measurement provides an indirect assessment of baroreflex, it is useful in those clinical situations that benefit from baroreflex evaluation. The HRT evaluation has thus been found appropriate in risk stratification after acute myocardial infarction, risk prediction, and monitoring of disease progression in heart failure, as well as in several other pathologies.
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Affiliation(s)
- Axel Bauer
- Deutsches Herzzentrum, Medizinische Klinik der Technischen Universität München, Munich, Germany
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Hallstrom AP, Wyse DG, McAnulty J. Clinical criteria for predicting benefit of ICD/PM in post myocardial infarction patients: an AVID and CAST analysis. J Interv Card Electrophysiol 2008; 23:159-66. [PMID: 18810620 DOI: 10.1007/s10840-008-9304-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Accepted: 07/11/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND Three clinical factors from the Antiarrhythmics Versus Implantable Defibrillators (AVID) trial-heart failure, left ventricular dysfunction and certain historical features defined a subgroup in which an implantable cardioverter defibrillator (ICD/PM) has a mortality advantage over amiodarone. METHODS These three factors were jointly evaluated in the AVID cohort with ischemic heart disease (IHD) and the results applied in placebo-treated post-infarction patients in the cardiac arrhythmia suppression trial (CAST). RESULTS Similar predictive power was noted in AVID patients with IHD. In CAST the factors defined three groups; one group (5.8%), corresponding to AVID patients that had high risk and benefited from an ICD/PM and another group (17.2%) corresponding to patients in AVID where the risk was moderate and ICD/PM and amiodarone had equal efficacy, demonstrated a two-fold higher risk of sudden arrhythmic than non-arrhythmic death and hence would be expected to benefit from antiarrhythmia therapy. The third group, corresponding to AVID patients with low risk of arrhythmia, demonstrated similar and low risks of sudden arrhythmic and non-arrhythmic death. Thus this group (77%) is unlikely to benefit from indiscriminate antiarrhythmia therapy. Onset of risk of death in CAST patients was offset from randomization by 3 to 6 months. CONCLUSIONS Readily available clinical criteria identify a small group likely to benefit from an ICD/PM after recent myocardial infarction (MI) and the remainder unlikely to benefit from nonselective ICD/PM therapy. Additional risk stratification should focus on the latter patients and be timed to allow ICD/PM implantation between 2 and 6 months after MI.
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Affiliation(s)
- Alfred P Hallstrom
- Department of Biostatistics, University of Washington, Seattle, WA 98105, USA.
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Brandes A, Bethge KP. [Long term electrocardiography (Holter monitoring)]. Herzschrittmacherther Elektrophysiol 2008; 19:107-129. [PMID: 18956158 DOI: 10.1007/s00399-008-0010-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Accepted: 07/14/2008] [Indexed: 05/27/2023]
Abstract
During the past almost 50 years Holter monitoring has become an established non-invasive diagnostic tool in clinical electrophysiology. It allows ECG recording independent of stationary monitoring facilities during daily life and, therefore, contains much information. In the beginning the main interest was directed towards quantitative and qualitative assessment of arrhythmias, their circadian behaviour, and the circadian behaviour of the heart rate. With advances in technology the analysis spectrum of Holter monitoring expanded, and it was used also for detection of silent myocardial ischaemia. New digital recorders and computers with large capacities made it possible to measure every single heart beat very accurately, which was a prerequisite for heart rate variability and QT-interval analysis, which provided new knowledge about the autonomic modulation of the heart rate and the circadian dynamicity of the QT interval, respectively. Beyond arrhythmia analysis Holter monitoring was increasingly used to assess prognosis in different cardiac conditions. It can also be valuable in assessing transient symptoms possibly related to arrhythmias or device dysfunction, which will not necessarily be revealed by simple device control.
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Affiliation(s)
- Axel Brandes
- Dept of Cardiology B, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark.
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Prognostic significance of inverse spatial QRS-T angle circadian pattern in myocardial infarction survivors. J Electrocardiol 2008; 42:79-84. [PMID: 18723188 DOI: 10.1016/j.jelectrocard.2008.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2008] [Indexed: 11/21/2022]
Abstract
BACKGROUND We investigated the predictive value of the spatial QRS-T angle (QRSTA) circadian variation in myocardial infarction (MI) patients. METHODS Analyzing 24-hour recordings (SEER MC, GE Marquette) from 151 MI patients (age 63 +/- 12.7), the QRSTA was computed in derived XYZ leads. QRS-T angle values were compared between daytime and night time. The end point was cardiac death or life-threatening ventricular arrhythmia in 1 year. RESULTS Overall, QRSTA was slightly higher during the day vs. the night (91 degrees vs. 87 degrees, P = .005). However, 33.8% of the patients showed an inverse diurnal QRSTA variation (higher values at night), which was correlated to the outcome (P = .001, odds ratio 6.7). In multivariate analysis, after entering all factors exhibiting univariate trend towards significance, inverse QRSTA circadian pattern remained significant (P = .036). CONCLUSION Inverse QRSTA circadian pattern was found to be associated with adverse outcome (22.4%) in MI patients, whereas a normal pattern was associated (96%) with a favorable outcome.
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Rojo-Alvarez JL, Barquero-Pérez O, Mora-Jiménez I, Everss E, Rodríguez-González AB, García-Alberola A. Heart rate turbulence denoising using support vector machines. IEEE Trans Biomed Eng 2008; 56:310-9. [PMID: 19272942 DOI: 10.1109/tbme.2008.2003146] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Heart rate turbulence (HRT) is a transient acceleration and subsequent deceleration of the heart rate after a premature ventricular complex (PVC), and it has been shown to be a strong risk stratification criterion in patients with cardiac disease. In order to reduce the noise level of the HRT signal, conventional measurements of HRT use a patient-averaged template of post-PVC tachogram (PPT), hence providing with long-term HRT indexes. We hypothesize that the reduction of the noise level at each isolated PPT, using signal processing techniques, will allow us to estimate short-term HRT indexes. Accordingly, its application could be extended to patients with reduced number of available PPT. In this paper, several HRT denoising procedures are proposed and tested, with special attention to support vector machine (SVM) estimation, as this is a robust algorithm that allows us to deal with few available time samples in the PPT. Pacing-stimulated HRT during electrophysiological study are used as a low-noise gold standard. Measurements in a 24-h Holter patient database reveal a significant reduction in the bias and the variance of HRT measurements. We conclude that SVM denoising yields short-term HRT measurements and improves the signal-to-noise level of long-term HRT measurements.
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Affiliation(s)
- José Luis Rojo-Alvarez
- Department of Signal Theory and Communications, University Rey Juan Carlos, 28943 Madrid, Spain.
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Szilágyi L, Szilágyi SM, Fördos G, Benyó Z. Quick ECG analysis for on-line holter monitoring systems. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2008; 2006:1678-81. [PMID: 17946060 DOI: 10.1109/iembs.2006.259583] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Computer-aided bedside patient monitoring requires real-time analysis of vital functions. On-line Holter monitors need reliable and quick algorithms to perform all the necessary signal processing tasks. This paper presents the methods that were conceptualized and implemented at the development of such a monitoring system at Medical Clinic No. 4 of Targu-Mures. The system performs the following ECG signal processing steps: (1) Decomposition of the ECG signals using multi-resolution wavelet transform, which also eliminates most of the high and low frequency noises. These components will serve as input for wave classification algorithms; (2) Identification of QRS complexes, P and T waves using two different algorithms: a sequential clustering and a neural-network-based classification. This latter also distinguishes normal R waves from abnormal cases; (3) Localization of several kinds of arrhythmia using a spectral method. An autoregressive model is applied to estimate the series of R-R intervals. The coefficients of the AR model are predicted using the Kalman filter, and these coefficients will determine a local spectrum for each QRS complex. By analyzing this spectrum, different arrhythmia cases are identified. The algorithms were tested using the MIT-BIH signal database and own multichannel ECG registrations. The QRS complex detection ratio is over 99.5%
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Affiliation(s)
- László Szilágyi
- Dept. of Control Eng. & Inf. Technol., Budapest Univ. of Technol. & Econ, Budapest, Hungary
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Csernath G, Szilagyi L, Fordos G, Szilagyi SM. A novel ECG telemetry and monitoring system based on Z-Wave communication. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2008; 2008:2361-2364. [PMID: 19163176 DOI: 10.1109/iembs.2008.4649673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This paper presents a novel ECG telemetry system based on Z-Wave communication protocol. The proposed system consists of small portable devices that acquire, compress and transmit the ECG to a RF-USB interface connected to a central monitoring computer. The received signals are filtered, QRS complexes and P and T waves are localized, and different waveforms are classified in order to be able to provide diagnosis tools like heart rate variability and turbulence analysis. Due to the limitation of communication bandwidth, the maximum number of measuring devices connected to a central monitor is four. The proposed system composed of inexpensive components can serve as flexible alternative to current ECG monitoring systems.
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Affiliation(s)
- Geza Csernath
- Hungarian Science University of Transylvania, Targu-Mures, Romania.
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De Ferrari GM, Sanzo A, Bertoletti A, Specchia G, Vanoli E, Schwartz PJ. Baroreflex Sensitivity Predicts Long-Term Cardiovascular Mortality After Myocardial Infarction Even in Patients With Preserved Left Ventricular Function. J Am Coll Cardiol 2007; 50:2285-90. [DOI: 10.1016/j.jacc.2007.08.043] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Revised: 07/09/2007] [Accepted: 08/06/2007] [Indexed: 10/22/2022]
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Kowalewski M, Alifier M, Bochen D, Urban M. Heart rate turbulence in children--age and heart rate relationships. Pediatr Res 2007; 62:710-4. [PMID: 17957160 DOI: 10.1203/pdr.0b013e3181598836] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Heart rate turbulence (HRT) is a chronotropic response of the sinus heart rhythm to ventricular premature beat (VPB). Children show decreasing heart rate together with the maturation of the autonomic nervous system. The aim of the research was to assess the relationship between HRT parameters, age, and heart rate and time domain heart rate variability (HRV) parameters in healthy children. Twenty-four-hour ECG Holter recording was performed on 398 healthy children. The mean RR interval preceding VPB, number of VPBs, and HRT parameters-turbulence onset (TO) and turbulence slope (TS)-were determined. We observed significant correlation among TS and mean RR and age. Children with prepubertal status have lower values of TS compared with those during puberty. According to given quartiles, upper for TO was > or =-0.8%, lower for TS was < or =4.56 ms/RR, 13 patients (3%) obtained abnormal both TO and TS. The correlations between HRT and HRV parameters were observed among the youngest children. Age and heart rate preceding VPB have no effect on HRT onset in children, whereas HRT slope is highly dependent on these variables. Our results support hypothesis that in older children HRT is dependent on autonomic tone and also determined by other intrinsic modulators.
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Affiliation(s)
- Marek Kowalewski
- Second Department of Pediatrics, Medical University in Białystok, Children's Hospital, 15-274 Białystok, Poland.
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Voss A, Schroeder R, Truebner S, Goernig M, Schirdewan A, Figulla HR. Spontaneous heart rate turbulence in patients with dilated cardiomyopathy. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2007; 2006:6426-9. [PMID: 17946766 DOI: 10.1109/iembs.2006.260072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Parameters of heart rate turbulence (HRT) and blood pressure turbulence (BPT) reflect the baroreflex mediated transient acceleration-deceleration response of the sinus node triggered by a premature ventricular complex (PVC) and are known to be useful risk markers in different cardiac diseases. However, the analyses of HRT and BPT are based on the prevalence of PVC. In this study the spontaneous HRT and BPT after most premature normal beats (MPNB) was investigated in comparison to HRT and BPT after PVC. ECG and blood pressure were recorded from 91 patients with dilated cardiomyopathy (DCM) and 45 healthy subjects (REF). In 69% of DCM and 33% of REF data sets PVCs were present. HRT and BPT were determined for all patients with PVC as well as in all patients triggered by MPNB. Univariate statistical analysis of the comparison between DCM and REF revealed similar results for HRT/BPT after PVC and MPNB. In conclusion, HRT and BPT triggered by PVC might be substituted by spontaneous HRT and BPT after MPNB. In contrast to the HRT and BPT after PVC, an increased number of data sets can be included in the analysis and may lead to an enhancement in risk stratification in different cardiac diseases.
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Affiliation(s)
- A Voss
- Dept. of Med. Eng., Univ. of Appl. Sci. Jena, Germany.
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Flevari P, Georgiadou P, Leftheriotis D, Livanis E, Theodorakis G, Th Kremastinos D. Heart Rate Turbulence After Short Runs of Nonsustained Ventricular Tachycardia in Chronic Heart Failure. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:787-95. [PMID: 17547613 DOI: 10.1111/j.1540-8159.2007.00751.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Heart rate turbulence (HRT) following isolated premature complexes is a baroreceptor-mediated prognostic marker. Short runs of spontaneous, nonsustained ventricular tachycardia (nsVT) exert a greater hemodynamic effect than extrasystoles and may trigger a more potent turbulence-like response (HRT(VT)), possibly related to other risk-related markers, such as heart rate variability (HRV), left ventricular ejection fraction (EF), and original HRT parameters (turbulence slope [TS] and turbulence onset [TO]). METHODS We studied 27 patients with heart failure (HF) and nsVT (4-7 beats) on 24-hour Holter electrocardiographic recordings (mean age 58 +/- 3.6 years, EF 36%+/- 5.0%). Following nsVT, TS(VT) and TO(VT) were measured according to the original definitions. HRV, TS, and TO were also assessed. RESULTS HRT(VT) parameters were related to HRV. A significant relation existed between TS(VT) and EF (r= 0.66, P < 0.05). HRT(VT) parameters were related to the originally described (TS and TO), whereas TO(VT) was higher than TO (1.63 +/- 1.6 vs -1.7 +/- 0.65, P < 0.05). CONCLUSIONS In mild-to-moderate HF, turbulence is observed following short nsVT runs and is related to prognostically important HRV indexes and EF. HRT(VT) is similar to HRT but TO(VT) is shifted toward more positive values than TO. HRT(VT) might be prognostically significant.
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Affiliation(s)
- Panayota Flevari
- Second Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece.
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Watanabe MA, Alford M, Schneider R, Bauer A, Barthel P, Stein PK, Schmidt G. Demonstration of circadian rhythm in heart rate turbulence using novel application of correlator functions. Heart Rhythm 2007; 4:292-300. [PMID: 17341391 DOI: 10.1016/j.hrthm.2006.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2006] [Accepted: 11/09/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Demonstration of a circadian rhythm in two parameters of heart rate turbulence--turbulence onset (TO) and turbulence slope (TS)--has been difficult. OBJECTIVE The aim of this study was to devise a new method for detecting circadian rhythm in noisy data and to apply it to selected Holter recordings from two postmyocardial infarction databases: Cardiac Arrhythmia Suppression Trial (CAST, n = 684) and Innovative Stratification of Arrhythmic Risk (ISAR, n = 327). METHODS For each patient, TS and TO were calculated for each hour with >4 ventricular premature contractions (VPCs). An autocorrelation function Corr(Deltat) = <TS(t) TS(t + Deltat)> then was calculated and averaged over all patients. Positive Corr(Deltat) indicates that TS at a given hour and Deltat hours later are similar. TO was treated likewise. Simulations and mathematical analysis showed that a circadian rhythm required Corr(Deltat) to have a U-shape consisting of positive values near Deltat = 0 and 23 and negative values for intermediate Deltat. Significant deviation of Corr(Deltat) from the correlator function of pure noise was evaluated as a Chi-square value. RESULTS Circadian patterns were not apparent in hourly averages of TS and TO plotted against clock time, which had large error bars. However, their correlator functions produced Chi-square values of approximately 10 in CAST (both P <.0001) and approximately 3 in ISAR (both P <.0001), indicating the presence of circadian rhythmicity. CONCLUSION Correlator functions may be a powerful tool for detecting the presence of circadian rhythms in noisy data, even with recordings limited to 24 hours.
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Affiliation(s)
- Mari A Watanabe
- Department of Internal Medicine, St. Louis University, St. Louis, Missouri 63110, USA.
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Nattel S, Comtois P. Teasing out circadian variability in heart rate turbulence: A new approach to detecting biorhythms underlying cardiac function. Heart Rhythm 2007; 4:301-3. [PMID: 17341392 DOI: 10.1016/j.hrthm.2006.12.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Indexed: 10/23/2022]
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Bauer A, Deisenhofer I, Schneider R, Zrenner B, Barthel P, Karch M, Wagenpfeil S, Schmitt C, Schmidt G. Effects of circumferential or segmental pulmonary vein ablation for paroxysmal atrial fibrillation on cardiac autonomic function. Heart Rhythm 2006; 3:1428-35. [PMID: 17161785 DOI: 10.1016/j.hrthm.2006.08.025] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2006] [Accepted: 08/22/2006] [Indexed: 11/16/2022]
Abstract
BACKGROUND Circumferential and segmental pulmonary vein ablations are two established treatment strategies for ablation of atrial fibrillation. Both techniques require the application of radiofrequency current at anatomical sites that are close to autonomic ganglia. However, the effects of current pulmonary vein ablation techniques on cardiac autonomic function are unknown. OBJECTIVE The purpose of this study was to analyze the short- and long-term effects of circumferential and segmental pulmonary vein ablation on cardiac autonomic function. METHODS One hundred patients with highly symptomatic atrial fibrillation were randomly assigned to undergo either circumferential or segmental pulmonary vein ablation. Holter recordings were recorded at baseline and at regular intervals for up to 1 year after ablation. Autonomic function was assessed by deceleration capacity and acceleration capacity of heart rate as well as by standard measures of heart rate variability. RESULTS In the circumferential pulmonary vein ablation group, deceleration capacity and acceleration capacity decreased highly significantly from 5.7 +/- 2.1 ms and -8.0 +/- 1.9 ms at baseline to 3.3 +/- 1.8 ms and -5.5 +/- 2.3 ms directly after ablation, respectively (P<.00001). Impairment of deceleration capacity and acceleration capacity was present up to 1 year after ablation. In the segmental pulmonary vein ablation group, deceleration capacity and acceleration capacity decreased from 5.8 +/- 2.0 ms and -7.8 +/- 1.6 ms at baseline to 3.4 +/- 1.2 ms and -6.0 +/- 2.4 ms directly after ablation (P<.00001), respectively. However, deceleration capacity and acceleration capacity returned to baseline values within 1 month. CONCLUSIONS Circumferential and segmental pulmonary vein ablations induce an immediate decrease of autonomic function. However, while this decrease is only transient with segmental pulmonary vein ablation, it persists with circumferential pulmonary vein ablation for at least 1 year.
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Affiliation(s)
- Axel Bauer
- I. Medizinische Klinik der Technischen Universität München and Deutsches Herzzentrum München, Munich, Germany
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Segerson NM, Wasmund SL, Abedin M, Pai RK, Daccarett M, Akoum N, Wall TS, Klein RC, Freedman RA, Hamdan MH. Heart rate turbulence parameters correlate with post-premature ventricular contraction changes in muscle sympathetic activity. Heart Rhythm 2006; 4:284-9. [PMID: 17341389 PMCID: PMC1865126 DOI: 10.1016/j.hrthm.2006.10.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2006] [Accepted: 10/18/2006] [Indexed: 01/09/2023]
Abstract
BACKGROUND Heart rate turbulence (HRT) has been shown to be vagally mediated with a strong correlation to baroreflex indices. However, the relationship between HRT and peripheral sympathetic nerve activity (SNA) after a premature ventricular contraction (PVC) remains unclear. OBJECTIVE We sought to evaluate the relationship between HRT and the changes in peripheral SNA after PVCs. METHODS We recorded postganglionic muscle SNA during electrocardiogram monitoring in eight patients with spontaneous PVCs. Fifty-two PVCs were observed and analyzed for turbulence onset (TO) and slope (TS). SNA was quantified during (1) the dominant burst after the PVC (dominant burst area) and (2) the 10 seconds after the dominant burst (postburst SNA). RESULTS The mean TO was 0.1% +/- 4.6%, and the mean TS was 6.1 +/- 6.6. The dominant burst area negatively correlated with TO (r = -0.50, P = .0002). The postburst SNA showed a significant positive correlation with TO (r = 0.44, P = .001) and a negative correlation with TS (r = -0.42, P = .002). These correlations remained significant after controlling for either the PVC coupling interval or the left ventricular ejection fraction. CONCLUSIONS Our findings highlight the relationship between perturbations in HRT and pathology in the sympathetic limb of the autonomic nervous system. Future studies are needed to evaluate the prognostic role of baroreflex control of sympathetic activity in patients with structural heart disease.
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Affiliation(s)
- Nathan M Segerson
- Department of Internal Medicine, Division of Cardiology, University of Utah, Salt Lake City, Utah 84132, USA.
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Casella M, Dello Russo A, Pace M, Pelargonio G, Ierardi C, Sanna T, Messano L, Bencardino G, Valsecchi S, Mangiola F, Lanza GA, Zecchi P, Crea F, Bellocci F. Heart Rate Turbulence as a Noninvasive Risk Predictor of Ventricular Tachyarrhythmias in Myotonic Dystrophy Type 1. J Cardiovasc Electrophysiol 2006; 17:871-6. [PMID: 16903966 DOI: 10.1111/j.1540-8167.2006.00517.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Myotonic dystrophy type 1 (MD1) is the most common muscular dystrophy of adult life. Cardiac involvement is characterized by disorders of atrioventricular conduction, ventricular arrhythmias, and sudden death. Heart rate turbulence (HRT) is a noninvasive risk predictor in patients affected by ischemic heart disease. The aim of our study is to assess the prognostic value of HRT in MD1 patients. METHODS AND RESULTS We performed HRT analysis by 24-hour Holter recording to calculate turbulence onset (TO) and turbulence slope (TS) in 29 MD1 patients (mean age 52 +/- 10 years), and in 30 patients (mean age 52 +/- 13 years) with frequent ventricular arrhythmias and structurally normal heart (VANH). An electrophysiological study (EPS) tested ventricular arrhythmias inducibility in 22 MD1 patients. TO was significantly different between MD1 and VANH patients (-1.66 +/- 2.04 and -2.98 +/- 1.79%, respectively, P 0.01), while no difference was observed in TS between MD1 and VANH patients (11.12 +/- 6.46 and 9.12 +/- 6 msec/beat, respectively). On EPS, sustained ventricular arrhythmias (SVA) were induced in six MD1 patients. TO was significantly different in inducible MD1 patients (0.88 +/- 1.95%), as compared with both noninducible (-2.49 +/- 1.43%, P < 0.001) or no eligible to EPS (-1.93 +/- 1.63%, P < 0.005) MD1 patients and to VANH patients (-2.98 +/- 1.79%, P < 0.001). CONCLUSIONS An impairment of TO, a measure of HRT, suggesting impaired cardiac parasympathetic activity, may be a useful, noninvasive predictor of arrhythmic risk in MD1 patients.
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Affiliation(s)
- Michela Casella
- Institute of Cardiology, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy.
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Watanabe MA. Heart Rate Turbulence Slope Reduction in Imminent Ventricular Tachyarrhythmia and its Implications. J Cardiovasc Electrophysiol 2006; 17:735-40. [PMID: 16836669 DOI: 10.1111/j.1540-8167.2006.00456.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The aim of this study was to see whether heart rate turbulence (HRT) parameters change preceding imminent ventricular tachyarrhythmias (VT/VF). METHODS AND RESULTS The Spontaneous Ventricular Tachyarrhythmia Database (Medtronic Version 1.0) consisting of 83 paired (control and pre-VT/VF) sets of 1,000 RR intervals recorded by the Medtronic Jewel Plus ICD was used. Sixty-one control records and 69 pre-VT/VF records had two or more ectopic beats, allowing calculation of six HRT indices: means and standard deviations (SD) of turbulence slope (TS), turbulence onset (TO), and turbulence timing (TT). The only index found to be different between control and pre-VT/VF records was SD of TS (4.2 +/- 3.0 control vs 3.1 +/- 1.9 pre-VT/VF, P < 0.05). Thirty-one datasets classified as having normal HRT in control demonstrated a decrease of both TS mean (P < 0.01) and SD (P < 0.01), and loss of correlation between TS mean and left ventricular ejection fraction (LVEF) preceding VT/VF (P < 0.0001 control, P = 0.8 pre-VT/VF). CONCLUSION Both mean and SD of TS are reduced before VT/VF, but only in patients who have normal baseline HRT, and are capable of manifesting reduction. This may be why previous studies could not agree on pre-arrhythmia characteristics.
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Affiliation(s)
- Mari A Watanabe
- Internal Medicine Department, Munich University of Technology, Munich, Germany.
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Abstract
Ambulatory electrocardiographic (AECG) monitoring is an essential tool in the diagnostic evaluation of patients with cardiac arrhythmias. Recent advances in solid-state technology have improved the quality of the ECG signals and new dedicated algorithms have expanded the clinical application of software-based AECG analysis systems. These advances, in addition to the availability of inexpensive large storage capacities, and very long-term continuous high-quality AECG monitoring, have opened new potential uses for AECG. New digital recorders have the capability of multichannel simultaneous recordings (from 3 to 12 leads) and for telemetred signal transduction. These possibilities will expand the traditional uses of AECG for arrhythmia detection, as arrhythmia monitoring to assess drug and device efficacies has been further defined by new studies. The analysis of transient ST-segment deviation still remains controversial, but considerably more data are now available, especially about the prognostic value of detecting asymptomatic ischaemia. Heart rate variability analysis has shown promise for predicting mortality rates in cardiac patients at high risk. We review recent advances in this field of non-invasive cardiac testing.
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Affiliation(s)
- Frank Enseleit
- Clinic of Cardiology, Cardiovascular Center, University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
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Watanabe MA. Role of hypotension in heart rate turbulence. Heart Rhythm 2005; 2:828-9. [PMID: 16051117 DOI: 10.1016/j.hrthm.2005.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2005] [Indexed: 10/25/2022]
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