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Li J, Sun W, Yang X, Tu B, Cai S, Hu F, Weng Z, Liu S, Lai Z, Zheng L, Yao Y. Characteristics of deceleration capacity and deceleration runs in vasovagal syncope. Clin Auton Res 2024; 34:143-151. [PMID: 37776375 DOI: 10.1007/s10286-023-00989-z] [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: 02/03/2023] [Accepted: 09/19/2023] [Indexed: 10/02/2023]
Abstract
PURPOSE Increased vagal activity plays a prominent role in vasovagal syncope (VVS). The aim of this study was to characterize vagal function in VVS by evaluating the heart rate (HR) deceleration capacity (DC) and the HR deceleration runs (DRs) in patients with VVS between attacks. METHODS A total of 188 consecutive VVS patients were enrolled in the study, of whom 129 had positive head-up tilt test (HUTT); 132 healthy participants were enrolled as controls. DC, DRs (DR2, i.e., episodes of 2 consecutive beat-to-beat HR decelerations), and the sum of DR8-10 (very long DR [VLDR]) were calculated using 24-h electrograms. Clinical characteristics, DC, and DRs were compared among syncope groups and controls. RESULTS Patients with VVS had higher DC (10.63 ± 2.1 vs. 6.58 ± 1.7 ms; P < 0.001) and lower minimum HR and DR6-10 than controls. No significant differences in DC or DR6-10 were found between the patients with positive and those with negative HUTT results. In multivariate logistic regression analysis, minimum HR ≥ 40 bpm (odds ratio [OR] 0.408, 95% confidence interval [CI] 0.167-0.989; P = 0.048), daytime DC ≥ 7.37 ms (OR 3.040, 95% CI 1.220-7.576; P = 0.013), and VLDR ≥ 0.046% (OR 0.306, 95% CI 0.138-0.679; P = 0.004) were demonstrated to be risk factors significantly associated with VVS. CONCLUSION Compared to healthy controls, patients with VVS demonstrated distinct HR deceleration profiles between attacks, including overall higher DC and lower DR6-10.
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Affiliation(s)
- Jiakun Li
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, National Key Laboratory, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Sun
- Cardiology department, Eastern Health-Box Hill Hospital, Melbourne, Australia
| | - Xu Yang
- Premium Care Center, Fuwai Hospital, National Center for Cardiovascular Diseases, National Key Laboratory, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Tu
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, National Key Laboratory, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Simin Cai
- Cardiac Arrhythmia Center, Huazhong Fuwai Hospital, Heart Center, Henan Provincial People's Hospital, The People's Hospital of Zhengzhou University, Henan, China
| | - Feng Hu
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zhiyuan Weng
- Cardiovascular Department, Fujian Institute of Hypertension, The First Affiliated Hospital, Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Shangyu Liu
- Department of Cardiovasology, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Yuhua District, Shijiazhuang, 050031, Hebei, China
| | - Zihao Lai
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, National Key Laboratory, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lihui Zheng
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, National Key Laboratory, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Yan Yao
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, National Key Laboratory, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Effect of antipsychotic use by patients with schizophrenia on deceleration capacity and its relation to the corrected QT interval. Gen Hosp Psychiatry 2023; 81:15-21. [PMID: 36716654 DOI: 10.1016/j.genhosppsych.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Schizophrenia patients treated with antipsychotics are at higher risk of sudden cardiac death. Decreased deceleration capacity (DC) of the heart rate is an accurate predictor of cardiac mortality. We evaluated the risk of sudden cardiac death due to antipsychotic use by assessing DC and examining the association between DC and the corrected QT interval (QTc) in schizophrenia patients. METHODS We measured the DC and QTc of 138 schizophrenia patients. We then compared the DC of 86 age- and sex-matched healthy controls with that of 86 schizophrenia patients. We investigated the correlation of DC of approximately 138 schizophrenia patients with prescribed doses of antipsychotics using linear regression analysis. We compared the DC of schizophrenia patients with and without prolonged QT intervals. RESULTS We found DC significantly differed between schizophrenia patients on antipsychotic medication and healthy controls. Additionally, DC was negatively correlated with antipsychotic use, especially chlorpromazine, zotepine, olanzapine and clozapine, in a dose-dependent manner. There was no significant association between DC and the QTc. CONCLUSION Assessing DC could facilitate monitoring and identification of increased risk of cardiac mortality in patients with schizophrenia that take antipsychotics. Assessing both DC and the QTc may enhance the accuracy of predicting sudden cardiac death.
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Mizera L, Rath D, Schoellmann A, Petersen-Uribe A, Avdiu A, Zdanyte M, Jaeger P, Heinzmann D, Müller K, Gawaz M, Eick C, Duckheim M. Deceleration capacity is associated with acute respiratory distress syndrome in COVID-19. Heart Lung 2021; 50:914-918. [PMID: 34428736 PMCID: PMC8326018 DOI: 10.1016/j.hrtlng.2021.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/25/2021] [Accepted: 07/28/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Acute respiratory distress syndrome (ARDS) is considered the main cause of COVID-19 associated morbidity and mortality. Early and reliable risk stratification is of crucial clinical importance in order to identify persons at risk for developing a severe course of disease. Deceleration capacity (DC) of heart rate as a marker of cardiac autonomic function predicts outcome in persons with myocardial infarction and heart failure. We hypothesized that reduced modulation of heart rate may be helpful in identifying persons with COVID-19 at risk for developing ARDS. METHODS We prospectively enrolled 60 consecutive COVID-19 positive persons presenting at the University Hospital of Tuebingen. Arterial blood gas analysis and 24 h-Holter ECG recordings were performed and analyzed at admission. The primary end point was defined as development of ARDS with regards to the Berlin classification. RESULTS 61.7% (37 of 60 persons) developed an ARDS. In persons with ARDS DC was significantly reduced when compared to persons with milder course of infection (3.2 ms vs. 6.6 ms, p < 0.001). DC achieved a good discrimination performance (AUC = 0.76) for ARDS in COVID-19 persons. In a multivariate analysis, decreased DC was associated with the development of ARDS. CONCLUSION Our data suggest a promising role of DC to risk stratification in COVID-19.
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Affiliation(s)
- Lars Mizera
- Department of Cardiology, Angiology and Cardiovascular Medicine, University of Tuebingen, Otfried-Müller Str.10, Tuebingen 72076, Germany
| | - Dominik Rath
- Department of Cardiology, Angiology and Cardiovascular Medicine, University of Tuebingen, Otfried-Müller Str.10, Tuebingen 72076, Germany
| | - Anna Schoellmann
- Department of Gastroenterology, Hepatology, Infectiology and Geriatrics, University of Tuebingen, Germany
| | - Alvaro Petersen-Uribe
- Department of Cardiology, Angiology and Cardiovascular Medicine, University of Tuebingen, Otfried-Müller Str.10, Tuebingen 72076, Germany
| | - Alban Avdiu
- Department of Cardiology, Angiology and Cardiovascular Medicine, University of Tuebingen, Otfried-Müller Str.10, Tuebingen 72076, Germany
| | - Monika Zdanyte
- Department of Cardiology, Angiology and Cardiovascular Medicine, University of Tuebingen, Otfried-Müller Str.10, Tuebingen 72076, Germany
| | - Philippa Jaeger
- Department of Cardiology, Angiology and Cardiovascular Medicine, University of Tuebingen, Otfried-Müller Str.10, Tuebingen 72076, Germany
| | - David Heinzmann
- Department of Cardiology, Angiology and Cardiovascular Medicine, University of Tuebingen, Otfried-Müller Str.10, Tuebingen 72076, Germany
| | - Karin Müller
- Department of Cardiology, Angiology and Cardiovascular Medicine, University of Tuebingen, Otfried-Müller Str.10, Tuebingen 72076, Germany
| | - Meinrad Gawaz
- Department of Cardiology, Angiology and Cardiovascular Medicine, University of Tuebingen, Otfried-Müller Str.10, Tuebingen 72076, Germany
| | - Christian Eick
- Department of Cardiology, Angiology and Cardiovascular Medicine, University of Tuebingen, Otfried-Müller Str.10, Tuebingen 72076, Germany.
| | - Martin Duckheim
- Department of Cardiology, Angiology and Cardiovascular Medicine, University of Tuebingen, Otfried-Müller Str.10, Tuebingen 72076, Germany
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Duckheim M, Gaebler M, Mizera L, Schreieck J, Poli S, Ziemann U, Gawaz M, Meyer-Zuern CS, Eick C. Deceleration capacity for rapid risk stratification in patients suffering from acute ischemic stroke: A prospective exploratory pilot study. Medicine (Baltimore) 2021; 100:e25333. [PMID: 33787630 PMCID: PMC8021320 DOI: 10.1097/md.0000000000025333] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/23/2021] [Indexed: 01/04/2023] Open
Abstract
Deceleration capacitiy for rapid risk stratification in stroke patientsCerebral ischemia is a major cause of neurologic deficit and patients suffering from ischemic stroke bear a relevant risk of mortality. Identifying stroke patients at high mortality risk is of crucial clinical relevance. Deceleration capacity of heart rate (DC) as a parameter of cardiac autonomic function is an excellent predictor of mortality in myocardial infarction and heart failure patients.The aim of our study was to evaluate whether DC provides prognostic information regarding mortality risk in patients with acute ischemic stroke.From September 2015 to March 2018 we prospectively enrolled consecutive patients presenting at the Stroke Unit of our university hospital with acute ischemic stroke who were in sinus rhythm. In these patients 24 hours-Holter-ECG recordings and evaluation of National Institute of Health Stroke Scale (NIHSS) were performed. DC was calculated according to a previously published algorithm. Primary endpoint was intrahospital mortality.Eight hundred seventy eight stroke patients were included in the study. Intrahospital mortality was 2.8% (25 patients). Both DC and NIHSS were significantly different between non-survivors and survivors (Mean ± SD: DC: 4.1 ± 2.8 ms vs 6.3 ± 3.3 ms, P < .001) (NIHSS: 7.6 ± 7.1 vs 4.3 ± 5.5, P = .02). DC achieved an area under the curve value (AUC) of 0.708 for predicting intrahospital mortality, while the AUC value of NIHSS was 0.641. In a binary logistic regression analysis, DC, NIHSS and age were independent predictors for intrahospital mortality (DC: HR CI 95%: 0.88 (0.79-0.97); P = .01; NIHSS: HR CI 95%: 1.08 (1.02-1.15); P = .01; Age: HR CI 95%: 1.07 (1.02-1.11); P = .004. The combination of NIHSS, age and DC in a prediction model led to a significant improvement of the AUC, which was 0.757 (P < .001, incremental development index [IDI] 95% CI: 0.037 (0.018-0.057)), compared to the individual risk parameters.Our study demonstrated that DC is suitable for both objective and independent risk stratification in patients suffering from ischemic stroke. The application of a prediction model combining NIHSS, age and DC is superior to the single markers in identifying patients at high mortality risk.
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Affiliation(s)
- Martin Duckheim
- Innere Medizin III, Department of Cardiology and Angiology, Eberhard-Karls-Universität Tübingen, Tübingen, Germany
| | - Martin Gaebler
- Innere Medizin III, Department of Cardiology and Angiology, Eberhard-Karls-Universität Tübingen, Tübingen, Germany
| | - Lars Mizera
- Innere Medizin III, Department of Cardiology and Angiology, Eberhard-Karls-Universität Tübingen, Tübingen, Germany
| | - Juergen Schreieck
- Innere Medizin III, Department of Cardiology and Angiology, Eberhard-Karls-Universität Tübingen, Tübingen, Germany
| | - Sven Poli
- Department of Neurology & Stroke and Hertie-Institute for Clinical Brain Research, Eberhard-Karls-Universität Tübingen, Tübingen, Germany
| | - Ulf Ziemann
- Department of Neurology & Stroke and Hertie-Institute for Clinical Brain Research, Eberhard-Karls-Universität Tübingen, Tübingen, Germany
| | - Meinrad Gawaz
- Innere Medizin III, Department of Cardiology and Angiology, Eberhard-Karls-Universität Tübingen, Tübingen, Germany
| | - Christine S. Meyer-Zuern
- Department of Cardiology, University Hospital Basel and Cardiovascular Research Institute, Basel, Switzerland
| | - Christian Eick
- Innere Medizin III, Department of Cardiology and Angiology, Eberhard-Karls-Universität Tübingen, Tübingen, Germany
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Heart rate variability for rapid risk stratification of emergency patients with malignant disease. Support Care Cancer 2018; 26:3289-3296. [DOI: 10.1007/s00520-018-4144-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 03/02/2018] [Indexed: 10/17/2022]
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