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Damoun N, Amekran Y, Taiek N, Hangouche AJE. Heart rate variability measurement and influencing factors: Towards the standardization of methodology. Glob Cardiol Sci Pract 2024; 2024:e202435. [PMID: 39351472 PMCID: PMC11439429 DOI: 10.21542/gcsp.2024.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 07/23/2024] [Indexed: 10/04/2024] Open
Abstract
Heart rate variability (HRV) is widely recognized as an effective and valuable tool for evaluating cardiac autonomic modulation. However, various factors can influence HRV before and during assessment, complicating the interpretation and comparability of results. This review outlines the different factors affecting HRV and underscores the importance of considering them to ensure consistent and reliable HRV outcomes. Key influencing factors are categorized into physiological (e.g., age, gender, genetics), lifestyle (e.g., physical activity, alcohol use, smoking, drugs, diet), environmental (e.g., time of day, temperature, noise), and methodological (e.g., body position, recording duration, and respiration) domains. Knowing these factors can help researchers and physicians gain a better understanding of HRV and improve the interpretation of their findings. Consequently, this can lead to the development of standardized methods for consistently assessing and interpreting HRV measures in clinical practice.
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Affiliation(s)
- Narjisse Damoun
- Department of Physiology, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, Morocco
| | - Youssra Amekran
- Department of Physiology, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, Morocco
| | - Nora Taiek
- Department of Physiology, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, Morocco
| | - Abdelkader Jalil El Hangouche
- Department of Physiology, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, Morocco
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2
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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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3
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Ben-David K, Wittels HL, Wishon MJ, Lee SJ, McDonald SM, Howard Wittels S. Tracking Cancer: Exploring Heart Rate Variability Patterns by Cancer Location and Progression. Cancers (Basel) 2024; 16:962. [PMID: 38473322 DOI: 10.3390/cancers16050962] [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: 01/21/2024] [Revised: 02/18/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
Reduced heart rate variability (HRV) is an autonomic nervous system (ANS) response that may indicate dysfunction in the human body. Consistent evidence shows cancer patients elicit lower HRV; however, only select cancer locations were previously evaluated. Thus, the aim of the current study was to explore HRV patterns in patients diagnosed with and in varying stages of the most prevalent cancers. At a single tertiary academic medical center, 798 patients were recruited. HRV was measured via an armband monitor (Warfighter MonitorTM, Tiger Tech Solutions, Inc., Miami, FL, USA) equipped with electrocardiographic capabilities and was recorded for 5 to 7 min with patients seated in an upright position. Three time-domain metrics were calculated: SDNN (standard deviation of the NN interval), rMSSD (the root mean square of successive differences of NN intervals), and the percentage of time in which the change in successive NN intervals exceeds 50ms within a measurement (pNN50). Of the 798 patients, 399 were diagnosed with cancer. Cancer diagnoses were obtained via medical records one week following the measurement. Analysis of variance models were performed comparing the HRV patterns between different cancers, cancer stages (I-IV), and demographic strata. A total of 85% of the cancer patients had breast, gastrointestinal, genitourinary, or respiratory cancer. The cancer patients were compared to a control non-cancer patient population with similar patient size and distributions for sex, age, body mass index, and co-morbidities. For all HRV metrics, non-cancer patients exhibited significantly higher rMSSDs (11.1 to 13.9 ms, p < 0.0001), SDNNs (22.8 to 27.7 ms, p < 0.0001), and pNN50s (6.2 to 8.1%, p < 0.0001) compared to stage I or II cancer patients. This significant trend was consistently observed across each cancer location. Similarly, compared to patients with stage III or IV cancer, non-cancer patients possessed lower HRs (-11.8 to -14.0 bpm, p < 0.0001) and higher rMSSDs (+31.7 to +32.8 ms, p < 0.0001), SDNNs (+45.2 to +45.8 ms), p < 0.0001, and pNN50s (19.2 to 21.6%, p < 0.0001). The HR and HRV patterns observed did not significantly differ between cancer locations (p = 0.96 to 1.00). The depressed HRVs observed uniformly across the most prevalent cancer locations and stages appeared to occur independent of patients' co-morbidities. This finding highlights the potentially effective use of HRV as a non-invasive tool for determining common cancer locations and their respective stages. More studies are needed to delineate the HRV patterns across different ages, between sexes and race/ethnic groups.
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Affiliation(s)
- Kfir Ben-David
- Department of Surgery, Division of Oncology, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
- Department of Surgery, Wertheim School of Medicine, Florida International University, Miami, FL 33199, USA
| | - Harrison L Wittels
- Tiger Tech Solutions, Inc., Miami, FL 33156, USA
- Science, Technology and Research, Inc., Miami, FL 33156, USA
| | | | - Stephen J Lee
- United States Army Research Laboratory, United States Army Combat Capabilities Development Command, Adelphi, MD 20783, USA
| | - Samantha M McDonald
- Tiger Tech Solutions, Inc., Miami, FL 33156, USA
- School of Kinesiology and Recreation, Illinois State University, Normal, IL 61761, USA
| | - S Howard Wittels
- Tiger Tech Solutions, Inc., Miami, FL 33156, USA
- Science, Technology and Research, Inc., Miami, FL 33156, USA
- Department of Anesthesiology, Mount Sinai Medical Center, Miami, FL 33140, USA
- Department of Anesthesiology, Wertheim School of Medicine, Florida International University, Miami, FL 33199, USA
- Miami Beach Anesthesiology Associates, Miami, FL 33140, USA
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4
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Rohr M, Tarvainen M, Miri S, Güney G, Vehkaoja A, Hoog Antink C. An extensive quantitative analysis of the effects of errors in beat-to-beat intervals on all commonly used HRV parameters. Sci Rep 2024; 14:2498. [PMID: 38291034 PMCID: PMC10828497 DOI: 10.1038/s41598-023-50701-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/23/2023] [Indexed: 02/01/2024] Open
Abstract
Heart rate variability (HRV) analysis is often used to estimate human health and fitness status. More specifically, a range of parameters that express the variability in beat-to-beat intervals are calculated from electrocardiogram beat detections. Since beat detection may yield erroneous interval data, these errors travel through the processing chain and may result in misleading parameter values that can lead to incorrect conclusions. In this study, we utilized Monte Carlo simulation on real data, Kolmogorov-Smirnov tests and Bland-Altman analysis to carry out extensive analysis of the noise sensitivity of different HRV parameters. The used noise models consider Gaussian and student-t distributed noise. As a result we observed that commonly used HRV parameters (e.g. pNN50 and LF/HF ratio) are especially sensitive to noise and that all parameters show biases to some extent. We conclude that researchers should be careful when reporting different HRV parameters, consider the distributions in addition to mean values, and consider reference data if applicable. The analysis of HRV parameter sensitivity to noise and resulting biases presented in this work generalizes over a wide population and can serve as a reference and thus provide a basis for the decision about which HRV parameters to choose under similar conditions.
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Affiliation(s)
- Maurice Rohr
- AI Systems in Medicine, Technical University of Darmstadt, 64283, Darmstadt, Germany.
| | - Mika Tarvainen
- Department of Technical Physics, University of Eastern Finland, 70211, Kuopio, Finland
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, 70211, Kuopio, Finland
| | - Seyedsadra Miri
- Faculty of Medicine and Health Technology, Tampere University, 33720, Tampere, Finland
- Finnish Cardiovascular Research Center, 33720, Tampere, Finland
| | - Gökhan Güney
- AI Systems in Medicine, Technical University of Darmstadt, 64283, Darmstadt, Germany
| | - Antti Vehkaoja
- Faculty of Medicine and Health Technology, Tampere University, 33720, Tampere, Finland
- Finnish Cardiovascular Research Center, 33720, Tampere, Finland
| | - Christoph Hoog Antink
- AI Systems in Medicine, Technical University of Darmstadt, 64283, Darmstadt, Germany
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Khandelwal E, Tripathi S, Gupta A, Singh A. Profile of Cardiovascular Autonomic Dysfunctions in Breast Cancer Patients. Cureus 2023; 15:e46773. [PMID: 37954780 PMCID: PMC10632730 DOI: 10.7759/cureus.46773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 11/14/2023] Open
Abstract
Background Patients on breast cancer chemotherapy frequently present with signs and symptoms of autonomic dysfunction. Cardiac autonomic dysfunction (CAD) is a significant cause of morbidity and mortality, affecting the quality of life with progressive advancing disease. It is associated with the short survival of breast cancer patients. Therefore, thoroughly assessing cardiovascular autonomic functions is crucial to monitor these patients' disease prognosis and chemotherapy side effects. The present study evaluated baseline heart rate variability (HRV) and Ewing's battery of cardiac autonomic reactivity tests in breast cancer patients on chemotherapy to evaluate CAD. Methodology This is a case-control study. Autonomic reactivity tests were performed in the autonomic function laboratory, Department of Physiology, All India Institute of Medical Sciences, Raipur. HRV was recorded using a lead II electrocardiogram (ECG) in two groups, namely, controls (n = 25 healthy female volunteers) and cases (n = 25 histologically proven stage I-III breast cancer patients, age 30-65 years, received three cycles of chemotherapy). Results Patients on chemotherapy had significantly lower reactivity for the time domain (all parameters) and frequency domain (absolute total power) of HRV compared to age-matched healthy controls. Autonomic reactivity showed significant loss in the patient group. Conclusions The sympathetic and parasympathetic parameters showed a significant loss of autonomic functions in the patient group compared to the healthy controls. This may be because of the chemotherapeutic drugs taken by the patients or cancer as the disease per se. As autonomic dysfunction is highly prevalent in patients with cancer and is associated with multiple symptoms, it is essential to study it in the cancer population.
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Affiliation(s)
- Ekta Khandelwal
- Department of Physiology, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Sumeet Tripathi
- Department of Physiology, Pt. Jawahar Lal Nehru Memorial Medical College, Raipur, IND
| | - Ashutosh Gupta
- Department of Surgical Oncology, Pt. Jawahar Lal Nehru Memorial Medical College, Raipur, IND
| | - Alok Singh
- Department of Pharmacology, All India Institute of Medical Sciences, Raipur, Raipur, IND
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Lavín-Pérez AM, Collado-Mateo D, Hinojo González C, de Juan Ferré A, Ruisánchez Villar C, Mayo X, Jiménez A. High-intensity exercise prescription guided by heart rate variability in breast cancer patients: a study protocol for a randomized controlled trial. BMC Sports Sci Med Rehabil 2023; 15:28. [PMID: 36890601 PMCID: PMC9993392 DOI: 10.1186/s13102-023-00634-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 02/16/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Breast cancer is a chronic disease with a large growth in its treatments, prognosis, improvements, side effects and rehabilitation therapies research. These advances have also highlighted the need to use physical exercise as a countermeasure to reduce the cardiotoxicity of pharmacological treatments, increase patients' strength and quality of life and improve body composition, physical condition and mental health. However, new investigations show the need for a closed exercise individualisation to produce higher physiological, physical and psychological benefits in remote exercise programs. To this end, the present study will use, in a novel way in this population, heart rate variability (HRV) as a measure for prescribing high-intensity training. Thus, the primary objective of this randomised clinical trial is to analyse the effects of a high-intensity exercise program daily guided by HRV, a preplanned moderate to high-intensity exercise intervention and a usual care group, in breast cancer patients after chemotherapy and radiotherapy treatments. METHODS For this purpose, a 16-week intervention will be carried out with 90 breast cancer patients distributed in 3 groups (a control group, a moderate to high-intensity preplanned exercise group and a high-intensity exercise group guided by HRV). Both physical exercise interventions will be developed remotely and supervised including strength and cardiovascular exercises. Physiological variables, such as cardiotoxicity, biomarkers, lipid profile, glucose, heart rate and blood pressure; physical measures like cardiorespiratory capacity, strength, flexibility, agility, balance and body composition; and psychosocial variables, as health-related quality of life, fatigue, functionality, self-esteem, movement fear, physical exercise level, anxiety and depression will be measure before, after the intervention and 3 and 6 months follow up. DISCUSSION Personalized high-intensity exercise could be a promising exercise intervention in contrast to moderate-intensity or usual care in breast cancer patients to reach higher clinical, physical and mental effects. In addition, the novelty of controlling HRV measures daily may reflect exercise effects and patients' adaptation in the preplanned exercise group and a new opportunity to adjust intensity. Moreover, findings may support the effectiveness and security of physical exercise remotely supervised, although with high-intensity exercise, to reach cardiotoxicity improvements and increase physical and psychosocial variables after breast cancer treatments. Trial registration ClinicalTrials.gov nº NCT05040867 ( https://clinicaltrials.gov/ct2/show/record/NCT05040867 ).
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Affiliation(s)
- Ana Myriam Lavín-Pérez
- Centre for Sport Studies, Rey Juan Carlos University, Madrid, Spain
- GO fitLAB, Ingesport, Madrid, Spain
- Program of Epidemiology and Public Health (Interuniversity), PhD International School of the Rey Juan Carlos University, Madrid, Spain
| | | | - Carmen Hinojo González
- Onchology Department, Hospital Universitario Marqués de Valdecilla and Instituto de Investigación Marqués de Valdecilla (IDIVAL)., Santander, Spain
| | - Ana de Juan Ferré
- Onchology Department, Hospital Universitario Marqués de Valdecilla and Instituto de Investigación Marqués de Valdecilla (IDIVAL)., Santander, Spain
| | - Cristina Ruisánchez Villar
- Cardiology Department, Hospital Universitario Marqués de Valdecilla and Instituto de Investigación Marqués de Valdecilla (IDIVAL)., Santander, Spain
| | - Xián Mayo
- Centre for Sport Studies, Rey Juan Carlos University, Madrid, Spain
| | - Alfonso Jiménez
- Centre for Sport Studies, Rey Juan Carlos University, Madrid, Spain
- GO fitLAB, Ingesport, Madrid, Spain
- Advanced Wellbeing Research Centre, College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
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7
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Brunet J, Wurz A, Hussien J, Pitman A, Conte E, Ennis JK, Herry CL, Seely AJE, Seely D. Exploring the Effects of Yoga Therapy on Heart Rate Variability and Patient-Reported Outcomes After Cancer Treatment: A Study Protocol. Integr Cancer Ther 2022; 21:15347354221075576. [PMID: 35393867 PMCID: PMC9016564 DOI: 10.1177/15347354221075576] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Following cancer treatment, adults commonly report worsened patient-reported outcomes (PROs) such as anxiety, stress, depression, persistent and upsetting cognitive complaints, unrelenting fatigue, and reduced quality of life. Poorer PROs are associated with disrupted autonomic nervous system functioning as measured by heart rate variability (HRV), both of which have been associated with greater morbidity and mortality. Interventions to improve HRV and PROs among adults following cancer treatment are needed. Yoga therapy holds promise as an intervention to improve HRV and PROs. Therefore, we conducted a single-subject exploratory experimental study to investigate the effects of yoga therapy on HRV and specific PROs (ie, cancer-related fatigue, anxiety, cognitive function, depression, stress, quality of life) in adults treated for cancer. To reduce publication bias, improve reproducibility, and serve as a reference for forthcoming reporting of study results, we present the study protocol for this study herein. METHODS Participants were adults who completed cancer treatment that were recruited from the Ottawa Integrative Cancer Centre. Consenting and eligible participants received one 1:1 yoga therapy session (ie, 1 participant, 1 Yoga Therapist) and 6 weekly group-based yoga therapy sessions (ie, 2-3 participants, 1 Yoga Therapist). Participants completed assessments 7 times: 3 times prior to the program (ie, -6 weeks, -3 weeks, immediately prior to the 1:1 yoga therapy session), immediately following the 1:1 yoga therapy session, prior to the first group-based yoga therapy session, after the last group-based yoga therapy session, and at a 6-week follow-up. Hierarchical linear modeling will be used to test the average effects of the yoga therapy program across participants. DISCUSSION This study will explore several novel hypotheses, including whether yoga therapy can improve HRV and/or specific PROs among adults treated for cancer acutely (ie, during a 1:1 yoga therapy session) and/or through repeated exposure (ie, after completing 6 weeks of group-based yoga therapy). Although the findings will require confirmation or refutation in future trials, they may provide initial evidence that YT may benefit adults treated for cancer. TRIAL REGISTRATION ISRCTN registry, ISRCTN64763228. Registered on December 12, 2021. This trial was registered retrospectively. URL of trial registry record: https://www.isrctn.com/ISRCTN64763228.
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Affiliation(s)
- Jennifer Brunet
- University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Institut du savoir de l'Hôpital Montfort, Ottawa, ON, Canada
| | - Amanda Wurz
- University of the Fraser Valley, Chilliwack, BC, Canada
| | | | - Anne Pitman
- The Centre for Health Innovation, Ottawa, ON, Canada
| | - Ellen Conte
- The Centre for Health Innovation, Ottawa, ON, Canada.,Canadian College of Naturopathic Medicine, Toronto, ON, Canada
| | - Julie K Ennis
- The Centre for Health Innovation, Ottawa, ON, Canada
| | | | - Andrew J E Seely
- University of Ottawa, Ottawa, ON, Canada.,The Ottawa Hospital, Ottawa, ON, Canada
| | - Dugald Seely
- University of Ottawa, Ottawa, ON, Canada.,The Centre for Health Innovation, Ottawa, ON, Canada.,Canadian College of Naturopathic Medicine, Toronto, ON, Canada
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8
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Vargas-Román K, Cortés-Martín J, Sánchez-García JC, Rodríguez-Blanque R, De La Fuente-Solana EI, Díaz-Rodríguez L. Autonomic Imbalance in Lymphoma Survivors. J Clin Med 2021; 10:jcm10194391. [PMID: 34640409 PMCID: PMC8509196 DOI: 10.3390/jcm10194391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/18/2021] [Accepted: 09/22/2021] [Indexed: 12/16/2022] Open
Abstract
Among the types of blood cancers, non-Hodgkin lymphoma is the most common. The usual treatments for this type of cancer can cause heart failure. A descriptive observational study was conducted that included 16 non-Hodgkin lymphoma survivors and 16 healthy controls matched by age and sex. Vagal tone was evaluated in the short term with a three-channel Holter device, and the time and frequency domains were analyzed following a previously accepted methodology to evaluate cardiac autonomic balance. The results of the analysis revealed that the standard deviation of the NN interval (F = 6.25, p = 0.021) and the square root of the mean of the sum of the differences between NN intervals (F = 9.74, p = 0.004) were significantly higher in healthy subjects than in lymphoma survivors. In the heart rate variability (HRV) index, there were no significant differences between the groups (F = 0.03, p = 0.85), nor in the parameters of the frequency domains LF (F = 1.94, p = 0.17), HF (F = 0.35, p = 0.55), and the ratio LF/HF (F = 3.07, p = 0.09). HRV values were lower in non-Hodgkin lymphoma survivors in the first year after treatment, resulting in autonomic imbalance compared to healthy paired subjects.
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Affiliation(s)
- Keyla Vargas-Román
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (J.C.-M.); (J.C.S.-G.); (R.R.-B.); (L.D.-R.)
- Spanish Education Ministry Program FPU16/01437, Methodology of Behavioral Sciences Department, Faculty of Psychology, University of Granada, 18071 Granada, Spain
- Correspondence:
| | - Jonathan Cortés-Martín
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (J.C.-M.); (J.C.S.-G.); (R.R.-B.); (L.D.-R.)
| | - Juan Carlos Sánchez-García
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (J.C.-M.); (J.C.S.-G.); (R.R.-B.); (L.D.-R.)
- Department of Nursing, School of Health Sciences, University of Granada, 18016 Granada, Spain
| | - Raquel Rodríguez-Blanque
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (J.C.-M.); (J.C.S.-G.); (R.R.-B.); (L.D.-R.)
- Health Technology Park, San Cecilio University Hospital, 18016 Granada, Spain
| | | | - Lourdes Díaz-Rodríguez
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (J.C.-M.); (J.C.S.-G.); (R.R.-B.); (L.D.-R.)
- Department of Nursing, School of Health Sciences, University of Granada, 18016 Granada, Spain
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Lavín-Pérez AM, Collado-Mateo D, Mayo X, Liguori G, Humphreys L, Jiménez A. Can Exercise Reduce the Autonomic Dysfunction of Patients With Cancer and Its Survivors? A Systematic Review and Meta-Analysis. Front Psychol 2021; 12:712823. [PMID: 34504462 PMCID: PMC8422989 DOI: 10.3389/fpsyg.2021.712823] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/12/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Cancer therapies have increased patient survival rates, but side effects such as cardiotoxicity and neurotoxicity can lead to autonomic nervous and cardiovascular system dysfunction. This would result in a decrease in parasympathetic activity and the enhancement of sympathetic activity. Heart rate variability (HRV), which reflects autonomic modulation, is a valuable physiological tool since it correlates with cancer-related fatigue, stress, depression, and mortality in patients with cancer. Objective: This study aimed to analyze the effects of exercise programs on the autonomic modulation, measured by the HRV of patients with cancer and its survivors. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the quality of the articles was assessed with the Physiotherapy Evidence Database (PEDro) scale. The meta-analysis statistic procedure was performed by using RevMan software version 5.3. Results: From the 252 articles found, six studies were included in the review involving 272 participants aged 30–75 years. Exercise programs had a mean length of 10.4 ± 4.6 weeks, a frequency of 3 ± 1.4 days/week, and a mean duration of 78 ± 23.9 min. In time-domain HRV measures, exercise may increase in the SD of normal-to-normal intervals [p < 0.00001, with a mean difference (MD) of 12.79 ms from 9.03 to 16.55] and a decreased root mean square of successive R–R interval differences (p = 0.002, with an MD of 13.08 ms from 4.90 to 21.27) in comparison with control groups (CG). The frequency-domain data reveal that the exercise group (EG) improve significantly more than the CGs in low frequency [absolute power: p < 0.0001, with a standardized mean difference (SMD) of 0.97 from 0.61 to 1.34; relative power: p = 0.04, with an MD = −7.70 from −15.4 to −0.36], high-frequency [absolute power: p = 0.001, with a SMD of 1.49 from 0.32 to 2.66; relative power: p = 0.04, with an MD of 8.00 normalized units (n.u.) from 0.20 to 15.80], and low-to-high frequency ratio (p = 0.007 with an MD of −0.32 from −0.55 to −0.09). Conclusion: Exercise programs could lead to positive effects on the autonomic modulation of patients with cancer and its survivors. More beneficial changes may occur with resistance and endurance workouts. However, due to the low number of interventions performed, further research is needed to substantiate the findings and to provide additional insights regarding the exercise intensity required to increase the autonomic modulation of the patient.
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Affiliation(s)
- Ana Myriam Lavín-Pérez
- PhD International School, Program of Epidemiology and Public Health (Interuniversity), Rey Juan Carlos University, Móstoles, Spain.,Centre for Sport Studies, Rey Juan Carlos University, Fuenlabrada, Spain.,GO fitLAB, Ingesport, Madrid, Spain
| | | | - Xián Mayo
- Centre for Sport Studies, Rey Juan Carlos University, Fuenlabrada, Spain
| | - Gary Liguori
- College of Health Sciences, University of Rhode Island, Kingston, NY, United States
| | - Liam Humphreys
- Advanced Wellbeing Research Centre, College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, United Kingdom
| | - Alfonso Jiménez
- Centre for Sport Studies, Rey Juan Carlos University, Fuenlabrada, Spain.,GO fitLAB, Ingesport, Madrid, Spain.,Advanced Wellbeing Research Centre, College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, United Kingdom
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10
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Wei L, Liang H, Mo M, Liu Z, Ye R, Ye H, Ouyang W, Yu W, Zhao W, Zhang X. The effect of remote ischemic postconditioning on autonomic function in patients with acute ischemic stroke: A Randomized Controlled Trail. Complement Ther Med 2020; 54:102541. [PMID: 33183660 DOI: 10.1016/j.ctim.2020.102541] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/22/2020] [Accepted: 08/13/2020] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE The evidence for the effect of remote ischemic postconditioning(RIpostC) on autonomic function in patients with acute ischemic stroke(AIS) is lacking and the neural mechanism underlying the protection of RIpostC remains speculative. This trial was aimed to evaluated the efficiency of RIpostC on autonomic function in AIS patients. DESIGN One hundred and six AIS patients were included in this prospective, randomized, placebo-controlled trial. Patients in intervention group (n = 57) received 4 cycles of alternating inflation (cuff inflation to 200 mmHg) and deflation for 5 min on healthy upper arm once a day for 30 days. The control group underwent a sham inflation and deflation cycles. Autonomic function was evaluated by heart rate variability (HRV). RESULTS All HRV parameters except for the ratio of low frequency to high frequency (P = 0.101) increased significantly with time (P < 0.001) in the two groups. The value of standard deviation of all normal R-R intervals(SDNN) and high frequency at day7 and day30 and the value of the percent of difference between adjacent normal R-R intervals (pNN50) at day 30 in RIpostC group was significantly higher than that of the sham-RIpostC group(P < 0.05). A significant time-by-group interaction was observed in SDNN、pNN50、and high frequency over time between two groups (P < 0.05). CONCLUSIONS 30-day RIpostC could improve autonomic function in AIS patients through the enhancement of the total autonomic nerve activity and vagus nerve activity. The mechanism of RIpostC mediating autonomic function needs to be further investigated.
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Affiliation(s)
- Lin Wei
- Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road 111, Yuexiu District, Guangzhou 510120, Guangdong, China
| | - Hao Liang
- School of Nursing, Guangzhou University of Chinese Medicine, Airport Road 12, Baiyun District, Guangzhou 510405, Guangdong, China
| | - Miaomiao Mo
- Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road 111, Yuexiu District, Guangzhou 510120, Guangdong, China
| | - Zhuyun Liu
- Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road 111, Yuexiu District, Guangzhou 510120, Guangdong, China
| | - Richun Ye
- Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road 111, Yuexiu District, Guangzhou 510120, Guangdong, China
| | - Huanwen Ye
- Department of Cardiac Function, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road 111, Yuexiu District, Guangzhou 510120, Guangdong, China
| | - Wenwei Ouyang
- Key Unit of Methodology in Clinical Research, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road 111, Yuexiu District, Guangzhou 510120, Guangdong, China
| | - Wenqi Yu
- Geriatrics dept(neurology), The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Inner Ring West Road 55, Panyu District, Guangzhou 510006, Guangdong, China
| | - Wenbo Zhao
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe Road 600, Tianhe District, Guangzhou 510632, Guangdong, China.
| | - Xiaopei Zhang
- Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road 111, Yuexiu District, Guangzhou 510120, Guangdong, China.
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Noor B, Akhavan S, Leuchter M, Yang EH, Ajijola OA. Quantitative assessment of cardiovascular autonomic impairment in cancer survivors: a single center case series. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2020; 6:11. [PMID: 32742722 PMCID: PMC7388471 DOI: 10.1186/s40959-020-00065-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/13/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Cardiovascular autonomic dysfunction in cancer survivors is poorly understood. OBJECTIVES To better characterize the clinical characteristics and types of autonomic dysfunction in this population. METHODS A retrospective analysis of cancer survivors within an academic cardio-oncology program referred for suspected autonomic dysfunction was performed. Autonomic reflex testing of adrenergic, cardiovagal, and sudomotor function was done. Autonomic impairment was graded on severity based on the Composite Autonomic Severity Score system. Patients with pre-existing autonomic dysfunction prior to their cancer diagnosis were excluded. RESULTS Of approximately 282 total patients in the UCLA Cardio-Oncology program, 24 were referred for suspected autonomic dysfunction and met the inclusion criteria. 22 had autonomic impairment on autonomic reflex testing. Eight patients were female, and the mean age at time of autonomic testing was 51.3 years. The average duration from cancer diagnosis to autonomic testing was 10.3 years. The reasons for referral included dizziness, tachycardia, palpitations, and syncope. The majority of patients (75%) had hematologic disorders. The most common chemotherapies administered were vinca alkaloids (54.2%), alkylating agents (66.7%), and anthracyclines (54.2%). Most patients received radiation to the thorax (66.7%) and neck (53.3%). Eleven patients had mild autonomic impairment, 7 had moderate, and 4 had severe autonomic impairment. Dysfunction was commonly present in the sympathetic and parasympathetic branches, but most pronounced in the sympathetic system. The majority of patients were diagnosed with orthostatic hypotension (50%), inappropriate sinus tachycardia (20.8%), and postural orthostatic tachycardia syndrome (12.5%) and had subjective improvement with treatment. CONCLUSION Cardiovascular autonomic dysfunction occurs in cancer survivors, and commonly affects both the sympathetic and parasympathetic systems. Symptom recognition in patients should prompt autonomic testing and treatment where appropriate.
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Affiliation(s)
- Benjamin Noor
- Division of Internal Medicine, Department of Medicine, University of California at Los Angeles, Los Angeles, CA USA
| | - Shannel Akhavan
- UCLA Cardio-Oncology Program and Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA USA
| | - Michael Leuchter
- UCLA Cardiac Arrhythmia and Neurocardiology Research Center, David Geffen School of Medicine at UCLA, University of California at Los Angeles, 100 Medical Plaza, Suite 660, Westwood Blvd, Los Angeles, CA 90095-1679 USA
| | - Eric H. Yang
- UCLA Cardio-Oncology Program and Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA USA
| | - Olujimi A. Ajijola
- UCLA Cardio-Oncology Program and Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA USA
- UCLA Cardiac Arrhythmia and Neurocardiology Research Center, David Geffen School of Medicine at UCLA, University of California at Los Angeles, 100 Medical Plaza, Suite 660, Westwood Blvd, Los Angeles, CA 90095-1679 USA
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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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The effect of preoperative depression and anxiety on heart rate variability in women with breast cancer. Breast Cancer 2020; 27:912-918. [PMID: 32266603 DOI: 10.1007/s12282-020-01087-y] [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] [Received: 11/06/2019] [Accepted: 04/02/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Anxiety and depression are prevalent in women with breast cancer. These can affect their autonomic nervous system and hemodynamic stability, which are important factors during operation. We aimed to assess the effect of anxiety and depression on heart rate variability (HRV) in patients with breast cancer. METHODS Forty-nine women with breast cancer, scheduled for surgery, were asked to complete depression and anxiety questionnaires and categorized into depressed/non-depressed and anxious/non-anxious groups. Their electrocardiography (EKG) were assessed for 150 s on admission, before, and after induction of anesthesia for the presence, frequency, and range of HRV. Patients' blood pressure (BP) and HR were recorded, and normal unit high frequency (nuHF), normal unit low frequency (nuLF), LF/HF ratio, HRV index, and systolic and diastolic BP were compared between the groups in three intervals. RESULTS Anxious and depressed groups had a significantly higher systolic, diastolic, and mean BP before and after induction and higher nuLF before induction, while the changes in nuLF, LF/HF ratio, and HRV index were not significant. Both groups with and without mood disorders had increased BP and HR before induction, which decreased after induction (P < 0.001). Decreased mean BP after induction was associated with anxiety (P < 0.05). CONCLUSION According to the results of this study, patients with depression had less HRV in the operating theater, than the non-depressed group. After induction of anesthesia, the decrease in BP was associated with anxiety, while BP of the depressed group was higher than the non-depressed group at all intervals.
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Anand A, Bhati P, Mujaddadi A, Verma S, Naqvi I, Hussain M. Influence of physical activity on cardiac autonomic control in patients with dyslipidaemia. COMPARATIVE EXERCISE PHYSIOLOGY 2019. [DOI: 10.3920/cep190024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The objective of this study was to compare the cardiac autonomic control of dyslipidaemia patients engaged in different levels of physical activity and to determine the predictive ability of physical activity for cardiac autonomic dysfunction in these patients. This study also aimed to compare the cardiac autonomic control of dyslipidaemia patients and healthy adults. 52 patients (age: 49.1±4.53 years) with dyslipidaemia were recruited along with 16 healthy adults. Physical activity levels were assessed by International Physical Activity Questionnaire, and subjects were divided into three categories – low, moderate, and high physical activity. Heart rate variability (HRV) analysis was performed for obtaining time and frequency domain parameters. Presence of cardiac autonomic dysfunction was defined as standard deviation of N-N intervals <44 ms. HRV parameters were compared between 3 groups of dyslipidaemia patients and healthy controls. Predictive ability of physical activity for cardiac autonomic dysfunction in dyslipidaemia was evaluated after adjusting clinical covariates. There was a significant difference between low-frequency power (cardiac sympathetic control), and ratio of low- and high-frequency (HF) power (sympatho-vagal balance) in low versus moderate physical activity group and low versus high physical activity group (P<0.001). Significant differences were also observed for HFnu power (cardiac vagal activity) and total power between the dyslipidaemia groups. Physical activity was found to be a significant (P=0.03), independent predictor of cardiac autonomic dysfunction in dyslipidaemia patients. Findings of the present study suggest that cardiac autonomic profile of dyslipidaemia patients with different physical activity levels varied significantly. Dyslipidaemia patients engaged in moderate and high physical activity demonstrated significantly less sympathetic activity and better sympatho-vagal balance than those engaged in low levels of physical activity; also, vagal cardiac control was significantly greater in high physical activity group. Lower levels of physical activity determined the presence of cardiac autonomic dysfunction in these patients at an optimal cut-off value of ≤1,558 Metabolic Equivalent of Tasks- min/week.
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Affiliation(s)
- A. Anand
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi-110025, India
| | - P. Bhati
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi-110025, India
| | - A. Mujaddadi
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi-110025, India
| | - S. Verma
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi-110025, India
| | - I.H. Naqvi
- M.A. Ansari Medical Centre, Jamia Millia Islamia (A Central University), New Delhi-110025, India
| | - M.E. Hussain
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi-110025, India
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15
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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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16
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Liu W, Qdaisat A, Soliman PT, Ramondetta L, Lopez G, Narayanan S, Zhou S, Cohen L, Bruera E, Yeung SCJ. Hypomagnesemia and Survival in Patients with Ovarian Cancer Who Received Chemotherapy with Carboplatin. Oncologist 2019; 24:e312-e317. [PMID: 30940743 PMCID: PMC6656478 DOI: 10.1634/theoncologist.2018-0465] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 02/27/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Hypomagnesemia is a known side effect of several antineoplastic agents, but its impact on outcomes of patients with cancer is not well understood. We examined whether magnesium abnormalities affect survival in patients with ovarian cancer who receive chemotherapy containing carboplatin. MATERIALS AND METHODS We included patients with advanced ovarian cancer who had undergone surgery and chemotherapy between January 1, 2004, and December 31, 2014, at our institution. Inclusion criteria were age 18 years or older, pathology of high-grade serous carcinoma, first treatment (surgery or chemotherapy) within 60 days of diagnosis, and chemotherapy containing carboplatin. The final cohort consisted of 229 patients. Vital signs and laboratory tests were recorded at baseline and during the treatment course. The associations between magnesium abnormalities (and other clinical characteristics) and survival were analyzed. RESULTS The median patient age was 64 years. Higher baseline heart rate (beats per minute; hazard ratio [HR] = 1.02, p = .002) and greater frequency of hypomagnesemia during the treatment course (HR = 1.05, p = .002) were significantly associated with shorter survival independent of completeness of tumor reduction (HR = 1.60, p = .02), and International Federation of Gynecology and Obstetrics stage (HR = 1.63, p = .01). CONCLUSION Baseline heart rate and the frequency of hypomagnesemia episodes during treatment are prognostic of survival for patients with advanced ovarian cancer receiving carboplatin-containing chemotherapy and tumor reductive surgery. Future research is needed for strategies to detect and prevent hypomagnesemia in this patient population. IMPLICATIONS FOR PRACTICE Despite standard laboratory tests and intravenous magnesium replacement prior to each cycle of chemotherapy, hypomagnesemia remains a common side effect of platinum-based chemotherapy. This study revealed that frequent occurrence of hypomagnesemia during the course of treatment including carboplatin-containing chemotherapy and tumor reductive surgery was strongly predictive of shorter survival in patients with advanced ovarian cancer. Strategies to effectively mitigate hypomagnesemia, such as more frequent detection, dietary recommendations, and timely replacement, should be considered in the overall cancer treatment plan for these patients.
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Affiliation(s)
- Wenli Liu
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Aiham Qdaisat
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Pamela T Soliman
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lois Ramondetta
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gabriel Lopez
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Santhosshi Narayanan
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shouhao Zhou
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lorenzo Cohen
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sai-Ching J Yeung
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Rawat JK, Roy S, Singh M, Guatam S, Yadav RK, Ansari MN, Aldossary SA, Saeedan AS, Kaithwas G. Transcutaneous Vagus Nerve Stimulation Regulates the Cholinergic Anti-inflammatory Pathway to Counteract 1, 2-Dimethylhydrazine Induced Colon Carcinogenesis in Albino wistar Rats. Front Pharmacol 2019; 10:353. [PMID: 31164817 PMCID: PMC6536668 DOI: 10.3389/fphar.2019.00353] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/21/2019] [Indexed: 12/12/2022] Open
Abstract
The present work was undertaken to study the effects of transcutaneous auricular vagus nerve stimulation (taVNS) on 1, 2-dimethyhydrazine (DMH) induced colon cancer and role of the cholinergic anti-inflammatory pathways (CAP) in the same. Groups of rats were randomly divided into ten groups (n = 8). DMH administration was very well apparent for autonomic dysfunction as observed through distorted hemodynamic (electrocardiogram and heart rate variability), increased aberrant crypt foci and flat neoplastic lesions (methylene blue staining, scanning electron microscopy and Hematoxylin and eosin staining). DMH administration was also recorded for per-oxidative damage. taVNS application restored the autonomic function, cellular morphology and curtailed the oxidative damage. DMH application conspicuously inhibited the mitochondrial apoptosis which was restored back after taVNS application, when scrutinized through immunoblotting and quantitative real time polymerase chain reaction studies. taVNS application up-regulated the CAP as perceived through increased expression for α7 nicotinic acetylcholine receptor(α7nAchR) and decreased expression for nuclear factor kappa-ligand-chain-enhancer of activated B cells (NFκBp65), tissue necrosis factor-α and high mobility group box-1 at protein and mRNA levels. All in all, taVNS up-surged the CAP to counteract DMH induced colon carcinogenesis. Among all the stimulation parameters used, taVNS 3 (pulse width-1 ms, frequency-6 Hz, voltage-6 v, duration-240 min) was observed to be the most effective. Since only chemotherapy and surgery are available options for management of CRC, which are troublesome and painful, there is currently no non-invasive method available for management of CRC. Results of the current study affirmed the effectiveness of taVNS against DMH induced colon cancer. The present study established taVNS as a novel and non-invasive approach toward the management of CRC.
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Affiliation(s)
- Jitendra K. Rawat
- Department of Pharmaceutical Sciences, Baba Saheb Bhimrao Ambedkar Central University Lucknow, Lucknow, India
| | - Subhadeep Roy
- Department of Pharmaceutical Sciences, Baba Saheb Bhimrao Ambedkar Central University Lucknow, Lucknow, India
| | - Manjari Singh
- Department of Pharmaceutical Sciences, Baba Saheb Bhimrao Ambedkar Central University Lucknow, Lucknow, India
| | - Swetlana Guatam
- Department of Pharmaceutical Sciences, Baba Saheb Bhimrao Ambedkar Central University Lucknow, Lucknow, India
| | - Rajnish K. Yadav
- Department of Pharmaceutical Sciences, Baba Saheb Bhimrao Ambedkar Central University Lucknow, Lucknow, India
| | - Mohd Nazam Ansari
- Department of Pharmacology, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Sara A. Aldossary
- Department of Pharmaceutical Sciences, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Abdulaziz S. Saeedan
- Department of Pharmacology, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Gaurav Kaithwas
- Department of Pharmaceutical Sciences, Baba Saheb Bhimrao Ambedkar Central University Lucknow, Lucknow, India
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Lee YH, Lai GM, Lee DC, Tsai Lai LJ, Chang YP. Promoting Physical and Psychological Rehabilitation Activities and Evaluating Potential Links Among Cancer-Related Fatigue, Fear of Recurrence, Quality of Life, and Physiological Indicators in Cancer Survivors. Integr Cancer Ther 2018; 17:1183-1194. [PMID: 30354701 PMCID: PMC6247550 DOI: 10.1177/1534735418805149] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objectives: Cancer-related fatigue and fear of recurrence (FOR) are
the most common symptoms in cancer survivors and severely affect quality of life
(QOL). This study aims to promote and evaluate the effectiveness of physical and
psychological rehabilitation activities for cancer survivors.
Methods: A longitudinal study with an interventional research
design was conducted. A total of 80 participants were randomly assigned to
experimental groups E1 (Qigong exercise [QE]) or E2 (stress management [SM]) or
the control group. The E1 and E2 groups received QE and SM, respectively, as
interventions once a week for 12 weeks, and effects were assessed.
Cancer-related fatigue, FOR, QOL, and heart rate variability (HRV) were
evaluated at baseline (T0), after 12 weeks (T1), and at the 3-month follow-up
(T2). Results: QE and SM effectively strengthened the physical and
psychological functions of cancer survivors at the T1 phase. Although
differences in FOR and QOL were not statistically significant, the scores were
decreased and increased, respectively. Although the effects during the T2 phase
were not as significant as those during T1, the score progress was maintained.
The effects on HRV were significantly different among the E1, E2, and control
groups at T1, which shows that the performance of both experimental groups was
better than that of the control group. Conclusions: Physical and
psychological rehabilitation activities should be practiced periodically and
should be led by professional staff. Long-term educational resources and care
should also be provided. HRV can be used to efficiently monitor the status of
the mind-body balance and is a more suitable index than questionnaires for
physical and psychological function evaluation in cancer survivors.
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Affiliation(s)
- Yi-Hua Lee
- 1 National Health Research Institutes, Zhunan, Miaoli County, Taiwan.,2 Da-Yeh University, Dacun, Changhua, Taiwan
| | - Gi-Ming Lai
- 3 Taipei Municipal Wanfang Hospital, Wenshan District, Taipei City, Taiwan.,4 Taipei Medical University, Taipei, Taiwan
| | - De-Chih Lee
- 2 Da-Yeh University, Dacun, Changhua, Taiwan
| | | | - Yuan-Ping Chang
- 6 Fooyin University, Daliao District, Kaohsiung City, Taiwan
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Matusik PS, Matusik PT, Stein PK. Cardiovascular reflex tests in patients with systemic lupus erythematosus: clinical performance and utility. Lupus 2018; 27:1759-1768. [DOI: 10.1177/0961203318783052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background This review summarizes current knowledge about cardiovascular reflex tests (CVRTs) and other selected autonomic nervous system (ANS) assessment tests in systemic lupus erythematosus (SLE) patients and assesses their clinical utility in this group of patients. Methods The PubMed database was searched for terms associated with CVRTs and SLE. Only papers available in full text and published in English were considered. Ultimately, 13 were selected and analyzed. Results In most of the studies CVRTs results were reported more likely to be abnormal in patients with SLE when compared with controls. The reported prevalence of ANS dysfunction in SLE, diagnosed using CVRTs, ranged from 23.5% to 82.7% of patients, likely because of different definitions of ANS dysfunction, variability in methods of performing CVRTs, and potential confounding factors. In general CVRTs results did not correlate with SLE activity or disease duration, but some CVRTs results correlated with some peptides associated with ANS function, including neuropeptide Y and vasoactive intestinal peptide. Conclusion Patients with SLE generally have abnormal or borderline results of CVRTs, which indicate prevalent abnormalities of the ANS in SLE. Performance of CVRTs requires good standardization of test conditions and familiarity with the proper administration and interpretation of these tests.
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Affiliation(s)
- P S Matusik
- Department of Radiology, University Hospital, Kraków, Poland
| | - P T Matusik
- Department of Electrocardiology, The John Paul II Hospital, Kraków, Poland
- Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - P K Stein
- Department of Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, USA
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21
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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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Kim K, Chae J, Lee S. The Role of Heart Rate Variability in Advanced Non-Small-Cell Lung Cancer Patients. J Palliat Care 2017. [DOI: 10.1177/082585971503100206] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Aim Several recent studies have suggested that assessing heart rate variability (HRV) is an easy method for obtaining prognostic information on cancer patients; however, these studies had limitations such as uncontrolled confounders and small numbers in a heterogeneous group. The intention of our study was to explore and validate the role of HRV variables in patients with advanced non-small-cell lung cancer (NSCLC). Method A total of 167 patients who were eligible for HRV testing were consecutively enrolled from a regional hospital in South Korea. Demographic and clinical variables, including the Eastern Cooperative Oncology Group (ECOG) performance status grade, NSCLC stage, therapeutic intervention, and other data were also recorded. The effects of time-domain and frequency-domain indices of HRV were compared with other clinical factors to determine overall survival. Results Among the HRV parameters, standard deviation of all normal-to-normal intervals (SDNN) significantly predicted poor survival by univariate analysis. However, multivariate analysis revealed that it was not an independent prognosticator for survival in NSCLC patients, as the HRV parameters significantly correlated with the ECOG performance status grade. Conclusion HRV variables should be used to monitor advanced NSCLC patients’ general well-being and ability to perform the activities of daily living rather than to predict their overall survival.
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Affiliation(s)
- Kyungsuk Kim
- Department of Medical Consilience, Graduate School, Dankook University, Yongin, Republic of Korea
| | - Jean Chae
- Department of Clinical Oncology, Integrative Cancer Center, Kyung Hee University Hospital at Gangdong, Kyung Hee University, Seoul, Republic of Korea
| | - Sanghun Lee
- Department of Medical Consilience, Graduate School, Dankook University, 152, Jukjeon-ro, Suji-gu, Yongin-si, Gyeonggi-do, #448-701 Republic of Korea
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Masel EK, Huber P, Engler T, Watzke HH. Heart rate variability during treatment of breakthrough pain in patients with advanced cancer: a pilot study. J Pain Res 2016; 9:1215-1220. [PMID: 28003771 PMCID: PMC5161332 DOI: 10.2147/jpr.s120343] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Decisions on the intensity of analgesic therapy and judgments regarding its efficacy are difficult at the end of life, when many patients are not fully conscious and pain is a very common symptom. In healthy individuals and in postoperative settings, nociception and subsequent pain relief have been shown to induce changes in the autonomic nervous system (ANS), which can be detected by measuring heart rate variability (HRV). Objectives The changes in the ANS were studied by measuring HRV during opioid therapy for cancer breakthrough pain (CBTP) in palliative-care patients with cancer and compared these changes with patient-reported pain levels on a numeric rating scale (NRS). Patients and methods The study included ten patients with advanced cancer and baseline opioid therapy. In each patient, a 24-hour peak-to-peak HRV measurement with a sampling rate of 4,000 Hz was performed. High frequency (HF), low frequency (LF), total power, pNN50 (indicating parasympathetic activity), and log LF/HF were obtained in two intervals prior to therapy and in four intervals thereafter. Intensity of CBTP was recorded using a patient-reported NRS prior to therapy and 30 minutes afterward. Results CBTP occurred in seven patients (three males and four females; mean age: 62 ± 5.2 years) and was treated with opioids. A highly significant positive correlation was found between opioid-induced reduction in patient-reported pain intensity based on NRS and changes in log LF/HF (r > 0.700; p < 0.05). Log LF/HF decreased in patients who had a reduction in pain of >2 points on the NRS but remained unchanged in the other patients. Conclusion Our data suggest that log LF/HF may be a useful surrogate marker for alleviation of CBTP in patients with advanced cancer and might allow detection of pain without active contribution from patients.
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Affiliation(s)
- Eva Katharina Masel
- Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Patrick Huber
- Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Tobias Engler
- Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Herbert Hans Watzke
- Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
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Chien TJ, Liu CY, Lu RH, Kuo CW, Lin YC, Hsu CH. Therapeutic efficacy of Traditional Chinese medicine, "Kuan-Sin-Yin", in patients undergoing chemotherapy for advanced colon cancer - A controlled trial. Complement Ther Med 2016; 29:204-212. [PMID: 27912948 DOI: 10.1016/j.ctim.2016.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 09/17/2016] [Accepted: 10/04/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Traditional Chinese Medicine (TCM) has been used increasingly as complementary medicine in cancer care. Kuan-Sin-Yin (KSY) is a TCM decoction containing seven herbs known to cause immunomodulation or anticancer activity, and which are associated with the TCM concept of Qi and energy supply. Kuan-Sin-Yin has cytostatic effects on cancer cells in animal models. OBJECTIVE The aim of this study is to evaluate the level of improvement in meridian energy and heart-rate variability (HRV) and to assess whether these observations are compatible with TCM theory. METHOD A non-randomized controlled trial was designed with monitoring of the meridian electro-conductivity and heart-rate variability (HRV) to compare the efficacy of Kuan-Sin-Yin in the control and experimental groups. 52 patients were enrolled in this study. We also measured cancer-related symptoms and quality of life as secondary outcomes. RESULTS We found that colon cancer patients who received KSY as complementary therapy benefitted with enhancement of meridian energy (Yin meridian: 27.90:35.45μA; p=0.014; Yang meridian: 27.09:33.55μA; p=0.024) and increases in HRV activity (78.40:129.04ms; SDNN: p=0.001) and parasympathetic tone(HF:1644.80:3217.92 ms2; p=0.003; RMMSD:99.76:164.52ms; p=0.002). Cancer-related symptoms decreased (ECOG>1:46.2:7.7%; p=0.0001), and quality of life (KSY group: PCS 35.46:42.12, p=0.0001; MCS: 44.50:47.55, p=0.209) was improved with statistical significance. CONCLUSIONS The correlation of positive results reflected in meridian energy and HRV activity confirms the positive role of complementary medicine of Kuan-Sin-Yin in cancer care.
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Affiliation(s)
- Tsai-Ju Chien
- Institute of Traditional Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Hemato-Oncology, Department of Internal Medicine, Branch of Zhong-xing, Taipei City Hospital, Taipei, Taiwan.
| | - Chia-Yu Liu
- Institute of Traditional Medicine, National Yang-Ming University, Taipei, Taiwan; Branch of Linsen and Chinese Medicine, Taipei City Hospital, Taipei, Taiwan; Taiwan International Traditional Chinese Medicine Training Center, Taiwan
| | - Ruey-Hwa Lu
- Division of Surgical-Oncology, Branch of Zhong-xing, Taipei City Hospital, Taipei, Taiwan
| | - Chin-Wei Kuo
- Division of Surgical-Oncology, Branch of Zhong-xing, Taipei City Hospital, Taipei, Taiwan
| | - Yang-Chao Lin
- Division of Gastroenterology, Department of Internal Medicine, Branch of Zhong-xing, Taipei City Hospital, Taipei, Taiwan
| | - Chung-Hua Hsu
- Institute of Traditional Medicine, National Yang-Ming University, Taipei, Taiwan; Branch of Linsen and Chinese Medicine, Taipei City Hospital, Taipei, Taiwan; Taiwan International Traditional Chinese Medicine Training Center, Taiwan.
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Abstract
INTRODUCTION Previous studies have shown that autonomic dysfunction is associated with shorter survival in patients with advanced cancer. We examined the association between heart rate variability, a measure of autonomic function, and survival in a large cohort of patients with cancer. METHODS We retrospectively examined the records of 651 patients with cancer who had undergone ambulatory electrocardiogram monitoring for 20 to 24 hours. Time domain heart rate variability (SD of normal-to-normal beat interval [SDNN]) was calculated using power spectral analysis. Survival data were compared between patients with SDNN ≥ 70 milliseconds (Group 1, n = 520) and SDNN < 70 milliseconds (Group 2, n = 131). RESULTS Two groups were similar in most variables, except that patients in group 2 had a significantly higher percentage of male patients (P = 0.03), hematological malignancies (P = 0.04), and use of non-selective serotonin reuptake inhibitor antidepressants (P = 0.04). Patients in group 2 had a significantly shorter survival rate (25% of patients in group 2 died by 18.7 weeks vs. 78.9 weeks in group 1 patients; P < 0.0001). Multivariate analysis showed that SDNN < 70 milliseconds remained significant for survival (hazard ratio 1.9 [95% confidence interval: 1.4-2.5]) independent of age, cancer stage, and performance status. CONCLUSION The presence of cancer in combination with decreased heart rate variability (SDNN < 70 milliseconds) is associated with shorter survival time.
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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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Chien TJ, Liu CY, Ko PH, Hsu CH. A Chinese Decoction, Kuan-Sin-Yin, Improves Autonomic Function and Cancer-Related Symptoms of Metastatic Colon Cancer. Integr Cancer Ther 2015; 15:113-23. [PMID: 26612784 DOI: 10.1177/1534735415617282] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Kuan-Sin-Yin (KSY) is a traditional Chinese medicine (TCM) decoction, which has been shown to have cytostatic effects on cancer cells and involved in the TCM theory of promoting yin-yang balance.Sonce many cancer patients suffer from autonomic dysfunction (AD), which correspond to yin-yang imbalance in TCM. The aim of this study is to evaluate the possible effect of KSY in metastatic colon cancer (mCRC) patients with AD. METHODS We conducted a single-group experiment. Total 52 qualified patients were enrolled. Participants took the KSY daily for 2 weeks. The primary outcome was KSY efficacy as reflected in the heart rate variability (HRV) and electrical conductivity (µA) over 12 meridian points. Autonomic function was examined before and after the KSY intervention. The vagal and sympathetic tone were recorded by HRV; 12 meridian energies were measured using a meridian energy analysis device. Secondary outcomes were cancer-related symptoms and patient quality of life (QoL). RESULTS The results showed that the KSY intervention improved AD via increasing the vagal tone (HF: P = .041), but not the sympathetic tone (LF: P = .154); total autonomic activity was significantly enhanced (HRV activity: P = .013). Intriguingly, energy increased more over the yin meridian (P = .010) than over the yang meridian (P = .015). Cancer-related symptoms and QoL were significantly improved (P < .05). CONCLUSION The safety and effectiveness of KSY in improving AD in mCRC patients are through regulating the vagal-sympathetic dynamic balance, which correspond to the TCM yin-yang concept of energy.
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Affiliation(s)
- Tsai-Ju Chien
- Institute of Traditional Medicine, National Yang-Ming University, Taipei, Taiwan Oncology Department, Zhong-Xing Branch, Taipei City Hospital, Taipei, Taiwan
| | - Chia-Yu Liu
- Institute of Traditional Medicine, National Yang-Ming University, Taipei, Taiwan Chinese Medicine and Lin-Sen Branch, Taipei City Hospital, Taipei, Taiwan
| | - Pin-Hao Ko
- National Taiwan University, Taipei, Taiwan
| | - Chung-Hua Hsu
- Institute of Traditional Medicine, National Yang-Ming University, Taipei, Taiwan Chinese Medicine and Lin-Sen Branch, Taipei City Hospital, Taipei, Taiwan
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Caro-Morán E, Fernández-Lao C, Galiano-Castillo N, Cantarero-Villanueva I, Arroyo-Morales M, Díaz-Rodríguez L. Heart Rate Variability in Breast Cancer Survivors After the First Year of Treatments: A Case-Controlled Study. Biol Res Nurs 2015; 18:43-9. [PMID: 25616419 DOI: 10.1177/1099800414568100] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The same aggressive treatments that have led to a reduction in the breast cancer may also have adverse effects on cardiac autonomic balance. The objective of this study was to compare heart rate variability (HRV) between breast cancer survivors in the first year posttreatment and healthy women, controlling for known confounders. This descriptive case-controlled study included 22 breast cancer survivors and 22 healthy age- and sex-matched controls. Short-term HRV was measured using an accepted methodology to assess the cardiac autonomic balance. One-way analysis of covariance results revealed that heart rate was significantly higher (F = 15.86, p < .001) and the standard deviation of normal-to-normal (NN) interval (F = 19.93, p = .001), square root of mean squared differences of successive NN intervals (F = 18.72, p = .001), HRV index (F = 5.44, p = .025), and high-frequency (F = 5.77, p = .03) values were significantly lower in the breast cancer survivors than in the matched controls. The principal finding of the presence of a cardiovascular imbalance in breast cancer survivors in comparison to healthy age-matched controls suggests that HRV study could be a clinically useful tool to detect cardiovascular disease in early-stage breast cancer survivors.
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Affiliation(s)
- Elena Caro-Morán
- Instituto Biosanitario Granada, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Carolina Fernández-Lao
- Instituto Biosanitario Granada, Faculty of Health Sciences, University of Granada, Granada, Spain Sport and Health University Research Institute, University of Granada, Granada, Spain
| | - Noelia Galiano-Castillo
- Instituto Biosanitario Granada, Faculty of Health Sciences, University of Granada, Granada, Spain Sport and Health University Research Institute, University of Granada, Granada, Spain
| | - Irene Cantarero-Villanueva
- Instituto Biosanitario Granada, Faculty of Health Sciences, University of Granada, Granada, Spain Sport and Health University Research Institute, University of Granada, Granada, Spain
| | - Manuel Arroyo-Morales
- Instituto Biosanitario Granada, Faculty of Health Sciences, University of Granada, Granada, Spain Sport and Health University Research Institute, University of Granada, Granada, Spain
| | - Lourdes Díaz-Rodríguez
- Instituto Biosanitario Granada, Faculty of Health Sciences, University of Granada, Granada, Spain Sport and Health University Research Institute, University of Granada, Granada, Spain Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain
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Hundsberger T, Omlin A, Haegele-Link S, Vehoff J, Strasser F. Autonomic dysfunction in cancer cachexia coincides with large fiber polyneuropathy. J Pain Symptom Manage 2014; 48:611-8.e1. [PMID: 24709363 DOI: 10.1016/j.jpainsymman.2013.11.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 11/16/2013] [Accepted: 11/21/2013] [Indexed: 01/06/2023]
Abstract
CONTEXT Cancer cachexia occurs in most patients suffering from solid malignancies. Recent works suggest paraneoplastic mechanisms. Empirical studies also found autonomic dysfunction in cancer patients, but comprehensive evaluation of the peripheral nervous system is lacking. OBJECTIVES To further understand the role of the autonomic and peripheral nervous system in cancer cachexia to guide treatment. METHODS We prospectively investigated cachectic cancer patients for parasympathetic autonomic dysfunction with a time-domain-based analysis of heart rate variability (breathing at rest, deep breath, and in response to the Valsalva maneuver). Blood pressure changes after the Valsalva maneuver were used as a marker of the sympathetic noradrenergic system. Orthostatic hypertension was investigated in response to active standing. We used a noninvasive continuous beat-to-beat heart rate assessment and blood pressure monitoring. The sympathetic cholinergic nervous system was evaluated with the sympathetic skin response. A detailed neurological examination, nerve conduction studies, and electromyography also were conducted. RESULTS A total of 13 patients were enrolled (median age 66 years). Median time from inclusion until death was 3.5 months. About 12 of the 13 patients showed abnormal results in at least one autonomic test. Sympathetic noradrenergic and cholinergic abnormalities were discovered in six patients each and five patients had orthostatic hypotension. Only one patient showed abnormal results in parasympathetic cholinergic tests. Asymptomatic large fiber polyneuropathy was detected in eight patients. CONCLUSION Large fiber polyneuropathy coincides with autonomic dysfunction in cachectic cancer patients. Our findings suggest a relevant role of sympathetic impairment in cancer cachexia.
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Affiliation(s)
- Thomas Hundsberger
- Department of Neurology, Cantonal Hospital, St. Gallen, Switzerland; Department of Hematology and Oncology, Cantonal Hospital, St. Gallen, Switzerland.
| | - Aurelius Omlin
- Department of Hematology and Oncology, Cantonal Hospital, St. Gallen, Switzerland
| | | | - Jochen Vehoff
- Department of Neurology, Cantonal Hospital, St. Gallen, Switzerland
| | - Florian Strasser
- Department of Hematology and Oncology, Cantonal Hospital, St. Gallen, Switzerland
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