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Mikolaskova I, Zvarik M, Hesko P, Kopcova M, Gidron Y, Rajcani J, Hunakova L, Kollarik B. Increased stress burden and electrodermal reactivity in bladder cancer patients in comparison to healthy controls. Heliyon 2024; 10:e34453. [PMID: 39113946 PMCID: PMC11305217 DOI: 10.1016/j.heliyon.2024.e34453] [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: 06/21/2024] [Accepted: 07/09/2024] [Indexed: 08/10/2024] Open
Abstract
The purpose of our study was to assess specific physiological parameters associated with stress responses in bladder cancer (BCa) patients compared to healthy individuals. By examining the transition from a supine to a sitting position, representing a mild physiological load, we investigated the changes in autonomic nervous system (ANS) activity as reflected by alterations in these parameters, indicating shifts in ANS regulation, using non-linear heart rate variability (HRV) parameters (0V%, 2UV%, parasympathetic and sympathetic nervous system - PNS and SNS indices), modified heart rate acceleration (ACmod) and deceleration capacities (DCmod), heart rate (HR), electrodermal activity (EDA), and also their correlations with perceived stress score. Our findings showed that BCa patients (n = 38) exhibited elevated resting HR, heightened SNS index, and increased EDA compared to their healthy counterparts (n = 47), indicating a notable physiological stress burden. The 0V% parameter showed a positive association with the SNS index, ACmod, HR, and EDA parameters, while displaying a negative correlation with the PNS index, DCmod and 2UV%. These non-linear HRV parameters, such as 0V% and 2UV%, offer nuanced insights into the complexities of heartbeat dynamics and autonomic regulation. After the transition from supine to sitting positions, BCa patients displayed higher EDA responses, indicating heightened stress reactivity and ANS sensitivity. These physiological distinctions persisted even when we did not prove differences in the levels of perceived stress between the studied groups. In conclusion, our study emphasizes the significance of identifying cancer patients at risk of ANS dysregulation, paving the way for tailored stress management strategies.
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Affiliation(s)
- I. Mikolaskova
- Institute of Immunology, Faculty of Medicine, Comenius University in Bratislava, Odborarske Namestie 14, 811 08, Bratislava, Slovakia
| | - M. Zvarik
- Department of Nuclear Physics and Biophysics, Faculty of Mathematics, Physics and Computer Science, Comenius University in Bratislava, Mlynska Dolina, 842 48 Bratislava 4, Slovakia
| | - P. Hesko
- Department of Urology, Saints Cyril and Methodius Hospital, University Hospital Bratislava, Antolská 11, 851 07 Bratislava, Slovakia
| | - M. Kopcova
- Institute of Immunology, Faculty of Medicine, Comenius University in Bratislava, Odborarske Namestie 14, 811 08, Bratislava, Slovakia
| | - Y. Gidron
- Department of Nursing, Faculty of Welfare and Health Sciences, University of Haifa, Haifa 3498838, Israel
| | - J. Rajcani
- Department of Psychology, Faculty of Arts, Comenius University, Gondova 2, 81499 Bratislava, Slovakia
| | - L. Hunakova
- Institute of Immunology, Faculty of Medicine, Comenius University in Bratislava, Odborarske Namestie 14, 811 08, Bratislava, Slovakia
| | - B. Kollarik
- Department of Urology, Saints Cyril and Methodius Hospital, University Hospital Bratislava, Antolská 11, 851 07 Bratislava, Slovakia
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Chand K, Chandra S, Dutt V. A comprehensive evaluation of linear and non-linear HRV parameters between paced breathing and stressful mental state. Heliyon 2024; 10:e32195. [PMID: 38873683 PMCID: PMC11170182 DOI: 10.1016/j.heliyon.2024.e32195] [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: 01/09/2024] [Revised: 05/22/2024] [Accepted: 05/29/2024] [Indexed: 06/15/2024] Open
Abstract
Background Heart rate variability (HRV) is a crucial metric that provides valuable insight into the balance between relaxation and stress. Previous research has shown that most HRV parameters improve during periods of mental relaxation, while decreasing during tasks involving cognitive workload. Although a comprehensive analysis of both linear and non-linear HRV parameters has been carried out in existing literature, there still exists a need for further research in this area. Additionally, limited knowledge exists regarding how specific interventions may influence the interpretation of these parameters and how the different parameters correlate under different interventions. This study aims to address these gaps by conducting a thorough comparison of different linear and non-linear HRV parameters under mentally relaxed versus stressful states. Methodology Participants were randomly and equally divided among two between-subjects groups: relaxed-stress (RS) (N = 22) and stress-relaxed (SR) (N = 22). In the RS group, a paced breathing task was given for 5 min to create relaxation, and was followed by a 5-min time-based mental calculation task to create stress. In the SR group, the order of the stress and relaxed tasks was reversed. There was a washout period of 15 min after the first task in both groups. Results Of the 37 HRV parameters, 33 differed significantly between the two interventions. The majority of the parameters exhibited an improving and degrading tendency of HRV parameters in the relaxed and stressed states, respectively. The correlation of the majority of HRV parameters decreases during stress, while prominent time domain and geometric domain parameters stand out in the correlation. Conclusion Overall, HRV parameters can be reliably used to assess a person's relaxed and stressed mental states during paced breathing and mental arithmetic task respectively. Furthermore, non-linear HRV parameters provide accurate estimators of the mental state, in addition to the commonly used linear parameters.
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Affiliation(s)
- Kulbhushan Chand
- IIT Mandi iHub and HCi Foundation, Indian Institute of Technology Mandi, Kamand, HP, India , 175005
| | - Shilpa Chandra
- Indian Institute of Technology Mandi, Kamand, HP, India , 175005
| | - Varun Dutt
- Indian Institute of Technology Mandi, Kamand, HP, India , 175005
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Rohr M, Tarvainen M, Miri S, Güney G, Vehkaoja A, Hoog Antink C. An extensive quantitative analysis of the effects of errors in beat-to-beat intervals on all commonly used HRV parameters. Sci Rep 2024; 14:2498. [PMID: 38291034 PMCID: PMC10828497 DOI: 10.1038/s41598-023-50701-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/23/2023] [Indexed: 02/01/2024] Open
Abstract
Heart rate variability (HRV) analysis is often used to estimate human health and fitness status. More specifically, a range of parameters that express the variability in beat-to-beat intervals are calculated from electrocardiogram beat detections. Since beat detection may yield erroneous interval data, these errors travel through the processing chain and may result in misleading parameter values that can lead to incorrect conclusions. In this study, we utilized Monte Carlo simulation on real data, Kolmogorov-Smirnov tests and Bland-Altman analysis to carry out extensive analysis of the noise sensitivity of different HRV parameters. The used noise models consider Gaussian and student-t distributed noise. As a result we observed that commonly used HRV parameters (e.g. pNN50 and LF/HF ratio) are especially sensitive to noise and that all parameters show biases to some extent. We conclude that researchers should be careful when reporting different HRV parameters, consider the distributions in addition to mean values, and consider reference data if applicable. The analysis of HRV parameter sensitivity to noise and resulting biases presented in this work generalizes over a wide population and can serve as a reference and thus provide a basis for the decision about which HRV parameters to choose under similar conditions.
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Affiliation(s)
- Maurice Rohr
- AI Systems in Medicine, Technical University of Darmstadt, 64283, Darmstadt, Germany.
| | - Mika Tarvainen
- Department of Technical Physics, University of Eastern Finland, 70211, Kuopio, Finland
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, 70211, Kuopio, Finland
| | - Seyedsadra Miri
- Faculty of Medicine and Health Technology, Tampere University, 33720, Tampere, Finland
- Finnish Cardiovascular Research Center, 33720, Tampere, Finland
| | - Gökhan Güney
- AI Systems in Medicine, Technical University of Darmstadt, 64283, Darmstadt, Germany
| | - Antti Vehkaoja
- Faculty of Medicine and Health Technology, Tampere University, 33720, Tampere, Finland
- Finnish Cardiovascular Research Center, 33720, Tampere, Finland
| | - Christoph Hoog Antink
- AI Systems in Medicine, Technical University of Darmstadt, 64283, Darmstadt, Germany
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Wu S, Guan W, Zhao H, Li G, Zhou Y, Shi B, Zhang X. Prognostic role of short-term heart rate variability and deceleration/acceleration capacities of heart rate in extensive-stage small cell lung cancer. Front Physiol 2023; 14:1277383. [PMID: 38028778 PMCID: PMC10663334 DOI: 10.3389/fphys.2023.1277383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Background: Prior research suggests that autonomic modulation investigated by heart rate variability (HRV) might act as a novel predictive biomarker for cancer prognosis, such as in breast cancer and pancreatic cancer. It is not clear whether there is a correlation between autonomic modulation and prognosis in patients with extensive-stage small cell lung cancer (ES-SCLC). Therefore, the purpose of the study was to examine the association between short-term HRV, deceleration capacity (DC) and acceleration capacity (AC) of heart rate and overall survival in patients with ES-SCLC. Methods: We recruited 40 patients with ES-SCLC, and 39 were included in the final analysis. A 5-min resting electrocardiogram of patients with ES-SCLC was collected using a microelectrocardiogram recorder to analyse short-term HRV, DC and AC. The following HRV parameters were used: standard deviation of the normal-normal intervals (SDNN) and root mean square of successive interval differences (RMSSD). Overall survival of patients with ES-SCLC was defined as time from the date of electrocardiogram measurement to the date of death or the last follow-up. Follow-up was last performed on 07 June 2023. There was a median follow-up time of 42.2 months. Results: Univariate analysis revealed that the HRV parameter SDNN, as well as DC significantly predicted the overall survival of ES-SCLC patients (all p < 0.05). Multivariate analysis showed that the HRV parameters SDNN (hazard ratio = 5.254, 95% CI: 1.817-15.189, p = 0.002), RMSSD (hazard ratio = 3.024, 95% CI: 1.093-8.372, p = 0.033), as well as DC (hazard ratio = 3.909, 95% CI: 1.353-11.293, p = 0.012) were independent prognostic factors in ES-SCLC patients. Conclusion: Decreased HRV parameters (SDNN, RMSSD) and DC are independently associated with shorter overall survival in ES-SCLC patients. Autonomic nervous system function (assessed based on HRV and DC) may be a new biomarker for evaluating the prognosis of patients with ES-SCLC.
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Affiliation(s)
- Shuang Wu
- School of Medicine, Yangzhou University, Yangzhou, Jiangsu, China
- Department of Radiation Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu, Anhui, China
| | - Weizheng Guan
- School of Medical Imaging, Bengbu Medical College, Bengbu, Anhui, China
- Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, Anhui, China
| | - Huan Zhao
- School of Medical Imaging, Bengbu Medical College, Bengbu, Anhui, China
- Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, Anhui, China
| | - Guangqiao Li
- School of Medical Imaging, Bengbu Medical College, Bengbu, Anhui, China
- Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, Anhui, China
| | - Yufu Zhou
- Department of Radiation Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu, Anhui, China
| | - Bo Shi
- School of Medical Imaging, Bengbu Medical College, Bengbu, Anhui, China
- Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, Anhui, China
| | - Xiaochun Zhang
- School of Medicine, Yangzhou University, Yangzhou, Jiangsu, China
- Department of Oncology, Yangzhou Hospital of Traditional Chinese Medicine, Yangzhou, Jiangsu, China
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Swieter E, Gross JM, Stephen J, Watterberg K, Maxwell JR. Pilot study shows skin-to-skin care with parents improves heart rate variability in preterm infants in the neonatal intensive care unit. Front Pediatr 2023; 11:1269405. [PMID: 37790693 PMCID: PMC10544889 DOI: 10.3389/fped.2023.1269405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 09/01/2023] [Indexed: 10/05/2023] Open
Abstract
Background Skin-to-skin care in the newborn intensive care unit typically lasts for short periods of time and enhances breastfeeding, attachment, and parental self-esteem. Heart rate variability (HRV) increases with gestational age and is a measure of maturation of parasympathetic vs. sympathetic autonomic nervous system activity. HRV measurements may be useful in capturing changes in autonomic regulation in response to skin-to-skin care. Objective To analyze the effects of skin-to-skin care on HRV in preterm infants receiving respiratory support. We hypothesized that skin-to-skin care would result in a more mature pattern of parasympathetic activity. Methods In this prospective crossover study, infants <30 weeks' gestation and 1-6 weeks postnatal age had HRV recorded for 30 min before, during, and after skin-to-skin care sessions. HRV characteristics analyzed included the standard deviation of the normal-to-normal interval (SDNN), the root mean squared of successive differences of normal-to-normal intervals (RMSSD), and the standard deviation of decelerations (SDDec). Results 10 infants between 25 5/7-29 6/7 weeks gestational age and 7-41 days postnatal age completed 22 sessions while receiving respiratory support (positive pressure ventilation or nasal cannula oxygen). Two measures of HRV (SDNN and RMSSD) were significantly decreased by the end of the skin-to-skin sessions, compared to pre-session values. SDNN decreased from a median of 10.44 ms before the session to 6.70 ms after being placed back in bed (p < 0.05), with RMSSD decreasing from a median of 6.80 ms before the session to 4.32 ms while being held at the end of 30 min (p < 0.05). Discussion Skin-to-skin care with a parent resulted in a more mature autonomic nervous system pattern in preterm infants receiving respiratory support, suggesting physiologic benefit for the infant. No adverse events were seen during any session.
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Affiliation(s)
- Erin Swieter
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, United States
| | - Jessica M. Gross
- Clinical and Translational Science Center, University of New Mexico, Albuquerque, NM, United States
| | - Julia Stephen
- The Mind Research Network a Division of Lovelace Biomedical Research Institute, Albuquerque, NM, United States
| | - Kristi Watterberg
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, United States
| | - Jessie R. Maxwell
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, United States
- Department of Neurosciences, University of New Mexico, Albuquerque, NM, United States
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Wu S, Guan W, Zhao H, Li G, Zhou Y, Shi B, Zhang X. Assessment of short-term effects of thoracic radiotherapy on the cardiovascular parasympathetic and sympathetic nervous systems. Front Neurosci 2023; 17:1256067. [PMID: 37732299 PMCID: PMC10507252 DOI: 10.3389/fnins.2023.1256067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/22/2023] [Indexed: 09/22/2023] Open
Abstract
Background Prior research suggests that cardiovascular autonomic dysfunction might be an early marker of cardiotoxicity induced by antitumor treatment and act as an early predictor of cardiovascular disease-related morbidity and mortality. The impact of thoracic radiotherapy on the parasympathetic and sympathetic nervous systems, however, remains unclear. Therefore, this study aimed to evaluate the short-term effects of thoracic radiotherapy on the autonomic nervous system, using deceleration capacity (DC), acceleration capacity (AC) of heart rate, and heart rate variability (HRV) as assessment tools. Methods A 5 min electrocardiogram was collected from 58 thoracic cancer patients before and after thoracic radiotherapy for DC, AC, and HRV analysis. HRV parameters employed included the standard deviation of the normal-normal interval (SDNN), root mean square of successive interval differences (RMSSD), low frequency power (LF), high frequency power (HF), total power (TP), and the LF to HF ratio. Some patients also received systemic therapies alongside radiotherapy; thus, patients were subdivided into a radiotherapy-only group (28 cases) and a combined radiotherapy and systemic therapies group (30 cases) for additional subgroup analysis. Results Thoracic radiotherapy resulted in a significant reduction in DC (8.5 [5.0, 14.2] vs. 5.3 [3.5, 9.4], p = 0.002) and HRV parameters SDNN (9.9 [7.03, 16.0] vs. 8.2 [6.0, 12.4], p = 0.003), RMSSD (9.9 [6.9, 17.5] vs. 7.7 [4.8, 14.3], p = 0.009), LF (29 [10, 135] vs. 24 [15, 50], p = 0.005), HF (35 [12, 101] vs. 16 [9, 46], p = 0.002), TP (74 [41, 273] vs. 50 [33, 118], p < 0.001), and a significant increase in AC (-8.2 [-14.8, -4.9] vs. -5.8 [-10.1, -3.3], p = 0.003) and mean heart rate (79.8 ± 12.6 vs. 83.9 ± 13.6, p = 0.010). Subgroup analysis indicated similar trends in mean heart rate, DC, AC, and HRV parameters (SDNN, RMSSD, LF, HF, TP) in both the radiotherapy group and the combined treatment group post-radiotherapy. No statistically significant difference was noted in the changes observed in DC, AC, and HRV between the two groups pre- and post-radiotherapy. Conclusion Thoracic radiotherapy may induce cardiovascular autonomic dysfunction by reducing parasympathetic activity and enhancing sympathetic activity. Importantly, the study found that the concurrent use of systemic therapies did not significantly amplify or contribute to the alterations in autonomic function in the short-term following thoracic radiotherapy. DC, AC and HRV are promising and feasible biomarkers for evaluating autonomic dysfunction caused by thoracic radiotherapy.
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Affiliation(s)
- Shuang Wu
- School of Medicine, Yangzhou University, Yangzhou, China
- Department of Radiation Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu, China
| | - Weizheng Guan
- School of Medical Imaging, Bengbu Medical College, Bengbu, China
- Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, China
| | - Huan Zhao
- School of Medical Imaging, Bengbu Medical College, Bengbu, China
- Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, China
| | - Guangqiao Li
- School of Medical Imaging, Bengbu Medical College, Bengbu, China
- Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, China
| | - Yufu Zhou
- Department of Radiation Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu, China
| | - Bo Shi
- School of Medical Imaging, Bengbu Medical College, Bengbu, China
- Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, China
| | - Xiaochun Zhang
- School of Medicine, Yangzhou University, Yangzhou, China
- Department of Oncology, Yangzhou Hospital of Traditional Chinese Medicine, Yangzhou, China
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He M, Zhao WB, Nguyen MN, Kiriazis H, Li YQ, Hu H, Du XJ. Association between heart rate variability indices and features of spontaneous ventricular tachyarrhythmias in mice. Clin Exp Pharmacol Physiol 2020; 47:1193-1202. [PMID: 32027390 DOI: 10.1111/1440-1681.13275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 12/20/2022]
Abstract
Direct evidence is limited for the association between heart rate variability (HRV) indices and ventricular tachyarrhythmias (VTAs). While galectin-3 (Gal-3) is regarded as a causal factor for cardiac remodelling and a biomarker for arrhythmias, its regulation on VTAs and HVR is unknown. Using aged transgenic (TG) mice with cardiac overexpression of β2 -adrenoceptors and spontaneous VTAs, we studied whether changes in HRV indices correlated with the severity of VTAs, and whether Gal-3 gene knockout (KO) in TG mice might limit VTA. Body-surface ECG was recorded (10-minute period) in 9- to 10-month-old mice of non-transgenic (nTG), TG and TG × Gal-3 knockout (TG/KO). Time-domain, frequency-domain and nonlinear-domain HRV indices were calculated using the R-R intervals extracted from ECG signals and compared with frequency of VTAs. TG and TG/KO mice developed frequent VTAs and showed significant changes in certain time-domain and nonlinear-domain HRV indices relative to nTG mice. The severity of VTAs in TG and TG/KO mice in combination, estimated by VTA counts and arrhythmia score, was significantly correlated with certain time-domain and nonlinear-domain HRV indices. In conclusion, significant changes in HRV indices were evident and correlated with the severity of spontaneous VTAs in TG mice. The frequency of VTA and HRV indices were largely comparable between TG and TG/KO mice. Deletion of Gal-3 in TG mice altered certain HRV indices implying influence by neuronally localized Gal-3 on autonomic nervous activity.
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Affiliation(s)
- Mi He
- Department of Cardiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
- School of Biomedical Engineering and Imaging Medicine, Third Military Medical University (Army Medical University), Chongqing, China
| | - Wei-Bo Zhao
- Department of Cardiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - My-Nhan Nguyen
- Experimental Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia
| | - Helen Kiriazis
- Experimental Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia
| | - Yong-Qin Li
- School of Biomedical Engineering and Imaging Medicine, Third Military Medical University (Army Medical University), Chongqing, China
| | - Houyuan Hu
- Department of Cardiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xiao-Jun Du
- Experimental Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi'an Jiaotong University (Health Science Center), Xi'an, China
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Benchimol-Barbosa PR, Nasario Junior O, Nadal J. Assessing Dynamic Atrioventricular Conduction Time to RR-interval Coupling in Athletes and Sedentary Subjects. Arq Bras Cardiol 2020; 115:71-77. [PMID: 32401843 PMCID: PMC8384324 DOI: 10.36660/abc.20190281] [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: 04/30/2019] [Accepted: 08/01/2019] [Indexed: 11/18/2022] Open
Abstract
Background Atrioventricular conduction time ( AVCT ) is influenced by autonomic input and subject to physiological remodeling. Objective To evaluate beat-by-beat AVCT and RR-interval variability in athletes and healthy sedentary subjects. Methods Twenty adults, including 10 healthy sedentary (Controls) and 10 elite long-distance runners (Athletes), age, weight and height-adjusted, underwent maximal metabolic equivalent (MET) assessment, and 15-min supine resting ECG recording seven days later. The interval between P-wave and R-wave peaks defined the AVCT . Mean (M) and standard deviation (SD) of consecutive RR-intervals (RR) and coupled AVCT were calculated, as well as regression lines of RR vs. AVCT (RR-AVCT) . Concordant AV conduction was defined as positive RR-AVCT slope and discordant otherwise. A multivariate linear regression model was developed to explain MET based on AVCT and RR-interval variability parameters. Significance-level: 5 %. Results In Athletes, M-RR and SD-RR values were higher than in Controls, whereas M-AVCT and SD-AVCT were not. RR-AVCT slopes were, respectively, 0.038 ± 0.022 and 0.0034 ± 0.017 (p < 0.05). Using a cut-off value of 0.0044 (AUC 0.92 ± 0.07; p < 0.001), RR-AVCT slope showed 100% specificity and 80% sensitivity. In a multivariate model, SD-RR and RR-AVCT slope were independent explanatory variables of MET (F-ratio: 17.2; p < 0.001), showing 100% specificity and 90% sensitivity (AUC 0.99 ± 0.02; p < 0.001). Conclusion In elite runners, AVCT to RR -interval dynamic coupling shows spontaneous discordant AV conduction, characterized by negative AVCT vs. RR -interval regression line slope. RR -intervals standard deviation and AVCT vs. RR -interval regression line slope are independent explanatory variables of MET (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).
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Affiliation(s)
| | - Olivassé Nasario Junior
- Instituto Alberto Luiz Coimbra de Pós-Graduação e Pesquisa de Engenharia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Jurandir Nadal
- Instituto Alberto Luiz Coimbra de Pós-Graduação e Pesquisa de Engenharia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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Preprocessing Unevenly Sampled RR Interval Signals to Enhance Estimation of Heart Rate Deceleration and Acceleration Capacities in Discriminating Chronic Heart Failure Patients from Healthy Controls. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2020; 2020:9763826. [PMID: 32328158 PMCID: PMC7150734 DOI: 10.1155/2020/9763826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/14/2020] [Accepted: 02/29/2020] [Indexed: 11/17/2022]
Abstract
Objective. The deceleration capacity (DC) and acceleration capacity (AC) of heart rate, which are recently proposed variants to the heart rate variability, are calculated from unevenly sampled RR interval signals using phase-rectified signal averaging. Although uneven sampling of these signals compromises heart rate variability analyses, its effect on DC and AC analyses remains to be addressed. Approach. We assess preprocessing (i.e., interpolation and resampling) of RR interval signals on the diagnostic effect of DC and AC from simulation and clinical data. The simulation analysis synthesizes unevenly sampled RR interval signals with known frequency components to evaluate the preprocessing performance for frequency extraction. The clinical analysis compares the conventional DC and AC calculation with the calculation using preprocessed RR interval signals on 24-hour data acquired from normal subjects and chronic heart failure patients. Main Results. The assessment of frequency components in the RR intervals using wavelet analysis becomes more robust with preprocessing. Moreover, preprocessing improves the diagnostic ability based on DC and AC for chronic heart failure patients, with area under the receiver operating characteristic curve increasing from 0.920 to 0.942 for DC and from 0.818 to 0.923 for AC. Significance. Both the simulation and clinical analyses demonstrate that interpolation and resampling of unevenly sampled RR interval signals improve the performance of DC and AC, enabling the discrimination of CHF patients from healthy controls.
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10
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Liu H, Zhan P, Shi J, Wang G, Wang B, Wang W. A refined method of quantifying deceleration capacity index for heart rate variability analysis. Biomed Eng Online 2018; 17:184. [PMID: 30563515 PMCID: PMC6299532 DOI: 10.1186/s12938-018-0618-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 12/13/2018] [Indexed: 11/14/2022] Open
Abstract
Background Phase-rectified signal averaging (PRSA) was often applied to assess the cardiac vagal modulation. Despite its broad use, this method suffers from the confounding effects of anomalous variants of sinus rhythm. This study aimed to improve the original PRSA method in deceleration capacity (DC) quantification. Methods The refined deceleration capacity (DCref) was calculated by excluding from non-vagally mediated abnormal variants of sinus rhythms. Holter recordings from 202 healthy subjects and 51 patients with end-stage renal disease (ESRD) have been used for validity. The DCref was compared to original DC (DCorg) by the area under receiver operating characteristic curve. Results Experimental results demonstrate that the original and refined DCs calculated from 24-h, 2-h, and 30-min Holter recordings are significantly lower in patients with ESRD than those in the healthy group. In receiver operating characteristic curve analysis, the DCref provides better performance than the DCorg in distinguishing between the patients with ESRD and healthy control subjects. Furthermore, the refined PRSA technique enhances the low frequency and attenuates high frequency components for spectral analysis in ESRD patients. Conclusions The DCref appears to reduce the influence of non-vagally mediated abnormal variants of sinus rhythm and highlighting the pathological influence. DCref, especially assessed from short-term electrocardiography recordings, may be complementary to existing autonomic function assessment, risk stratification, and efficacy prediction strategies.
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Affiliation(s)
- Hongyun Liu
- Department of Biomedical Engineering, Chinese PLA General Hospital, Room_105, South Ward Building, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.,Center of Medical Device R & D and Clinical Evaluation, Chinese PLA General Hospital, Beijing, 100853, China
| | - Ping Zhan
- Center of Medical Device R & D and Clinical Evaluation, Chinese PLA General Hospital, Beijing, 100853, China
| | - Jinlong Shi
- Department of Biomedical Engineering, Chinese PLA General Hospital, Room_105, South Ward Building, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.,Center of Medical Device R & D and Clinical Evaluation, Chinese PLA General Hospital, Beijing, 100853, China
| | - Guojing Wang
- Department of Biomedical Engineering, Chinese PLA General Hospital, Room_105, South Ward Building, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.,Center of Medical Device R & D and Clinical Evaluation, Chinese PLA General Hospital, Beijing, 100853, China
| | - Buqing Wang
- Department of Biomedical Engineering, Chinese PLA General Hospital, Room_105, South Ward Building, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Weidong Wang
- Department of Biomedical Engineering, Chinese PLA General Hospital, Room_105, South Ward Building, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China. .,Center of Medical Device R & D and Clinical Evaluation, Chinese PLA General Hospital, Beijing, 100853, China.
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11
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Pan Q, Zhou G, Wang R, Yu Y, Li F, Fang L, Yan J, Ning G. The degree of heart rate asymmetry is crucial for the validity of the deceleration and acceleration capacity indices of heart rate: A model-based study. Comput Biol Med 2016; 76:39-49. [PMID: 27392228 DOI: 10.1016/j.compbiomed.2016.06.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 05/24/2016] [Accepted: 06/20/2016] [Indexed: 11/20/2022]
Abstract
The deceleration capacity (DC) and acceleration capacity (AC) of heart rate are a pair of indices used for evaluating the autonomic nervous system (ANS). We assessed the role of heart rate asymmetry (HRA) in defining the relative performance of DC and AC using a mathematical model, which is able to generate a realistic RR interval (RRI) time series with controlled ANS states. The simulation produced a set of RRI series with random sympathetic and vagal activities. The multi-scale DCs and ACs were computed from the RRI series, and the correlation of DC and AC with the ANS functions was analyzed to evaluate the performance of the indices. In the model, the HRA level was modified by changing the inspiration/expiration (I/E) ratio to examine the influence of HRA on the performances of DC and AC. The results show that on the conventional scales (T=1, s=2), an HRA level above 50% results in a stronger association of DC with the ANS, compared with AC. On higher scales (T=4, s=6), there was no HRA and DC showed a similar performance to AC for all I/E ratios. The data suggest that the HRA level determines which of DC or AC is the optimal index for expressing ANS functions. Future clinical applications of DC and AC should be accompanied by an HRA analysis to provide a better index for assessing ANS.
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Affiliation(s)
- Qing Pan
- College of Information Engineering, Zhejiang University of Technology, 288 Liuhe Road, Hangzhou 310023, China
| | - Gongzhan Zhou
- College of Information Engineering, Zhejiang University of Technology, 288 Liuhe Road, Hangzhou 310023, China
| | - Ruofan Wang
- Department of Biomedical Engineering, Key Laboratory of Biomedical Engineering of Ministry of Education, Zhejiang University, 38 Zheda Road, Hangzhou 310027, China
| | - Yihua Yu
- Department of ICU, Zhejiang Hospital, 12 Lingyin Road, Hangzhou 310013, China
| | - Feng Li
- College of Information Engineering, Zhejiang University of Technology, 288 Liuhe Road, Hangzhou 310023, China
| | - Luping Fang
- College of Information Engineering, Zhejiang University of Technology, 288 Liuhe Road, Hangzhou 310023, China
| | - Jing Yan
- Department of ICU, Zhejiang Hospital, 12 Lingyin Road, Hangzhou 310013, China.
| | - Gangmin Ning
- Department of Biomedical Engineering, Key Laboratory of Biomedical Engineering of Ministry of Education, Zhejiang University, 38 Zheda Road, Hangzhou 310027, China.
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12
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Pan Q, Zhou G, Wang R, Cai G, Yan J, Fang L, Ning G. Do the deceleration/acceleration capacities of heart rate reflect cardiac sympathetic or vagal activity? A model study. Med Biol Eng Comput 2016; 54:1921-1933. [PMID: 27059998 DOI: 10.1007/s11517-016-1486-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 03/04/2016] [Indexed: 12/22/2022]
Abstract
Despite increased application of the deceleration capacity (DC) and acceleration capacity (AC) of heart rate indices as indicators of autonomic nervous system (ANS) function, it remains controversial as to whether they reflect cardiac sympathetic or vagal activity. We addressed this problem using a cardiovascular system model that allows analysis of DC and AC under controllable levels of sympathetic and vagal activities. Multi-scale DCs and ACs with various timescales T and wavelet scales s were computed from the simulated RR interval series under randomly fluctuating levels of ANS activity, and the correlations of the indices to ANS functions were assessed. Results showed that under the conventional scales (T = 1, s = 2), both DC and AC were solely dependent on vagal activity. With higher scales (T = 3, s = 5), both DC and AC were positively correlated to sympathetic activity and negatively correlated to vagal activity. These data suggest that DC and AC provide information on the same aspects of ANS activity and that their physiological significance is highly influenced by the timescales and wavelet scales used in the computation.
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Affiliation(s)
- Qing Pan
- College of Information Engineering, Zhejiang University of Technology, 288 Liuhe Road, Hangzhou, 310023, China
| | - Gongzhan Zhou
- College of Information Engineering, Zhejiang University of Technology, 288 Liuhe Road, Hangzhou, 310023, China
| | - Ruofan Wang
- Department of Biomedical Engineering, Key Laboratory of Biomedical Engineering of Ministry of Education, Zhejiang University, 38 Zheda Road, Hangzhou, 310027, China
| | - Guolong Cai
- Department of ICU, Zhejiang Hospital, 12 Lingyin Road, Hangzhou, 310013, China
| | - Jing Yan
- Department of ICU, Zhejiang Hospital, 12 Lingyin Road, Hangzhou, 310013, China
| | - Luping Fang
- College of Information Engineering, Zhejiang University of Technology, 288 Liuhe Road, Hangzhou, 310023, China
| | - Gangmin Ning
- Department of Biomedical Engineering, Key Laboratory of Biomedical Engineering of Ministry of Education, Zhejiang University, 38 Zheda Road, Hangzhou, 310027, China.
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13
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Nasario-Junior O, Benchimol-Barbosa PR, Pedrosa RC, Nadal J. Assessment of Autonomic Function by Phase Rectification of RRInterval Histogram Analysis in Chagas Disease. Arq Bras Cardiol 2015; 104:450-5. [PMID: 26131700 PMCID: PMC4484677 DOI: 10.5935/abc.20150032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 01/26/2015] [Indexed: 11/20/2022] Open
Abstract
Background In chronic Chagas disease (ChD), impairment of cardiac autonomic function bears
prognostic implications. Phase‑rectification of RR-interval series isolates the
sympathetic, acceleration phase (AC) and parasympathetic, deceleration phase (DC)
influences on cardiac autonomic modulation. Objective This study investigated heart rate variability (HRV) as a function of RR-interval
to assess autonomic function in healthy and ChD subjects. Methods Control (n = 20) and ChD (n = 20) groups were studied. All underwent 60-min
head-up tilt table test under ECG recording. Histogram of RR-interval series was
calculated, with 100 ms class, ranging from 600–1100 ms. In each class, mean
RR-intervals (MNN) and root-mean-squared difference (RMSNN) of consecutive normal
RR-intervals that suited a particular class were calculated. Average of all RMSNN
values in each class was analyzed as function of MNN, in the whole series
(RMSNNT), and in AC (RMSNNAC) and DC (RMSNNDC)
phases. Slopes of linear regression lines were compared between groups using
Student t-test. Correlation coefficients were tested before comparisons. RMSNN was
log-transformed. (α < 0.05). Results Correlation coefficient was significant in all regressions (p < 0.05). In the
control group, RMSNNT, RMSNNAC, and RMSNNDC
significantly increased linearly with MNN (p < 0.05). In ChD, only
RMSNNAC showed significant increase as a function of MNN, whereas
RMSNNT and RMSNNDC did not. Conclusion HRV increases in proportion with the RR-interval in healthy subjects. This
behavior is lost in ChD, particularly in the DC phase, indicating cardiac vagal
incompetence.
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Affiliation(s)
- Olivassé Nasario-Junior
- Programa de Engenharia Biomédica, COPPE, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Roberto Coury Pedrosa
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Jurandir Nadal
- Programa de Engenharia Biomédica, COPPE, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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