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Fares S, Bakkar NMZ, Alami R, Lakkis I, Badr K. Longitudinal study on the effect of surgical weight loss on beat-to-beat blood pressure variability in patients undergoing bariatric surgery: a study protocol. BMJ Open 2021; 11:e050957. [PMID: 34667007 PMCID: PMC8527146 DOI: 10.1136/bmjopen-2021-050957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Alterations in linear and non-linear parameters of beat-to-beat blood pressure variability (BPV) have been shown to predict disease prognosis and distinguish between risk categories in various pathological conditions, independently of average blood pressure levels. Obesity places subjects at elevated risk of vascular diseases, including hypertension, resulting in serious cardiac, respiratory and cerebral events. However, little is known about the status of vascular dynamics in obese and morbidly obese adults. METHODS AND ANALYSIS In this present quasi-experimental longitudinal study, changes in beat-to-beat BPV, using continuous, non-invasive blood pressure monitoring, in obese subjects undergoing bariatric surgery are characterised. The capacity of linear and non-linear measures of BPV to detect differences between hypertensive, prehypertensive and normotensive obese subjects prebariatric and postbariatric surgery are tested. Additionally, potential correlations between beat-to-beat BPV and age, body mass index, gender and comorbidities will be investigated. In parallel, the impact of the unsteady fluctuations of beat-to-beat blood pressure on the dynamic stresses imparted by blood flow on blood vessel walls will be explored. We expect to find altered BPV profiles in hypertensive and prehypertensive subjects as compared with normotensive subjects. We also expect to see differential normalisation in BPV profiles between hypertensive, prehypertensive and normotensive subjects over time. ETHICS AND DISSEMINATION The study has been approved by the Institutional Review Board at the American University of Beirut (IRB ID: BIO-2018-0040). Study results will be made available to the public through publications in peer-reviewed journals and conference papers and/or presentations.
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Affiliation(s)
- Souha Fares
- Rafic Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
| | | | - Ramzi Alami
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Issam Lakkis
- Department of Mechanical Engineering, American University of Beirut Faculty of Engineering and Architecture, Beirut, Lebanon
| | - Kamal Badr
- Department of Internal Medicine, American University of Beirut Faculty of Medicine, Beirut, Lebanon
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Farah NM, Amran AD, Che Muhamed AM. Attenuation of stress-induced cardiovascular reactivity following high-intensity interval exercise in untrained males. J Sports Sci 2021; 39:2755-2762. [PMID: 34323655 DOI: 10.1080/02640414.2021.1957294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Exaggerated cardiovascular (CV) reactivity to stress is associated with negative cardiovascular outcomes. This study aimed to investigate the effects of acute high-intensity interval exercise (HIIE) and moderate-intensity exercise (MIE) on CV reactivity in response to a stress challenge in untrained males. Thirteen, normotensive males (age: 22.8 ± 2 years, BMI: 21.9 ± 3.6 kg/m2) underwent three conditions in counterbalanced order: HIIE (bodyweight exercises; 80-90% HRR), MIE (treadmill-jog; 55-60% HRR) and seated rest (CON) separated by 7-10 days. Thirty minutes after performing HIIE, MIE or CON, subjects underwent a 2-min cold pressor task (CPT). Blood pressure (BP) and heart rate (HR) were measured before, during, and after CPT. CV reactivity, i.e., the change in BP and HR responses were compared across conditions. Systolic BP reactivity were attenuated following HIIE (-60%, p = 0.015) and MIE (-42%, p = 0.033) compared to CON, but no differences were observed between HIIE and MIE. HR reactivity was not different across all conditions. We conclude that performing HIIE or MIE 30 minutes prior to acute stress exposure lowers BP reactivity compared to rest in untrained males. These findings highlight the potential benefits of HIIE in lowering stress-induced elevations in blood pressure.
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Affiliation(s)
- Nor Mf Farah
- Center for Community Health Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Amerull Daneal Amran
- Department of Biomedical Science, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ahmad Munir Che Muhamed
- Lifestyle Science Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Pulau Pinang, Malaysia
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Beat-to-beat blood pressure variability: an early predictor of disease and cardiovascular risk. J Hypertens 2021; 39:830-845. [PMID: 33399302 DOI: 10.1097/hjh.0000000000002733] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Blood pressure (BP) varies on the long, short and very-short term. Owing to the hidden physiological and pathological information present in BP time-series, increasing interest has been given to the study of continuous, beat-to-beat BP variability (BPV) using invasive and noninvasive methods. Different linear and nonlinear parameters of variability are employed in the characterization of BP signals in health and disease. Although linear parameters of beat-to-beat BPV are mainly measures of dispersion, such as standard deviation (SD), nonlinear parameters of BPV quantify the degree of complexity/irregularity- using measures of entropy or self-similarity/correlation. In this review, we summarize the value of linear and nonlinear parameters in reflecting different information about the pathophysiology of changes in beat-to-beat BPV independent of or superior to mean BP. We then provide a comparison of the relative power of linear and nonlinear parameters of beat-to-beat BPV in detecting early and subtle differences in various states. The practical advantage and utility of beat-to-beat BPV monitoring support its incorporation into routine clinical practices.
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Javorka M, Krohova J, Czippelova B, Turianikova Z, Mazgutova N, Wiszt R, Ciljakova M, Cernochova D, Pernice R, Busacca A, Faes L. Respiratory Sinus Arrhythmia Mechanisms in Young Obese Subjects. Front Neurosci 2020; 14:204. [PMID: 32218722 PMCID: PMC7079685 DOI: 10.3389/fnins.2020.00204] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 02/24/2020] [Indexed: 12/12/2022] Open
Abstract
Autonomic nervous system (ANS) activity and imbalance between its sympathetic and parasympathetic components are important factors contributing to the initiation and progression of many cardiovascular disorders related to obesity. The results on respiratory sinus arrhythmia (RSA) magnitude changes as a parasympathetic index were not straightforward in previous studies on young obese subjects. Considering the potentially unbalanced ANS regulation with impaired parasympathetic control in obese patients, the aim of this study was to compare the relative contribution of baroreflex and non-baroreflex (central) mechanisms to the origin of RSA in obese vs. control subjects. To this end, we applied a recently proposed information-theoretic methodology - partial information decomposition (PID) - to the time series of heart rate variability (HRV, computed from RR intervals in the ECG), systolic blood pressure (SBP) variability, and respiration (RESP) pattern measured in 29 obese and 29 age- and gender-matched non-obese adolescents and young adults monitored in the resting supine position and during postural and cognitive stress evoked by head-up tilt and mental arithmetic. PID was used to quantify the so-called unique information transferred from RESP to HRV and from SBP to HRV, reflecting, respectively, non-baroreflex and RESP-unrelated baroreflex HRV mechanisms, and the redundant information transferred from (RESP, SBP) to HRV, reflecting RESP-related baroreflex RSA mechanisms. Our results suggest that obesity is associated: (i) with blunted involvement of non-baroreflex RSA mechanisms, documented by the lower unique information transferred from RESP to HRV at rest; and (ii) with a reduced response to postural stress (but not to mental stress), documented by the lack of changes in the unique information transferred from RESP and SBP to HRV in obese subjects moving from supine to upright, and by a decreased redundant information transfer in obese compared to controls in the upright position. These findings were observed in the presence of an unchanged RSA magnitude measured as the high frequency (HF) power of HRV, thus suggesting that the changes in ANS imbalance related to obesity in adolescents and young adults are subtle and can be revealed by dissecting RSA mechanisms into its components during various challenges.
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Affiliation(s)
- Michal Javorka
- Department of Physiology and Biomedical Center Martin, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | - Jana Krohova
- Department of Physiology and Biomedical Center Martin, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | - Barbora Czippelova
- Department of Physiology and Biomedical Center Martin, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | - Zuzana Turianikova
- Department of Physiology and Biomedical Center Martin, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | - Nikoleta Mazgutova
- Department of Physiology and Biomedical Center Martin, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | - Radovan Wiszt
- Department of Physiology and Biomedical Center Martin, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | - Miriam Ciljakova
- Department of Pediatrics, National Institute of Diabetes and Endocrinology, Lubochna, Slovakia
- Department of Pediatrics, Jessenius Faculty of Medicine, Comenius University and University Hospital, Martin, Slovakia
| | - Dana Cernochova
- Department of Pediatrics, National Institute of Diabetes and Endocrinology, Lubochna, Slovakia
- Department of Pediatrics, Jessenius Faculty of Medicine, Comenius University and University Hospital, Martin, Slovakia
| | - Riccardo Pernice
- Department of Engineering, University of Palermo, Palermo, Italy
| | | | - Luca Faes
- Department of Engineering, University of Palermo, Palermo, Italy
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González GH, Infante O, Martínez-García P, Pérez-Grovas H, Saavedra N, Caviedes A, Becerra B, Lerma C. Dynamical interaction between heart rate and blood pressure of end-stage renal disease patients evaluated by cross recurrence plot diagonal analysis. J Appl Physiol (1985) 2020; 128:189-196. [PMID: 31804893 DOI: 10.1152/japplphysiol.00364.2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The assessment of spontaneous variability of blood pressure and heart rate is based on specific physiological hypotheses about dynamic features, for example, the baroreflex modulation of heart rate over time in daily life. Usually, arterial baroreflex control of heart rate is explored without delays between blood pressure and heart rate data points, within a narrow range of values, excluding the analysis of saturation regions or low-threshold changes. In this work, we examine the dynamic interactions between systolic blood pressure (SBP) and interbeat interval (IBI), in 15-min length time series and for the first time using the analysis of diagonals derived from a cross-recurrence plots in healthy persons and end-stage renal disease (ESRD) patients. We found that ESRD patients have stronger intermittent dynamical interactions between IBI and SBP, but they lose most of the dynamical interactions. Although healthy subjects exhibit a continuously changing order of precedence between IBI and SBP at different lags, ESRD patients preserve this changing order of precedence only for lags >0 beats.NEW & NOTEWORTHY This study is the first to compare the time-variant pattern of systolic blood pressure (SBP) and interbeat interval (IBI) coupling between ESRD patients and healthy volunteers through the analysis of diagonal in cross-recurrence plots, and in the face of an orthostatic challenge. Our results demonstrated alternant interactions on the order of precedence (IBI → SBP or SBP→ IBI) at different time delays. This pattern is different in resting position and during active standing for the two groups studied, and interestingly, some association patterns are lost in ESRD patients. These patterns of alternant interactions on the order of precedence could be related to autonomic neural activities and cardiovascular synchronization at different scales both in time and space. This could reflect physiological adaptive flexibility of cardiovascular regulation. Losing some association patterns in ESRD may be the result of chronic adjustments of many physiological mechanisms (including chronic sympathetic hyperactivity), which could increase cardiovascular vulnerability to hemodynamic challenges.
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Affiliation(s)
- G Hortensia González
- Taller de Biofísica, Departamento de Física, Facultad de Ciencias, Universidad Nacional Autónoma de México, México, Distrito Federal, México
| | - Oscar Infante
- Departamento de Instrumentación Electromecánica, Instituto Nacional de Cardiología Ignacio Chávez, México, Distrito Federal, México
| | - Paola Martínez-García
- Servicio de Radio-Oncología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, Distrito Federal, México
| | - Héctor Pérez-Grovas
- Departamento de Nefrología, Instituto Nacional de Cardiología Ignacio Chávez, México, Distrito Federal, México
| | - Nadia Saavedra
- Departamento de Nefrología, Instituto Nacional de Cardiología Ignacio Chávez, México, Distrito Federal, México
| | - Amaya Caviedes
- Departamento de Nefrología, Instituto Nacional de Cardiología Ignacio Chávez, México, Distrito Federal, México
| | - Brayans Becerra
- Departamento de Instrumentación Electromecánica, Instituto Nacional de Cardiología Ignacio Chávez, México, Distrito Federal, México
| | - Claudia Lerma
- Departamento de Instrumentación Electromecánica, Instituto Nacional de Cardiología Ignacio Chávez, México, Distrito Federal, México
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Javorka M, Czippelova B, Turianikova Z, Lazarova Z, Tonhajzerova I, Javorka K, Baumert M. Causal coherence analysis of cardiovascular variables in obese preadolescents and adolescents. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:1793-6. [PMID: 26736627 DOI: 10.1109/embc.2015.7318727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Obesity during adulthood has been associated with cardiovascular disease, but its adverse effects during adolescence are less well established. The aim of this study was to probe cardiovascular control in obese adolescence by studying causal coherence between cardiovascular variables. Sixty minutes of resting ECG and finger blood pressure were recorded in 19 obese and 19 non-obese subjects in the supine position to measure pair-wise spectral coherence in the low frequency band between heart rate, systolic and diastolic blood pressure, pulse pressure, total peripheral resistance and left ventricular ejection time. We observed that causal coherences in {systolic blood pressure → total peripheral resistance} and {left ventricular ejection time → systolic blood pressure} directions were significantly decreased in obese preadolescents and adolescents when compared to the healthy control group, despite the lack of difference in the magnitude of oscillations of cardiovascular variables. In conclusion, causal coherence analysis of cardiovascular variables may give new insight into cardiovascular dysregulation in young obese subjects.
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