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Kwon SB, Weinerman B, Nametz D, Megjhani M, Lee I, Habib A, Barry O, Park S. Non-invasive pulse arrival time is associated with cardiac index in pediatric heart transplant patients with normal ejection fraction. Physiol Meas 2024; 45:07NT01. [PMID: 38986482 PMCID: PMC11262133 DOI: 10.1088/1361-6579/ad61b9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 06/05/2024] [Accepted: 07/10/2024] [Indexed: 07/12/2024]
Abstract
Objective.Cardiac Index (CI) is a key physiologic parameter to ensure end organ perfusion in the pediatric intensive care unit (PICU). Determination of CI requires invasive cardiac measurements and is not routinely done at the PICU bedside. To date, there is no gold standard non-invasive means to determine CI. This study aims to use a novel non-invasive methodology, based on routine continuous physiologic data, called Pulse Arrival Time (PAT) as a surrogate for CI in patients with normal Ejection Fraction (EF).Approach.Electrocardiogram (ECG) and photoplethysmogram (PPG) signals were collected from beside monitors at a sampling frequency of 250 samples per second. Continuous PAT, derived from the ECG and PPG waveforms was averaged per patient. Pearson's correlation coefficient was calculated between PAT and CI, PAT and heart rate (HR), and PAT and EF.Main Results.Twenty patients underwent right heart cardiac catheterization. The mean age of patients was 11.7 ± 5.4 years old, ranging from 11 months old to 19 years old, the median age was 13.4 years old. HR in this cohort was 93.8 ± 17.0 beats per minute. The average EF was 54.4 ± 9.6%. The average CI was 3.51 ± 0.72 l min-1m-2, with ranging from 2.6 to 4.77 l min-1m-2. The average PAT was 0.31 ± 0.12 s. Pearson correlation analysis showed a positive correlation between PAT and CI (0.57,p< 0.01). Pearson correlation between HR and CI, and correlation between EF and CI was 0.22 (p= 0.35) and 0.03 (p= 0.23) respectively. The correlation between PAT, when indexed by HR (i.e. PAT × HR), and CI minimally improved to 0.58 (p< 0.01).Significance.This pilot study demonstrates that PAT may serve as a valuable surrogate marker for CI at the bedside, as a non-invasive and continuous modality in the PICU. The use of PAT in clinical practice remains to be thoroughly investigated.
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Affiliation(s)
- Soon Bin Kwon
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
- Program in Hospital and Intensive Care Informatics, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
| | - Bennett Weinerman
- Program in Hospital and Intensive Care Informatics, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
- Columbia University College of Physicians and Surgeons, Division of Pediatric Critical Care and Hospital Medicine, New York, NY, United States of America
| | - Daniel Nametz
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
- Program in Hospital and Intensive Care Informatics, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
| | - Murad Megjhani
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
- Program in Hospital and Intensive Care Informatics, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
| | - Isaac Lee
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
- Program in Hospital and Intensive Care Informatics, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
| | - Anthony Habib
- Columbia University College of Physicians and Surgeons, Division of Pediatric Anesthesiology, New York, NY, United States of America
| | - Oliver Barry
- Columbia University College of Physicians and Surgeons, Division of Pediatric Cardiology, New York, NY, United States of America
| | - Soojin Park
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
- Program in Hospital and Intensive Care Informatics, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
- NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, United States of America
- Department of Biomedical Informatics, Columbia University, New York, NY, United States of America
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Haapala EA, Leppänen MH, Lee E, Savonen K, Laukkanen JA, Kähönen M, Brage S, Lakka TA. Accumulating Sedentary Time and Physical Activity From Childhood to Adolescence and Cardiac Function in Adolescence. J Am Heart Assoc 2024; 13:e031837. [PMID: 38497441 PMCID: PMC11010014 DOI: 10.1161/jaha.123.031837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 02/16/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Increased physical activity (PA) may mitigate the negative cardiovascular health effects of sedentary behavior in adolescents. However, the relationship of PA and sedentary time from childhood with cardiac function in adolescence remains underexplored. Therefore, we investigated the associations of cumulative sedentary time and PA from childhood to adolescence with cardiac function in adolescence. METHODS AND RESULTS Participants were 153 adolescents (69 girls) who were aged 6 to 8 years at baseline, 8 to 10 years at 2-year follow-up, and 15 to 17 years at 8-year follow-up. Cumulative sedentary time and PA exposure between baseline and 2-year follow-up and between baseline and 8-year follow-up were measured using a combined accelerometer and heart rate monitor. Cardiac function was assessed using impedance cardiography at 8-year follow-up. The data were analyzed using linear regression analyses adjusted for age and sex. Cumulative moderate to vigorous PA (standardized regression coefficient [β]=-0.323 [95% CI, -0.527 to -0.119]) and vigorous PA (β=-0.295 [95% CI, -0.508 to -0.083]) from baseline to 8-year follow-up were inversely associated with cardiac work at 8-year follow-up. Conversely, cumulative sedentary time had a positive association (β=0.245 [95% CI, 0.092-0.398]). Cumulative vigorous PA from baseline to 8-year follow-up was inversely associated with cardiac work index at 8-year follow-up (β=-0.218 [95% CI, -0.436 to 0.000]). CONCLUSIONS Higher levels of sedentary time and lower levels of PA during childhood were associated with higher cardiac work in adolescence, highlighting the importance of increasing PA and reducing sedentary time from childhood.
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Affiliation(s)
- Eero A. Haapala
- Faculty of Sport and Health SciencesUniversity of JyväskyläJyväskyläFinland
- Institute of Biomedicine, School of MedicineUniversity of Eastern FinlandKuopioFinland
| | - Marja H. Leppänen
- Institute of Biomedicine, School of MedicineUniversity of Eastern FinlandKuopioFinland
- Faculty of MedicineUniversity of HelsinkiFinland
| | - Earric Lee
- Faculty of Sport and Health SciencesUniversity of JyväskyläJyväskyläFinland
| | - Kai Savonen
- Foundation for Research in Health Exercise and NutritionKuopio Research Institute of Exercise MedicineKuopioFinland
| | - Jari A. Laukkanen
- Institute of Public Health and Clinical NutritionUniversity of Eastern FinlandKuopioFinland
- Department of MedicineWellbeing Services County of Central FinlandJyväskyläFinland
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital and Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
| | - Soren Brage
- MRC Epidemiology UnitUniversity of Cambridge School of Clinical MedicineCambridgeUnited Kingdom
| | - Timo A. Lakka
- Institute of Biomedicine, School of MedicineUniversity of Eastern FinlandKuopioFinland
- Foundation for Research in Health Exercise and NutritionKuopio Research Institute of Exercise MedicineKuopioFinland
- Department of Clinical Physiology and Nuclear ImagingUniversity of Eastern Finland and Kuopio University HospitalKuopioFinland
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Franzoni L, Oliveira RCD, Busin D, Turella DJP, Costa RR, Saffi MAL, Silveira ADD, Stein R. Non-Invasive Assessment of Cardiodynamics by Impedance Cardiography during the Six-Minute Walk Test in Patients with Heart Failure. Arq Bras Cardiol 2023; 120:e20230087. [PMID: 38232243 DOI: 10.36660/abc.20230087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/21/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Central Illustration: Non-Invasive Assessment of Cardiodynamics by Impedance Cardiography during the Six-Minute Walk Test in Patients with Heart Failure. The six-minute walk test (6MWT) is commonly used to evaluate heart failure (HF) patients. However, several clinical factors can influence the distance walked in the test. Signal-morphology impedance cardiography (SM-ICG) is a useful tool to noninvasively assess hemodynamics. OBJECTIVE This study aimed to compare cardiac output (CO), heart rate (HR), and stroke volume (SV) acceleration and deceleration responses to 6MWT in individuals with HF and reduced ejection fraction (HFrEF) and healthy controls. METHODS This is a cross-sectional observational study. CO, HR, SV and cardiac index (CI) were evaluated before, during, and after the 6MWT assessed by SM-ICG. The level of significance adopted in the statistical analysis was 5%. RESULTS Twenty-seven participants were included (13 HFrEF and 14 healthy controls). CO and HR acceleration significantly differed between groups (p<0.01; p=0.039, respectively). We found significant differences in SV, CO and CI between groups (p<0.01). Linear regression showed an impaired SV contribution to CO change in HFrEF group (22.9% versus 57.4%). CONCLUSION The main finding of the study was that individuals with HFrEF showed lower CO and HR acceleration values during the submaximal exercise test compared to healthy controls. This may indicate an imbalance in the autonomic response to exercise in this condition.
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Affiliation(s)
- Leandro Franzoni
- Programa de Pós-Graduação em Ciências da Saúde: Cardiologia e Ciências Cardiovasculares ( UFRGS ), Porto Alegre , RS - Brasil
| | - Rafael Cechet de Oliveira
- Programa de Pós-Graduação em Ciências da Saúde: Cardiologia e Ciências Cardiovasculares ( UFRGS ), Porto Alegre , RS - Brasil
| | - Diego Busin
- Universidade de Caxias do Sul , Caxias do Sul , RS - Brasil
| | | | - Rochelle Rocha Costa
- Universidade de Brasília - Programa de Pós-Graduação em Educação Física , Porto Alegre , RS - Brasil
| | | | | | - Ricardo Stein
- Programa de Pós-Graduação em Ciências da Saúde: Cardiologia e Ciências Cardiovasculares ( UFRGS ), Porto Alegre , RS - Brasil
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Kawałkiewicz W, Majewska A, Janus‐Kubiak M, Marcinkowska‐Gapińska A, Urbaniak‐Olejnik M, Hojan‐Jezierska D, Kubisz L. Ulcerated skin evaluation by electrical impedance measurements. Int Wound J 2023; 20:3580-3585. [PMID: 37218406 PMCID: PMC10588364 DOI: 10.1111/iwj.14233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 05/24/2023] Open
Abstract
In the presented study, the transdermal results from the areas surrounding the ulcerated skin areas were compared with those obtained from healthy skin tissue. The analysis of electrical parameters, such as the slope of the Nyquist plot, min. IM, min. RE, min. f, Imagine part index, Phase index, Real part index, and Magnitude index were conducted. Electrical parameters have been measured in the group without lower leg ulceration and in the group with lower leg ulcers. On the basis of the statistical analysis, it was determined that these parameters may be effective in the evaluation of the skin. In fact, the skin surrounding the ulceration was characterised by different values of electrical parameters as compared with healthy skin tissue. A statistically significant difference was found in the electrical parameters obtained for the healthy leg skin and the skin surrounding the ulceration. This study was to investigate the applicability of electrical parameters in the evaluation of the skin in lower leg ulcers. The electrical parameters can be used as an effective tool in assessing the condition of the skin, both healthy and surrounding the ulcerations. The most useful parameters in assessing skin condition using electrical parameters include min. IM, min. RE, min. f, Imagine part index, Phase index, and Magnitude index.
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Affiliation(s)
- Weronika Kawałkiewicz
- Department of Biophysics, Chair of BiophysicsPoznan University of Medical SciencesPoznańPoland
| | - Anna Majewska
- Department of Hearing Healthcare Profession, Chair of BiophysicsPoznan University of Medical SciencesPoznańPoland
| | - Marta Janus‐Kubiak
- Department of Biophysics, Chair of BiophysicsPoznan University of Medical SciencesPoznańPoland
| | | | - Marta Urbaniak‐Olejnik
- Department of Hearing Healthcare Profession, Chair of BiophysicsPoznan University of Medical SciencesPoznańPoland
| | - Dorota Hojan‐Jezierska
- Department of Hearing Healthcare Profession, Chair of BiophysicsPoznan University of Medical SciencesPoznańPoland
| | - Leszek Kubisz
- Department of Biophysics, Chair of BiophysicsPoznan University of Medical SciencesPoznańPoland
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Sheikh SAA, Gurel NZ, Gupta S, Chukwu IV, Levantsevych O, Alkhalaf M, Soudan M, Abdulbaki R, Haffar A, Vaccarino V, Inan OT, Shah AJ, Clifford GD, Rad AB. Data-driven approach for automatic detection of aortic valve opening: B point detection from impedance cardiogram. Psychophysiology 2022; 59:e14128. [PMID: 35717594 PMCID: PMC9643604 DOI: 10.1111/psyp.14128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 05/02/2022] [Accepted: 05/24/2022] [Indexed: 11/29/2022]
Abstract
Pre-ejection period (PEP), an indicator of sympathetic nervous system activity, is useful in psychophysiology and cardiovascular studies. Accurate PEP measurement is challenging and relies on robust identification of the timing of aortic valve opening, marked as the B point on impedance cardiogram (ICG) signals. The ICG sensitivity to noise and its waveform's morphological variability makes automated B point detection difficult, requiring inefficient and cumbersome expert visual annotation. In this article, we propose a machine learning-based automated algorithm to detect the aortic valve opening for PEP measurement, which is robust against noise and ICG morphological variations. We analyzed over 60 hr of synchronized ECG and ICG records from 189 subjects. A total of 3657 averaged beats were formed using our recently developed ICG noise removal algorithm. Features such as the averaged ICG waveform, its first and second derivatives, as well as high-level morphological and critical hemodynamic parameters were extracted and fed into the regression algorithms to estimate the B point location. The morphological features were extracted from our proposed "variable" physiologically valid search-window related to diverse B point shapes. A subject-wise nested cross-validation procedure was performed for parameter tuning and model assessment. After examining multiple regression models, Adaboost was selected, which demonstrated superior performance and higher robustness to five state-of-the-art algorithms that were evaluated in terms of low mean absolute error of 3.5 ms, low median absolute error of 0.0 ms, high correlation with experts' estimates (Pearson coefficient = 0.9), and low standard deviation of errors of 9.2 ms. For reproducibility, an open-source toolbox is provided.
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Affiliation(s)
- Shafa-at Ali Sheikh
- Department of Biomedical Informatics, Emory University, Atlanta, USA
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, USA
| | - Nil Z. Gurel
- Neurocardiology Research Center of Excellence and Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Shishir Gupta
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Ikenna V. Chukwu
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Oleksiy Levantsevych
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Mhmtjamil Alkhalaf
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Majd Soudan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Rami Abdulbaki
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Ammer Haffar
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Omer T. Inan
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, USA
| | - Amit J. Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, USA
- Atlanta Veterans Affairs Health Care System, Atlanta, USA
| | - Gari D. Clifford
- Department of Biomedical Informatics, Emory University, Atlanta, USA
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, USA
| | - Ali Bahrami Rad
- Department of Biomedical Informatics, Emory University, Atlanta, USA
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6
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Muacevic A, Adler JR. Autonomic Nervous System Monitoring: Cardiac Magnetic Resonance Imaging Data as a Surrogate for Autonomic Data in Children. Cureus 2022; 14:e32014. [PMID: 36589173 PMCID: PMC9797874 DOI: 10.7759/cureus.32014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 11/30/2022] Open
Abstract
Perioperative autonomic nervous system (ANS) measurements are evolving toward increasing import and utility. We present a three-year-old male with Down Syndrome who underwent ambulatory autonomic monitoring during surgery followed by cardiac magnetic resonance (CMR) imaging. Autonomic data from both environments are compared to age-related norms. We are the first to describe a method for acquiring and trending autonomic data from clinically indicated CMR scans in order to monitor autonomic function. These data are proof of concept for the use of routinely collected CMR data as a surrogate for autonomic data in children, noting differences in the autonomic effects of anesthetic techniques.
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Harteveld LM, Blom NA, van Dijk JG, Reijntjes RH, van Someren PJ, Kerkhof FI, Kuipers IM, Rammeloo LAJ, de Geus EJC, ten Harkel ADJ. Orthostatic stress response in pediatric Fontan patients and the effect of ACE inhibition. PLoS One 2022; 17:e0273940. [PMID: 36048833 PMCID: PMC9436155 DOI: 10.1371/journal.pone.0273940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 08/18/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Many cardiocirculatory mechanisms are involved in the adaptation to orthostatic stress. While these mechanisms may be impaired in Fontan patients. However, it is yet unclear how Fontan patients, who exhibit a critical fluid balance, respond to orthostatic stress. Angiotensin converting enzyme inhibitors are often prescribed to Fontan patients, but they may negatively influence orthostatic tolerance. Therefore, we evaluated the response to orthostatic stress in pediatric Fontan patients before and after treatment with enalapril.
Methods
Thirty-five Fontan patients (aged 14 years) with moderate-good systolic ventricular function without pre-existent enalapril treatment were included. Before and after a three-month enalapril treatment period, the hemodynamic response to head-up tilt test was evaluated by various parameters including cardiac index, blood pressure, cerebral blood flow, aortic stiffness and cardiac autonomous nervous activity. Thirty-four healthy subjects (aged 13 years) served as controls.
Results
Fontan patients had a decreased cerebral blood flow and increased aortic stiffness in the supine position compared to controls, while all other factors did not differ. Patients and controls showed a comparable response to head-up tilt test for most parameters. Twenty-seven patients completed the enalapril study with a mean dosage of 0.3±0.1mg/kg/day. Most parameters were unaffected by enalapril, only the percent decrease in cardiac index to tilt was higher after treatment, but the cardiac index during tilt was not lower (3.0L/min/m2 pre-enalapril versus 2.8L/min/m2 after treatment; P = 0.15).
Conclusion
Pediatric Fontan patients adequately respond to orthostasis with maintenance of blood pressure and cerebral blood flow and sufficient autonomic response. Enalapril treatment did not alter the response.
Clinical trial information
Scientific title: ACE inhibition in Fontan patients: its effect on body fluid regulation (sAFE-study).
The Netherlands National Trial Register: Trail NL6415. Registered 2017-07-20.
Trial information: https://www.trialregister.nl/trial/6415
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Affiliation(s)
- Lisette M. Harteveld
- The Center for Congenital Heart Disease Amsterdam–Leiden, Leiden, The Netherlands
- Willem-Alexander Children’s Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- * E-mail:
| | - Nico A. Blom
- The Center for Congenital Heart Disease Amsterdam–Leiden, Leiden, The Netherlands
- Willem-Alexander Children’s Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Pediatric Cardiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - J. Gert van Dijk
- Department of Neurology and Clinical Neurophysiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert H. Reijntjes
- Department of Neurology and Clinical Neurophysiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Paul J. van Someren
- Department of Neurology and Clinical Neurophysiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Fabian I. Kerkhof
- Department of Neurology and Clinical Neurophysiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Irene M. Kuipers
- The Center for Congenital Heart Disease Amsterdam–Leiden, Leiden, The Netherlands
- Department of Pediatric Cardiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Lukas A. J. Rammeloo
- The Center for Congenital Heart Disease Amsterdam–Leiden, Leiden, The Netherlands
- Department of Pediatric Cardiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Eco J. C. de Geus
- Department of Biological Psychology, Faculty of Human Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Arend D. J. ten Harkel
- The Center for Congenital Heart Disease Amsterdam–Leiden, Leiden, The Netherlands
- Willem-Alexander Children’s Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Barbier A, Chen JH, Huizinga JD. Autism Spectrum Disorder in Children Is Not Associated With Abnormal Autonomic Nervous System Function: Hypothesis and Theory. Front Psychiatry 2022; 13:830234. [PMID: 35370829 PMCID: PMC8964964 DOI: 10.3389/fpsyt.2022.830234] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/10/2022] [Indexed: 12/20/2022] Open
Abstract
The quest to understand the pathophysiology of autism spectrum disorder (ASD) has led to extensive literature that purports to provide evidence for autonomic dysfunction based on heart rate and heart rate variability (HRV), in particular respiratory sinus arrhythmia (RSA), a measure of parasympathetic functioning. Many studies conclude that autism is associated with vagal withdrawal and sympathetic hyperactivation based on HRV and electrodermal analyses. We will argue that a critical analysis of the data leads to the hypothesis that autonomic nervous system dysfunction is not a dominant feature of autism. Most children with ASD have normal parasympathetic baseline values and normal autonomic responses to social stimuli. The existing HRV and electrodermal data cannot lead to the conclusion of an over-excitation of the sympathetic nervous system. A small subgroup of ASD children in experimental settings has relatively low RSA values and relatively high heart rates. The data suggest that this is likely associated with a relatively high level of anxiety during study conditions, associated with co-morbidities such as constipation, or due to the use of psychoactive medication. Many studies interpret their data to conform with a preferred hypothesis of autonomic dysfunction as a trait of autism, related to the polyvagal theory, but the HRV evidence is to the contrary. HRV analysis may identify children with ASD having autonomic dysfunction due to co-morbidities.
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Affiliation(s)
- Ashley Barbier
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Ji-Hong Chen
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jan D Huizinga
- Department of Medicine, McMaster University, Hamilton, ON, Canada
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Harteveld LM, Blom NA, Terol Espinosa de Los Monteros C, van Dijk JG, Kuipers IM, Rammeloo LAJ, de Geus EJC, Hazekamp MG, Ten Harkel ADJ. Determinants of exercise limitation in contemporary paediatric Fontan patients with an extra cardiac conduit. Int J Cardiol 2021; 341:31-38. [PMID: 34375703 DOI: 10.1016/j.ijcard.2021.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/13/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Although various determinants of exercise limitation in Fontan patients have been studied, most research has been performed in patients who underwent different surgical procedures with differing haemodynamic characteristics. The aim of the current study was to evaluate non-invasively measured cardiovascular parameters and their influence on exercise performance in paediatric Fontan patients with an extracardiac conduit and moderate-good systolic ventricular function. METHODS Fontan patients, between 8 and 18 years of age, with moderate to good systolic ventricular function and an extracardiac conduit were included. Exercise performance and cardiovascular assessment, comprising echocardiography, aortic stiffness measurement and ambulatory measurement of cardiac autonomous nervous activity were performed on the same day. Healthy subjects served as controls. RESULTS Thirty-six Fontan patients (age 14.0 years) and thirty-five healthy subjects (age 12.8 years) were included. Compared to controls, Fontan patients had reduced diastolic ventricular function and increased arterial stiffness. No differences were found in heart rate (HR) and cardiac parasympathetic nervous activity. In Fontan patients, maximal as well as submaximal exercise capacity was impaired, with the percentage of predicted capacity ranging between 54 and 72%. Chronotropic competence, however, was good with a peak HR of 174 (94% of predicted). Lower maximal and submaximal exercise capacity was correlated with a higher HR at rest, higher pulse wave velocity of the aorta and a lower ratio of early and late diastolic flow velocity. CONCLUSION Contemporary paediatric Fontan patients have an impaired exercise capacity with preserved chronotropic competence. Exercise performance correlates with heart rate at rest, diastolic function and aortic stiffness.
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Affiliation(s)
- Lisette M Harteveld
- The Centre for Congenital Heart Disease Amsterdam-Leiden, Leiden, the Netherlands; Willem-Alexander Children's Hospital, Department of Paediatrics, Division of Paediatric Cardiology, Leiden University Medical Centre, the Netherlands.
| | - Nico A Blom
- The Centre for Congenital Heart Disease Amsterdam-Leiden, Leiden, the Netherlands; Willem-Alexander Children's Hospital, Department of Paediatrics, Division of Paediatric Cardiology, Leiden University Medical Centre, the Netherlands; Department of Paediatric Cardiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | | | - J Gert van Dijk
- Department of Neurology and Clinical Neurophysiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Irene M Kuipers
- The Centre for Congenital Heart Disease Amsterdam-Leiden, Leiden, the Netherlands; Department of Paediatric Cardiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Lukas A J Rammeloo
- The Centre for Congenital Heart Disease Amsterdam-Leiden, Leiden, the Netherlands; Department of Paediatric Cardiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Eco J C de Geus
- Department of Biological Psychology, Faculty of Human Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Mark G Hazekamp
- The Centre for Congenital Heart Disease Amsterdam-Leiden, Leiden, the Netherlands; Department of Cardiothoracic Surgery, Leiden University Medical Centre, the Netherlands
| | - Arend D J Ten Harkel
- The Centre for Congenital Heart Disease Amsterdam-Leiden, Leiden, the Netherlands; Willem-Alexander Children's Hospital, Department of Paediatrics, Division of Paediatric Cardiology, Leiden University Medical Centre, the Netherlands
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10
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Harteveld LM, Nederend I, Ten Harkel ADJ, Schutte NM, de Rooij SR, Vrijkotte TGM, Oldenhof H, Popma A, Jansen LMC, Suurland J, Swaab H, de Geus EJC. Maturation of the Cardiac Autonomic Nervous System Activity in Children and Adolescents. J Am Heart Assoc 2021; 10:e017405. [PMID: 33525889 PMCID: PMC7955328 DOI: 10.1161/jaha.120.017405] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Despite the increasing interest in cardiac autonomic nervous activity, the normal development is not fully understood. The main aim was to determine the maturation of different cardiac sympathetic‐(SNS) and parasympathetic nervous system (PNS) activity parameters in healthy patients aged 0.5 to 20 years. A second aim was to determine potential sex differences. Methods and Results Five studies covering the 0.5‐ to 20‐year age range provided impedance‐ and electrocardiography recordings from which heart rate, different PNS‐parameters (eg, respiratory sinus arrhythmia) and an SNS‐parameter (pre‐ejection period) were collected. Age trends were computed in the mean values across 12 age‐bins and in the age‐specific variances. Age was associated with changes in mean and variance of all parameters. PNS‐activity followed a cubic trend, with an exponential increase from infancy, a plateau phase during middle childhood, followed by a decrease to adolescence. SNS‐activity showed a more linear trend, with a gradual decrease from infancy to adolescence. Boys had higher SNS‐activity at ages 11 to 15 years, while PNS‐activity was higher at 5 and 11 to 12 years with the plateau level reached earlier in girls. Interindividual variation was high at all ages. Variance was reasonably stable for SNS‐ and the log‐transformed PNS‐parameters. Conclusions Cardiac PNS‐ and SNS‐activity in childhood follows different maturational trajectories. Whereas PNS‐activity shows a cubic trend with a plateau phase during middle childhood, SNS‐activity shows a linear decrease from 0.5 to 20 years. Despite the large samples used, clinical use of the sex‐specific centile and percentile normative values is modest in view of the large individual differences, even within narrow age bands.
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Affiliation(s)
- Lisette M Harteveld
- Department of Pediatric Cardiology Leiden University Medical Center Leiden The Netherlands
| | - Ineke Nederend
- Department of Pediatric Cardiology Leiden University Medical Center Leiden The Netherlands.,Department of Biological Psychology Faculty of Human Behavioral and Movement Sciences Vrije Universiteit AmsterdamAmsterdam Public Health Research Institute Amsterdam The Netherlands
| | - Arend D J Ten Harkel
- Department of Pediatric Cardiology Leiden University Medical Center Leiden The Netherlands
| | - Nienke M Schutte
- Department of Biological Psychology Faculty of Human Behavioral and Movement Sciences Vrije Universiteit AmsterdamAmsterdam Public Health Research Institute Amsterdam The Netherlands
| | - Susanne R de Rooij
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics Amsterdam University Medical CenterAcademic Medical Center Amsterdam The Netherlands.,Department of Public Health Amsterdam Public Health Research InstituteAmsterdam University Medical CenterUniversity of Amsterdam Amsterdam The Netherlands
| | - Tanja G M Vrijkotte
- Department of Public Health Amsterdam Public Health Research InstituteAmsterdam University Medical CenterUniversity of Amsterdam Amsterdam The Netherlands
| | - Helena Oldenhof
- Department of Child and Adolescent Psychiatry Amsterdam University Medical CenterVU University Medical Centre Amsterdam The Netherlands
| | - Arne Popma
- Department of Child and Adolescent Psychiatry Amsterdam University Medical CenterVU University Medical Centre Amsterdam The Netherlands
| | - Lucres M C Jansen
- Department of Child and Adolescent Psychiatry Amsterdam University Medical CenterVU University Medical Centre Amsterdam The Netherlands
| | - Jill Suurland
- Department of Clinical Child and Adolescent Studies and Leiden Institute for Brain and Cognition Leiden University Leiden The Netherlands
| | - Hanna Swaab
- Department of Clinical Child and Adolescent Studies and Leiden Institute for Brain and Cognition Leiden University Leiden The Netherlands
| | - Eco J C de Geus
- Department of Biological Psychology Faculty of Human Behavioral and Movement Sciences Vrije Universiteit AmsterdamAmsterdam Public Health Research Institute Amsterdam The Netherlands
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11
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van der Mee DJ, Duivestein Q, Gevonden MJ, Westerink JHDM, de Geus EJC. The short Sing-a-Song Stress Test: A practical and valid test of autonomic responses induced by social-evaluative stress. Auton Neurosci 2020; 224:102612. [PMID: 31962195 DOI: 10.1016/j.autneu.2019.102612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/11/2019] [Accepted: 12/16/2019] [Indexed: 10/25/2022]
Abstract
The Sing-a-Song Stress Test (SSST) was recently developed as an alternative to the Trier Social Stress Test (TSST) to investigate autonomic nervous system responses to social-evaluative stress. In the SSST, participants are suddenly cued to sing a song in the presence of confederates. However, the SSST is still quite long (~15 min) and the requirement for confederates makes it labor-intensive. The current study tested whether a shorter (~6.5 min), single-experimenter, version of the SSST can still reliably elicit subjective and physiological stress reactivity. Our sample consisted of 87 healthy young adult participants (age range: 18-35 years). During the short SSST and a speeded reaction time task, in which aversive loud tones were to be avoided (TA), we measured heart period (HP), sympathetic nervous system (SNS) activity using pre-ejection-period (PEP), skin conductance level (SCL), and non-specific skin conductance responses (ns.SCR), and parasympathetic nervous system (PNS) activity using respiratory-sinus-arrhythmia (RSA) and the root-mean-square of successive differences (RMSSD). The short SSST induced significant decreases in positive affect and increases in negative affect. MANOVAs on the clusters of SNS and PNS variables showed that the short SSST elicited significant HP (-118.46 ms), PEP (-7.76 ms), SCL (+4.85 μS), ns.SCR (+8.42 peaks/min) and RMSSD (-14.67) reactivity. Affective, SNS, and PNS reactivity to the new SSST social-evaluative stress task were of comparable magnitude to that evoked by the TA mental stressor. We conclude that the short SSST is a valid and cost-effective task for large scaled studies to induce social-evaluative stress to a sufficient degree to evoke measurable changes in PNS and SNS activity and affective state.
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Affiliation(s)
- D J van der Mee
- Department of Biological Psychology, VU University Amsterdam, Amsterdam, the Netherlands.
| | - Q Duivestein
- Department of Biological Psychology, VU University Amsterdam, Amsterdam, the Netherlands
| | - M J Gevonden
- Department of Biological Psychology, VU University Amsterdam, Amsterdam, the Netherlands
| | - J H D M Westerink
- Eindhoven University of Technology, Eindhoven, the Netherlands; Philips Research, Eindhoven, the Netherlands
| | - E J C de Geus
- Department of Biological Psychology, VU University Amsterdam, Amsterdam, the Netherlands
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12
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Kubisz L, Hojan-Jezierska D, Szewczyk M, Majewska A, Kawałkiewicz W, Pankowski E, Janus M, Cwajda-Białasik J, Mościcka P, Jawień A. In vivo electrical impedance measurement in human skin assessment. PURE APPL CHEM 2019. [DOI: 10.1515/pac-2018-1106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Structural and chemical alterations in living tissue are reflected in electrical impedance changes. However, due to the complexity of skin structure, the relation between electrical parameters and physiological/pathological conditions is difficult to establish. The impedance dispersion reflects the clinical status of the examined skin tissue and, therefore, it is frequently used in a non-invasive evaluation of exposing skin to various factors. The method has been used to assess the effect of the fish collagen on the skin of patients suffering from the leg ulcer. Therefore, from a number of different approaches to skin electrical impedance dispersion, the one considered to be safe was selected and applied. This paper presents a short review of different technical approaches to in vivo electrical impedance measurements, as well as an analysis of the results and the effect of fish collagen locally administered on human skin.
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Affiliation(s)
- Leszek Kubisz
- Department of Biophysics, Chair of Biophysics , Poznan University of Medical Sciences in Poznań , Poznań , Poland
| | - Dorota Hojan-Jezierska
- Department of Hearing Healthcare Profession, Chair of Biophysics , Poznan University of Medical Sciences in Poznań , Poznań , Poland
| | - Maria Szewczyk
- Department of Vascular Surgery and Angiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz , Nicolaus Copernicus University in Torun , Bydgoszcz , Poland
- Department of Perioperative Nursing, Department of Surgical Nursing and Chronic Wound Care , Nicolaus Copernicus University , Ludwic Rydygier Collegium Medicum in Bydgoszcz , Bydgoszcz , Poland
- Outpatient Department for Chronic Wound Management , University Hospital No 1 in Bydgoszcz , Bydgoszcz , Poland
| | - Anna Majewska
- Department of Hearing Healthcare Profession, Chair of Biophysics , Poznan University of Medical Sciences in Poznań , Poznań , Poland
| | - Weronika Kawałkiewicz
- Department of Biophysics, Chair of Biophysics , Poznan University of Medical Sciences in Poznań , Poznań , Poland
| | - Edward Pankowski
- Department of Biophysics, Chair of Biophysics , Poznan University of Medical Sciences in Poznań , Poznań , Poland
| | - Marta Janus
- Department of Biophysics, Chair of Biophysics , Poznan University of Medical Sciences in Poznań , Poznań , Poland
| | - Justyna Cwajda-Białasik
- Department of Vascular Surgery and Angiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz , Nicolaus Copernicus University in Torun , Bydgoszcz , Poland
- Department of Perioperative Nursing, Department of Surgical Nursing and Chronic Wound Care , Nicolaus Copernicus University , Ludwic Rydygier Collegium Medicum in Bydgoszcz , Bydgoszcz , Poland
- Outpatient Department for Chronic Wound Management , University Hospital No 1 in Bydgoszcz , Bydgoszcz , Poland
| | - Paulina Mościcka
- Department of Vascular Surgery and Angiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz , Nicolaus Copernicus University in Torun , Bydgoszcz , Poland
- Department of Perioperative Nursing, Department of Surgical Nursing and Chronic Wound Care , Nicolaus Copernicus University , Ludwic Rydygier Collegium Medicum in Bydgoszcz , Bydgoszcz , Poland
- Outpatient Department for Chronic Wound Management , University Hospital No 1 in Bydgoszcz , Bydgoszcz , Poland
| | - Arkadiusz Jawień
- Department of Vascular Surgery and Angiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz , Nicolaus Copernicus University in Torun , Bydgoszcz , Poland
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13
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Nederend I, de Geus EJC, Blom NA, Ten Harkel ADJ. Long-term follow-up after ventricular septal defect repair in children: cardiac autonomic control, cardiac function and exercise capacity. Eur J Cardiothorac Surg 2019; 53:1082-1088. [PMID: 29253118 DOI: 10.1093/ejcts/ezx438] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/12/2017] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES Survival after surgical repair of a ventricular septal defect (VSD) is good, but, as in almost all congenital heart diseases, late complications are frequent in adulthood. The exact mechanisms, timing and who is at risk are not fully understood. Altered cardiac autonomic nervous system (ANS) activity might play a role in these long-term sequelae. The aim of this study was to extensively evaluate children late after VSD repair including their cardiac ANS activity, cardiac function and exercise capacity. METHODS Thirty-three patients after surgical VSD repair and 66 healthy age-matched controls underwent 24-h monitoring of ANS control and cardiac output using impedance cardiography, detailed echocardiography and cardiopulmonary exercise testing. RESULTS Ambulatory cardiac ANS control was not different between the patients and the controls. Right ventricular function, exercise capacity and ambulatory cardiac output were decreased in patients compared with the controls. No relationships were found between cardiac ANS activity and cardiac function. CONCLUSIONS Long (average time after repair was 9.9 years) after successful surgical correction of a VSD, cardiac ANS control is not different from the controls. Right ventricular function and exercise capacity are impaired in VSD patients. Post-surgical outcome in these patients may be less benign than presently assumed; therefore, follow-up should be continued into adulthood to detect adverse outcomes in a timely fashion.
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Affiliation(s)
- Ineke Nederend
- Department of Biological Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Pediatric Cardiology, LUMC University Medical Center, Leiden, Netherlands
| | - Eco J C de Geus
- Department of Biological Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Nico A Blom
- Department of Pediatric Cardiology, LUMC University Medical Center, Leiden, Netherlands
| | - Arend D J Ten Harkel
- Department of Pediatric Cardiology, LUMC University Medical Center, Leiden, Netherlands
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14
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15
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Forouzanfar M, Baker FC, de Zambotti M, McCall C, Giovangrandi L, Kovacs GTA. Toward a better noninvasive assessment of preejection period: A novel automatic algorithm for B-point detection and correction on thoracic impedance cardiogram. Psychophysiology 2018; 55:e13072. [PMID: 29512163 PMCID: PMC6105363 DOI: 10.1111/psyp.13072] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/11/2018] [Accepted: 02/08/2018] [Indexed: 11/28/2022]
Abstract
Impedance cardiography is the most common clinically validated, noninvasive method for determining the timing of the opening of the aortic valve, an important event used for measuring preejection period, which reflects sympathetic beta-adrenergic influences on the heart. Automatic detection of the exact time of the opening of the aortic valve (B point on the impedance cardiogram) has proven to be challenging as its appearance varies between and within individuals and may manifest as a reversal, inflection, or rapid slope change of the thoracic impedance derivative's (dZ/dt) rapid rise. Here, a novel automatic algorithm is proposed for the detection of the B point by finding the main rapid rise of the dZ/dt signal, which is due to blood ejection. Several conditions based on zero crossings, minima, and maxima of the dZ/dt signal and its derivatives are considered to reject any unwanted noise and artifacts and select the true B-point location. The detected B-point locations are then corrected by modeling the B-point time data using forward and reverse autoregressive models. The proposed algorithm is validated against expert-detected B points and is compared with different conventional methods; it significantly outperforms them by at least 54% in mean error, 30% in mean absolute error, and 27% in standard deviation of error. This algorithm can be adopted in ambulatory studies requiring beat-to-beat evaluation of cardiac hemodynamic parameters over extended time periods where expert scoring is not feasible.
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Affiliation(s)
- Mohamad Forouzanfar
- Center for Health Sciences, SRI International, Menlo Park, California, USA.,Transducers Lab, Department of Electrical Engineering, Stanford University, Stanford, California, USA
| | - Fiona C Baker
- Center for Health Sciences, SRI International, Menlo Park, California, USA
| | | | - Corey McCall
- Transducers Lab, Department of Electrical Engineering, Stanford University, Stanford, California, USA
| | - Laurent Giovangrandi
- Transducers Lab, Department of Electrical Engineering, Stanford University, Stanford, California, USA
| | - Gregory T A Kovacs
- Center for Health Sciences, SRI International, Menlo Park, California, USA.,Transducers Lab, Department of Electrical Engineering, Stanford University, Stanford, California, USA
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