1
|
Belzile D, Auclair A, Roberge J, Piché ME, Lebel A, Pettigrew M, Marceau S, Biertho L, Poirier P. Heart rate variability after bariatric surgery: The add-on value of exercise. Eur J Sport Sci 2023; 23:415-422. [PMID: 34890532 DOI: 10.1080/17461391.2021.2017488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To assess the impact of bariatric surgery and an added supervised exercise training programme on heart rate variability (HRV) in patients with severe obesity. METHODS Fifty-nine patients who underwent bariatric surgery were randomised in the post-operative period to a 12-week supervised exercise training programme (moderate intensity combination aerobic/resistance exercise training programme) or a control group. Indices of HRV including time-domain, spectral-domain, and nonlinear parameters were measured preoperatively, and at 3, 6, and 12 months. RESULTS After the surgical procedure, both groups improved anthropometric parameters. Type 2 diabetes, hypertension, and dyslipidemia resolutions were similar between groups. Total body weight loss at 6 and 12 months were also comparable between groups (6 months: 28 ± 6 vs. 30 ± 6%; 12 months: 38 ± 9 vs. 38 ± 10%; control vs. intervention group respectively). Bariatric surgery improved HRV parameters at 12 months compared to the pre-operative values in the intervention group: standard deviation of R-R interval (SDNN) (156.0 ± 46.4 vs. 122.6 ± 33.1 ms), low frequency (LF) (6.3 ± 0.8 vs. 5.8 ± 0.7 ms2), and high frequency (HF) (5.1 ± 0.8 vs. 4.7 ± 0.9 ms2) (all p<0.001). For the control patients, similar improvements in SDNN (150.0 ± 39.4 vs. 118.8 ± 20.1 ms), LF (6.1 ± 0.9 vs. 5.7 ± 0.8 ms2), and HF (5.0 ± 0.9 vs. 4.7 ± 0.9 ms2) were obtained (all p<0.001). However, there was no add-on impact of the supervised exercise training programme on HRV after 12 months (p>0.05 for all HRV parameters). CONCLUSION Bariatric surgery is associated with an improvement in HRV. A supervised exercise training programme in the post-operative period did not modulate further the benefits of bariatric surgery regarding HRV parameters.
Collapse
Affiliation(s)
- D Belzile
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada
| | - A Auclair
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada
| | - J Roberge
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada
| | - M E Piché
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada.,Faculty of medicine, Laval University, Québec, Canada
| | - A Lebel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada
| | - M Pettigrew
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada.,Faculty of pharmacy, Laval University, Québec, Canada
| | - S Marceau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada.,Faculty of medicine, Laval University, Québec, Canada
| | - L Biertho
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada.,Faculty of medicine, Laval University, Québec, Canada
| | - P Poirier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada.,Faculty of pharmacy, Laval University, Québec, Canada
| |
Collapse
|
2
|
Ardissino M, Vincent M, Hines O, Amin R, Eichhorn C, Tang AR, Collins P, Moussa O, Purkayastha S. Long-term cardiovascular outcomes after orlistat therapy in patients with obesity: a nationwide, propensity-score matched cohort study. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2021; 8:179-186. [PMID: 33991094 DOI: 10.1093/ehjcvp/pvaa133] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 08/25/2020] [Indexed: 11/14/2022]
Abstract
AIMS The rising prevalence of obesity and its associated comorbidities represent a growing public health issue; in particular, obesity is known to be a major risk factor for cardiovascular disease. Despite the evidence behind the efficacy of orlistat in achieving weight loss in patients with obesity, no study thus far has quantified its long-term effect on cardiovascular outcomes. The purpose of this study is to explore long-term cardiovascular outcomes after orlistat therapy. METHODS AND RESULTS A propensity-score matched cohort study was conducted on the nation-wide electronic primary and integrated secondary healthcare records of the Clinical Practice Research Datalink (CPRD). The 36 876 patients with obesity in the CPRD database who had completed a course of orlistat during follow-up were matched on a 1:1 basis with equal numbers of controls who had not taken orlistat. Patients were followed up for a median of 6 years for the occurrence of the primary composite endpoint of major adverse cardiovascular events (fatal or non-fatal myocardial infarction or ischaemic stroke), and a number of secondary endpoints including primary endpoint components individually, the occurrence of new-onset heart failure, coronary revascularization, new chronic kidney disease stage III+ (CKD3+), and all-cause mortality. During the median study follow-up of 6 years, the occurrence of major adverse cardiovascular events was lower in the orlistat cohort [hazard ratio (HR) 0.74; 95% confidence interval (CI) 0.66-0.83, P < 0.001]. Patients who took orlistat experienced lower rates of myocardial infarction (HR 0.77; 95% CI 0.66-0.88, P < 0.001) and ischaemic stroke (HR 0.68; 95% CI 0.56 to -0.84, P < 0.001) as well as new-onset heart failure (HR 0.79; 95% CI 0.67-0.94, P = 0.007). There was no differences in revascularization rates (HR 1.12; 95% CI 0.91-1.38, P = 0.27), but a lower rate of both CKD3+ development (HR 0.78; 95% CI 0.73-0.83, P < 0.001) and mortality (HR 0.39, 95% CI 0.36 to -0.41, P < 0.001) was observed. CONCLUSION In this nation-wide, propensity-score matched study, orlistat was associated with lower rates of overall major adverse cardiovascular events, new-onset heart failure, renal failure, and mortality. This study adds to current evidence on the known improvements in cardiovascular risk factor profiles of orlistat treatment by suggesting a potential role in primary prevention.
Collapse
Affiliation(s)
- Maddalena Ardissino
- Department of Medicine, Imperial College London, Exhibition Road, London SW7 2AZ, UK
| | - Matthew Vincent
- Department of Medicine, Imperial College London, Exhibition Road, London SW7 2AZ, UK
| | - Oliver Hines
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Ravi Amin
- Department of Medicine, Imperial College London, Exhibition Road, London SW7 2AZ, UK
| | - Christian Eichhorn
- Department of Medicine, Imperial College London, Exhibition Road, London SW7 2AZ, UK.,Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Alice R Tang
- Department of Medicine, Imperial College London, Exhibition Road, London SW7 2AZ, UK
| | - Peter Collins
- Department of Medicine, Imperial College London, Exhibition Road, London SW7 2AZ, UK.,Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, Sydney Street, London SW3 6NP, UK
| | - Osama Moussa
- Division of Surgery and Cancer, Imperial College London, Praed Street, London W2 1NY, UK
| | - Sanjay Purkayastha
- Department of Medicine, Imperial College London, Exhibition Road, London SW7 2AZ, UK.,Division of Surgery and Cancer, Imperial College London, Praed Street, London W2 1NY, UK.,Imperial Weight Centre, Imperial College Healthcare NHS trust, Praed Street, London W2 1NY, UK
| |
Collapse
|
3
|
Benjamim CJR, Pontes YMDM, de Sousa Junior FW, Porto AA, Bueno Júnior CR, Marcelino da Silva AA, Ferro Cavalcante TC, Garner DM, Valenti VE. Does bariatric surgery improve cardiac autonomic modulation assessed by heart rate variability? A systematic review. Surg Obes Relat Dis 2021; 17:1497-1509. [PMID: 33958294 DOI: 10.1016/j.soard.2021.03.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/04/2021] [Accepted: 03/20/2021] [Indexed: 11/17/2022]
Abstract
Our study aimed to explore the influence of bariatric surgery (BS) on heart rate (HR) variability (HRV) through a systematic review. Manuscripts were selected based on electronic searches of the MEDLINE, EMBASE, and CINAHL databases from the inception of each database up to year 2020, and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Searching of these studies was systematized using the Population Intervention Comparison Outcome Study Design strategy. We selected randomized and nonrandomized controlled trials and cohorts from prospective studies that reported the influence of BS on HRV. We assessed the quality rating using the Black and Downs questionnaire. Following the screening and eligibility stages, 14 studies were included in the review. All studies agreed that BS promotes an increase in parasympathetic HR control and HRV and a decrease in HR. Yet the literature does not provide evidence that these outcomes are directly caused by the surgical procedure. There is limited evidence to support that patients with type 2 diabetes have greater improvement in HRV as an interim measure, to individuals without. The decrease in insulin resistance was correlated with the increase in HRV in some studies, but, other studies are unsupportive of this outcome. Improvements in 2 metabolic parameters (e.g., leptin, N-terminal pro B-type natriuretic peptide) were connected with superior increases in HRV. This review demonstrated that BS promotes an increase in HRV, indicating improved autonomic control of HR.
Collapse
Affiliation(s)
- Cicero Jonas R Benjamim
- Development, Nutrition, Phytotherapy and Hygiene Research Group, University of Pernambuco, Petrolina, Brazil; Autonomic Nervous System Center, Sao Paulo State University, Marilia, Brazil
| | - Yasmim Mota de M Pontes
- Physiological and Collective Sciences Nucleus, School of Juazeiro do Norte, Juazeiro do Norte, Brazil
| | | | - Andrey Alves Porto
- Autonomic Nervous System Center, Sao Paulo State University, Marilia, Brazil; Department of Physical Therapy, Faculty of Sciences and Technologies, UNESP, Presidente Prudente, Brazil
| | - Carlos Roberto Bueno Júnior
- Ribeirão Preto Medical School, Department of Medical Clinic, University of São Paulo, Ribeirão Preto, Brazil
| | - Amanda A Marcelino da Silva
- Development, Nutrition, Phytotherapy and Hygiene Research Group, University of Pernambuco, Petrolina, Brazil
| | - Taisy C Ferro Cavalcante
- Development, Nutrition, Phytotherapy and Hygiene Research Group, University of Pernambuco, Petrolina, Brazil
| | - David M Garner
- Cardiorespiratory Research Group, Department of Biological and Medical Sciences, Faculty of Health and Life Sciences, Oxford Brookes University, Headington Campus, Oxford, United Kingdom
| | - Vitor E Valenti
- Autonomic Nervous System Center, Sao Paulo State University, Marilia, Brazil.
| |
Collapse
|
4
|
Auclair A, Biertho L, Marceau S, Hould FS, Biron S, Lebel S, Julien F, Lescelleur O, Lacasse Y, Piché ME, Cianflone K, Parlee SD, Goralski K, Martin J, Bastien M, St-Pierre DH, Poirier P. Bariatric Surgery-Induced Resolution of Hypertension and Obstructive Sleep Apnea: Impact of Modulation of Body Fat, Ectopic Fat, Autonomic Nervous Activity, Inflammatory and Adipokine Profiles. Obes Surg 2018; 27:3156-3164. [PMID: 28555408 DOI: 10.1007/s11695-017-2737-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Obesity-associated systemic hypertension (HTN) and obstructive sleep apnea (OSA) have multiple pathophysiological pathways including ectopic fat deposition, inflammation, altered adipokine profile, and increased sympathetic nervous activity. We characterized these potential mechanisms in severely obese patients with or without HTN and OSA. We also compared changes of these mechanisms at 12 months following biliopancreatic diversion with duodenal switch (BPD-DS) surgery according to HTN and OSA resolution. METHODS Sixty-two severely obese patients were evaluated at baseline and 12 months; 40 patients underwent BPD-DS. Blood samples, bioelectrical impedance analysis, computed tomography scan, and 24-h heart rate monitoring were performed. OSA have been determined with polysomnography and HTN with blood pressure measurement and medical file. RESULTS Patients with HTN (n = 35) and OSA (n = 32) were older men with higher ectopic fat deposition and lower parasympathetic nervous activity without difference in adipokines and inflammatory markers. Lower reduction in weight was observed in patients with unresolved HTN (-40.9 ± 3.3 kg vs. -55.6 ± 3.8 kg; p = 0.001) and OSA (-41.4 ± 10.7 kg vs. -51.0 ± 15.2 kg; p = 0.006). Visceral adipose tissue reduction was lower in patients with unresolved HTN (-171.0 ± 25.7 cm2 vs. -274.5 ± 29.0 cm2; p = 0.001) in contrast to a trend for lower abdominal subcutaneous adipose tissue reduction in patients with unresolved OSA (-247.7 ± 91.5 cm2 vs. -390.5 ± 109.1 cm2; p = 0.08). At 12 months, parasympathetic activity was lowest in unresolved HTN and OSA patients, without difference in adipokines and inflammatory biomarkers. CONCLUSION Lower ectopic fat mobilization, lower level of parasympathetic nervous activity, and lower subcutaneous adiposity mobilization may play a role in the pathophysiology of unresolved HTN and OSA following BPD-DS surgery.
Collapse
Affiliation(s)
- Audrey Auclair
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada.,Faculty of Pharmacy, Laval University, Québec, Canada
| | - Laurent Biertho
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada.,Faculty of Medicine, Laval University, Québec, Canada
| | - Simon Marceau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada.,Faculty of Medicine, Laval University, Québec, Canada
| | - Frédéric-Simon Hould
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada.,Faculty of Medicine, Laval University, Québec, Canada
| | - Simon Biron
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada.,Faculty of Medicine, Laval University, Québec, Canada
| | - Stéfane Lebel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada.,Faculty of Medicine, Laval University, Québec, Canada
| | - François Julien
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada.,Faculty of Medicine, Laval University, Québec, Canada
| | - Odette Lescelleur
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada.,Faculty of Medicine, Laval University, Québec, Canada
| | - Yves Lacasse
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Marie-Eve Piché
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada.,Faculty of Medicine, Laval University, Québec, Canada
| | - Katherine Cianflone
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Sebastian Demian Parlee
- Department of Molecular & Integrative Physiology, University of Michigan School of Medicine, Detroit, USA
| | - Kerry Goralski
- College of Pharmacy, Dalhousie University, Halifax, Canada.,Department of Pharmacology, Dalhousie University, Halifax, Canada
| | - Julie Martin
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada.,Faculty of Pharmacy, Laval University, Québec, Canada
| | - Marjorie Bastien
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada.,Faculty of Pharmacy, Laval University, Québec, Canada
| | - David H St-Pierre
- Department of Exercise Sciences, Université du Québec à Montréal, Québec, Canada
| | - Paul Poirier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada. .,Faculty of Pharmacy, Laval University, Québec, Canada.
| |
Collapse
|
5
|
Leclerc J, Arsenault M, Després JP, Brassard P, Gaudreault V, Bergeron J, Alméras N, Tremblay A, Auclair A, Ross MK, Denault-Bissonnette S, Poirier P. Determinants of Improvement In Left Ventricular Diastolic Function Following a 1-Year Lifestyle Modification Program in Abdominally Obese Men with Features of the Metabolic Syndrome. Metab Syndr Relat Disord 2016; 14:483-491. [PMID: 27754772 DOI: 10.1089/met.2016.0021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Abdominal obesity and presence of the metabolic syndrome (MetS) are associated with cardiac abnormalities. Among those, left ventricular diastolic dysfunction (LVDD) is the most frequently encountered in clinical practice. Few studies evaluated the reversibility of LVDD by an approach promoting lifestyle modifications in abdominally obese subjects with MetS. METHODS We assessed the impact of a 1-year lifestyle modification program combining nutritional and physical activity counseling on LVDD and metabolic profile of abdominally obese men with MetS. Echocardiograms, oral glucose tolerance test, lipids profile, dual energy X-ray absorptiometry, computed tomography scans (visceral obesity assessment), heart rate variability (HRV), as well as maximal and submaximal exercise tests were performed in participants before and after a 1-year program combining healthy eating and a physical activity/exercise program. RESULTS Fifty-one abdominally obese men participated in this study. At baseline, 86% of the participants had LVDD (n = 44). After the 1-year program, LVDD improved in 57% of participants (n = 29, P < 0.0001). All metabolic, adiposity, and exercise tolerance measures improved from baseline (P < 0.0001), but were not associated with improvement in LVDD. Participants who improved LVDD had better exercise performance at baseline. Exercise tolerance during the submaximal exercise test, parasympathetic cardiac autonomic activity, and fasting insulin predicted 50% of LVDD improvements. CONCLUSIONS There was a significant improvement in LVDD after a 1-year lifestyle intervention program in abdominally obese men with MetS, such an improvement being associated with increased exercise tolerance, enhanced HRV, and reduced insulin levels.
Collapse
Affiliation(s)
- Jacinthe Leclerc
- 1 Centre de recherche , Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada .,2 Faculté de Pharmacie, Université Laval , Québec, Canada
| | - Marie Arsenault
- 1 Centre de recherche , Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada .,3 Faculté de médecine, Université Laval , Québec, Canada
| | - Jean-Pierre Després
- 1 Centre de recherche , Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada .,4 Département de kinésiologie, Faculté de médecine, Université Laval , Québec, Canada
| | - Patrice Brassard
- 1 Centre de recherche , Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada .,4 Département de kinésiologie, Faculté de médecine, Université Laval , Québec, Canada
| | - Valérie Gaudreault
- 1 Centre de recherche , Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada .,2 Faculté de Pharmacie, Université Laval , Québec, Canada
| | - Jean Bergeron
- 3 Faculté de médecine, Université Laval , Québec, Canada .,5 Centre Hospitalier Universitaire de Québec-Université Laval , Québec, Canada
| | - Natalie Alméras
- 1 Centre de recherche , Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada .,3 Faculté de médecine, Université Laval , Québec, Canada
| | - Angelo Tremblay
- 4 Département de kinésiologie, Faculté de médecine, Université Laval , Québec, Canada
| | - Audrey Auclair
- 1 Centre de recherche , Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada .,2 Faculté de Pharmacie, Université Laval , Québec, Canada
| | - Marie-Kristelle Ross
- 1 Centre de recherche , Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada .,3 Faculté de médecine, Université Laval , Québec, Canada .,6 Centre Hospitalier de Lévis , Québec, Québec, Canada
| | - Stéphanie Denault-Bissonnette
- 1 Centre de recherche , Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada .,3 Faculté de médecine, Université Laval , Québec, Canada .,5 Centre Hospitalier Universitaire de Québec-Université Laval , Québec, Canada
| | - Paul Poirier
- 1 Centre de recherche , Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada .,2 Faculté de Pharmacie, Université Laval , Québec, Canada
| |
Collapse
|
6
|
Yi SH, Lee K, Shin DG, Kim JS, Ki HC. Differential association of adiposity measures with heart rate variability measures in Koreans. Yonsei Med J 2013; 54:55-61. [PMID: 23225799 PMCID: PMC3521274 DOI: 10.3349/ymj.2013.54.1.55] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Although obesity has been associated with imbalances in cardiac autonomic nervous system, it is unclear whether there are differential relationships between adiposity measures and heart rate variability (HRV) measures. We aimed to examine differences in the relationship between adiposity measures and HRV indices in a healthy Korean population. MATERIALS AND METHODS In all, 1409 non-smokers (811 males, 598 females) without known histories of cardiovascular (CV), endocrine, or neurological diseases underwent adiposity measurements [(body mass index (BMI), percentage of body fat mass (PBF), and waist-to-hip ratio (WHR)], the HRV assessment (SDNN, RMSSD, LF, HF, LF/HF, and pNN50), and examination for CV risk factors (fasting glucose, LDL-cholesterol, HDL-cholesterol, triglycerides, hs-CRP, and blood pressure). RESULTS Compared with BMI and PBF, WHR was more strongly correlated with each HRV index and more likely to predict decreased HRV (<15 percentile vs. ≥ 15 percentile of each HRV index) in ROC curves analysis. In linear regression analysis, all adiposity measures were inversely associated with each HRV measure before adjusting for age, gender, and CV risk factors (p<0.05). After adjusting for the covariates, WHR was inversely related to RMSSD, LF, and pNN50; PBF with RMSSD, HF, and pNN50; BMI with RMSSD (p<0.05). The inversed association between HRV indices and the gender-specific WHR tertile was significant for subjects with BMI ≥ 25 kg/m(2), but not for those with BMI <25 kg/m(2). CONCLUSION WHR and PBF appear to be better indicators for low HRV than BMI, and the association between abdominal adiposity and HRV may be stronger in overweight subjects.
Collapse
Affiliation(s)
- Sang Hoon Yi
- School of Computer Aided Science & Institute of Basic Science, Inje University, Gimhae, Korea
| | - Kayoung Lee
- Department of Family Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Dong-Gu Shin
- Cardiovascular Division, Yeungnam University Hospital, Daegu, Korea
| | - Jun Su Kim
- Department of Family Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hee-Cheol Ki
- School of Computer Engineering & Ubiquitous Healthcare Research Center, Inje University, Gimhae, Korea
| |
Collapse
|
7
|
Variabilité de la fréquence cardiaque : un marqueur de risque cardiométabolique en santé publique. BULLETIN DE L ACADEMIE NATIONALE DE MEDECINE 2013. [DOI: 10.1016/s0001-4079(19)31635-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|