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Martinez P, Grinand M, Cheggour S, Taieb J, Gourjon G. How to properly evaluate cardiac vagal tone in oncology studies: a state-of-the-art review. JOURNAL OF THE NATIONAL CANCER CENTER 2024; 4:36-46. [PMID: 39036385 PMCID: PMC11256691 DOI: 10.1016/j.jncc.2024.02.002] [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: 12/12/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 07/23/2024] Open
Abstract
Heart rate variability (HRV) analysis provides an assessment of cardiac vagal tone and consequently global cardiac health as well as systemic condition. In systemic diseases such as cancer and during treatments that affect the whole body, like chemotherapy, the vagus nerve activity is low and deregulated. Some studies focus on using HRV to predict mortality in oncology. However, in cancer patients, systemic alterations substantially increase artifacts during HRV measurement, especially atrial ectopic beats. Moreover, HRV may be altered by various factors (duration and time of measurement, breathing, drugs, and other confounding factors) that alter each metric in different ways. The Standard Deviation of all Normal to Normal intervals (SDNN) is the most commonly used metric to evaluate HRV in oncology, but it does not appear to be specific to the cardiac vagal tone. Thus, cardiac vagal activity diagnosis and vital prognosis of cancer patients can be biased. Our review presents the main HRV metrics that can be currently used in oncology studies and their links with vagus nerve and cancer. We present the influence of external factors and the required duration and time of measurement. Considering all these parameters, this review proposes seven key points for an assessment of HRV and cardiac vagal tone in patients with cancer.
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Affiliation(s)
- Pierrick Martinez
- Scientific and Osteopathic Research Department, Institut de Formation en Ostéopathie du Grand Avignon, 403 Rue Marcel Demonque, Avignon, France
| | - Marilyne Grinand
- Département de recherche clinique, Centre hospitalier d'Avignon, 305A Rue Raoul Follereau, Avignon, France
| | - Saïda Cheggour
- Service de cardiologie, Centre hospitalier d'Avignon, 305A Rue Raoul Follereau, Avignon, France
| | - Jérôme Taieb
- Service de cardiologie, Centre Hospitalier du pays d'Aix-Pertuis, Avenue des Tamaris Aix-en-Provence, France
| | - Géraud Gourjon
- Scientific and Osteopathic Research Department, Institut de Formation en Ostéopathie du Grand Avignon, 403 Rue Marcel Demonque, Avignon, France
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Molfino A, Gallicchio C, Imbimbo G, Melena M, Antonini S, Gigante A, Muscaritoli M. Evaluation of Anorexia in Cancer and Its Association with Autonomic Nervous System Activity Assessed by Heart Rate Variability. Nutrients 2023; 15:4936. [PMID: 38068794 PMCID: PMC10707971 DOI: 10.3390/nu15234936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/21/2023] [Accepted: 11/26/2023] [Indexed: 12/18/2023] Open
Abstract
Alterations in the central nervous system in cancer patients are pivotal in determining appetite dysregulation and body weight loss (BWL). Autonomic nervous system activity was tested by measuring heart rate variability (HRV) in cancer patients presenting with anorexia. We considered inpatients with different types of cancer and investigated anorexia using their FAACT scores. HRV was evaluated by a three-channel Holter ECG. The domains of low frequencies (LF, sympathetic activity) and high frequencies (HF, parasympathetic activity) were calculated. Also, SDNN (autonomic activity) and RMSSD (parasympathetic activity) were assessed. We enrolled 56 patients with cancer and 23 controls. In cancer patients, RMSSD and SDNN were lower than in controls (p < 0.001 and p = 0.009). Sympathetic activity (LF nu) was lower in cancer patients than in controls (p = 0.023), including sympathovagal balance (LF/HF nu ratio) (p = 0.025). RMSSD was reduced in anorexic (p < 0.001) and non-anorexic (p = 0.003) cancer patients compared to controls. The SDNN was lower in anorexic cancer patients than in non-anorexic cancer patients (p = 0.025), and it was lower in anorexic cancer patients than in controls (p = 0.001). LF nu was lower in anorexic cancer patients than in controls (p = 0.015), as was LF/HF (p = 0.031). SDNN was negatively correlated with BWL in the cancer group (rho = -0.40; p = 0.007). Our data support the hypothesis that autonomic nervous system dysregulation exists in patients with cancer presenting with anorexia, with implications for its diagnosis and treatment.
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Affiliation(s)
- Alessio Molfino
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (C.G.); (G.I.); (M.M.); (S.A.); (A.G.); (M.M.)
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Kumaria A, Ashkan K. Novel therapeutic strategies in glioma targeting glutamatergic neurotransmission. Brain Res 2023; 1818:148515. [PMID: 37543066 DOI: 10.1016/j.brainres.2023.148515] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 07/11/2023] [Accepted: 07/30/2023] [Indexed: 08/07/2023]
Abstract
High grade gliomas carry a poor prognosis despite aggressive surgical and adjuvant approaches including chemoradiotherapy. Recent studies have demonstrated a mitogenic association between neuronal electrical activity and glioma growth involving the PI3K-mTOR pathway. As the predominant excitatory neurotransmitter of the brain, glutamate signalling in particular has been shown to promote glioma invasion and growth. The concept of the neurogliomal synapse has been established whereby glutamatergic receptors on glioma cells have been shown to promote tumour propagation. Targeting glutamatergic signalling is therefore a potential treatment option in glioma. Antiepileptic medications decrease excess neuronal electrical activity and some may possess anti-glutamate effects. Although antiepileptic medications continue to be investigated for an anti-glioma effect, good quality randomised trial evidence is lacking. Other pharmacological strategies that downregulate glutamatergic signalling include riluzole, memantine and anaesthetic agents. Neuromodulatory interventions possessing potential anti-glutamate activity include deep brain stimulation and vagus nerve stimulation - this contributes to the anti-seizure efficacy of the latter and the possible neuroprotective effect of the former. A possible role of neuromodulation as a novel anti-glioma modality has previously been proposed and that hypothesis is extended to include these modalities. Similarly, the significant survival benefit in glioblastoma attributable to alternating electrical fields (Tumour Treating Fields) may be a result of disruption to neurogliomal signalling. Further studies exploring excitatory neurotransmission and glutamatergic signalling and their role in glioma origin, growth and propagation are therefore warranted.
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Affiliation(s)
- Ashwin Kumaria
- Department of Neurosurgery, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, UK.
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Afonso AI, Amaro-Leal Â, Machado F, Rocha I, Geraldes V. Doxorubicin Dose-Dependent Impact on Physiological Balance-A Holistic Approach in a Rat Model. BIOLOGY 2023; 12:1031. [PMID: 37508460 PMCID: PMC10376408 DOI: 10.3390/biology12071031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023]
Abstract
Doxorubicin (DOX) is commonly used in several chemotherapies to treat various cancers, but it is known to cause cardiotoxicity and cardiac symptoms. Autonomic dysfunction is thought to contribute to the cardiotoxic effects of DOX, but the specific dose required to disrupt homeostatic processes is still unclear and is influenced by numerous factors. This study aimed to investigate how the DOX dosage affects autonomic function and physiological parameters, to elucidate the neurocardiac mechanisms underlying the observed cardiovascular side effects. Wistar rats were treated with DOX for four weeks and divided into three dosing groups: DOX8 (2 mg/kg/week), DOX16 (4 mg/kg/week), and DOX20 (5 mg/kg/week). A control group received NaCl 0.9% saline (1 mL/kg/week). In an acute experiment, we recorded blood pressure (BP), electrocardiogram, heart rate (HR), and respiratory rate (RF). Baroreflex gain and chemoreflex sensitivity were calculated, and cardiac tissue was analyzed with picrosirius histochemistry to measure collagen content. Our results showed that the LF/HF ratio, indicative of autonomic activity, was altered along with hypotension and bradycardia at a cumulative DOX dose threshold of 16 mg/kg. We observed a positive correlation between DOX dose and BP, HR, urinary norepinephrine, LF/HF ratio, and fibrotic heart area. Lower LF/HF ratios were associated with high DOX doses, reflecting drug-induced impairment of autonomic control of HR. This study provides valuable insights into the dose-dependent effects of DOX on physiological parameters and the development of cardiovascular dysfunction. These findings are critical, which is important for optimizing the management and therapeutic strategies for patients undergoing DOX-based chemotherapy.
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Affiliation(s)
- Ana I Afonso
- Cardiovascular Centre of the University of Lisbon, 1649-028 Lisbon, Portugal
| | - Ângela Amaro-Leal
- Cardiovascular Centre of the University of Lisbon, 1649-028 Lisbon, Portugal
- Egas Moniz School of Health and Science, 2829-511 Caparica, Portugal
| | - Filipa Machado
- Cardiovascular Centre of the University of Lisbon, 1649-028 Lisbon, Portugal
| | - Isabel Rocha
- Cardiovascular Centre of the University of Lisbon, 1649-028 Lisbon, Portugal
- Institute of Physiology, Faculty of Medicine of the University of Lisbon, 1649-028 Lisbon, Portugal
| | - Vera Geraldes
- Cardiovascular Centre of the University of Lisbon, 1649-028 Lisbon, Portugal
- Institute of Physiology, Faculty of Medicine of the University of Lisbon, 1649-028 Lisbon, Portugal
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Petrescu M, Udriștoiu I, Militaru F, Petrescu AR, Târtea G, Raicea V, Ciurea AM, Petrescu AM, Vere CC. The Assessment of Heart Rate Variability in Patients with Pancreatic Cancer. CURRENT HEALTH SCIENCES JOURNAL 2023; 49:172-178. [PMID: 37779831 PMCID: PMC10541060 DOI: 10.12865/chsj.49.02.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 03/12/2023] [Indexed: 10/03/2023]
Abstract
The aim of our study is to provide an assessment of heart rate variability (HRV) as a predictor for the survival of patients with pancreatic cancer (PCa). We conducted a retrospective, descriptive study. 53 consecutive patients who were newly diagnosed with pancreatic cancer (PCa), were included. In the end, 41 patients were included in the analysis, out of which 14 patients survived at least until the 24-month follow-up, while 27 patients died within 24 months from the diagnosis. These patients were monitored with 24-hour Holter electrocardiogram (ECG) prior to the initiation of any therapy for determining heart rate variability. To establish the cut-off values of HRV, 24-hour Holter ECG recordings of 20 healthy subjects were analyzed. In addition to heart rate analysis, HRV indices were also analyzed: SDNN, rMSSD, ULF and VLF. Median survival in patients with low value of SDNN was 9 months, compared to patients with hight SDNN where median survival was 15 months (Hazard ratio 2.301, 95% CI of ratio 0.9080 to 5.833, p= 0.034). Although low values of the HRV indices in the frequency domain were associated with reduced survival, no statistically significant differences were recorded. The reduction of heart rate variability indices is a negative prognostic factor in patients newly diagnosed with pancreatic cancer.
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Affiliation(s)
- Mihai Petrescu
- Department of Psychiatry, University of Medicine and Pharmacy of Craiova, Romania
| | - Ion Udriștoiu
- Department of Psychiatry, University of Medicine and Pharmacy of Craiova, Romania
| | - Felicia Militaru
- Department of Psychiatry, University of Medicine and Pharmacy of Craiova, Romania
| | | | - Georgică Târtea
- Department of Physiology, University of Medicine and Pharmacy of Craiova, Romania
| | - Victor Raicea
- Department of Cardiovascular Surgery, University of Medicine and Pharmacy of Craiova, Romania
| | - Ana-Maria Ciurea
- Department of Oncology, University of Medicine and Pharmacy of Craiova, Romania
| | - Ana-Maria Petrescu
- Department of Obstretics and Gynecology, University of Medicine and Pharmacy of Craiova, Romania
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Cherifi F, Lefevre Arbogast S, Font J, Abdeddaim C, Becourt S, Penel N, Coquan E, Lequesne J, Gidron Y, Joly F. The promising prognostic value of vagal nerve activity at the initial management of ovarian cancer. Front Oncol 2022; 12:1049970. [PMID: 36523968 PMCID: PMC9745166 DOI: 10.3389/fonc.2022.1049970] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/08/2022] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE Identifying new modifiable prognostic markers is important for ovarian cancer (OC). Low parasympathic activity is associated with inflammation, oxidative stress and sympathetic nervous system activation. Previous studies reported that low vagal nerve activity, measured by low heart rate variability (HRV), may predict poor cancer prognosis. We aimed to examine the prognostic value of HRV in OC. METHODS This bicentric retrospective study included patients diagnosed with serous OC FIGO stage ≥IIB, between January 2015 and August 2019, with electrocardiograms (ECG) available around diagnosis. HRV was measured from ECG using the time domain parameter of standard deviation of all normal-to-normal heartbeat intervals (SDNN). Optimal SDNN cut-off was determined using the Youden index criteria of time-dependent ROC curves. We used multivariate cox proportional hazard models to investigate the association between HRV and overall survival (OS), while adjusting for well-known OC prognostic factors. RESULTS The 202 patients included were 65.7 years-old on average, 93% had stage FIGO IIIC/IV, 56% had complete surgical resection. Median OS was 38.6 months [95%CI:34.4-47.4]. The median SDNN was 11.1ms, with an optimal cut-off of 10ms to predict OS. OS was shorter for patients with low HRV compared to high HRV (26.4 vs 45.1 months; p<0.001). In multivariate analysis, HRV remained an independent prognostic factor with a two-fold higher risk of death among patients with low SDNN compared to those with high SDNN (HR=2.03, 95%CI=1.35-3.06, p<0.001). CONCLUSION Low HRV, was associated with worse OS in OC patients, supporting previous studies on the prognostic role of HRV in cancer. If replicated in prospective studies, vagal nerve activity may be a new therapeutic target in OC.
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Affiliation(s)
- François Cherifi
- Department of Medical Oncology, Centre François Baclesse, Caen, France
- Department of Clinical Research, Centre Francois Baclesse, Caen, France
| | - Sophie Lefevre Arbogast
- Department of Clinical Research, Centre Francois Baclesse, Caen, France
- Normandie Université, UNICAEN, Institut National de la Santé et de la Recherche Médicale (Inserm) U1086, ANTICIPE, Caen, France
| | - Jonaz Font
- Department of Cardiology, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Cyril Abdeddaim
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | | | - Nicolas Penel
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | - Elodie Coquan
- Department of Medical Oncology, Centre François Baclesse, Caen, France
- Department of Clinical Research, Centre Francois Baclesse, Caen, France
| | - Justine Lequesne
- Department of Clinical Research, Centre Francois Baclesse, Caen, France
| | - Yori Gidron
- Department of Nursing, Faculty of Health Sciences, Haifa University, Haifa, Israel
| | - Florence Joly
- Department of Medical Oncology, Centre François Baclesse, Caen, France
- Normandie Université, UNICAEN, Institut National de la Santé et de la Recherche Médicale (Inserm) U1086, ANTICIPE, Caen, France
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Foucré C, Schulz S, Stritter W, von Mackensen I, Luchte J, Ivaki P, Voss A, Ghadjar P, Seifert G. Randomized Pilot Trial Using External Yarrow Liver Compress Applications With Metastatic Cancer Patients Suffering From Fatigue: Evaluation of Sympathetic Modulation by Heart Rate Variability Analysis. Integr Cancer Ther 2022; 21:15347354221081253. [PMID: 35430924 PMCID: PMC9019351 DOI: 10.1177/15347354221081253] [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] [Indexed: 11/21/2022] Open
Abstract
Background: Liver compresses are commonly applied in complementary medicine during cancer treatment and are believed to have an energizing effect. We conducted a pilot study to investigate the influence of external application of yarrow liver compresses on the autonomous nervous system by analyzing the heart rate variability (HRV) in metastatic cancer patients undergoing radiation therapy and suffering from cancer-related fatigue (CRF). Methods: A randomized pilot trial was undertaken with patients suffering from CRF receiving palliative radiation therapy for bone or brain metastasis over 2 weeks. CRF patients were randomized into an intervention group receiving yarrow liver compresses and a control group receiving no external application. HRV was analyzed at the beginning (T1) and end (T2) period of the study during daytime (d) and nighttime (n) in both groups and quantified using time-, frequency-, and nonlinear dynamics domains. Results: A total of 39 patients were randomized between September 2017 and August 2019 and a total of 20 patients (10 per group) were available for analysis. For both groups, significant differences in HRV analyses were found in the comparison over the timeline between the first and second measurement (T1d→T2d) during daytime. Specifically, the intervention group showed decreased HRV and complexity of heart rate regulation, indicating increased sympathetic activity at time T2d, whereas the control group showed increased HRV and complexity of heart rate regulation, indicating increased vagal activity at time T2d. Furthermore, the observed HRV analyses showed almost no significant differences between the 2 groups in a direct comparison at the beginning and the end of the study (exception: T2d). Conclusions: Yarrow liver compresses led to increased sympathetic activity during daytime in the intervention group, whereas in the control group, which did not receive any external application, increased parasympathetic activity was observed.
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Affiliation(s)
- Clara Foucré
- Charité—Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | | | - Pune Ivaki
- Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Voss
- University of Technology Ilmenau, Ilmenau, Germany
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Wu S, Li G, Guan W, Zhao H, Wang J, Zhou Y, Zhou Y, Shi B. Low Heart Rate Variability Predicts Poor Overall Survival of Lung Cancer Patients With Brain Metastases. Front Neurosci 2022; 16:839874. [PMID: 35250470 PMCID: PMC8891474 DOI: 10.3389/fnins.2022.839874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/26/2022] [Indexed: 01/04/2023] Open
Abstract
Background The aim of this prospective study was to evaluate the association between heart rate variability (HRV) and overall survival of lung cancer patients with brain metastases (LCBM). Methods Fifty-six LCBM patients were enrolled in this study. Five-minute electrocardiograms were collected before the time to first brain radiotherapy. HRV was analyzed quantitatively by using the time domain parameters, i.e., the standard deviation of all normal-normal intervals (SDNN) and the root mean square of successive differences (RMSSD). Survival time for LCBM patients was defined as from the date of HRV testing to the date of death or the last follow-up. Results In the univariate analysis, SDNN ≤ 13 ms (P = 0.003) and RMSSD ≤ 4.8 ms (P = 0.014) significantly predicted poor survival. Multivariate analysis confirmed that RMSSD ≤ 4.8 ms (P = 0.013, hazard ratio = 3.457, 95% confidence interval = 1.303–9.171) was also an independent negative prognostic factor after adjusting for mean heart rate, Karnofsky performance status, and number of brain metastases in LCBM patients. Conclusion Decreased RMSSD is independently associated with shorter survival time in LCBM patients. HRV might be a novel predictive biomarker for LCBM prognosis.
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Affiliation(s)
- Shuang Wu
- Department of Radiation Oncology, The First Affiliated Hospital of 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
| | - 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
| | - Jingfeng Wang
- School of Medical Imaging, Bengbu Medical College, Bengbu, China
- Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, China
| | - Yongchun Zhou
- Department of Radiation Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Yufu Zhou
- Department of Radiation Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
- *Correspondence: Yufu Zhou,
| | - 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
- Bo Shi,
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Cakan P, Yildiz S, Akyay A, Öncül Y. Intensive chemotherapy perturbs heart rate variability in children with cancer. Neurophysiol Clin 2021; 52:69-80. [PMID: 34973888 DOI: 10.1016/j.neucli.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES In children, cancer chemotherapy may impair the functioning of the cardiac autonomic nervous system. Moreover, it is not known whether there are any differences between intensive and maintenance phases of chemotherapy. Therefore, the aim of the current study was to assess autonomic nervous system activity using heart rate variability, in children receiving intensive or maintenance cancer chemotherapy. METHODS For that purpose, children who were healthy (healthy control, n = 30), receiving intensive chemotherapy (chemotherapy, n = 30), and receiving maintenance chemotherapy (maintenance, n = 25) were included in the study. Autonomic nervous system activity was measured by means of heart rate variability. Electrocardiogram recordings were used to calculate time- and frequency-domain heart rate variability parameters. RESULTS Time-domain parameters such as standard deviation of NN intervals and frequency-domain parameters such as total power were lower during the intensive chemotherapy but not during maintenance phase (standard deviation of NN intervals: 50±5, 33±3, and 48±3 ms, and total power: 2613±504, 1379±296 and 2295±264 ms2, respectively for healthy control, chemotherapy and maintenance groups, P<0.001 for both standard deviation of NN intervals and total power). DISCUSSION The present results indicate that intensive chemotherapy perturbs the function of heart rate variability in children, with recovery during the maintenance phase. This suggests that intensive chemotherapy is likely to affect the autonomic nervous system but this effect does not appear to be permanent.
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Affiliation(s)
- Pinar Cakan
- Department of Physiology, University of Health Sciences, Hamidiye Faculty of Medicine, Istanbul, Turkey.
| | - Sedat Yildiz
- Department of Physiology Inonu University, Faculty of Medicine, Malatya, Turkey
| | - Arzu Akyay
- Department of Pediatric Hematology, Inonu University, Faculty of Medicine, Malatya, Turkey
| | - Yurday Öncül
- Department of Pediatric Hematology, Inonu University, Faculty of Medicine, Malatya, Turkey
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Wang J, Liu J, Gao L, Li G, Sun Y, Shi B. Heart Rate Variability is an Independent Predictor of Lymph Node Metastasis in Patients with Cervical Cancer. Cancer Manag Res 2021; 13:8821-8830. [PMID: 34853536 PMCID: PMC8627856 DOI: 10.2147/cmar.s336268] [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: 08/26/2021] [Accepted: 11/11/2021] [Indexed: 01/19/2023] Open
Abstract
Purpose Heart rate variability (HRV) has been reported as a useful biomarker for prognostic factors in a variety of cancers. The purpose of this study was to explore the predictive value of preoperative HRV for lymph node metastasis (LNM) in patients with cervical cancer (CC). Patients and Methods A total of 77 patients with CC were included, including 18 LNM and 59 non-LNM patients. A five-minute resting electrocardiogram (ECG) was collected before surgery for the analysis of HRV time domain, frequency domain and Poincaré plot parameters (ie, SDNN, RMSSD, LF, HF, LF/HF, SD1, SD2 and SD2/SD1). Student’s t-tests and logistic regression were performed to determine the relationship between HRV and LNM. Results The LNM group had significantly lower SDNN, LF, and SD2 than the non-LNM group (all p < 0.05; all Cohen’s d > 0.5). Binary logistic regression analysis indicated that SDNN, LF and SD2 were still significantly associated with LNM. Specifically, for each 1 ms decrease in SDNN and SD2 and each 1 logarithmic unit decrease in ln (LF), the odds of LNM increased by 12%, 9%, and 86%, respectively (all p < 0.05). Conclusion These findings suggest an association between HRV and CC LNM, and HRV could be a potential noninvasive biomarker for the prediction of LNM in CC patients.
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Affiliation(s)
- Jingfeng Wang
- School of Medical Imaging, Bengbu Medical College, Bengbu, Anhui, 233030, People's Republic of China.,Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, Anhui, 233030, People's Republic of China
| | - Jian Liu
- Department of Gynecologic Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu, Anhui, 233004, People's Republic of China
| | - Longfei Gao
- Department of Gynecologic Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu, Anhui, 233004, People's Republic of China
| | - Guangqiao Li
- School of Medical Imaging, Bengbu Medical College, Bengbu, Anhui, 233030, People's Republic of China.,Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, Anhui, 233030, People's Republic of China
| | - Yilin Sun
- Department of Gynecologic Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu, Anhui, 233004, People's Republic of China
| | - Bo Shi
- School of Medical Imaging, Bengbu Medical College, Bengbu, Anhui, 233030, People's Republic of China.,Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, Anhui, 233030, People's Republic of China
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Vigier M, Vigier B, Andritsch E, Schwerdtfeger AR. Cancer classification using machine learning and HRV analysis: preliminary evidence from a pilot study. Sci Rep 2021; 11:22292. [PMID: 34785733 PMCID: PMC8595703 DOI: 10.1038/s41598-021-01779-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 11/01/2021] [Indexed: 12/16/2022] Open
Abstract
Most cancer patients exhibit autonomic dysfunction with attenuated heart rate variability (HRV) levels compared to healthy controls. This research aimed to create and evaluate a machine learning (ML) model enabling discrimination between cancer patients and healthy controls based on 5-min-ECG recordings. We selected 12 HRV features based on previous research and compared the results between cancer patients and healthy individuals using Wilcoxon sum-rank test. Recursive Feature Elimination (RFE) identified the top five features, averaged over 5 min and employed them as input to three different ML. Next, we created an ensemble model based on a stacking method that aggregated the predictions from all three base classifiers. All HRV features were significantly different between the two groups. SDNN, RMSSD, pNN50%, HRV triangular index, and SD1 were selected by RFE and used as an input to three different ML. All three base-classifiers performed above chance level, RF being the most efficient with a testing accuracy of 83%. The ensemble model showed a classification accuracy of 86% and an AUC of 0.95. The results obtained by ML algorithms suggest HRV parameters could be a reliable input for differentiating between cancer patients and healthy controls. Results should be interpreted in light of some limitations that call for replication studies with larger sample sizes.
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Affiliation(s)
- Marta Vigier
- Division of Oncology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. .,Institute of Psychology, University of Graz, Graz, Austria.
| | | | - Elisabeth Andritsch
- Division of Oncology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
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Wang YM, Cheng JY, Wang CJ, Hseu SS, Huang EY. Outcomes and Prognosis of Non-Elderly Patients with Brain Metastases-A Prospective Cohort Incorporating Individualized Assessment of Heart Rate Variability. J Pers Med 2021; 11:jpm11111049. [PMID: 34834401 PMCID: PMC8618592 DOI: 10.3390/jpm11111049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 10/14/2021] [Accepted: 10/17/2021] [Indexed: 12/19/2022] Open
Abstract
Outcomes and prognostic factors among patients with brain metastases (BM) have been widely studied, but seldom for the non-elderly. Heart rate variability (HRV) is a physiological phenomenon and has been shown as a survival prognostic factor in cancer patients. This study aimed to evaluate the outcomes and prognosis among non-elderly BM patients with the incorporation of HRV analysis. Forty non-elderly BM patients treated using whole brain radiotherapy (WBRT) were studied from January 2010 prospectively with 5-min electrocardiography (ECG) recordings. Individualized HRV was generated by the ECG, and the time domain HRV index SDNN was chosen for survival analysis. The median overall survival (OS) for the entire group was 6.21 months. Univariate analysis revealed that a KPS < 80 (p = 0.019) and an SDNN < 10 ms (p = 0.007) demonstrated statistical significance for OS; multivariate analysis confirmed that a KPS < 80 (p = 0.004; HR = 3.060, CI = 1.437–6.517) and an SDNN < 10 ms (p = 0.010; HR = 2.664, CI = 1.262–5.624) were independent prognostic factors. Prospective studies for risk stratification among non-elderly BM patients based on our results are warranted to validate our findings.
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Affiliation(s)
- Yu-Ming Wang
- Department & Institute of Physiology, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan;
- Department of Radiation Oncology & Proton and Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (J.-Y.C.); (C.-J.W.)
- School of Traditional Chinese Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Jen-Yu Cheng
- Department of Radiation Oncology & Proton and Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (J.-Y.C.); (C.-J.W.)
| | - Chong-Jong Wang
- Department of Radiation Oncology & Proton and Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (J.-Y.C.); (C.-J.W.)
| | - Shu-Shya Hseu
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
| | - Eng-Yen Huang
- Department of Radiation Oncology & Proton and Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (J.-Y.C.); (C.-J.W.)
- School of Traditional Chinese Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Correspondence: ; Tel.: +886-7-731-7123 (ext. 7000)
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The biology of stress in cancer: Applying the biobehavioral framework to adolescent and young adult oncology research. Brain Behav Immun Health 2021; 17:100321. [PMID: 34589815 PMCID: PMC8474169 DOI: 10.1016/j.bbih.2021.100321] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/28/2021] [Accepted: 08/07/2021] [Indexed: 12/19/2022] Open
Abstract
The stress response influences the development and trajectory of cancer through a host of complex neuroimmune mechanisms. Basic, translational, and clinical research has elucidated these biobehavioral connections and offers a new paradigm for scientific investigation and patient care. Using a biobehavioral approach could offer new diagnostic and therapeutic opportunities in oncology, and this approach will be particularly impactful for adolescent and young adult (AYA) patients with cancer. To date, nearly all biobehavioral oncology research has been done in the adult population. And yet, AYAs have traditionally poorer mental health and cancer-related outcomes, and thus represent a population that could benefit from parallel psychosocial and biomedical intervention. Future biobehavioral work in oncology should focus on the AYA population, integrating new cancer therapies and technology into the next generation of research. Translational research efforts are clarifying the role of stress in cancer biology and patient outcomes. AYAs have poorer cancer-related and mental health outcomes, but nearly all biobehavioral oncology studies are in adults. Future work in immunotherapy, digital health technology, and interdisciplinary cooperation will advance the field. A translational biobehavioral approach brings the paradigm of precision medicine to psychosocial care in cancer.
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Lai Y, Zhou X, Guo F, Jin X, Meng G, Zhou L, Chen H, Liu Z, Yu L, Jiang H. Non-invasive transcutaneous vagal nerve stimulation improves myocardial performance in doxorubicin-induced cardiotoxicity. Cardiovasc Res 2021; 118:1821-1834. [PMID: 34145895 DOI: 10.1093/cvr/cvab209] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/17/2021] [Indexed: 12/29/2022] Open
Abstract
AIMS The clinical use of antitumor agent doxorubicin (DOX) is hampered by its dose-dependent cardiotoxicity. Development of highly efficient and safe adjuvant intervention for preventing DOX-induced adverse cardiac events is urgently needed. We aimed to investigate whether transcutaneous vagal nerve stimulation (tVNS) plays a cardio-protective role in DOX-induced cardiotoxicity. METHODS AND RESULTS Healthy male adult Sprague Dawley rats were used in the experiment and were randomly divided into four groups including control, DOX, tVNS and DOX+tVNS groups. A cumulative dose of 15 mg/kg DOX was intraperitoneally injected into rats to generate cardiotoxicity. Non-invasive tVNS was conducted for 6 weeks (30 min/day). After six-week intervention, the indices from the echocardiography revealed that tVNS significantly improved left ventricular function compared to the DOX group. The increased malondialdehyde (MDA) and Interleukin-1β (IL-1β), and decreased superoxide dismutase (SOD) were observed in the DOX group, while tVNS significantly prevented these changes. From cardiac histopathological analysis, the DOX+tVNS group showed a mild myocardial damage, and decreases in cardiac fibrosis and myocardial apoptosis compared to the DOX group. Heart rate variability (HRV) analysis showed that tVNS significantly inhibited DOX-induced sympathetic hyperactivity compared to the DOX group. Additionally, the results of RNA-sequencing analysis showed that there were 245 differentially expressed genes in the DOX group compared to the control group, among which 39 genes were downregulated by tVNS and most of these genes were involved in immune system. Moreover, tVNS significantly downregulated the relative mRNA expressions of chemokine-related genes and macrophages recruitment compared to the DOX group. CONCLUSION These results suggest that tVNS prevented DOX-induced cardiotoxicity by rebalancing autonomic tone, ameliorating cardiac dysfunction and remodeling. Notably, crosstalk between autonomic neuromodulation and innate immune cells macrophages mediated by chemokines might be involved in the underlying mechanisms. A TRANSLATIONAL PERSPECTIVE Non-invasive tVNS has been identified an effective neuromodulation strategy exerting beneficial effects on rebalancing autonomic tone and cardiac pathological conditions. The present study provided direct evidence for a beneficial role of tVNS in preventing DOX-induced autonomic dysfunction and cardiotoxicity in vivo. Additionally, recent studies revealed the importance of sympathetic nerve fibers involving in tumorigenesis and the benefits of higher vagal tone for tumor prognosis either in animal or human trials. Together, tVNS may not only become a novel, nonpharmacological adjuvant therapy for preventing doxorubicin-induced cardiotoxicity, but also may be beneficial for prognosis of cancer patients during chemotherapy. In our future study, we would investigate the effect of tVNS on both combined chemotherapy-induced cardiotoxicity and the antitumor efficacy of DOX in tumor models.
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Affiliation(s)
- Yanqiu Lai
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China
- Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
- Cardiac Autonomic Nervous System Research Center of Wuhan University, No. 238 Jiefang Road, Wuchang District, Wuhan City, Hubei Province, 430060, China
| | - Xiaoya Zhou
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China
- Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
- Cardiac Autonomic Nervous System Research Center of Wuhan University, No. 238 Jiefang Road, Wuchang District, Wuhan City, Hubei Province, 430060, China
| | - Fuding Guo
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China
- Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
- Cardiac Autonomic Nervous System Research Center of Wuhan University, No. 238 Jiefang Road, Wuchang District, Wuhan City, Hubei Province, 430060, China
| | - Xiaoxing Jin
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China
- Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
- Cardiac Autonomic Nervous System Research Center of Wuhan University, No. 238 Jiefang Road, Wuchang District, Wuhan City, Hubei Province, 430060, China
| | - Guannan Meng
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China
- Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
- Cardiac Autonomic Nervous System Research Center of Wuhan University, No. 238 Jiefang Road, Wuchang District, Wuhan City, Hubei Province, 430060, China
| | - Liping Zhou
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China
- Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
- Cardiac Autonomic Nervous System Research Center of Wuhan University, No. 238 Jiefang Road, Wuchang District, Wuhan City, Hubei Province, 430060, China
| | - Hu Chen
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China
- Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
- Cardiac Autonomic Nervous System Research Center of Wuhan University, No. 238 Jiefang Road, Wuchang District, Wuhan City, Hubei Province, 430060, China
| | - Zhihao Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China
- Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
- Cardiac Autonomic Nervous System Research Center of Wuhan University, No. 238 Jiefang Road, Wuchang District, Wuhan City, Hubei Province, 430060, China
| | - Lilei Yu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China
- Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
- Cardiac Autonomic Nervous System Research Center of Wuhan University, No. 238 Jiefang Road, Wuchang District, Wuhan City, Hubei Province, 430060, China
| | - Hong Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China
- Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
- Cardiac Autonomic Nervous System Research Center of Wuhan University, No. 238 Jiefang Road, Wuchang District, Wuhan City, Hubei Province, 430060, China
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The Prognostic Correlation of Heart Rate Variability at Diagnosis with Survival of Patients with Hepatocellular Carcinoma. Diagnostics (Basel) 2021; 11:diagnostics11050890. [PMID: 34067711 PMCID: PMC8156854 DOI: 10.3390/diagnostics11050890] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 01/05/2023] Open
Abstract
Background: Heart rate variability (HRV) indices have been shown to be associated with prognosis in various types of cancer. This study aims to assess the ability of these indices to predict survival in hepatocellular carcinoma (HCC) patients after diagnosis. Methods: We retrospectively collected data from 231 patients diagnosed with HCC between January 2014 and March 2018. The baseline clinical-pathological variables and HRV indices (extracted from Holter electrocardiogram recordings) were analyzed. Results: Univariate and multivariate analyses were performed to identify the predictive value of the above factors for overall survival (OS). The univariate analysis revealed that an age > 60 years, hepatitis C, portal vein involvement (thrombosis), a tumor size > 5 cm, alpha-fetoprotein (AFP) > 400 ng/mL, serum albumin, and C-reactive protein (CRP) were risk factors for poor OS. Multivariable Cox regression analyses identified that a tumor size > 5 cm and AFP > 400 ng/mL predict poorer outcomes in HCC patients. It should be mentioned that, in both the univariate analysis and in the multivariate analysis, between HRV indices, SDNN (standard deviation of all normal-to-normal (NN) intervals) < 110 ms was an independent risk factor for OS with an HR of 3.646 (95% CI 2.143 to 6.205). Conclusion: This study demonstrates that HRV indices identify HCC patients at high risk of death and suggests that such monitoring might guide the need for early therapy in these types of patients, as well as the fact that HRV can be a potential noninvasive biomarker for HCC prognosis.
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Hohneck A, Reyser C, Merx K, Weingärtner S, Mavratzas A, Schumacher G, Linhuber C, Hofmann WK, Burkholder I, Hofheinz RD. Differential Effects of Sound Intervention and Rest on Cardiovascular Parameters in Cancer Patients: A Randomized Cross-over Trial. Integr Cancer Ther 2021; 20:1534735421995239. [PMID: 33813930 PMCID: PMC8024455 DOI: 10.1177/1534735421995239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: Music therapy or sound interventions were shown to confer beneficial effects in patients with cancer for instance in terms of pain or fear relief and improvement of other patient reported outcomes. Cardiovascular parameters, especially heart rate variability (HRV) were found to have prognostic implications in cancer patients. In this trial we aimed to investigate the effects of a sound intervention on cardiovascular parameters compared to rest in patients with cancer. Methods and results: Using a randomized cross-over design, 52 patients (male 13, female 39) with cancer were recruited to receive both a 15-minute sound intervention and a 15-minute rest intervention within 4 weeks with at least a one-week blanking period. Cardiovascular parameters (among others HRV, aortic pulse wave velocity [PWV], augmentation index [Aix], aortic blood pressure [BP], heart rate [HR]) were assessed immediately before (pre) and after (post) the intervention had taken place. HRV (Root mean square of successive RR interval differences [RMSSD, ms]) significantly increased, during sound intervention (median RMSSD pre 24 [range 5-112] vs post 22 [range 9-141], P = .03). Likewise, median PWV, as a direct marker of arterial stiffness, was significantly reduced by sound intervention ([m/s] pre 8.5 [range 5.6-19.6] vs post 8.3 [range 5.6-15.6], P = .04). For both parameters no statistically significant change during rest was observed. HR was lowered by both, rest (P < .0001) and sound intervention (P = .02), with a more pronounced effect by rest. A significant increase in systolic aortic blood pressure was shown by rest ([mmHg] median 101 [range 78-150] vs post median 103 [range 71-152], P = .04) but not during sound intervention (P = .59), while rest intervention led to a decrease in resistance index (pre median 33 [range 13-92] vs post median 32 [11-84], P = .02). Conclusion: In comparison with rest, a single sound intervention in patients with cancer improved cardiovascular parameters commonly associated with increased stress levels. Studies with longer follow-up and multiple interventions are warranted. Trial Registration: ISRCTN registry 70947363.
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Affiliation(s)
- Anna Hohneck
- University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christina Reyser
- University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Kirsten Merx
- University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Simone Weingärtner
- University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Athanasios Mavratzas
- University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | | | - Wolf-Karsten Hofmann
- University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Iris Burkholder
- University of Applied Sciences of the Saarland, Saarbrucken, Germany
| | - Ralf-Dieter Hofheinz
- University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Fractal Dynamics in the RR Interval of Craniopharyngioma and Adrenal Tumor in Adolescence. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1338:183-191. [DOI: 10.1007/978-3-030-78775-2_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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18
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[Tumor effects on the heart and circulation]. Internist (Berl) 2020; 61:1120-1124. [PMID: 33052455 DOI: 10.1007/s00108-020-00887-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
As a result of the continuous development of modern cancer treatment, more cancer patients can be cured every year. However, since many patients experience cardiovascular problems before, during and after their cancer treatment, cardio-oncology is becoming increasingly important. Numerous therapies can cause cardiotoxicity, such as chemotherapy, immunotherapy, antibody therapy and radiotherapy. If these remain undetected, the patient may develop, e.g. heart failure or severe heart valve damage. The broad spectrum of cardiovascular comorbidities has become an immense challenge for cardiologists and oncologists. Cardio-oncology also deals with the effects that cancer has on the cardiovascular system. New research indicates that the tumor itself also has direct negative effects on the heart, mediated by messenger substances. Therefore, it is important to understand which cancer patients are at increased cardiovascular risk, thereby enabling the development of new therapeutic approaches in the long term to maintain mobility and improve patient prognosis.
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Is pre-operative heart rate variability a prognostic indicator for overall survival and cancer recurrence in patients with primary colorectal cancer? PLoS One 2020; 15:e0237244. [PMID: 32817663 PMCID: PMC7440652 DOI: 10.1371/journal.pone.0237244] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 07/22/2020] [Indexed: 12/24/2022] Open
Abstract
Background Heart Rate Variability (HRV) represents efferent vagus nerve activity which is suggested to be inversely related to fundamental mechanisms of tumorigenesis and to be a predictor of prognosis in various types of cancer. HRV is also believed to predict the occurrence and severity of post-operative complications. We aimed to determine the role of pre-operative HRV as a prognostic factor in overall and cancer free survival in patients with colorectal cancer. Methods Retrospective analysis was performed in a detailed dataset of patients diagnosed with primary colorectal cancer between January 2010 and December 2016, who underwent curative surgical treatment. HRV was measured as time-domain parameters (SDNN (Standard Deviation of NN-intervals) and RMSSD (Root Mean Square of Successive Differences)) based on pre-operative 10 second ECGs. Groups were created by baseline HRV: Low HRV (SDNN <20ms or RMSSD <19ms) and normal HRV (SDNN ≥20ms or RMSSD ≥19ms). Primary endpoints were overall and cancer free survival. Results A total of 428 patients were included in this study. HRV was not significantly associated with overall survival (SDNN <20ms vs SDNN ≥20ms:24.4% vs 22.8%, adjusted HR = 0.952 (0.607–1.493), p = 0.829; RMSSD <19ms vs RMSSD ≥19ms:27.0% vs 19.5%, adjusted HR = 1.321 (0.802–2.178), p = 0.274) or cancer recurrence (SDNN <20ms vs ≥20ms:20.1% vs 18.7%, adjusted HR = 0.976 (0.599–1.592), p = 0.924; RMSSD <19ms vs ≥19ms, 21.5% vs 16.9%, adjusted HR = 1.192 (0.706–2.011), p = 0.511). There was no significant association between HRV and CEA-level at one year follow-up, or between HRV and occurrence of a post-operative complication or the severity of post-operative complications. Conclusions Heart rate variability was not associated with overall or cancer free survival in patients with primary colorectal cancer who underwent curative surgical treatment. These results do not align with results found in studies including only patients with advanced cancer, which suggests that there is only an association in the other direction, cancer causing low HRV.
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Janczarek I, Kędzierski W, Wilk I, Wnuk–Pawlak E, Rakowska A. Comparison of daily heart rate variability in old and young horses: A preliminary study. J Vet Behav 2020. [DOI: 10.1016/j.jveb.2020.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Saeedan AS, Rastogi S, Ansari MN. Roflumilast counteracts DMH-induced preneoplastic colon damage in albino Wistar rats. Hum Exp Toxicol 2020; 39:1545-1555. [PMID: 32524861 DOI: 10.1177/0960327120931165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The study explored the chemoprophylactic potential of roflumilast against 1,2-dimethylhydrazine (DMH) actuated preneoplastic colon damage in albino Wistar rats. METHODS Animals were arbitrarily divided into five groups of six animals each. DMH was used to induce preneoplastic colon damage (20 mg/kg/7 days, subcutaneously, for 42 days). Roflumilast was administered subcutaneously at two doses (1 and 5 mg/kg/day, from day 28 to 42). At the end of the study, the animals were recorded for the electrocardiographic changes and heart rate variability (HRV) paradigms on 42nd day, using PowerLab system. Blood samples were collected from all the animals to measure hydrogen sulfide (H2S) and nitric acid. The colon tissue was dissected out and analyzed for inflammatory markers, biochemical parameters including, superoxide dismutase, thiobarbituric acid reactive substances, catalase, and glutathione reductase and histopathology. RESULTS DMH caused derangement of HRV factors, abnormal antioxidant markers, and elevated levels of inflammatory markers. H2S and nitric oxide levels upsurge in DMH-treated rats and promoted preneoplastic damage. Histopathologically, loss of crypts, goblet cells, and distorted lamina propria were observed in toxic group. Treatment with roflumilast was able to curtail down oxidative stress and inflammatory markers and stabilitate the hemodynamic derangements as well as was able to restore the normal architecture of colonic mucosa. CONCLUSION The findings from the present study conclude that treatment with roflumilast positively modulates the preneoplastic colon damage.
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Affiliation(s)
- A S Saeedan
- Department of Pharmacology and Toxicology, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia
| | - S Rastogi
- Department of Pharmaceutical Sciences, School of Biosciences and Biotechnology, Babasaheb Bhimrao Ambedkar University (A Central University), Lucknow, Uttar Pradesh, India
| | - M N Ansari
- Department of Pharmacology and Toxicology, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia
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Is heart rate variability a valuable method to investigate cardiac autonomic dysfunction in subjects with leukemia? A systematic review to evaluate its importance in clinical practice. Support Care Cancer 2019; 28:35-42. [PMID: 31444641 DOI: 10.1007/s00520-019-05047-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/16/2019] [Indexed: 12/19/2022]
Abstract
Impaired cardiovascular and autonomic function during treatment and during recovery from leukemia has been indicated. In this context, heart rate variability (HRV) is a non-invasive measure that describes the oscillations of the intervals between consecutive heart beats (RR intervals), influenced by the autonomic nervous system. We intend to review literature showing HRV changes in leukemia subjects. The articles selected in the current review were attained up to March 2018, and the search was limited to articles in English language, published in peer-reviewed journals, with both adult and child age samples. The articles were investigated in the five electronic databases: PubMed, Physiotherapy Evidence Database (PEDro), Cochrane Clinical Trials, Scientific Electronic Library Online (SciELO), and Excerpta Medica dataBASE (EMBASE). Towards the end of the research, 9 studies were included. Subjects undergoing treatment for leukemia have reduced HRV, signifying decreased vagal control of heart rate. The subjects that undertook leukemia treatment and their survivors experienced a reduction in HRV with subsequent recovery, but the recovery time is ill defined. HRV is reduced in leukemia subjects who progress to neuropathy secondary to chemotherapy, accompanied by cardiac dysfunction. We advocate the use of HRV to evaluate autonomic function and decide the treatment to prevent autonomic impairment in leukemia subjects.
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Otsuka K, Cornelissen G, Kubo Y, Shibata K, Mizuno K, Ohshima H, Furukawa S, Mukai C. Anti-aging effects of long-term space missions, estimated by heart rate variability. Sci Rep 2019; 9:8995. [PMID: 31222071 PMCID: PMC6586662 DOI: 10.1038/s41598-019-45387-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 06/05/2019] [Indexed: 02/07/2023] Open
Abstract
Reports that aging slows down in space prompted this investigation of anti-aging effects in humans by analyzing astronauts' heart rate variability (HRV). Ambulatory 48-hour electrocardiograms from 7 astronauts (42.1 ± 6.8 years; 6 men) 20.6 ± 2.7 days (ISS01) and 138.6 ± 21.8 days (ISS02) after launch were divided into 24-hour spans of relative lower or higher magnetic disturbance, based on geomagnetic measures in Tromso, Norway. Magnetic disturbances were significantly higher on disturbed than on quiet days (ISS01: 72.01 ± 33.82 versus 33.96 ± 17.90 nT, P = 0.0307; ISS02: 71.06 ± 51.52 versus 32.53 ± 27.27 nT, P = 0.0308). SDNNIDX was increased on disturbed days (by 5.5% during ISS01, P = 0.0110), as were other HRV indices during ISS02 (SDANN, 12.5%, P = 0.0243; Triangular Index, 8.4%, P = 0.0469; and TF-component, 17.2%, P = 0.0054), suggesting the action of an anti-aging or longevity effect. The effect on TF was stronger during light (12:00-17:00) than during darkness (0:00-05:00) (P = 0.0268). The brain default mode network (DMN) was activated, gauged by increases in the LF-band (9.7%, P = 0.0730) and MF1-band (9.9%, P = 0.0281). Magnetic changes in the magnetosphere can affect and enhance HRV indices in space, involving an anti-aging or longevity effect, probably in association with the brain DMN, in a light-dependent manner and/or with help from the circadian clock.
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Affiliation(s)
- Kuniaki Otsuka
- Executive Medical Center, Totsuka Royal Clinic, Tokyo Women's Medical University, Tokyo, Japan.
- Halberg Chronobiology Center, University of Minnesota, Minneapolis, Minnesota, USA.
| | - Germaine Cornelissen
- Halberg Chronobiology Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Yutaka Kubo
- Department of Medicine, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan
| | - Koichi Shibata
- Department of Medicine, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan
| | - Koh Mizuno
- Faculty of Education, Tohoku Fukushi University, Miyagi, Japan
- Space Biomedical Research Group, Japan Aerospace Exploration Agency, Tokyo, Japan
| | - Hiroshi Ohshima
- Space Biomedical Research Group, Japan Aerospace Exploration Agency, Tokyo, Japan
| | - Satoshi Furukawa
- Space Biomedical Research Group, Japan Aerospace Exploration Agency, Tokyo, Japan
| | - Chiaki Mukai
- Space Biomedical Research Group, Japan Aerospace Exploration Agency, Tokyo, Japan
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Buoncervello M, Maccari S, Ascione B, Gambardella L, Marconi M, Spada M, Macchia D, Stati T, Patrizio M, Malorni W, Matarrese P, Marano G, Gabriele L. Inflammatory cytokines associated with cancer growth induce mitochondria and cytoskeleton alterations in cardiomyocytes. J Cell Physiol 2019; 234:20453-20468. [PMID: 30982981 PMCID: PMC6767566 DOI: 10.1002/jcp.28647] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 03/19/2019] [Accepted: 03/19/2019] [Indexed: 12/13/2022]
Abstract
Cardiac dysfunction is often observed in patients with cancer also representing a serious problem limiting chemotherapeutic intervention and even patient survival. In view of the recently established role of the immune system in the control of cancer growth, the present work has been undertaken to investigate the effects of a panel of the most important inflammatory cytokines on the integrity and function of mitochondria, as well as of the cytoskeleton, two key elements in the functioning of cardiomyocytes. Either mitochondria features or actomyosin cytoskeleton organization of in vitro‐cultured cardiomyocytes treated with different inflammatory cytokines were analyzed. In addition, to investigate the interplay between tumor growth and cardiac function in an in vivo system, immunocompetent female mice were inoculated with cancer cells and treated with the chemotherapeutic drug doxorubicin at a dosing schedule able to suppress tumor growth without inducing cardiac alterations. Analyses carried out in cardiomyocytes treated with the inflammatory cytokines, such as tumor necrosis factor α (TNF‐α), interferon γ (IFN‐γ), interleukin 6 (IL‐6), IL‐8, and IL‐1β revealed severe phenotypic changes, for example, of contractile cytoskeletal elements, mitochondrial membrane potential, mitochondrial reactive oxygen species production and mitochondria network organization. Accordingly, in immunocompetent mice, the tumor growth was accompanied by increased levels of the inflammatory cytokines TNF‐α, IFN‐γ, IL‐6, and IL‐8, either in serum or in the heart tissue, together with a significant reduction of ventricular systolic function. The alterations of mitochondria and of microfilament system of cardiomyocytes, due to the systemic inflammation associated with cancer growth, could be responsible for remote cardiac injury and impairment of systolic function observed in vivo.
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Affiliation(s)
- Maria Buoncervello
- Research Coordination and Support Service, Istituto Superiore di Sanità, Rome, Italy
| | - Sonia Maccari
- Center for Gender-Specific Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Barbara Ascione
- Center for Gender-Specific Medicine, Oncology Unit, Istituto Superiore di Sanità, Rome, Italy
| | - Lucrezia Gambardella
- Center for Gender-Specific Medicine, Oncology Unit, Istituto Superiore di Sanità, Rome, Italy
| | - Matteo Marconi
- Center for Gender-Specific Medicine, Oncology Unit, Istituto Superiore di Sanità, Rome, Italy
| | - Massimo Spada
- National Centre of Animal Research and Welfare, Istituto Superiore di Sanità, Rome, Italy
| | - Daniele Macchia
- National Centre of Animal Research and Welfare, Istituto Superiore di Sanità, Rome, Italy
| | - Tonino Stati
- Center for Gender-Specific Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Mario Patrizio
- Center for Gender-Specific Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Walter Malorni
- Center for Gender-Specific Medicine, Oncology Unit, Istituto Superiore di Sanità, Rome, Italy.,Department of Biology, University of Tor Vergata, Rome, Italy
| | - Paola Matarrese
- Center for Gender-Specific Medicine, Oncology Unit, Istituto Superiore di Sanità, Rome, Italy
| | - Giuseppe Marano
- Center for Gender-Specific Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Lucia Gabriele
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
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Caru M, Corbin D, Périé D, Lemay V, Delfrate J, Drouin S, Bertout L, Krajinovic M, Laverdière C, Andelfinger G, Sinnett D, Curnier D. Doxorubicin treatments induce significant changes on the cardiac autonomic nervous system in childhood acute lymphoblastic leukemia long-term survivors. Clin Res Cardiol 2019; 108:1000-1008. [DOI: 10.1007/s00392-019-01427-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 01/29/2019] [Indexed: 12/12/2022]
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Dose-response relationship between very vigorous physical activity and cardiovascular health assessed by heart rate variability in adults: Cross-sectional results from the EPIMOV study. PLoS One 2019; 14:e0210216. [PMID: 30703127 PMCID: PMC6354985 DOI: 10.1371/journal.pone.0210216] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 12/18/2018] [Indexed: 12/31/2022] Open
Abstract
The minimum amount of physical activity needed to obtain health benefits has been widely determined. Unlikely, the impact of extreme amounts of very vigorous physical activity (VVPA, ≥ 8 metabolic equivalents) to the heart remains controversial. We aimed to evaluate the dose-response relationship between VVPA and heart rate variability (HRV) in adults. We selected 1040 asymptomatic individuals (60% women, 42 ± 15 years, 28 ± 6 kg/m2) from the Epidemiology and Human Movement Study (EPIMOV). Participants remained in the supine position for 10 min, and we selected an intermediate 5-min window for HRV analysis. The standard deviation of the RR intervals, root mean square of RR intervals, successive RR intervals that differ > 50 ms, powers of the low-and high-frequency bands and Poincaré plot standard deviations were quantified. Participants used a triaxial accelerometer (Actigraph GT3x+) above the dominant hip for 4-7 consecutive days for quantifying their physical activity. We also evaluated the maximum oxygen uptake ([Formula: see text]) during an exercise test. We stratified participants into five groups according to the VVPA in min/week (group 1, ≤ 1.50; 2, 1.51-3.16; 3, 3.17-3.54; 4, 3.55-20.75; and 5, > 20.75). The linear trends of the HRV through the quintiles of VVPA were investigated. We used logarithmic transformations to compare the five groups adjusted for age, sex, cardiovascular risk, and [Formula: see text]. We found a better HRV with increased VVPA for all HRV indices studied (p trend < 0.05). However, group 5 did not differ from group 4 (p > 0.05) for none of the indices. We conclude that there is an incremental benefit of VVPA on HRV of asymptomatic adults. Since we found neither additional benefits nor the harmful impact of amounts of VVPA as high as 22 min/week on HRV, our results should not discourage asymptomatic adults to perform VVPA.
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da Cruz CJG, Porto LGG, da Silva Rolim P, de Souza Pires D, Garcia GL, Molina GE. Impact of heart rate on reproducibility of heart rate variability analysis in the supine and standing positions in healthy men. Clinics (Sao Paulo) 2019; 74:e806. [PMID: 31411277 PMCID: PMC6683304 DOI: 10.6061/clinics/2019/e806] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 03/12/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The reliability of heart rate variability (HRV) analysis is not yet fully understood, especially considering different body positions and the mathematical influence of heart rate. The aim of this study was to evaluate the reliability of HRV in supine and standing positions, with and without mathematical adjustment of HRV by the average R-R interval (iRR). METHODS We evaluated 37 young males (23.1±4 years; 25.1±3 kg/m2). A 5-min segment of the iRR was collected in the supine and standing positions on three occasions separated by 48-hour intervals. Absolute and relative reliability of temporal and spectral indices were assessed by the coefficient of variation (CV) and the intraclass correlation coefficient (ICC), respectively. RESULTS We did not observe differences in HRV indices in the three occasions in the supine or standing position (p>0.05). Moderate to good reproducibility was observed for temporal and spectral indices of HRV in the supine position (ICC: 0.65-0.89; CV: 0.9-19.8). In the orthostatic position, low to good reproducibility was observed (ICC: 0.35-0.89; CV: 1.1-34.8), with higher ICCs for temporal indices. After mathematical adjustment, only a small modification in HRV reliability was observed in both positions. CONCLUSIONS In young adult males, the mathematical adjustment of HRV by the average iRR led to a nonsignificant effect on HRV reliability. Additionally, HRV reliability is dependent on body position and the index analyzed. Promising measures in both supine and standing positions include r-MSSD and the HF band (parasympathetic indices).
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Affiliation(s)
- Carlos Janssen Gomes da Cruz
- Grupo de Estudos e Pesquisas em Funcao Autonomica Cardiaca (GEFAC), Centro Universitario Euro Americano - UNIEURO, Brasilia, DF, BR
- Laboratorio de Fisiologia do Exercicio, Faculdade de Educacao Fisica, Universidade de Brasilia, Brasilia, DF, BR
- *Corresponding author. E-mail:
| | - Luiz Guilherme Grossi Porto
- Laboratorio de Fisiologia do Exercicio, Faculdade de Educacao Fisica, Universidade de Brasilia, Brasilia, DF, BR
| | - Paloma da Silva Rolim
- Grupo de Estudos e Pesquisas em Funcao Autonomica Cardiaca (GEFAC), Centro Universitario Euro Americano - UNIEURO, Brasilia, DF, BR
| | - Deleon de Souza Pires
- Grupo de Estudos e Pesquisas em Funcao Autonomica Cardiaca (GEFAC), Centro Universitario Euro Americano - UNIEURO, Brasilia, DF, BR
| | - Giliard Lago Garcia
- Laboratorio de Fisiologia do Exercicio, Faculdade de Educacao Fisica, Universidade de Brasilia, Brasilia, DF, BR
| | - Guilherme Eckhardt Molina
- Laboratorio de Fisiologia do Exercicio, Faculdade de Educacao Fisica, Universidade de Brasilia, Brasilia, DF, BR
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Groarke JD, Mahmood SS, Payne D, Ganatra S, Hainer J, Neilan TG, Partridge AH, Di Carli MF, Jones LW, Mehra MR, Nohria A. Case-control study of heart rate abnormalities across the breast cancer survivorship continuum. Cancer Med 2018; 8:447-454. [PMID: 30578624 PMCID: PMC6346251 DOI: 10.1002/cam4.1916] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 11/07/2022] Open
Abstract
Background Mechanisms underlying impaired exercise capacity and increased cardiovascular mortality observed in breast cancer (BC) patients remain unclear. The prevalence, functional, and prognostic significance of elevated resting heart rate (HR) and abnormal heart rate recovery (HRR) in breast cancer (BC) requires evaluation. Methods In a single‐center, retrospective, case‐control study of women referred for exercise treadmill testing (ETT), 448 BC patients (62.6 ± 10.0 years) were compared to 448 cancer‐free, age‐matched controls. Elevated resting HR was defined as HR ≥80 bpm at rest. Abnormal HRR at 1‐minute following exercise was defined as ≤12 bpm if active recovery or ≤18 bpm if passive recovery. Association of these parameters with exercise capacity and all‐cause mortality was evaluated. Results Elevated resting HR (23.7% vs 17.0%, P = 0.013) and abnormal HRR (25.9% vs 20.3%, P = 0.048) were more prevalent in BC cohort than controls. In adjusted analyses, BC patients with elevated resting HR (−0.9 METs (SE 0.3); P = 0.0003) or abnormal HRR (−1.3 METs (SE 0.3); P < 0.0001) had significant reductions in metabolic equivalents (METs) achieved during exercise. Elevated resting HR was not associated with mortality. There was a trend toward increased mortality in BC cohort with abnormal HRR (adjusted hazard ratio 2.06 (95% CI 0.95‐4.44, P = 0.07)). Conclusions Women across the BC survivorship continuum, referred for ETT, have an increased prevalence of elevated resting HR and abnormal HRR relative to cancer‐free, age‐matched female controls. These parameters were associated with decreased exercise capacity. Strategies to modulate these abnormalities may help improve functional capacity in this cohort.
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Affiliation(s)
- John D Groarke
- Heart and Vascular Center, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.,Adult Survivorship Program, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
| | - Syed S Mahmood
- Heart and Vascular Center, Brigham and Women's Hospital, Boston, Massachusetts.,Cardio-Oncology Program, Massachusetts General Hospital, Boston, Massachusetts
| | - David Payne
- Heart and Vascular Center, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sarju Ganatra
- Heart and Vascular Center, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jon Hainer
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Tomas G Neilan
- Cardio-Oncology Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Ann H Partridge
- Adult Survivorship Program, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
| | - Marcelo F Di Carli
- Heart and Vascular Center, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lee W Jones
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York
| | - Mandeep R Mehra
- Heart and Vascular Center, Brigham and Women's Hospital, Boston, Massachusetts
| | - Anju Nohria
- Heart and Vascular Center, Brigham and Women's Hospital, Boston, Massachusetts.,Adult Survivorship Program, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
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Okada M, Okada K, Fujii K. Influence of polypharmacy on heart rate variability in older adults at the Hiroshima Atomic Bomb Survivors Recuperation Research Center, Japan. PLoS One 2018; 13:e0209081. [PMID: 30540860 PMCID: PMC6291139 DOI: 10.1371/journal.pone.0209081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 11/28/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Many studies have identified the risk of polypharmacy, but physiological evidence and methods of evaluation in these studies were poor. The relationship between polypharmacy and heart rate variability in older adults remains unclear. We investigated the relationship between polypharmacy in older adults, including atomic bomb survivors, and heart rate variability. METHODS We surveyed 56 older adults who did not need nursing care assistance in the Hiroshima Atomic Bomb Survivors Recuperation Center. Chronic diseases, types of medication, and lifestyle were assessed, and heart rate variability at rest was measured. We calculated heart rate variability indices including standard deviation of normal-to-normal RR intervals (SDNN), total power (TP), and very low frequency (VLF) and analyzed the relationship between the number of daily medication types and heart rate variability indices in older adults. The differences in heart rate variability indices were analyzed using six medications as a cut-off point. RESULTS Participants included 36 atomic bomb survivors and 20 non-atomic bomb survivors. The mean number of medication types was 3.6±3.4 (mean±standard deviation). SDNN, TP, and VLF decreased with an increased number of medications in all participants (P<0.01). When the standard of polypharmacy was set to more than six types of medications, SDNN, TP, and VLF were significantly lower in older adults who took six or more medications. Additionally, the mean number of medication types among atomic bomb survivors was higher than that of non-atomic bomb survivors (P = 0.008). The SDNN was significantly lower when atomic bomb survivors took six or more medications (P<0.001). CONCLUSIONS We found that a lower heart rate variability in older adults, including atomic bomb survivors, is associated with polypharmacy. We showed physiological evidence of the influence of polypharmacy, which may be important for the healthy life expectancy and prognosis in older adults.
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Affiliation(s)
- Masahiro Okada
- Department of Food and Dietetics, Hiroshima Bunka Gakuen Two-Year College, 3-5-1 Nagatsukanishi, Asaminami-ku, Hiroshima, Japan
- * E-mail:
| | - Kosuke Okada
- Department of Internal Medicine COOP Saeki Hospital, 3-11-29 Yahata-higashi, Saeki-ku, Hiroshima, Japan
| | - Kohyu Fujii
- Department of Food and Dietetics, Hiroshima Bunka Gakuen Two-Year College, 3-5-1 Nagatsukanishi, Asaminami-ku, Hiroshima, Japan
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Ask TF, Lugo RG, Sütterlin S. The Neuro-Immuno-Senescence Integrative Model (NISIM) on the Negative Association Between Parasympathetic Activity and Cellular Senescence. Front Neurosci 2018; 12:726. [PMID: 30369866 PMCID: PMC6194361 DOI: 10.3389/fnins.2018.00726] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 09/21/2018] [Indexed: 12/26/2022] Open
Abstract
There is evidence that accumulated senescent cells drive age-related pathologies, but the antecedents to the cellular stressors that induce senescence remain poorly understood. Previous research suggests that there is a relationship between shorter telomere length, an antecedent to cellular senescence, and psychological stress. Existing models do not sufficiently account for the specific pathways from which psychological stress regulation is converted into production of reactive oxygen species. We propose the neuro-immuno-senescence integrative model (NISIM) suggesting how vagally mediated heart rate variability (HRV) might be related to cellular senescence. Prefrontally modulated, and vagally mediated cortical influences on the autonomic nervous system, expressed as HRV, affects the immune system by adrenergic stimulation and cholinergic inhibition of cytokine production in macrophages and neutrophils. Previous findings indicate that low HRV is associated with increased production of the pro-inflammatory cytokines IL-6 and TNF-α. IL-6 and TNF-α can activate the NFκB pathway, increasing production of reactive oxygen species that can cause DNA damage. Vagally mediated HRV has been related to an individual's ability to regulate stress, and is lower in people with shorter telomeres. Based on these previous findings, the NISIM suggest that the main pathway from psychological stress to individual differences in oxidative telomere damage originates in the neuroanatomical components that modulate HRV, and culminates in the cytokine-induced activation of NFκB. Accumulated senescent cells in the brain is hypothesized to promote age-related neurodegenerative disease, and previous reports suggest an association between low HRV and onset of Alzheimer's and Parkinson's disease. Accumulating senescent cells in peripheral tissues secreting senescence-associated secretory phenotype factors can alter tissue structure and function which can induce cancer and promote tumor growth and metastasis in old age, and previous research suggested that ability to regulate psychological stress has a negative association with cancer onset. We therefore conclude that the NISIM can account for a large proportion of the individual differences in the psychological stress-related antecedents to cellular senescence, and suggest that it can be useful in providing a dynamic framework for understanding the pathways by which psychological stress induce pathologies in old age.
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Affiliation(s)
- Torvald F. Ask
- Research Group on Cognition, Health, and Performance, Institute of Psychology, Inland Norway University of Applied Sciences, Lillehammer, Norway
| | - Ricardo G. Lugo
- Research Group on Cognition, Health, and Performance, Institute of Psychology, Inland Norway University of Applied Sciences, Lillehammer, Norway
| | - Stefan Sütterlin
- Faculty of Health and Welfare Sciences, Østfold University College, Halden, Norway
- Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
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Mizera L, Boehm K, Duckheim M, Groga-Bada P, Gawaz M, Zuern CS, Eick C. Autonomic Nervous System Activity for Risk Stratification of Emergency Patients With Pneumonia. J Emerg Med 2018; 55:472-480. [PMID: 30057006 DOI: 10.1016/j.jemermed.2018.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 06/01/2018] [Accepted: 06/12/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Community-acquired pneumonia (CAP) causes appreciable morbidity and mortality in adults, especially in those ≥65 years of age. At hospital admission, an immediate and reliable risk assessment is necessary to detect patients with possible fatal outcome. OBJECTIVE We aimed to evaluate markers of the autonomic nervous system based on an electrocardiogram to predict mortality in patients with CAP. METHODS For this purpose, the deceleration capacity (DC) of heart rate was calculated in 253 patients who presented to the emergency department with CAP. The 30-day mortality rate was defined as the primary endpoint (PEP). The secondary endpoint was the total mortality within 180 days. RESULTS PEP was reached in 33 patients (13%). The DC, measured in milliseconds, was significantly lower in patients who reached the PEP than in those who did not (2.3 ± 1.5 ms vs. 3.6 ± 2.3 ms, p = 0.004). The DC was also significantly lower in nonsurvivors than in survivors at the time of the secondary endpoint (2.3 ± 1.5 ms vs. 3.7 ± 2.4 ms, p < 0.001). Our results indicate that DC is an independent predictor of 30- and 180-day mortality. CONCLUSION DC was independently associated with death from CAP in our study. As a practical consequence, DC could be useful in triage decisions. Patients with certain high risks could benefit from adjuvant treatment and special medical attention.
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Affiliation(s)
- Lars Mizera
- Department of Cardiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Katharina Boehm
- Department of Cardiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Martin Duckheim
- Department of Cardiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Patrick Groga-Bada
- Department of Cardiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Meinrad Gawaz
- Department of Cardiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Christine S Zuern
- Department of Cardiology, University Hospital Tuebingen, Tuebingen, Germany; Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Christian Eick
- Department of Cardiology, University Hospital Tuebingen, Tuebingen, Germany
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The Role of the Vagus Nerve in Cancer Prognosis: A Systematic and a Comprehensive Review. JOURNAL OF ONCOLOGY 2018; 2018:1236787. [PMID: 30057605 PMCID: PMC6051067 DOI: 10.1155/2018/1236787] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 06/10/2018] [Indexed: 12/11/2022]
Abstract
This article reviews the role of the vagus nerve in tumor modulation and cancer prognosis. We present a systematic review of 12 epidemiological studies examining the relationship between heart rate variability, the main vagus nerve index, and prognosis in cancer patients (survival and tumor markers). These studies show that initially high vagal nerve activity predicts better cancer prognosis, and, in some studies, independent of confounders such as cancer stage and treatments. Since the design of the epidemiological studies is correlational, any causal relationship between heart rate variability and cancer prognosis cannot be inferred. However, various semi-experimental cohort studies in humans and experimental studies in animals have examined this causal relationship. The second part of this paper presents a comprehensive review including human and animal cohort and experimental studies showing that vagotomy accelerates tumor growth, while vagal nerve activation improves cancer prognosis. Based on all reviewed studies, it is concluded that the evidence supports a protective role of the vagus nerve in cancer and specifically in the metastatic stage.
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Kloter E, Barrueto K, Klein SD, Scholkmann F, Wolf U. Heart Rate Variability as a Prognostic Factor for Cancer Survival - A Systematic Review. Front Physiol 2018; 9:623. [PMID: 29896113 PMCID: PMC5986915 DOI: 10.3389/fphys.2018.00623] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/08/2018] [Indexed: 12/11/2022] Open
Abstract
An increasing cancer incidence affecting any age and social class is putting serious strain on populations and health care systems around the world. This systematic literature search aims (i) to examine the correlation of heart rate variability (HRV) and cancer patients' prognosis, (ii) to examine the relationship of HRV and clinicopathological features, and (iii) to compare HRV between different patient groups, and between patient and control groups. We conducted a systematic literature review following the PRISMA Statement. We searched the PubMed and EMBASE databases for publications released by December 2017. The search terms were: "cancer" AND "heart rate variability" AND "human" NOT "animal" NOT "review." A total of 19 studies were finally included in this review. Most publications were high-quality observational studies. The studies showed that higher HRV correlated positively with patients' progression of disease and outcome. Thus, we conclude that individuals with higher HRV and advanced coping mechanisms seem to have a better prognosis in cancer progression. HRV appears to be a useful aspect to access the general health status of cancer patients.
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Affiliation(s)
- Evelyne Kloter
- Institute of Complementary Medicine, University of Bern, Bern, Switzerland
| | - Katja Barrueto
- Institute of Complementary Medicine, University of Bern, Bern, Switzerland
| | - Sabine D Klein
- Institute of Complementary Medicine, University of Bern, Bern, Switzerland
| | - Felix Scholkmann
- Institute of Complementary Medicine, University of Bern, Bern, Switzerland
| | - Ursula Wolf
- Institute of Complementary Medicine, University of Bern, Bern, Switzerland
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35
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Cardiac autonomic modulation impairments in advanced breast cancer patients. Clin Res Cardiol 2018; 107:924-936. [PMID: 29721647 DOI: 10.1007/s00392-018-1264-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/25/2018] [Indexed: 02/07/2023]
Abstract
AIM To compare cardiac autonomic modulation in early- versus advanced-stage breast cancer patients before any type of cancer treatment and investigate associated factors. METHODS AND RESULTS This cross-sectional study included women (30-69 years old) with primary diagnosis of breast cancer and women with benign breast tumors. We evaluated cardiac modulation by heart rate variability and assessed factors of anxiety, depression, physical activity, and other relevant medical variables. Patients were divided into three groups based on TNM staging of cancer severity: early-stage cancer (n = 42), advanced-stage cancer (n = 37), or benign breast tumors to serve as a control (n = 37). We analyzed heart rate variability in time and frequency domains. The advanced-stage cancer group had lower vagal modulation than early-stage and benign groups; also, the advance-stage group had lower overall heart rate variability when compared to benign conditions. Heart rate variability was influenced by age, menopausal status, and BMI. CONCLUSIONS Heart rate variability seems to be a promising, non-invasive tool for early diagnosis of autonomic dysfunction in breast cancer and detection of cardiovascular impairments at cancer diagnosis. Cardiac autonomic modulation is inversely associated with breast cancer staging.
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Shyamsunder Shukla R, Aggarwal Y. Nonlinear Heart Rate Variability based artificial intelligence in lung cancer prediction. J Appl Biomed 2018. [DOI: 10.1016/j.jab.2017.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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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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Shukla R, Aggarwal Y. Time-domain heart rate variability-based computer-aided prognosis of lung cancer. Indian J Cancer 2018; 55:61-65. [DOI: 10.4103/ijc.ijc_395_17] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Pecceu E, Stebbing B, Martinez Pereira Y, Handel I, Culshaw G, Hodgkiss-Geere H, Lawrence J. Vasovagal tonus index (VVTI) as an indirect assessment of remission status in canine multicentric lymphoma undergoing multi-drug chemotherapy. Vet Res Commun 2017; 41:249-256. [PMID: 28791606 PMCID: PMC5694533 DOI: 10.1007/s11259-017-9695-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/21/2017] [Indexed: 12/19/2022]
Abstract
Vasovagal tonus index (VVTI) is an indirect measure of heart rate variability and may serve as a marker of disease severity. Higher heart rate variability has predicted lower tumour burden and improved survival in humans with various tumour types. The purpose of this pilot study was to evaluate VVTI as a biomarker of remission status in canine lymphoma. The primary hypothesis was that VVTI would be increased in dogs in remission compared to dogs out of remission. Twenty-seven dogs were prospectively enrolled if they had a diagnosis of intermediate to high-grade lymphoma and underwent multidrug chemotherapy. Serial electrocardiogram data were collected under standard conditions and relationships between VVTI, remission status and other clinical variables were evaluated. VVTI from dogs in remission (partial or complete) did not differ from dogs with fulminant lymphoma (naive or at time of relapse). Dogs in partial remission had higher VVTI than dogs in complete remission (p = 0.021). Higher baseline VVTI was associated with higher subsequent scores (p < 0.001). VVTI also correlated with anxiety level (p = 0.03). Based on this pilot study, VVTI did not hold any obvious promise as a useful clinical biomarker of remission status. Further investigation may better elucidate the clinical and prognostic utility of VVTI in dogs with lymphoma.
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Affiliation(s)
- Evi Pecceu
- Royal (Dick) School of Veterinary Studies & Roslin Institute, University of Edinburgh, Roslin, EH25 9RG, UK.
| | - Brittainy Stebbing
- Royal (Dick) School of Veterinary Studies & Roslin Institute, University of Edinburgh, Roslin, EH25 9RG, UK
| | - Yolanda Martinez Pereira
- Royal (Dick) School of Veterinary Studies & Roslin Institute, University of Edinburgh, Roslin, EH25 9RG, UK
| | - Ian Handel
- Royal (Dick) School of Veterinary Studies & Roslin Institute, University of Edinburgh, Roslin, EH25 9RG, UK
| | - Geoff Culshaw
- Royal (Dick) School of Veterinary Studies & Roslin Institute, University of Edinburgh, Roslin, EH25 9RG, UK
| | - Hannah Hodgkiss-Geere
- Royal (Dick) School of Veterinary Studies & Roslin Institute, University of Edinburgh, Roslin, EH25 9RG, UK.,Small Animal Teaching Hospital, University of Liverpool, Liverpool, CH64 7TE, UK
| | - Jessica Lawrence
- Royal (Dick) School of Veterinary Studies & Roslin Institute, University of Edinburgh, Roslin, EH25 9RG, UK.,College of Veterinary Medicine, University of Minnesota, St Paul, MN, 55108, USA
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Majeed F, Yar T, Alsunni A, Alhawaj AF, AlRahim A, Alzaki M. Synergistic effect of energy drinks and overweight/obesity on cardiac autonomic testing using the Valsalva maneuver in university students. Ann Saudi Med 2017; 37:181-188. [PMID: 28578355 PMCID: PMC6150576 DOI: 10.5144/0256-4947.2017.181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Obesity and caffeine consumption may lead to autonomic disturbances that can result in a wide range of cardiovascular disorders. OBJECTIVES To determine autonomic disturbances produced by the synergistic effects of overweight or obesity (OW/OB) and energy drinks. DESIGN Cross-sectional, analytical. SETTING Physiology department at a university in Saudi Arabia. SUBJECTS AND METHODS University students, 18-22 years of age, of normal weight (NW) and OW/OB were recruited by convenience sampling. Autonomic testing by the Valsalva ratio (VR) along with systolic and diastolic blood pressure, pulse pressure, and mean arterial blood pressure were measured at baseline (0 minute) and 60 minutes after energy drink consumption. MAIN OUTCOME MEASURE(S) Autonomic disturbance, hemodynamic changes. RESULTS In 50 (27 males and 23 females) subjects, 21 NW and 29 OW/OB, a significant decrease in VR was observed in OW/OB subjects and in NW and OW/OB females at 60 minutes after energy drink consumption. Values of systolic and diastolic blood pressure, pulse pressure and mean arterial blood pressure were also significantly higher in OW/OB and in females as compared to NW and males. BMI was negatively correlated with VR and diastolic blood pressure at 60 minutes. CONCLUSION Obesity and energy drinks alter autonomic functions. In some individuals, OW/OB may augment these effects. LIMITATIONS Due to time and resource restraints, only the acute effects of energy drinks were examined.
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Affiliation(s)
- Farrukh Majeed
- Dr. Farrukh Majeed, Department of Physiology,, College of Medicine,, University of Dammam,, Al-Rakha, Dammam 31451, Saudi Arabia, +966 13 333 5132, , ORCID: http://orcid.org/0000-0002-2987-601X
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Odinets T, Briskin Y. Impact of personality-oriented programs of physical rehabilitation on the heart rate variability in women with post-mastectomy syndrome. Physiotherapy 2017. [DOI: 10.1515/physio-2016-0007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AbstractIntroduction. The aim of the study was to determine the effect of personality-oriented physical rehabilitation programs on the heart rate variability in women with post-mastectomy syndrome. Methods. The following methods were applied: theoretical analysis of scientific and methodologic literature data, heart rate variability analysis, and mathematical statistical methods. The subjects of the study were 50 women with late symptoms of post-mastectomy syndrome. The study was conducted during the ambulatory rehabilitation stage after Madden radical mastectomy. All the indicators of the heart rate variability were equivalent in the main and comparison groups at the beginning of rehabilitation. The impact of training was examined every 6 months over the course of a year. Results. Measurements were taken three times: at the beginning of rehabilitation and after 6 and 12 months. It was found that most of the investigated parameters of heart rate variability in both groups steadily improved during the year of rehabilitation. The average values of stress index and amplitude of mode after 12 months of rehabilitation were lower in the main group than in the comparison group but the values of the standard deviation of normal-to-normal intervals and the very low-frequency component of the spectrum were better by 6.48 ms (p < 0.05) and 203.29 ms2 (p < 0.05), respectively. Conclusions. The personality-oriented programs of physical rehabilitation were effective in augmenting heart rate variability and restoring autonomic balance in patients with post-mastectomy syndrome.
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Zhou X, Ma Z, Zhang L, Zhou S, Wang J, Wang B, Fu W. Heart rate variability in the prediction of survival in patients with cancer: A systematic review and meta-analysis. J Psychosom Res 2016; 89:20-5. [PMID: 27663106 DOI: 10.1016/j.jpsychores.2016.08.004] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 08/04/2016] [Accepted: 08/07/2016] [Indexed: 01/17/2023]
Abstract
PURPOSE Although the predictive value of vagal nerve activity, indexed by heart rate variability (HRV), has been confirmed in a variety of diseases, its value in the prediction of survival in cancer patients still remains controversial. The aim of this meta-analysis was to evaluate the predictive value of HRV in cancer patients in an evidence based manner. METHODS A systematic review and meta-analysis was conducted through a comprehensive search of the PubMed, EMBASE and the Cochrane Central Library databases for all studies regarding HRV, vagal nerve activity and cancer. Pooled data of overall survival was analyzed. RESULTS Six studies with 1286 patients were included in our meta analysis. Analysis of the pooled data revealed that overall survival was significantly longer in the higher HRV group than in the lower HRV group (HR 0.70, 95% CI [0.60, 0.82]; P<0.001, I2=27%). CONCLUSION The current evidence indicates a predictive value of HRV in the survival of patients with cancer and higher vagal nerve activity might predict longer survival, but the results should be applied with caution considering the heterogeneity between included studies.
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Affiliation(s)
- Xin Zhou
- Department of general surgery, Peking University Third Hospital, Beijing 100191, China
| | - Zhaolai Ma
- Department of general surgery, Peking University Third Hospital, Beijing 100191, China
| | - Lingfu Zhang
- Department of general surgery, Peking University Third Hospital, Beijing 100191, China
| | - Shuzhe Zhou
- National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital/Institute of Mental Health), the Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Jilian Wang
- Department of general surgery, Peking University Third Hospital, Beijing 100191, China
| | - Bingyan Wang
- Department of general surgery, Peking University Third Hospital, Beijing 100191, China
| | - Wei Fu
- Department of general surgery, Peking University Third Hospital, Beijing 100191, China.
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Akintola AA, van de Pol V, Bimmel D, Maan AC, van Heemst D. Comparative Analysis of the Equivital EQ02 Lifemonitor with Holter Ambulatory ECG Device for Continuous Measurement of ECG, Heart Rate, and Heart Rate Variability: A Validation Study for Precision and Accuracy. Front Physiol 2016; 7:391. [PMID: 27708585 PMCID: PMC5030218 DOI: 10.3389/fphys.2016.00391] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 08/23/2016] [Indexed: 11/13/2022] Open
Abstract
Background: The Equivital (EQ02) is a multi-parameter telemetric device offering both real-time and/or retrospective, synchronized monitoring of ECG, HR, and HRV, respiration, activity, and temperature. Unlike the Holter, which is the gold standard for continuous ECG measurement, EQO2 continuously monitors ECG via electrodes interwoven in the textile of a wearable belt. Objective: To compare EQ02 with the Holter for continuous home measurement of ECG, heart rate (HR), and heart rate variability (HRV). Methods: Eighteen healthy participants wore, simultaneously for 24 h, the Holter and EQ02 monitors. Per participant, averaged HR, and HRV per 5 min from the two devices were compared using Pearson correlation, paired T-test, and Bland-Altman analyses. Accuracy and precision metrics included mean absolute relative difference (MARD). Results: Artifact content of EQ02 data varied widely between (range 1.93-56.45%) and within (range 0.75-9.61%) participants. Comparing the EQ02 to the Holter, the Pearson correlations were respectively 0.724, 0.955, and 0.997 for datasets containing all data and data with < 50 or < 20% artifacts respectively. For datasets containing respectively all data, data with < 50, or < 20% artifacts, bias estimated by Bland-Altman analysis was -2.8, -1.0, and -0.8 beats per minute and 24 h MARD was 7.08, 3.01, and 1.5. After selecting a 3-h stretch of data containing 1.15% artifacts, Pearson correlation was 0.786 for HRV measured as standard deviation of NN intervals (SDNN). Conclusions: Although the EQ02 can accurately measure ECG and HRV, its accuracy and precision is highly dependent on artifact content. This is a limitation for clinical use in individual patients. However, the advantages of the EQ02 (ability to simultaneously monitor several physiologic parameters) may outweigh its disadvantages (higher artifact load) for research purposes and/ or for home monitoring in larger groups of study participants. Further studies can be aimed at minimizing the artifacts.
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Affiliation(s)
- Abimbola A Akintola
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center Leiden, Netherlands
| | - Vera van de Pol
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center Leiden, Netherlands
| | - Daniel Bimmel
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center Leiden, Netherlands
| | - Arie C Maan
- Department of Cardiology, Leiden University Medical Center Leiden, Netherlands
| | - Diana van Heemst
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center Leiden, Netherlands
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Mishra RK, Sammi SR, Rawat JK, Roy S, Singh M, Gautam S, Yadav RK, Devi U, Ansari MN, Saeedan AS, Saraf SA, Pandey R, Kaithwas G. Palonosetron attenuates 1,2-dimethyl hydrazine induced preneoplastic colon damage through downregulating acetylcholinesterase expression and up-regulating synaptic acetylcholine concentration. RSC Adv 2016. [DOI: 10.1039/c6ra04614b] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The present study was undertaken to evaluate the effect of palonosetron (PAL) against 1,2-dimethylhydrazine (DMH)-induced colon cancer.
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