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Ruangsuphaphichat A, Brockmann L, Sirasaporn P, Manimmanakorn N, Hunt KJ, Saengsuwan J. Test-retest reliability of short- and long-term heart rate variability in individuals with spinal cord injury. Spinal Cord 2023; 61:658-666. [PMID: 37779114 PMCID: PMC10691965 DOI: 10.1038/s41393-023-00935-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 10/03/2023]
Abstract
STUDY DESIGN Cross-sectional. OBJECTIVES To investigate test-retest reliability of heart rate variability (HRV) metrics in SCI without restriction of activity over long (24-h) and shorter durations (5-min, 10-min, 1-h, 3-h and 6-h). SETTINGS University hospital in Khon Kaen, Thailand. METHODS Forty-five participants (11 with tetraplegia and 34 with paraplegia) underwent two 24-h recordings of RR-intervals to derive time and frequency HRV metrics. Relative reliability was assessed by intraclass correlation coefficient (ICC) and absolute reliability by coefficient of variation (CV) and Bland-Altman limits of agreement (LoA). RESULTS For 5- and 10-min durations, eight of eleven HRV metrics had moderate to excellent reliability (ICC 0.40-0.76); the remaining three were poor (ICC < 0.4). HRV values from 1-h and 3-h durations showed moderate to excellent reliability (ICC of 0.46-0.81), except for 1-h reliability of ULF and TP (ICC of 0.06 and 0.30, respectively). Relative reliability was excellent (ICC of 0.77-0.92) for 6-h and 24-h durations in all HRV metrics. Absolute reliability improved as recording duration increased (lower CVs and narrower LoAs). Participants with high AD risk (SCI level at or above T6) showed lower test-retest reliability of HF and LF values than participants with low AD risk. CONCLUSION Relative reliability of HRV was excellent for 6-h and 24-h. The best absolute reliability values were for 24-h duration. Time-domain outcomes were more reliable than frequency domain outcomes. Participants with high risk of AD, particularly those with tetraplegia, showed lower reliability, especially for HF and LF.
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Affiliation(s)
| | - Lars Brockmann
- The Laboratory for Rehabilitation Engineering, Institute for Human Centred Engineering, Bern University of Applied Sciences, Biel, Switzerland
| | - Patpiya Sirasaporn
- Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Nuttaset Manimmanakorn
- Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kenneth J Hunt
- The Laboratory for Rehabilitation Engineering, Institute for Human Centred Engineering, Bern University of Applied Sciences, Biel, Switzerland
| | - Jittima Saengsuwan
- Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
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Mehta PK, Wei J, Shufelt C, Quesada O, Shaw L, Bairey Merz CN. Gender-Related Differences in Chest Pain Syndromes in the Frontiers in CV Medicine Special Issue: Sex & Gender in CV Medicine. Front Cardiovasc Med 2021; 8:744788. [PMID: 34869650 PMCID: PMC8635525 DOI: 10.3389/fcvm.2021.744788] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/13/2021] [Indexed: 12/30/2022] Open
Abstract
Coronary artery disease (CAD) is the leading cause of morbidity and mortality among both women and men, yet women continue to have delays in diagnosis and treatment. The lack of recognition of sex-specific biological and socio-cultural gender-related differences in chest pain presentation of CAD may, in part, explain these disparities. Sex and gender differences in pain mechanisms including psychological susceptibility, the autonomic nervous system (ANS) reactivity, and visceral innervation likely contribute to chest pain differences. CAD risk scores and typical/atypical angina characterization no longer appear relevant and should not be used in women and men. Women more often have ischemia with no obstructive CAD (INOCA) and myocardial infarction, contributing to diagnostic and therapeutic equipoise. Existing knowledge demonstrates that chest pain often does not relate to obstructive CAD, suggesting a more thoughtful approach to percutaneous coronary intervention (PCI) and medical therapy for chest pain in stable obstructive CAD. Emerging knowledge regarding the central and ANS and visceral pain processing in patients with and without angina offers explanatory mechanisms for chest pain and should be investigated with interdisciplinary teams of cardiologists, neuroscientists, bio-behavioral experts, and pain specialists. Improved understanding of sex and gender differences in chest pain, including biological pathways as well as sociocultural contributions, is needed to improve clinical care in both women and men.
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Affiliation(s)
- Puja K Mehta
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute and Emory Women's Heart Center, Emory University School of Medicine, Atlanta, GA, United States
| | - Janet Wei
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States
| | - Chrisandra Shufelt
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States
| | - Odayme Quesada
- Women's Heart Center, The Christ Hospital Heart Institute, Cincinnati, OH, United States
| | - Leslee Shaw
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States
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Inter- and intra-researcher reproducibility of heart rate variability parameters in three human cohorts. Sci Rep 2020; 10:11399. [PMID: 32647148 PMCID: PMC7347623 DOI: 10.1038/s41598-020-68197-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/16/2020] [Indexed: 12/17/2022] Open
Abstract
Heart rate variability (HRV) is a valid and non-invasive indicator of cardiac autonomic nervous system functioning. Short-term HRV recordings (e.g., 10 min long) produce data that usually is manually processed. Researcher subjective decision-making on data processing could produce inter- or intra-researcher differences whose magnitude has not been previously quantified in three independent human cohorts. This study examines the inter- and intra-researcher reproducibility of HRV parameters (i.e., the influence of R–R interval selection by different researchers and by the same researcher in different moments on the quantification of HRV parameters, respectively) derived from short-term recordings in a cohort of children with overweight/obesity, young adults and middle-age adults. Participants were recruited from 3 different studies: 107 children (10.03 ± 1.13 years, 58% male), 132 young adults (22.22 ± 2.20 years, 33% males) and 73 middle-aged adults (53.62 ± 5.18 years, 48% males). HRV was measured using a Polar RS800CX heart rate monitor. The intraclass correlation coefficient (ICC) ranged from 0.703 to 0.989 and from 0.950 to 0.998 for inter-and intra-researcher reproducibility, respectively. Limits of agreement for HRV parameters were higher for the inter-researcher processing compared with the intra-researcher processing. On average, the intra-researcher differences were 31%, 62%, and 80% smaller than the inter-researchers differences based on Coefficient of Variation in children, young and middle-aged adults, respectively. Our study provides the quantification of the inter-researcher and intra-researcher differences in three independent human cohorts, which could elicit some clinical relevant differences for HRV parameters. Based on our findings, we recommend the HRV data signal processing to be performed always by the same trained researcher and we postulate a development of algorithms for an automatic ECG selection.
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Cardiac autonomic function and vasomotor symptoms: too much break and not enough accelerator? Menopause 2017; 24:719-721. [DOI: 10.1097/gme.0000000000000925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Farah BQ, Lima AHRDA, Cavalcante BR, de Oliveira LMFT, Brito ALDS, de Barros MVG, Ritti-Dias RM. Intra-individuals and inter- and intra-observer reliability of short-term heart rate variability in adolescents. Clin Physiol Funct Imaging 2014; 36:33-9. [DOI: 10.1111/cpf.12190] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 08/15/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Breno Quintella Farah
- Associate Graduate Program in Physical Education; University of Pernambuco; Recife PE Brazil
- Study and Research Group on Hemodynamics and Exercise Metabolism-GEPHEME; University of Pernambuco; Recife PE Brazil
| | - Aluísio Henrique Rodrigues de Andra Lima
- Study and Research Group on Hemodynamics and Exercise Metabolism-GEPHEME; University of Pernambuco; Recife PE Brazil
- School of Physical Education and Sport; University of São Paulo; São Paulo SP Brazil
| | - Bruno Remígio Cavalcante
- Study and Research Group on Hemodynamics and Exercise Metabolism-GEPHEME; University of Pernambuco; Recife PE Brazil
| | | | | | | | - Raphael Mendes Ritti-Dias
- Associate Graduate Program in Physical Education; University of Pernambuco; Recife PE Brazil
- Study and Research Group on Hemodynamics and Exercise Metabolism-GEPHEME; University of Pernambuco; Recife PE Brazil
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Mehta PK, Polk DM, Zhang X, Li N, Painovich J, Kothawade K, Kirschner J, Qiao Y, Ma X, Chen YDI, Brantman A, Shufelt C, Minissian M, Merz CNB. A randomized controlled trial of acupuncture in stable ischemic heart disease patients. Int J Cardiol 2014; 176:367-74. [PMID: 25103909 DOI: 10.1016/j.ijcard.2014.07.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 05/19/2014] [Accepted: 07/05/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Heart rate variability (HRV) is reduced in stable ischemic heart disease (SIHD) patients and is associated with sudden cardiac death (SCD). We evaluated the impact of traditional acupuncture (TA) on cardiac autonomic function measured by HRV in SIHD patients. METHODS We conducted a randomized controlled study of TA, sham acupuncture (SA), and waiting control (WC) in 151 SIHD subjects. The TA group received needle insertion at acupuncture sites, the SA group received a sham at non-acupuncture sites, while the WC group received nothing. The TA and SA groups received 3 treatments/week for 12 weeks. 24-Hour, mental arithmetic stress, and cold pressor (COP) HRV was collected at entry and exit, along with BP, lipids, insulin resistance, hs-CRP, salivary cortisol, peripheral endothelial function by tonometry (PAT), and psychosocial variables. RESULTS Mean age was 63 ± 10; 50% had prior myocardial infarction. Comparison of WC and SA groups demonstrated differences consistent with the unblinded WC status; therefore by design, the control groups were not merged. Exit mental stress HRV was higher in TA vs. SA for markers of parasympathetic tone (p ≤ 0.025), including a 17% higher vagal activity (p=0.008). There were no differences in exit 24-hour or COP HRV, BP, lipids, insulin resistance, hs-CRP, salivary cortisol, PAT, or psychosocial variables. CONCLUSIONS TA results in intermediate effects on autonomic function in SIHD patients. TA effect on HRV may be clinically relevant and should be explored further. These data document feasibility and provide sample size estimation for a clinical trial of TA in SIHD patients for the prevention of SCD. CONDENSED ABSTRACT We conducted a randomized, single-blind trial of traditional acupuncture (TA) vs. sham acupuncture (SA) vs waiting control (WC) in stable ischemic heart disease (SIHD) patients to evaluate cardiac autonomic function measured by heart rate variability (HRV). Exit mental stress HRV was higher in the TA compared to SA group for time and frequency domain markers of parasympathetic tone (all p ≤ 0.025), including a 17% higher vagal activity (p=0.008). These data document feasibility and provide sample size estimation for an outcome-based clinical trial of TA in SIHD patients for the prevention of sudden cardiac death.
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Affiliation(s)
- Puja K Mehta
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
| | - Donna M Polk
- Division of Cardiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Xiao Zhang
- Biostatistics and Bioinformatics, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, United States
| | - Ning Li
- Department of Biomathematics, University of California at Los Angeles, Los Angeles, CA, United States
| | - Jeannette Painovich
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
| | - Kamlesh Kothawade
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
| | - Joan Kirschner
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
| | - Yi Qiao
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
| | - Xiuling Ma
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
| | - Yii-Der Ida Chen
- Molecular Biochemistry and Steroid Chemistry Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Anna Brantman
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
| | - Chrisandra Shufelt
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
| | - Margo Minissian
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States.
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Israel B, Buysse DJ, Krafty RT, Begley A, Miewald J, Hall M. Short-term stability of sleep and heart rate variability in good sleepers and patients with insomnia: for some measures, one night is enough. Sleep 2012; 35:1285-91. [PMID: 22942507 DOI: 10.5665/sleep.2088] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Quantify the short-term stability of multiple indices of sleep and nocturnal physiology in good sleeper controls and primary insomnia patients. DESIGN Intra-class correlation coefficients (ICC) were used to quantify the short-term stability of study outcomes. SETTING Sleep laboratory. PARTICIPANTS Fifty-four adults with primary insomnia (PI) and 22 good sleeper controls (GSC). MEASUREMENTS Visually scored sleep outcomes included indices of sleep duration, continuity, and architecture. Quantitative EEG outcomes included power in the delta, theta, alpha, sigma, and beta bands during NREM sleep. Power spectral analysis was used to estimate high-frequency heart rate variability (HRV) and the ratio of low- to high-frequency HRV power during NREM and REM sleep. RESULTS With the exception of percent stage 3+4 sleep; visually scored sleep outcomes did not exhibit short-term stability across study nights. Most QEEG outcomes demonstrated short-term stability in both groups. Although power in the beta band was stable in the PI group (ICC = 0.75), it tended to be less stable in GSCs (ICC = 0.55). Both measures of cardiac autonomic tone exhibited short-term stability in GSCs and PIs during NREM and REM sleep. CONCLUSIONS Most QEEG bandwidths and HRV during sleep show high short-term stability in good sleepers and patients with insomnia alike. One night of data is, thus, sufficient to derive reliable estimates of these outcomes in studies focused on group differences or correlates of QEEG and/or HRV. In contrast, one night of data is unlikely to generate reliable estimates of PSG-assessed sleep duration, continuity or architecture, with the exception of slow wave sleep.
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Affiliation(s)
- Benjamin Israel
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Seely AJE, Macklem P. Fractal variability: an emergent property of complex dissipative systems. CHAOS (WOODBURY, N.Y.) 2012; 22:013108. [PMID: 22462984 DOI: 10.1063/1.3675622] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The patterns of variation of physiologic parameters, such as heart and respiratory rate, and their alteration with age and illness have long been under investigation; however, the origin and significance of scale-invariant fractal temporal structures that characterize healthy biologic variability remain unknown. Quite independently, atmospheric and planetary scientists have led breakthroughs in the science of non-equilibrium thermodynamics. In this paper, we aim to provide two novel hypotheses regarding the origin and etiology of both the degree of variability and its fractal properties. In a complex dissipative system, we hypothesize that the degree of variability reflects the adaptability of the system and is proportional to maximum work output possible divided by resting work output. Reductions in maximal work output (and oxygen consumption) or elevation in resting work output (or oxygen consumption) will thus reduce overall degree of variability. Second, we hypothesize that the fractal nature of variability is a self-organizing emergent property of complex dissipative systems, precisely because it enables the system's ability to optimally dissipate energy gradients and maximize entropy production. In physiologic terms, fractal patterns in space (e.g., fractal vasculature) or time (e.g., cardiopulmonary variability) optimize the ability to deliver oxygen and clear carbon dioxide and waste. Examples of falsifiability are discussed, along with the need to further define necessary boundary conditions. Last, as our focus is bedside utility, potential clinical applications of this understanding are briefly discussed. The hypotheses are clinically relevant and have potential widespread scientific relevance.
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Affiliation(s)
- Andrew J E Seely
- Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada.
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Dantas E, Gonçalves C, Silva A, Rodrigues S, Ramos M, Andreão R, Pimentel E, Lunz W, Mill J. Reproducibility of heart rate variability parameters measured in healthy subjects at rest and after a postural change maneuver. Braz J Med Biol Res 2010; 43:982-8. [DOI: 10.1590/s0100-879x2010007500101] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 09/08/2010] [Indexed: 11/22/2022] Open
Affiliation(s)
- E.M. Dantas
- Universidade Federal do Espírito Santo, Brasil
| | | | | | | | - M.S. Ramos
- Centro Federal de Educação Tecnológica do Espírito Santo, Brasil
| | - R.V. Andreão
- Centro Federal de Educação Tecnológica do Espírito Santo, Brasil
| | | | - W. Lunz
- Universidade Federal do Espírito Santo, Brasil
| | - J.G. Mill
- Universidade Federal do Espírito Santo, Brasil
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Patel RB, Ng J, Reddy V, Chokshi M, Parikh K, Subacius H, Alsheikh-Ali AA, Nguyen T, Link MS, Goldberger JJ, Ilkhanoff L, Kadish AH. Early Repolarization Associated With Ventricular Arrhythmias in Patients With Chronic Coronary Artery Disease. Circ Arrhythm Electrophysiol 2010; 3:489-95. [DOI: 10.1161/circep.109.921130] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Ravi B. Patel
- From the Division of Cardiology (R.B.P., J.N., V.R., M.C., K.P., H.S., J.J.G., L.I., A.H.K.), Feinberg School of Medicine, Northwestern University, Chicago, Ill; the Division of Cardiology (A.A.A.-A., T.N., M.S.L.), Tufts Medical Center, Tufts University School of Medicine, Boston, Mass; and the Institute of Cardiac Sciences (A.A.A.-A.), Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Jason Ng
- From the Division of Cardiology (R.B.P., J.N., V.R., M.C., K.P., H.S., J.J.G., L.I., A.H.K.), Feinberg School of Medicine, Northwestern University, Chicago, Ill; the Division of Cardiology (A.A.A.-A., T.N., M.S.L.), Tufts Medical Center, Tufts University School of Medicine, Boston, Mass; and the Institute of Cardiac Sciences (A.A.A.-A.), Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Vikram Reddy
- From the Division of Cardiology (R.B.P., J.N., V.R., M.C., K.P., H.S., J.J.G., L.I., A.H.K.), Feinberg School of Medicine, Northwestern University, Chicago, Ill; the Division of Cardiology (A.A.A.-A., T.N., M.S.L.), Tufts Medical Center, Tufts University School of Medicine, Boston, Mass; and the Institute of Cardiac Sciences (A.A.A.-A.), Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Moulin Chokshi
- From the Division of Cardiology (R.B.P., J.N., V.R., M.C., K.P., H.S., J.J.G., L.I., A.H.K.), Feinberg School of Medicine, Northwestern University, Chicago, Ill; the Division of Cardiology (A.A.A.-A., T.N., M.S.L.), Tufts Medical Center, Tufts University School of Medicine, Boston, Mass; and the Institute of Cardiac Sciences (A.A.A.-A.), Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Kishan Parikh
- From the Division of Cardiology (R.B.P., J.N., V.R., M.C., K.P., H.S., J.J.G., L.I., A.H.K.), Feinberg School of Medicine, Northwestern University, Chicago, Ill; the Division of Cardiology (A.A.A.-A., T.N., M.S.L.), Tufts Medical Center, Tufts University School of Medicine, Boston, Mass; and the Institute of Cardiac Sciences (A.A.A.-A.), Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Haris Subacius
- From the Division of Cardiology (R.B.P., J.N., V.R., M.C., K.P., H.S., J.J.G., L.I., A.H.K.), Feinberg School of Medicine, Northwestern University, Chicago, Ill; the Division of Cardiology (A.A.A.-A., T.N., M.S.L.), Tufts Medical Center, Tufts University School of Medicine, Boston, Mass; and the Institute of Cardiac Sciences (A.A.A.-A.), Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Alawi A. Alsheikh-Ali
- From the Division of Cardiology (R.B.P., J.N., V.R., M.C., K.P., H.S., J.J.G., L.I., A.H.K.), Feinberg School of Medicine, Northwestern University, Chicago, Ill; the Division of Cardiology (A.A.A.-A., T.N., M.S.L.), Tufts Medical Center, Tufts University School of Medicine, Boston, Mass; and the Institute of Cardiac Sciences (A.A.A.-A.), Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Tuan Nguyen
- From the Division of Cardiology (R.B.P., J.N., V.R., M.C., K.P., H.S., J.J.G., L.I., A.H.K.), Feinberg School of Medicine, Northwestern University, Chicago, Ill; the Division of Cardiology (A.A.A.-A., T.N., M.S.L.), Tufts Medical Center, Tufts University School of Medicine, Boston, Mass; and the Institute of Cardiac Sciences (A.A.A.-A.), Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Mark S. Link
- From the Division of Cardiology (R.B.P., J.N., V.R., M.C., K.P., H.S., J.J.G., L.I., A.H.K.), Feinberg School of Medicine, Northwestern University, Chicago, Ill; the Division of Cardiology (A.A.A.-A., T.N., M.S.L.), Tufts Medical Center, Tufts University School of Medicine, Boston, Mass; and the Institute of Cardiac Sciences (A.A.A.-A.), Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Jeffrey J. Goldberger
- From the Division of Cardiology (R.B.P., J.N., V.R., M.C., K.P., H.S., J.J.G., L.I., A.H.K.), Feinberg School of Medicine, Northwestern University, Chicago, Ill; the Division of Cardiology (A.A.A.-A., T.N., M.S.L.), Tufts Medical Center, Tufts University School of Medicine, Boston, Mass; and the Institute of Cardiac Sciences (A.A.A.-A.), Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Leonard Ilkhanoff
- From the Division of Cardiology (R.B.P., J.N., V.R., M.C., K.P., H.S., J.J.G., L.I., A.H.K.), Feinberg School of Medicine, Northwestern University, Chicago, Ill; the Division of Cardiology (A.A.A.-A., T.N., M.S.L.), Tufts Medical Center, Tufts University School of Medicine, Boston, Mass; and the Institute of Cardiac Sciences (A.A.A.-A.), Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Alan H. Kadish
- From the Division of Cardiology (R.B.P., J.N., V.R., M.C., K.P., H.S., J.J.G., L.I., A.H.K.), Feinberg School of Medicine, Northwestern University, Chicago, Ill; the Division of Cardiology (A.A.A.-A., T.N., M.S.L.), Tufts Medical Center, Tufts University School of Medicine, Boston, Mass; and the Institute of Cardiac Sciences (A.A.A.-A.), Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
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Ahmad S, Tejuja A, Newman KD, Zarychanski R, Seely AJ. Clinical review: a review and analysis of heart rate variability and the diagnosis and prognosis of infection. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2009; 13:232. [PMID: 20017889 PMCID: PMC2811891 DOI: 10.1186/cc8132] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Bacterial infection leading to organ failure is the most common cause of death in critically ill patients. Early diagnosis and expeditious treatment is a cornerstone of therapy. Evaluating the systemic host response to infection as a complex system provides novel insights: however, bedside application with clinical value remains wanting. Providing an integrative measure of an altered host response, the patterns and character of heart rate fluctuations measured over intervals-in-time may be analysed with a panel of mathematical techniques that quantify overall fluctuation, spectral composition, scale-free variation, and degree of irregularity or complexity. Using these techniques, heart rate variability (HRV) has been documented to be both altered in the presence of systemic infection, and correlated with its severity. In this review and analysis, we evaluate the use of HRV monitoring to provide early diagnosis of infection, document the prognostic implications of altered HRV in infection, identify current limitations, highlight future research challenges, and propose improvement strategies. Given existing evidence and potential for further technological advances, we believe that longitudinal, individualized, and comprehensive HRV monitoring in critically ill patients at risk for or with existing infection offers a means to harness the clinical potential of this bedside application of complex systems science.
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Affiliation(s)
- Saif Ahmad
- Ottawa Hospital Research Institute, Ottawa, Ontario, K1Y 4E9, Canada.
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Association between symptoms of depression and anxiety with heart rate variability in patients with implantable cardioverter defibrillators. Psychosom Med 2009; 71:821-7. [PMID: 19661191 PMCID: PMC2794038 DOI: 10.1097/psy.0b013e3181b39aa1] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This study investigated whether depression and anxiety symptoms are associated with measures of autonomic nervous system dysfunction in patients with implantable cardioverter defibrillators who are at high risk of cardiac rhythm disturbances. Depression and anxiety are associated with autonomic nervous system dysfunction, which may promote the risk of malignant cardiac arrhythmias. METHODS Patients with an implantable cardioverter defibrillator (ICD) underwent ambulatory electrocardiographic (ECG) monitoring (n = 44, mean age = 62.1 +/- 9.3 years). Depression was assessed using the Beck Depression Inventory and anxiety was evaluated using the Taylor Manifest Anxiety Scale. Heart rate variability was assessed using time (RMSSD, pNN50, and SDNN) and frequency domain measures derived from 24-hour R-R intervals. Multivariate models were adjusted for age, sex, hypertension, diabetes, and smoking status. RESULTS Defibrillator patients with elevated depression symptoms (n = 12) had significantly lower RMSSD (15.25 +/- 1.66 ms versus 24.97 +/- 2.44 ms, p = .002) and pNN50 (1.83 +/- 0.77 versus 5.61 +/- 1.04, p = .006) than defibrillator patients with low depression symptoms (n = 32). These associations remained significant after multivariate adjustment for covariates. ICD patients with high anxiety levels (n = 10) displayed lower RMSSD (p = .013), which became marginally significant when adjusting for covariates (p = .069). CONCLUSIONS Depression and anxiety in defibrillator patients are associated with autonomic nervous system dysfunction indices of reduced parasympathetic control. Autonomic nervous system dysfunction may partially explain the association between depression and anxiety with life-threatening cardiac outcomes in vulnerable patients.
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Björkander I, Forslund L, Ericson M, Rehnqvist N, Hjemdahl P, Kahan T. Long-term stability of heart rate variability in chronic stable angina pectoris, and the impact of an acute myocardial infarction. Clin Physiol Funct Imaging 2009; 29:201-8. [DOI: 10.1111/j.1475-097x.2009.00857.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Pardo Y, Merz CN, Velasquez I, Paul-Labrador M, Agarwala A, Peter CT. Exercise conditioning and heart rate variability: evidence of a threshold effect. Clin Cardiol 2009; 23:615-20. [PMID: 10941549 PMCID: PMC6654924 DOI: 10.1002/clc.4960230813] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND A protective effect of exercise in preventing sudden cardiac death is supported by studies in healthy populations as well as in patients with cardiac disease. The mechanisms involved in this protective effect are unknown. HYPOTHESIS We hypothesized that exercise conditioning would beneficially alter autonomic nervous system tone, measured by heart rate variability. METHODS We prospectively studied 20 cardiac patients enrolled in a Phase 2 12-week cardiac rehabilitation program following a recent cardiac event. The patients underwent 24 h Holter monitoring at program entry and 12 weeks later. Heart rate variability analysis was assessed for both time domain and spectral analysis. RESULTS The group demonstrated a modest mean conditioning effect, indicated by an average reduction in resting heart rate from 81 +/- 16 to 75 +/- 12 beats/min (p = 0.03), and an increase in training METS from 2.1 +/- 0.4 to 3.3 +/- 1.1 (p < 0.0001). Overall, 15 of 20 (75%) patients demonstrated increased total and high-frequency power, and mean high-frequency power was significantly increased (3.9 +/- 1.4 vs. 4.4 +/- 1.0 ln, p = 0.05). When stratified according to the magnitude of exercise conditioning, patients achieving an increase of > 1.5 training METS demonstrated significant increases in SDNN, SDANN index, SDNN index, pNN50, total power, and high-frequency power (all p < 0.05) (see text for explanation of abbreviations). CONCLUSIONS Exercise conditioning improves heart rate variability in cardiac patients, particularly in patients who achieve a threshold of > 1.5 training METS increase over a 12-week period. These study results are supportive of the concept that exercise training lowers the risk of sudden cardiac death via increased vagal tone, which likely beneficially alters ventricular fibrillatory and ischemic thresholds.
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Affiliation(s)
- Y Pardo
- Department of Medicine, Cedars-Sinai Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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15
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Reproducibility and validity of heart rate variability and respiration rate measurements in participants with prolonged fatigue complaints. Int Arch Occup Environ Health 2008; 82:623-30. [PMID: 19034486 DOI: 10.1007/s00420-008-0391-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Accepted: 11/07/2008] [Indexed: 10/21/2022]
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16
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Kop WJ, Weinstein AA, Deuster PA, Whittaker KS, Tracy RP. Inflammatory markers and negative mood symptoms following exercise withdrawal. Brain Behav Immun 2008; 22:1190-6. [PMID: 18619772 DOI: 10.1016/j.bbi.2008.05.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Revised: 05/09/2008] [Accepted: 05/20/2008] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Physical inactivity is associated with elevated inflammatory markers, but little is known about the time trajectories of reduced physical activity and inflammatory markers. Changes in inflammatory markers in response to withholding regular aerobic exercise were prospectively examined and correlated with increased negative mood symptoms and fatigue that accompany exercise withdrawal. METHODS Participants with regular exercise habits (N=40, mean age of 31.3+/-7.5 years, 55% women) were randomized to aerobic exercise withdrawal or to continue regular exercise for 2 weeks. Protocol adherence was documented using ambulatory actigraphy. Inflammatory markers (interleukin-6, C-reactive protein, fibrinogen and soluble intercellular adhesion molecule-1) were assessed at weekly intervals. Negative mood was measured with the Profile of Mood States (POMS) and the Beck Depression Inventory (BDI), and fatigue with the Multidimensional Fatigue Inventory (MFI). Autonomic nervous system activity was examined using heart rate variability-based indices. RESULTS Changes in inflammatory markers did not differ between exercise withdrawal and control groups (multivariate p interaction=0.25). Exercise withdrawal resulted in increased negative mood symptoms and fatigue from baseline to day 14 compared to controls (p DeltaPOMS=0.008, p DeltaBDI=0.002; p DeltaMFI=0.003), but these responses were not associated with changes in inflammatory markers (p-values >0.10). Inflammatory markers were also not correlated with autonomic nervous system dysregulation (p-values >0.10). CONCLUSION Inflammatory markers were not increased following 2 weeks of exercise withdrawal. Negative mood symptoms and fatigue were not accounted for by changes in inflammatory markers. Compensatory feedback mechanisms may operate among healthy individuals to promote resilience from the effects of reduced exercise.
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Affiliation(s)
- Willem J Kop
- Department of Medicine, University of Maryland Medical Center, 22 South Greene Street, S3B04, Baltimore, MD 21201, USA.
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17
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Brown SJ, Brown JA. Resting and Postexercise Cardiac Autonomic Control in Trained Masters Athletes. J Physiol Sci 2007; 57:23-9. [PMID: 17178009 DOI: 10.2170/physiolsci.rp012306] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2006] [Accepted: 12/18/2006] [Indexed: 11/05/2022]
Abstract
This study used measures of heart rate variability during recovery from high-intensity exercise in trained Master athletes to examine postexercise cardiac autonomic regulation. Seven males (mean age 52.1 +/- 3.3 yr; mass 85.1 +/- 18.0 kg) and 6 females (mean age 50.5 +/- 2.9 yr; mass 63.1 +/- 6.0 kg) performed incremental exercise to an intensity that induced a >4.5 mmol capillary blood lactate concentration, followed by incremental exercise to volitional exhaustion (VO2(max)). A 6 min ECG recording before (Pre) and after (Post) exercise was analyzed in the time (mean rr interval, sd rr) and frequency domains (total power, very low frequency [VLF: 0-0.04 Hz], low frequency [LF: 0.04-0.15 Hz], high frequency [HF: 0.15-0.4 Hz]). VO2(max) for males and females was 49.4 +/- 7.1 ml kg(-1) min(-1) and 45.1 +/- 10.1 ml kg(-1) min(-1), respectively. Lower mean rr interval (Pre: 1,048 +/- 128 ms; Post: 730 +/- 78 ms; P < 0.001) and lower sd rr (Pre: 77 +/- 30 ms; Post: 43 +/- 17 ms; P < 0.001) were recorded following exercise, with no differences based on gender. Total power decreased following exercise (Pre: 6,331 +/- 6,119 ms; Post: 1,921 +/- 1,552 ms). When normalized for changes in total power, a decreased HF component (Pre: 34.52 +/- 14.79 n.u.; Post: 18.49 +/- 13.64 n.u.; P < 0.05) with no change in LF component (Pre: 61.00 +/- 18.66 n.u.; Post: 69.63 +/- 23.97 n.u.; P = 0.34) was recorded. No gender differences in HRV in the frequency domain were recorded. Decreased heart rate variability in both time and frequency domains suggested an increased parasympathetic withdrawal during the autonomic control of postexercise tachycardia in trained Master athletes.
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Affiliation(s)
- S J Brown
- Institute of Food, Nutrition and Human Health, Massey University Albany, Auckland, New Zealand.
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18
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Guijt AM, Sluiter JK, Frings-Dresen MHW. Test-Retest Reliability of Heart Rate Variability and Respiration Rate at Rest and during Light Physical Activity in Normal Subjects. Arch Med Res 2007; 38:113-20. [PMID: 17174734 DOI: 10.1016/j.arcmed.2006.07.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Accepted: 07/21/2006] [Indexed: 11/17/2022]
Abstract
BACKGROUND A variable that remains stable over repeated measurements (in stable conditions) is ideal for tracking modifications of the clinical state. The aim of the present study is to examine test-retest reliability of time-domain heart rate variability and respiration rate measurements using a portable device on normal subjects during rest and light physical activity. METHODS Twenty-six normal subjects [18 females and 8 males aged 28 +/- 6 years and 34 +/- 12 years (mean +/- SD), respectively] underwent two measurements for time-domain heart rate variability (SDNN and RMSSD) and respiration rate, with 7 days in between. Measurements took place under three conditions: lying down in a laboratory, cycling in a laboratory and sleeping in an ambulatory surrounding. Reliability was assessed statistically by calculating intra-class correlation coefficients (ICC). RESULTS Reliability was found to be good to excellent for both time-domain heart rate variability (SDNN: ICC values between 0.74 and 0.85, RMSSD: ICC values between 0.75 and 0.98) and for respiration rate (ICC values between 0.77 and 0.96). CONCLUSIONS Both time-domain heart rate variability and respiration rate can be reliably assessed. However, we advise reliability research in a clinical setting before using the device for tracking modifications in a clinical state.
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Affiliation(s)
- Alida M Guijt
- Coronel Institute of Occupational Health, Academic Medical Center, Universiteit van Amsterdam, Amsterdam, The Netherlands
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19
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Tarkiainen TH, Timonen KL, Tiittanen P, Hartikainen JEK, Pekkanen J, Hoek G, Ibald-Mulli A, Vanninen EJ. Stability over time of short-term heart rate variability. Clin Auton Res 2005; 15:394-9. [PMID: 16362542 DOI: 10.1007/s10286-005-0302-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2003] [Accepted: 06/08/2005] [Indexed: 11/27/2022]
Abstract
Heart rate variability (HRV) is a widely used method to assess cardiac autonomic control. However, the reproducibility of especially short-term HRV has not been properly evaluated. Therefore, we assessed the stability of short-term HRV over a three to four month period. We had seven consecutive electrocardiographic (ECG) recordings from 89 subjects with stable coronary artery disease obtained during a large multicenter study. The HRV assessments were performed from these 40-minute ECG-recordings simulating normal daily activities, i. e., recordings consisting of 5 to 10 minute periods of rest, paced breathing, standing, submaximal exercise and recovery. Both time and frequency domain HRV analyses were conducted from the whole 40-minute recordings and from the 5-minute periods of rest and paced breathing. The coefficient of variation (CV) varied between 5.1-16.7% for the 40-minute and 6.0-37.1% for the 5-minute time domain and 4.4-11.0 % for the 40-minute and 7.2-16.5 % for the 5-minute frequency domain measurements. The mean of the RR intervals and the total power showed the highest stability over time. The most unstable measure was the standard deviation of all NN intervals (SDNN). In conclusion, most short-term HRV measures were highly stable over time indicating low physiological variation. However, the SDNN showed large variability in consecutive recordings.
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Affiliation(s)
- Tuula H Tarkiainen
- Dept. of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Kuopio, Finland.
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20
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Zaliūnas R, Brazdzionyte J, Zabiela V, Jurkevicius R. Effects of amlodipine and lacidipine on heart rate variability in hypertensive patients with stable angina pectoris and isolated left ventricular diastolic dysfunction. Int J Cardiol 2005; 101:347-53. [PMID: 15907400 DOI: 10.1016/j.ijcard.2004.03.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2003] [Revised: 02/02/2004] [Accepted: 03/03/2004] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To estimate the influence of therapy with amlodipine (A) or lacidipine (L) on heart rate variability (HRV) time and frequency domain parameters in hypertensive patients with stable angina pectoris and isolated left ventricular diastolic dysfunction. METHODS After a 1-week washout period, the patients were randomized to receive amlodipine 10 mg (30 patients) or lacidipine 6 mg (30 patients) once-daily for 4 weeks. HRV parameters were determined over a period of 24 h, echocardiography and exercise test were performed before and after treatment. RESULTS All HRV time domain parameters after applying amlodipine did not change significantly. A reliable decrease only of the root mean square of differences between adjacent normal-to-normal intervals (RMSSD)-32.9 +/- 13 vs. 27.5 +/- 9-was noticed after treatment with lacidipine. In the lacidipine group, the change of RMSSD negatively correlated with the extent of ST segment depression during exercise testing (R = -0.43; P < 0.05). Both drugs reduced total power (A, 2234 +/- 1270 vs. 1813 +/- 889; L, 2205 +/- 1151 vs. 1825 +/- 896; P < 0.01), very low (A, 1451 +/- 733 vs. 1143 +/- 534; L, 1413 +/- 759 vs. 1213 +/- 616; P < 0.05), and low frequency power (A, 610 +/- 459 vs. 447 +/- 321; L, 569 +/- 323 vs. 442 +/- 241; P < 0.01). After amlodipine, high frequency power remained unchanged, whereas low-high frequency ratio decreased (4.54 +/- 1.72 vs. 3.77+/-1.73; P < 0.05). After lacidipine, high frequency power decreased (178.8 +/- 153.2 vs. 132.1 +/- 79.3; P < 0.05), whereas the ratio of low frequency to high frequency did not change. CONCLUSIONS Amlodipine and lacidipine reduce the influence of humoral control and sympathetic autonomic nervous system activity. The autonomic balance becomes shifted toward the increased vagal activity only by amlodipine.
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Affiliation(s)
- Remigijus Zaliūnas
- Eiveniu 2, Department of Cardiology, Kaunas University of Medicine, Kaunas, Lithuania.
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21
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Seely AJE, Macklem PT. Complex systems and the technology of variability analysis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2004; 8:R367-84. [PMID: 15566580 PMCID: PMC1065053 DOI: 10.1186/cc2948] [Citation(s) in RCA: 240] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2004] [Revised: 08/05/2004] [Accepted: 08/09/2004] [Indexed: 01/09/2023]
Abstract
Characteristic patterns of variation over time, namely rhythms, represent a defining feature of complex systems, one that is synonymous with life. Despite the intrinsic dynamic, interdependent and nonlinear relationships of their parts, complex biological systems exhibit robust systemic stability. Applied to critical care, it is the systemic properties of the host response to a physiological insult that manifest as health or illness and determine outcome in our patients. Variability analysis provides a novel technology with which to evaluate the overall properties of a complex system. This review highlights the means by which we scientifically measure variation, including analyses of overall variation (time domain analysis, frequency distribution, spectral power), frequency contribution (spectral analysis), scale invariant (fractal) behaviour (detrended fluctuation and power law analysis) and regularity (approximate and multiscale entropy). Each technique is presented with a definition, interpretation, clinical application, advantages, limitations and summary of its calculation. The ubiquitous association between altered variability and illness is highlighted, followed by an analysis of how variability analysis may significantly improve prognostication of severity of illness and guide therapeutic intervention in critically ill patients.
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Affiliation(s)
- Andrew J E Seely
- Thoracic Surgery and Critical Care Medicine, University of Ottawa, Ottawa, Ontario, Canada.
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22
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Bairey Merz CN, Dwyer J, Nordstrom CK, Walton KG, Salerno JW, Schneider RH. Psychosocial stress and cardiovascular disease: pathophysiological links. Behav Med 2002; 27:141-7. [PMID: 12165968 PMCID: PMC2979339 DOI: 10.1080/08964280209596039] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The remarkable decline in cardiovascular disease (CVD) experienced in developed countries over the last 40 years appears to have abated. Currently, many CVD patients continue to show cardiac events despite optimal treatment of traditional risk factors. This evidence suggests that additional interventions, particularly those aimed at nontraditional factors, might be useful for continuing the decline. Psychosocial stress is a newly recognized (nontraditional) risk factor that appears to contribute to all recognized mechanisms underlying cardiac events, specifically, (a) clustering of traditional cardiovascular risk factors, (b) endothelial dysfunction, (c) myocardial ischemia, (d) plaque rupture, (e) thrombosis, and (f) malignant arrhythmias. A better understanding of the behavioral and physiologic associations between psychosocial stress and CVD will assist researchers in identifying effective approaches for reducing or reversing the damaging effects of stress and may lead to further reductions of CVD morbidity and mortality.
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Affiliation(s)
- C Noel Bairey Merz
- Cedars-Sinai Medical Center, University of California Los Angeles, School of Medicine, USA.
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23
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Kop WJ, Verdino RJ, Gottdiener JS, O'Leary ST, Bairey Merz CN, Krantz DS. Changes in heart rate and heart rate variability before ambulatory ischemic events(1). J Am Coll Cardiol 2001; 38:742-9. [PMID: 11527627 DOI: 10.1016/s0735-1097(01)01451-6] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The aim of this study was to determine the time course of autonomic nervous system activity preceding ambulatory ischemic events. BACKGROUND Vagal withdrawal can produce myocardial ischemia and may be involved in the genesis of ambulatory ischemic events. We analyzed trajectories of heart rate variability (HRV) 1 h before and after ischemic events, and we examined the role of exercise and mental stress in preischemic autonomic changes. METHODS Male patients with stable coronary artery disease (n = 19; 62.1 +/- 9.3 years) underwent 48-h ambulatory electrocardiographic monitoring. Frequency domain HRV measures were assessed for 60 min before and after each of 68 ischemic events and during nonischemic heart rate-matched control periods. RESULTS High-frequency HRV decreased from -60, -20 to -10 min before ischemic events (4.8 +/- 1.3; 4.6 +/- 1.3; 4.4 +/- 1.2 ln [ms(2)], respectively; p = 0.04) and further from -4, -2 min, until ischemia (4.4 +/- 1.3; 4.1 +/- 1.3; 3.7 +/- 1.2 ln [ms(2)]; p's < 0.01). Low frequency HRV decreases started at -4 min (p < 0.05). Ischemic events occurring at high mental activities were preceded by depressed high frequency HRV levels compared with events at low mental activity (p = 0.038 at -4 min, p = 0.045 at -2 min), whereas the effects of mental activities were not observed during nonischemic control periods. Heart rate variability measures remained significantly decreased for 20 min after recovery of ST-segment depression when events were triggered by high activity levels. CONCLUSIONS Autonomic changes consistent with vagal withdrawal can act as a precipitating factor for daily life ischemia, particularly in episodes triggered by mental activities.
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Affiliation(s)
- W J Kop
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences Bethesda, Bethesda, Maryland 20814, USA.
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Anastasiou-Nana MI, Karagounis LA, Kanakakis J, Kouvelas NE, Geramoutsos A, Chalkias K, Karelas J, Nanas JN. Correlation and stability of heart rate and ventricular ectopy variability in patients with congestive heart failure. Am J Cardiol 2001; 88:175-9, A6. [PMID: 11448419 DOI: 10.1016/s0002-9149(01)01617-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The stability of indexes of heart rate variability and their possible association with spontaneous variability of ventricular ectopy was examined in 13 patients with advanced congestive heart failure over 14 consecutive days of 24-hour ambulatory electrocardiographic recording. It was found that time and frequency domain measures of heart rate variability are stable over time and are inversely correlated with spontaneous variability of ventricular ectopy.
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Affiliation(s)
- M I Anastasiou-Nana
- University of Athens School of Medicine, Department of Clinical Therapeutics, "Alexandra" Hospital, Athens, Greece
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25
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Batten LA, Urbina EM, Berenson GS. Interobserver reproducibility of heart rate variability in children (the Bogalusa Heart Study). Am J Cardiol 2000; 86:1264-6, A9. [PMID: 11090806 DOI: 10.1016/s0002-9149(00)01217-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Changes in time and frequency domain measures of heart rate variability appear to correlate with morbidity and mortality in patients with congenital heart disease. This study demonstrates that these measures are highly reproducible in children, a finding that has been previously described only in adults.
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Affiliation(s)
- L A Batten
- Tulane Center for Cardiovascular Health and Department of Pediatrics, New Orleans, Louisiana 70112, USA
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Yi G, Gallagher MM, Yap YG, Guo XH, Harrison R, McDonald JT, Camm AJ, Malik M. Consistency of multicenter measurements of heart rate variability in survivors of acute myocardial infarction. Pacing Clin Electrophysiol 2000; 23:157-64. [PMID: 10709223 DOI: 10.1111/j.1540-8159.2000.tb00796.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Heart rate variability (HRV) analysis from 24-hour ambulatory ECG has been widely used in risk stratification of patients after myocardial infarction (MI). The accuracy of HRV assessment is known to potentially vary when different commercial systems are used. However, the consistency of HRV measurements has never been fully investigated. Twenty-six post-MI patients (mean age 59 +/- 8 years, 22 men) were studied, of whom 13 succumbed to sudden cardiac death (SCD) within 1 year and 13 remained alive for at least 3 years (MI survivors). Each patient had a 24-hour Holter ECG recorded before hospital discharge. HRV analysis was performed four times from the same recordings using three different Holter tape analysis systems (Marquette, Reynolds, and CardioData) by four independent operators (CardioData system was used twice, once in the United Kingdom and once in the United States). Mean normal-to-normal RR intervals (mNN) and 3 HRV parameters (SDNN, RMSSD, and HRV triangular index [HRVi]) were derived from each recording. The consistency of mNN and HRV measurements was evaluated by coefficient of variance (CV) and by the Bland-Altman method. The results demonstrated that (1) all indices measured by different systems were statistically similar (P = NS) except the measurement of RMSSD (P = 0.01), (2) the measurements of mNN were highly reproducible with a maximum mean difference of 1.8 +/- 13.8 ms and maximum limits of agreement from -14.6 to +15.6 ms. The maximum mean differences were--1.8 +/- 1.4 unit and 4.4 +/- 9.6 ms for HRVi and SDNN, respectively, and RMSSD was less reproducible with a maximum mean difference of--11.1 +/- 11.5 ms, and limits of agreement from -16.2 to +9.6 ms; and (3) the consistency of mNN (CV 0.9% +/- 0.9%) was significantly higher than that of HRVi, SDNN, and RMSSD (P < 0.0001). The consistency of HRVi was similar to that of SDNN (4.8% +/- 2.1% vs 5.7% +/- 4.8%, P = 0.4), and the consistency of RMSSD (26.6% +/- 13.3%) was significantly lower than that of the other measurements (P < 0.00001). In conclusion, the measurements of mNN by different analytical systems are the most consistent among the parameters studied. The global 24-hour measurements of HRV (SDNN and HRVi) are highly reproducible, whereas the measurement of short-term HRV components (RMSSD) is significantly less reproducible.
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Affiliation(s)
- G Yi
- Department of Cardiological Sciences, St. George's Hospital Medical School, London, England
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27
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Girgis I, Chakko S, de Marchena E, Jara C, Diaz P, Castellanos A, Myerburg RJ. Effect of clonidine on heart rate variability in congestive heart failure. Am J Cardiol 1998; 82:335-7. [PMID: 9708663 DOI: 10.1016/s0002-9149(98)00329-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In patients with congestive heart failure, abnormal heart rate variability is a predictor of total mortality and sudden cardiac death. Drugs that improve heart rate variability may have a potential role for improving the survival among these patients. The effects of clonidine were studied in 24 patients with congestive heart failure, sinus rhythm, a left ventricular ejection fraction <0.40, and systolic blood pressure > 115 mm Hg. A 6-minute corridor walk test and 24-hour Holter monitoring were performed before and 42+/-24 days after initiation of clonidine therapy (Catapres-TTS patch, mean dose: 0.33+/-0.21 mg). Changes in other medications used at baseline were not allowed. One patient died suddenly. Two patients did not complete the protocol due to worsening congestive heart failure, which required changes in medications, 1 patient discontinued due to hypotension, and 2 for personal reasons. Among the 18 patients who completed the protocol, the mean RR interval of sinus beats increased from 760+/-106 to 822+/-125 ms (p=0.001) and the distance covered during the 6-minute walk test increased from 1,148+/-277 to 1,255+/-359 feet (p=0.042). Systolic blood pressure decreased from 139+/-15 to 119+/-10 mm Hg (p <0.0001). The following increases were noted in the heart rate variability measurements: high-frequency power in 0.15 to 0.40 Hz: 4.58+/-1.07 to 4.94+/-1.17 In (ms), p=0.002; SD: 47.0+/-16.9 to 52.5+/-18.4 ms, p=0.034; SD of the mean of all RR intervals in 24 hours: 116+/-94 to 130+/-19 ms, p=0.033; SD of all 5-minute mean RR intervals: 106+/-44 to 124+/-66 ms, p=0.042; root-mean square of difference of successive RR intervals: 28.8+/-10.7 to 34.1+/-14.2 ms, p=0.017. Clonidine improves heart rate variability in the patients with congestive heart failure by increasing the parasympathetic tone. It is well tolerated by most patients with heart failure and may have a beneficial effect on exercise capacity.
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Affiliation(s)
- I Girgis
- Department of Medicine, University of Miami School of Medicine, Department of Veterans Affairs Medical Center, Florida 33125, USA
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