1
|
Zeid S, Buch G, Velmeden D, Söhne J, Schulz A, Schuch A, Tröbs SO, Heidorn MW, Müller F, Strauch K, Coboeken K, Lackner KJ, Gori T, Münzel T, Prochaska JH, Wild PS. Heart rate variability: reference values and role for clinical profile and mortality in individuals with heart failure. Clin Res Cardiol 2024; 113:1317-1330. [PMID: 37422841 PMCID: PMC11371886 DOI: 10.1007/s00392-023-02248-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 06/19/2023] [Indexed: 07/11/2023]
Abstract
AIMS To establish reference values and clinically relevant determinants for measures of heart rate variability (HRV) and to assess their relevance for clinical outcome prediction in individuals with heart failure. METHODS Data from the MyoVasc study (NCT04064450; N = 3289), a prospective cohort on chronic heart failure with a highly standardized, 5 h examination, and Holter ECG recording were investigated. HRV markers were selected using a systematic literature screen and a data-driven approach. Reference values were determined from a healthy subsample. Clinical determinants of HRV were investigated via multivariable linear regression analyses, while their relationship with mortality was investigated by multivariable Cox regression analyses. RESULTS Holter ECG recordings were available for analysis in 1001 study participants (mean age 64.5 ± 10.5 years; female sex 35.4%). While the most frequently reported HRV markers in literature were from time and frequency domains, the data-driven approach revealed predominantly non-linear HRV measures. Age, sex, dyslipidemia, family history of myocardial infarction or stroke, peripheral artery disease, and heart failure were strongly related to HRV in multivariable models. In a follow-up period of 6.5 years, acceleration capacity [HRperSD 1.53 (95% CI 1.21/1.93), p = 0.0004], deceleration capacity [HRperSD: 0.70 (95% CI 0.55/0.88), p = 0.002], and time lag [HRperSD 1.22 (95% CI 1.03/1.44), p = 0.018] were the strongest predictors of all-cause mortality in individuals with heart failure independently of cardiovascular risk factors, comorbidities, and medication. CONCLUSION HRV markers are associated with the cardiovascular clinical profile and are strong and independent predictors of survival in heart failure. This underscores clinical relevance and interventional potential for individuals with heart failure. CLINICALTRIALS GOV IDENTIFIER NCT04064450.
Collapse
Affiliation(s)
- Silav Zeid
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Gregor Buch
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - David Velmeden
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Jakob Söhne
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Andreas Schulz
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Alexander Schuch
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Sven-Oliver Tröbs
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Marc William Heidorn
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Felix Müller
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Konstantin Strauch
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Katrin Coboeken
- SPM Methods and Applications, Research and Development, Pharmaceuticals, BAYER AG, Wuppertal, Germany
| | - Karl J Lackner
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Tommaso Gori
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
- Cardiology I, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Thomas Münzel
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
- Cardiology I, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jürgen H Prochaska
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
- Clinical Epidemiology and Systems Medicine, Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Philipp S Wild
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany.
- Clinical Epidemiology and Systems Medicine, Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
- Institute of Molecular Biology (IMB), Mainz, Germany.
| |
Collapse
|
2
|
Cathey BM, Bellach A, Troendle J, Smith K, Osgood S, Raja N, Kozel BA, Levin MD. Increased heart rate fragmentation in those with Williams-Beuren syndrome suggests nonautonomic mechanistic contributors to sudden death risk. Am J Physiol Heart Circ Physiol 2024; 327:H521-H532. [PMID: 38904853 DOI: 10.1152/ajpheart.00601.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 06/12/2024] [Accepted: 06/12/2024] [Indexed: 06/22/2024]
Abstract
Williams-Beuren syndrome (WBS) is a rare genetic condition caused by a chromosomal microdeletion at 7q11.23. It is a multisystem disorder characterized by distinct facies, intellectual disability, and supravalvar aortic stenosis (SVAS). Those with WBS are at increased risk of sudden death, but mechanisms underlying this remain poorly understood. We recently demonstrated autonomic abnormalities in those with WBS that are associated with increased susceptibility to arrhythmia and sudden cardiac death (SCD). A recently introduced method for heart rate variability (HRV) analysis called "heart rate fragmentation" (HRF) correlates with adverse cardiovascular events (CVEs) and death in studies where heart rate variability (HRV) failed to identify high-risk subjects. Some argue that HRF quantifies nonautonomic cardiovascular modulators. We, therefore, sought to apply HRF analysis to a WBS cohort to determine 1) if those with WBS show differences in HRF compared with healthy controls and 2) if HRF helps characterize HRV abnormalities in those with WBS. Similar to studies of those with coronary artery disease (CAD) and atherosclerosis, we found significantly higher HRF (4 out of 7 metrics) in those with WBS compared with healthy controls. Multivariable analyses showed a weak-to-moderate association between HRF and HRV, suggesting that HRF may reflect HRV characteristics not fully captured by traditional HRV metrics (autonomic markers). We also introduce a new metric inspired by HRF methodology, significant acute rate drop (SARD), which may detect vagal activity more directly. HRF and SARD may improve on traditional HRV measures to identify those at greatest risk for SCD both in those with WBS and in other populations.NEW & NOTEWORTHY This work is the first to apply heart rate fragmentation analyses to individuals with Williams syndrome and posits that the heart rate fragmentation parameter W3 may enable detection and investigation of phenomena underlying the proarrhythmic short-long-short RR interval sequences paradigm known to precede ventricular fibrillation and ventricular tachycardia. It also forwards a novel method for quantifying sinus arrhythmia and sinus pauses that likely correlate with parasympathetic activity.
Collapse
Affiliation(s)
- Brianna M Cathey
- School of Engineering Medicine, Texas A&M University, Houston, Texas, United States
- Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Anna Bellach
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - James Troendle
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Kevin Smith
- Nursing Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States
| | - Sharon Osgood
- Office of the Clinical Director, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Neelam Raja
- School of Engineering Medicine, Texas A&M University, Houston, Texas, United States
| | - Beth A Kozel
- Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Mark D Levin
- Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States
| |
Collapse
|
3
|
Meira do Valle SS, Hong H. Acupuncture Treatment for Generalized Anxiety Disorder by Activating the Vagus Nerve and Improving Heart-Rate Variability and Heart-Rhythm Coherence, A Case-Series Study. Med Acupunct 2024; 36:21-26. [PMID: 38405597 PMCID: PMC10890946 DOI: 10.1089/acu.2023.0036] [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: 02/27/2024] Open
Abstract
Objective The goal of this case series was to observe the effectiveness of acupuncture for reducing sympathetic stress and anxiety-related symptoms in generalized anxiety disorder. The effect of acupuncture on the balance of the autonomic nervous system was also examined. Materials and Methods This was a case-series study with 10 participants enrolled. Each participant received acupuncture treatment 2 times per week for 4 weeks. Participants were evaluated with the Generalized Anxiety Disorder-7 (GAD-7) scale and the Body Perception Questionnaire-Short Form (BPQ-SF) before and after the treatment program. Heart-rate variability heart-rhythm coherence (HRC) was also assessed during each acupuncture session. Results Five participants completed the program. Both GAD-7 and BPQ mean scores showed significant reductions. The mean HRC high-coherence ratio also increased significantly after acupuncture treatment. No adverse effects occurred. Conclusions Acupuncture may be an effective therapy for sympathetic stress and anxiety-related symptoms. The mechanism of action may be through activating the vagus nerve and improving the HRC high coherence ratio. It is feasible to conduct larger clinical trials with random controls, longer treatment durations, and long-term follow-ups to support the results of this study.
Collapse
Affiliation(s)
| | - Harry Hong
- Atlantic Institute of Oriental Medicine, Fort Lauderdale, Florida, USA
| |
Collapse
|
4
|
Perek S, Nussinovitch U, Sagi N, Gidron Y, Raz-Pasteur A. Prognostic implications of ultra-short heart rate variability indices in hospitalized patients with infective endocarditis. PLoS One 2023; 18:e0287607. [PMID: 37352199 PMCID: PMC10289432 DOI: 10.1371/journal.pone.0287607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/08/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Infective endocarditis (IE) is a disease that poses a serious health risk. It is important to identify high-risk patients early in the course of their treatment. In the current study, we evaluated the prognostic value of ultra-short heart-rate variability (HRV), an index of vagal nerve activity, in IE. METHODS Retrospective analysis was performed on adult patients admitted to a tertiary hospital due to IE. A logistic regression (LR) was used to determine whether clinical, laboratory, and HRV parameters were predictive of specific clinical features (valve type, staphylococcal infection) or severe short-term complications (cardiac, metastatic infection, and death). The accuracy of the model was evaluated through the measurement of the area under the curve (AUC) of the receiver operating characteristic curve (ROC). An analysis of survival was conducted using Cox regression. A number of HRV indices were calculated, including the standard deviation of normal heart-beat intervals (SDNN) and the root mean square of successive differences (RMSSD). RESULTS 75 patients, aged 60.3(±18.6) years old, were examined. When compared with published age- and gender-adjusted HRV norms, SDNN and RMSSD were found to be relatively low in our cohort (75%-76% lower than the median; 33%-41% lower than the 2nd percentile). 26(34.6%) patients developed a metastatic infection, with RMSSD<7.03ms (adjusted odds ratio (aOR) 9.340, p = 0.002), incorporated in a multivariate LR model (AUC 0.833). Furthermore, 27(36.0%) patients were diagnosed with Staphylococcus IE, with SDNN<4.92ms (aOR 5.235, p = 0.004), a major component of the multivariate LR model (AUC 0.741). Multivariate Cox regression survival model, included RMSSD (HR 1.008, p = 0.012). CONCLUSION SDNN, and particularly RMSSD, derived from ultra-short ECG recordings, may provide prognostic information about patients presenting with IE.
Collapse
Affiliation(s)
- Shay Perek
- Department of Internal Medicine A, Rambam Health Care Campus, Haifa, Israel
- Department of Emergency Medicine, Rambam Health Care Campus, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, The Technion–Israel Institute of Technology, Haifa, Israel
| | - Udi Nussinovitch
- Department of Cardiology, Wolfson Medical Center, Holon, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Neta Sagi
- Department of Pediatrics A, Rambam Health Care Campus, Haifa, Israel
| | - Yori Gidron
- Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Ayelet Raz-Pasteur
- Department of Internal Medicine A, Rambam Health Care Campus, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, The Technion–Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
5
|
Hung WC, Yu TH, Wu CC, Lee TL, Tsai IT, Hsuan CF, Chen CY, Chung FM, Lee YJ, Tang WH. FABP3, FABP4, and heart rate variability among patients with chronic schizophrenia. Front Endocrinol (Lausanne) 2023; 14:1165621. [PMID: 37255976 PMCID: PMC10225495 DOI: 10.3389/fendo.2023.1165621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/04/2023] [Indexed: 06/01/2023] Open
Abstract
Introduction The prevalence of cardiovascular disease (CVD) and CVD-related deaths in patients with schizophrenia is high. An elevated risk of CVD has been associated with low heart rate variability (HRV). There is increasing evidence that fatty acid-binding protein (FABP)3 and FABP4 play roles in the development and progression of CVD. This study aimed to explore the association of circulating FABP3/FABP4 levels with HRV in patients with chronic schizophrenia. Methods We included 265 consecutive patients with chronic schizophrenia who attended a disease management program. We used an enzyme-linked immunosorbent assay for the measurement of plasma concentrations of FABP3 and FABP4. Standard HRV was recorded at baseline following a standard protocol. Mean high- and low-frequency (HF/LF) HRV values were analyzed by tertile of FABP3 and FABP4 using one-way analysis of variance, and linear regression analysis was performed to assess trends. Results A positive association between FABP3 and creatinine was found in multiple regression analysis. In addition, negative associations between levels of hematocrit, hemoglobin, HF HRV, and estimated glomerular filtration rate (eGFR) with FABP3 were also found. Moreover, positive associations between FABP4 with body mass index, diabetes mellitus, hypertension, systolic blood pressure, low-density lipoprotein-cholesterol, triglycerides, creatinine, and FABP3 were found. Furthermore, negative associations between levels of high-density lipoprotein-cholesterol, eGFR, and HF HRV with FABP4 were found. We also found a significant inverse association between FABP3 and HF HRV (p for trend = 0.008), and significant inverse associations between FABP4 with HF and LF HRV (p for trend = 0.007 and 0.017, respectively). Discussion Together, this suggests that elevated levels of FABP3 and FABP4 may be linked to health problems related to CVD in patients with chronic schizophrenia.
Collapse
Affiliation(s)
- Wei-Chin Hung
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Teng-Hung Yu
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Cheng-Ching Wu
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Division of Cardiology, Department of Internal Medicine, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Thung-Lip Lee
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - I-Ting Tsai
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Department of Emergency, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Chin-Feng Hsuan
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Division of Cardiology, Department of Internal Medicine, E-Da Dachang Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Chun-Yu Chen
- Division of General Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fu-Mei Chung
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Yau-Jiunn Lee
- Department Head, Lee’s Endocrinologic Clinic, Pingtung, Taiwan
| | - Wei-Hua Tang
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Yuli Branch, Hualien, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| |
Collapse
|
6
|
Muñoz-Diosdado A, Solís-Montufar ÉE, Zamora-Justo JA. Visibility Graph Analysis of Heartbeat Time Series: Comparison of Young vs. Old, Healthy vs. Diseased, Rest vs. Exercise, and Sedentary vs. Active. ENTROPY (BASEL, SWITZERLAND) 2023; 25:e25040677. [PMID: 37190463 PMCID: PMC10137780 DOI: 10.3390/e25040677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023]
Abstract
Using the visibility graph algorithm (VGA), a complex network can be associated with a time series, such that the properties of the time series can be obtained by studying those of the network. Any value of the time series becomes a node of the network, and the number of other nodes that it is connected to can be quantified. The degree of connectivity of a node is positively correlated with its magnitude. The slope of the regression line is denoted by k-M, and, in this work, this parameter was calculated for the cardiac interbeat time series of different contrasting groups, namely: young vs. elderly; healthy subjects vs. patients with congestive heart failure (CHF); young subjects and adults at rest vs. exercising young subjects and adults; and, finally, sedentary young subjects and adults vs. active young subjects and adults. In addition, other network parameters, including the average degree and the average path length, of these time series networks were also analyzed. Significant differences were observed in the k-M parameter, average degree, and average path length for all analyzed groups. This methodology based on the analysis of the three mentioned parameters of complex networks has the advantage that such parameters are very easy to calculate, and it is useful to classify heartbeat time series of subjects with CHF vs. healthy subjects, and also for young vs. elderly subjects and sedentary vs. active subjects.
Collapse
Affiliation(s)
- Alejandro Muñoz-Diosdado
- Instituto Politécnico Nacional, Unidad Profesional Interdisciplinaria de Biotecnología, Mexico City 07340, Mexico
| | - Éric E Solís-Montufar
- Instituto Politécnico Nacional, Unidad Profesional Interdisciplinaria de Biotecnología, Mexico City 07340, Mexico
| | - José A Zamora-Justo
- Instituto Politécnico Nacional, Unidad Profesional Interdisciplinaria de Biotecnología, Mexico City 07340, Mexico
- Instituto Tecnológico de Santo Domingo (INTEC), Santo Domingo 10602, Dominican Republic
| |
Collapse
|
7
|
Pulse Wave Velocity and Blood Pressure Variability as Prognostic Indicators in Very Elderly Patients. J Clin Med 2023; 12:jcm12041510. [PMID: 36836044 PMCID: PMC9963376 DOI: 10.3390/jcm12041510] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/09/2023] [Accepted: 02/11/2023] [Indexed: 02/17/2023] Open
Abstract
There is scarce evidence for the prognostic importance of hemodynamic measures, such as blood pressure (BP), BP variability, and arterial stiffness, in the very elderly population with advanced chronic conditions. We aimed to evaluate the prognostic importance of 24 h BP, BP variability, and arterial stiffness in a cohort of very elderly patients admitted to the hospital due to a decompensated chronic disease. We studied 249 patients older than 80 (66% women; 60% congestive heart failure). Noninvasive 24 h monitoring was used to determine 24 h brachial and central BP, BP and heart rate variabilities, aortic pulse wave velocity, and BP variability ratios during admission. The primary outcome was 1-year mortality. Aortic pulse wave velocity (3.3 times for each SD increase) and BP variability ratio (31% for each SD increase) were associated with 1-year mortality, after adjustments for clinical confounders. Increased systolic BP variability (38% increase for each SD change) and reduced heart rate variability (32% increase for each SD change) also predicted 1-year mortality. In conclusion, increased aortic stiffness and BP and heart rate variabilities predict 1-year mortality in very elderly patients with decompensated chronic conditions. Measurements of such estimates could be useful in the prognostic evaluation of this specific population.
Collapse
|
8
|
Hurvitz N, Elkhateeb N, Sigawi T, Rinsky-Halivni L, Ilan Y. Improving the effectiveness of anti-aging modalities by using the constrained disorder principle-based management algorithms. FRONTIERS IN AGING 2022; 3:1044038. [PMID: 36589143 PMCID: PMC9795077 DOI: 10.3389/fragi.2022.1044038] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022]
Abstract
Aging is a complex biological process with multifactorial nature underlined by genetic, environmental, and social factors. In the present paper, we review several mechanisms of aging and the pre-clinically and clinically studied anti-aging therapies. Variability characterizes biological processes from the genome to cellular organelles, biochemical processes, and whole organs' function. Aging is associated with alterations in the degrees of variability and complexity of systems. The constrained disorder principle defines living organisms based on their inherent disorder within arbitrary boundaries and defines aging as having a lower variability or moving outside the boundaries of variability. We focus on associations between variability and hallmarks of aging and discuss the roles of disorder and variability of systems in the pathogenesis of aging. The paper presents the concept of implementing the constrained disease principle-based second-generation artificial intelligence systems for improving anti-aging modalities. The platform uses constrained noise to enhance systems' efficiency and slow the aging process. Described is the potential use of second-generation artificial intelligence systems in patients with chronic disease and its implications for the aged population.
Collapse
Affiliation(s)
- Noa Hurvitz
- Faculty of Medicine, Hebrew University and Department of Medicine, Hadassah Medical Center, Jerusalem, Israel
| | - Narmine Elkhateeb
- Faculty of Medicine, Hebrew University and Department of Medicine, Hadassah Medical Center, Jerusalem, Israel
| | - Tal Sigawi
- Faculty of Medicine, Hebrew University and Department of Medicine, Hadassah Medical Center, Jerusalem, Israel
| | - Lilah Rinsky-Halivni
- Braun School of Public Health, Hebrew University of Jerusalem, Jerusalem, Israel,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Yaron Ilan
- Faculty of Medicine, Hebrew University and Department of Medicine, Hadassah Medical Center, Jerusalem, Israel,*Correspondence: Yaron Ilan,
| |
Collapse
|
9
|
Touzot M, Reach P, Mobio A, Sacco E, Fels A, Beaussier H, Ureña-Torres P, Chatellier G, Ridel C, Zuber M. Association of Electrochemical Skin Conductance by Sudoscan and Cardiovascular Outcomes in Hemodialysis Patients. Kidney Int Rep 2022; 7:2734-2736. [PMID: 36506235 PMCID: PMC9727515 DOI: 10.1016/j.ekir.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/18/2022] [Accepted: 09/12/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Maxime Touzot
- AURA Paris Plaisance, Dialyse et aphérèse thérapeutique, Paris, France
- Correspondence: Maxime Touzot, AURA Paris Plaisance, Dialyse et aphérèse thérapeutique, Paris, France.
| | - Pauline Reach
- Service de neurologie, Groupe Hospitalier Saint-joseph, Paris, France
- Pauline Reach, Service de neurologie, Groupe Hospitalier Saint-joseph, Paris, France.
| | - Angela Mobio
- AURA Paris Plaisance, Dialyse et aphérèse thérapeutique, Paris, France
| | - Emmanuelle Sacco
- Centre de recherche Clinique, Groupe Hospitalier Saint-joseph Paris, France
| | - Audrey Fels
- Centre de recherche Clinique, Groupe Hospitalier Saint-joseph Paris, France
| | - Hélène Beaussier
- Centre de recherche Clinique, Groupe Hospitalier Saint-joseph Paris, France
| | | | - Gilles Chatellier
- CIC 1418, Hôpital Européen Georges Pompidou Paris France
- Université de Paris, Paris, France
| | - Christophe Ridel
- AURA Paris Plaisance, Dialyse et aphérèse thérapeutique, Paris, France
| | - Mathieu Zuber
- Service de neurologie, Groupe Hospitalier Saint-joseph, Paris, France
- Université de Paris, Paris, France
| |
Collapse
|
10
|
Ramesh S, James MT, Holroyd‐Leduc JM, Wilton SB, Sola DY, Ahmed SB. Heart rate variability as a function of menopausal status, menstrual cycle phase, and estradiol level. Physiol Rep 2022; 10:e15298. [PMID: 35608101 PMCID: PMC9127980 DOI: 10.14814/phy2.15298] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/17/2022] [Accepted: 04/22/2022] [Indexed: 05/15/2023] Open
Abstract
Low estradiol status is associated with increased cardiovascular risk. We sought to determine the association between heart rate variability (HRV), a marker of cardiovascular risk, at baseline and in response to stressor as a function of menopausal status, menstrual cycle phase and estradiol level. Forty-one healthy women (13 postmenopausal, 28 premenopausal) were studied. Eleven premenopausal women were additionally studied in the high and low estradiol phases of the menstrual cycle. HRV was calculated by spectral power analysis (low Frequency (LF), high frequency (HF) and LF:HF) at baseline and in response to graded Angiotensin II (AngII) infusion. The primary outcomes were differences in HRV at baseline and in response to AngII. Compared to premenopausal women in the low estradiol phase, postmenopausal women demonstrated lower baseline LF (p = 0.01) and HF (p < 0.001) measures, which were not significant after adjustment for age and BMI. In response to AngII, a decrease in cardioprotective HRV (ΔHF = -0.43 ± 0.46 ln ms2 , p = 0.005 vs. baseline) was observed in postmenopausal women versus premenopausal women. Baseline HRV parameters did not differ by menstrual phase in premenopausal women. During the low estradiol phase, no differences were observed in the HRV response to AngII challenge. In contrast, women in the high estradiol phase were unable to maintain HRV (ΔLF = -0.07 ± 0.46 ln ms2 , p = 0.048 response vs. baseline, ΔHF = -0.33 ± 0.74 ln ms2, p = 0.048 response vs. baseline). No association was observed between any measure of HRV and estradiol level. Menopausal status and the high estradiol phase in premenopausal women were associated with reduced HRV, a marker of cardiovascular risk. Understanding the role of estradiol in the modulation of cardiac autonomic tone may help guide risk reduction strategies in women.
Collapse
Affiliation(s)
- Sharanya Ramesh
- Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Matthew T. James
- Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Libin Cardiovascular InstituteCalgaryAlbertaCanada
| | | | - Stephen B. Wilton
- Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Darlene Y Sola
- Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Sofia B. Ahmed
- Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Libin Cardiovascular InstituteCalgaryAlbertaCanada
| |
Collapse
|
11
|
Factors Associated with Reduced Heart Rate Variability in the General Japanese Population: The Iwaki Cross-Sectional Research Study. Healthcare (Basel) 2022; 10:healthcare10050793. [PMID: 35627930 PMCID: PMC9141757 DOI: 10.3390/healthcare10050793] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/20/2022] [Accepted: 04/22/2022] [Indexed: 12/20/2022] Open
Abstract
Although many studies have reported factors associated with reduced heart rate variability (HRV) in Western populations, evidence is limited among Asian populations. Therefore, we investigated the factors associated with reduced HRV values in a general Japanese population by measuring HRV among the participants of the Iwaki Health Promotion Project who underwent medical examination in 2019. We performed 90-s HRV measurements in 1065 participants. Of these, we evaluated the coefficient of variation in R–R intervals (CVRR) and standard deviation in R–R intervals (SDNN). Blood was collected under a fasting condition, and investigations of glucose metabolism, lipid metabolism, renal function, liver function, advanced glycation end products, and blood pressure were performed. A multivariate regression analysis of the association between CVRR or SDNN and blood test parameters and blood pressure in 987 participants with adequately completed HRV assessments showed that reduced CVRR or SDNN was associated with higher levels of glycated hemoglobin (HbA1c), glycoalbumin, blood glucose, triglycerides, creatinine, plasma pentosidine, and diastolic blood pressure. In the general Japanese population, higher levels of HbA1c, glycoalbumin, blood glucose, triglycerides, creatinine, plasma pentosidine, and diastolic blood pressure are associated with reduced CVRR or SDNN, which are typical HRV parameters.
Collapse
|
12
|
Pereira ABN, Santana LL, Rocha LDB, Cunha KDC, Rocha LSDO, Santos MCDS, Normando VMF, Torres DDC, Rocha RSB. Physical Exercise Affects Quality of Life and Cardiac Autonomic Modulation in Patients With Chronic Kidney Failure Submitted to Hemodialysis: A Randomized Clinical Trial. Percept Mot Skills 2022; 129:696-713. [DOI: 10.1177/00315125221085811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Performing physical exercise during hemodialysis has been debated regarding safety and efficacy for improving life quality for patients with chronic kidney disease (CKD). Thus, we explored the influence of physical exercise during hemodialysis on both autonomic modulation of heart rate and quality of life for patients with CKF in a randomized clinical trial. We randomly allocated participants requiring hemodialysis to an experimental exercise group (EG) and a control no-exercise group (CG) and assessed their quality of life with the Kidney Disease Quality of Life Short Form—KDQOL-SF™ 1.3 and with Polar RS800CX to monitor their heart rate variability (HRV) before and three months after the end of the exercise intervention. EG participants reported a significant increase in their quality of life ( p = .05, physical function, physical aspects, pain, emotional well-being, emotional function; p = .03, energy and fatigue) and showed HRV improvement ( p = .05, RMSSD, SDNN, and SD2; p = .004, SD1) after three months of exercise. Thus, we recommend supervised physical exercise during hemodialysis for carefully selected patients.
Collapse
Affiliation(s)
| | | | | | - Katiane Da Costa Cunha
- Department of Morphology and Physiological Sciences, University of Pará State, Belém, Brazil
| | | | | | | | | | | |
Collapse
|
13
|
Mallamaci F, Tripepi R, Torino C, Tripepi G, Sarafidis P, Zoccali C. Early morning hemodynamic changes and left ventricular hypertrophy and mortality in hemodialysis patients. J Nephrol 2022; 35:1399-1407. [PMID: 35303286 DOI: 10.1007/s40620-022-01281-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/07/2022] [Indexed: 01/08/2023]
Abstract
INTRODUCTION An exaggeration of the early morning increase in BP, a phenomenon accompanied by a parallel rise in heart rate (HR), is a marker of high cardiovascular risk. The early morning changes in these parameters have not been investigated in the hemodialysis population. METHODS In a pilot, single center study including a series of 58 patients we measured the pre-awakening BP and HR surges and the nocturnal dipping of the same parameters as well as other established indicators of autonomic function (weighted 24 h systolic BP and HR variability) and tested their relationship with the left ventricular mass index (LVMI) and with the risk of death over a median follow up of 40 months. RESULTS The pre-awakening HR surge (r = - 0.46, P = 0.001) but not the corresponding BP surge (r = - 0.1, P = 0.98) was associated with LVMI and the risk of death [HR (1 unit): 0.89, 95% CI 0.83-0.96, P = 0.001]. The link between the pre-awakening HR surge with these outcome measures was robust and largely independent of established risk factors in the hemodialysis population, including the nocturnal dipping of BP. Weighted 24 h systolic BP and HR variability did not correlate with LVMI (all P > 0.11) nor with the risk of death (P > 0.11) and were also independent of the nocturnal dipping of systolic BP and HR. CONCLUSION This pilot study suggests that the low early morning changes in HR, likely reflecting enhanced sympathetic activity, entail a high risk for left ventricular hypertrophy (LVH) and mortality in the hemodialysis population.
Collapse
Affiliation(s)
- Francesca Mallamaci
- CNR-IFC, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy.,Divisione di Nefrologia e, Trapianto Renale Grande Ospedale Metropolitano, Reggio Calabria, Italy
| | - Rocco Tripepi
- CNR-IFC, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Claudia Torino
- CNR-IFC, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Giovanni Tripepi
- CNR-IFC, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Pantelis Sarafidis
- Department of Nephrology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Carmine Zoccali
- Renal Research Institute, New York, USA. .,Associazione Ipertensione Nefrologia e Trapianto Renale (IPNET), Reggio Calabria, Italy. .,IPNET C/o CNR-IFC and Nefrologia Grande Ospedale Metropolitano, Reggio Calabria, Italy.
| |
Collapse
|
14
|
Chueainta P, Punyapornwithaya V, Tangjitjaroen W, Pongkan W, Boonyapakorn C. Acupuncture Improves Heart Rate Variability, Oxidative Stress Level, Exercise Tolerance, and Quality of Life in Tracheal Collapse Dogs. Vet Sci 2022; 9:vetsci9020088. [PMID: 35202341 PMCID: PMC8875848 DOI: 10.3390/vetsci9020088] [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] [Received: 01/21/2022] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 02/01/2023] Open
Abstract
Among the respiratory disorders in dogs from small breeds, tracheal collapse is one of the most commonly found in clinical practice. Presently, acupuncture is widely used as an alternative treatment which was shown to bring about positive effects in the treatment of human respiratory diseases. The present study demonstrated the effect of acupuncture on tracheal collapse dogs. We hypothesized that acupuncture can help dogs suffering from tracheal collapse by improving various parameters including heart rate variability, serum biomarkers for oxidative stress, exercise performance, and quality of life. Twenty client-owned dogs from small breeds with tracheal collapse disease were enrolled. The study was divided into two 5-week periods. During the first period, the dogs received normal veterinary care but received no acupuncture treatment (NAC). After completing that period, all forms of treatment were withheld for one week before the beginning of the second period. In the second period, all dogs restarted normal veterinary care and underwent acupuncture treatment (AC) once a week for five consecutive weeks. Blood was collected at the beginning and end of each of the two periods for malondialdehyde (MDA) level measurement. Heart rate variability (HRV) was recorded at the 1st, 3rd and 5th weeks of both periods. Exercise tests were performed at the beginning and end of AC period and questionnaire interviews with the owners were accomplished at the end of each period. The results showed that acupuncture can alleviate clinical signs of tracheal collapse, reduce MDA level, and improve sympathovagal balance. We suggest that acupuncture treatment could be used as an adjunct treatment for canine tracheal collapse.
Collapse
Affiliation(s)
- Phurion Chueainta
- Veterinary Cardiopulmonary Clinic, Small Animal Hospital, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.C.); (W.P.)
| | - Veerasak Punyapornwithaya
- Department of Food Animal Clinic, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai 50100, Thailand;
| | - Weerapongse Tangjitjaroen
- Department of Companion Animal and Wildlife Clinic, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai 50100, Thailand;
| | - Wanpitak Pongkan
- Veterinary Cardiopulmonary Clinic, Small Animal Hospital, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.C.); (W.P.)
- Department of Veterinary Biosciences and Veterinary Public Health, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai 50100, Thailand
- Integrative Research Center for Veterinary Preventive Medicine, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai 50100, Thailand
| | - Chavalit Boonyapakorn
- Veterinary Cardiopulmonary Clinic, Small Animal Hospital, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.C.); (W.P.)
- Department of Companion Animal and Wildlife Clinic, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai 50100, Thailand;
- Integrative Research Center for Veterinary Preventive Medicine, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai 50100, Thailand
- Correspondence:
| |
Collapse
|
15
|
Menshov VA, Trofimov AV, Zagurskaya AV, Berdnikova NG, Yablonskaya OI, Platonova AG. Influence of Nicotine from Diverse Delivery Tools on the Autonomic Nervous and Hormonal Systems. Biomedicines 2022; 10:biomedicines10010121. [PMID: 35052800 PMCID: PMC8773565 DOI: 10.3390/biomedicines10010121] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/02/2022] [Accepted: 01/03/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Through measurements of the heart rate variability (HRV) accompanied by the pertinent biomarker assays, the effects of nicotine and byproducts derived from alternative nicotine delivery systems (ANDS) on the autonomic nervous system (ANS) and hormonal system have been investigated. Methods: HRV was studied in a group of volunteers (17 people), involving non-smokers, i.e., who never smoked before (11), ex-smokers (4) and active smokers (2). ANDS and smoking simulators, including regular, nicotine-free and electronic cigarettes; tobacco heating systems; chewing gums and nicotine packs of oral fixation (nic-packs), were used. Blood pressure, levels of stress hormones in saliva and catecholamines in the blood were also monitored. Results: HRV analysis showed relatively small changes in HRV and in the other studied parameters with the systemic use of nic-packs with low and moderate nicotine contents (up to 6 mg) compared to other ANDS. Conclusions: The HRV method is proven to be a promising technique for evaluation of the risks associated with smoking, dual use of various ANDS and studying the biomedical aspects of smoking cessation. Nic-packs are shown to be leaders in biological safety among the studied ANDS. A sharp surge in the activity of the sympathetic division of the ANS within the first minutes of the use of nicotine packs implies that nicotine begins to act already at very low doses (before entering the blood physically in any significant amount) through fast signal transmission to the brain from the nicotinic and taste buds located in the mouth area.
Collapse
Affiliation(s)
- Valerii A. Menshov
- Emanuel Institute of Biochemical Physics, Russian Academy of Sciences, 119334 Moscow, Russia; (N.G.B.); (O.I.Y.)
- Correspondence: (V.A.M.); (A.V.T.); Tel.: +7-495-9397358 (A.V.T.); Fax: +7-499-1374101 (V.A.M. & A.V.T.)
| | - Aleksei V. Trofimov
- Emanuel Institute of Biochemical Physics, Russian Academy of Sciences, 119334 Moscow, Russia; (N.G.B.); (O.I.Y.)
- Moscow Institute of Physics and Technology (National Research University), 141701 Dolgoprudny, Russia
- Correspondence: (V.A.M.); (A.V.T.); Tel.: +7-495-9397358 (A.V.T.); Fax: +7-499-1374101 (V.A.M. & A.V.T.)
| | | | - Nadezda G. Berdnikova
- Emanuel Institute of Biochemical Physics, Russian Academy of Sciences, 119334 Moscow, Russia; (N.G.B.); (O.I.Y.)
- Department of Clinical Pharmacology, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia
| | - Olga I. Yablonskaya
- Emanuel Institute of Biochemical Physics, Russian Academy of Sciences, 119334 Moscow, Russia; (N.G.B.); (O.I.Y.)
| | | |
Collapse
|
16
|
Lahens NF, Rahman M, Cohen JB, Cohen DL, Chen J, Weir MR, Feldman HI, Grant GR, Townsend RR, Skarke C, Study Investigators* ATCRIC. Time-specific associations of wearable sensor-based cardiovascular and behavioral readouts with disease phenotypes in the outpatient setting of the Chronic Renal Insufficiency Cohort. Digit Health 2022; 8:20552076221107903. [PMID: 35746950 PMCID: PMC9210076 DOI: 10.1177/20552076221107903] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/30/2022] [Indexed: 11/15/2022] Open
Abstract
Patients with chronic kidney disease are at risk of developing cardiovascular disease. To facilitate out-of-clinic evaluation, we piloted wearable device-based analysis of heart rate variability and behavioral readouts in patients with chronic kidney disease from the Chronic Renal Insufficiency Cohort and controls (n = 49). Time-specific partitioning of heart rate variability readouts confirm higher parasympathetic nervous activity during the night (mean RR at night 14.4 ± 1.9 ms vs. 12.8 ± 2.1 ms during active hours; n = 47, analysis of variance (ANOVA) q = 0.001). The α2 long-term fluctuations in the detrended fluctuation analysis, a parameter predictive of cardiovascular mortality, significantly differentiated between diabetic and nondiabetic patients (prominent at night with 0.58 ± 0.2 vs. 0.45 ± 0.12, respectively, adj. p = 0.004). Both diabetic and nondiabetic chronic kidney disease patients showed loss of rhythmic organization compared to controls, with diabetic chronic kidney disease patients exhibiting deconsolidation of peak phases between their activity and standard deviation of interbeat intervals rhythms (mean phase difference chronic kidney disease 8.3 h, chronic kidney disease/type 2 diabetes mellitus 4 h, controls 6.8 h). This work provides a roadmap toward deriving actionable clinical insights from the data collected by wearable devices outside of highly controlled clinical environments.
Collapse
Affiliation(s)
- Nicholas F. Lahens
- Institute for Translational Medicine and Therapeutics (ITMAT), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia,
PA, USA
| | - Mahboob Rahman
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Jordana B. Cohen
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Debbie L. Cohen
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jing Chen
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Matthew R. Weir
- Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Harold I. Feldman
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Gregory R. Grant
- Institute for Translational Medicine and Therapeutics (ITMAT), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Raymond R. Townsend
- Institute for Translational Medicine and Therapeutics (ITMAT), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Carsten Skarke
- Institute for Translational Medicine and Therapeutics (ITMAT), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia,
PA, USA
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | |
Collapse
|
17
|
Costa MD, Redline S, Hughes TM, Heckbert SR, Goldberger AL. Prediction of Cognitive Decline Using Heart Rate Fragmentation Analysis: The Multi-Ethnic Study of Atherosclerosis. Front Aging Neurosci 2021; 13:708130. [PMID: 34512310 PMCID: PMC8428192 DOI: 10.3389/fnagi.2021.708130] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/06/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Heart rate fragmentation (HRF), a new non-invasive metric quantifying cardiac neuroautonomic function, is associated with increasing age and cardiovascular disease. Since these are risk factors for cognitive decline and dementia, in the Multi-Ethnic Study of Atherosclerosis (MESA), we investigated whether disrupted cardiac neuroautonomic function, evidenced by increased HRF, would be associated with worse cognitive function assessed concurrently and at a later examination, and with greater cognitive decline. Methods: HRF was derived from the ECG channel of the polysomnographic recordings obtained in an ancillary study (n = 1,897) conducted in conjunction with MESA exam 5 (2010–2012). Cognitive function was assessed at exam 5 and 6.4 ± 0.5 years later at exam 6 (2016–2018) with tests of global cognitive performance (the Cognitive Abilities Screening Instrument, CASI), processing speed (Digit Symbol Coding, DSC) and working memory (Digit Span). Multivariable regression models were used to quantify the associations between HRF indices and cognitive scores. Results: The participants’ mean age was 68 ± 9 years (54% female). Higher HRF at baseline was independently associated with lower cognitive scores at both exams 5 and 6. Specifically, in cross-sectional analyses, a one-standard deviation (SD) (13.7%) increase in HRF was associated with a 0.51 (95% CI: 0.17–0.86) points reduction in CASI and a 1.12 (0.34–1.90) points reduction in DSC. Quantitatively similar effects were obtained in longitudinal analyses. A one-SD increase in HRF was associated with a 0.44 (0.03–0.86) and a 1.04 (0.28–1.81) points reduction in CASI and DSC from exams 5 to 6, respectively. HRF added predictive value to the Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE-APOE-ε4) risk score and to models adjusted for serum concentration of NT-proBNP, an analyte associated with cognitive impairment and dementia. Conclusion: Increased HRF assessed during sleep was independently associated with diminished cognitive performance (concurrent and future) and with greater cognitive decline. These findings lend support to the links between cardiac neuroautonomic regulation and cognitive function. As a non-invasive, repeatable and inexpensive probe, HRF technology may be useful in monitoring cognitive status, predicting risk of dementia and assessing therapeutic interventions.
Collapse
Affiliation(s)
- Madalena D Costa
- Margret and H. A. Rey Institute for Non-linear Dynamics in Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Department of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, United States.,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Timothy M Hughes
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States.,Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Ary L Goldberger
- Margret and H. A. Rey Institute for Non-linear Dynamics in Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| |
Collapse
|
18
|
Min JW, Chang JY, Lee H, Park Y, Ko EJ, Cho JH, Yang CW, Chung BH. Clinical significance of heart rate variability for the monitoring of cardiac autonomic neuropathy in end-stage renal disease patients. Nutr Metab Cardiovasc Dis 2021; 31:2089-2098. [PMID: 33975739 DOI: 10.1016/j.numecd.2021.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/01/2021] [Accepted: 03/17/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS The aim of this study is to determine whether the measurement of continuous heart rate variability (HRV) is useful in the evaluation of cardiac autonomic neuropathy (CAN) in end-stage renal disease (ESRD) patients. METHODS AND RESULTS This cross-sectional study was performed at Seoul St. Mary's hospital between June 2017 and February 2018. Seventy-seven ESRD patients, and 29 healthy controls (HCs) were asked to wear a continuous ambulatory HRV monitor for 24 h. General cardiac function was evaluated using transthoracic echocardiogram (TTE), pulse wave velocity (PWV), coronary calcium scoring (CCS), and 24-h ambulatory blood pressure monitoring (ABPM). HRV parameters of ESRD patients and HCs, and the correlation of HRV parameters with cardiovascular screening methods were observed. All HRV parameters were significantly decreased in ESRD patients compared to HCs (P < 0.001). In the correlation analysis between TTE results and HRV parameters, 24-h standard deviation of all N-N intervals (24SDNN), 24-h standard deviation of sequential 5-min N-N interval means (24DANN) and Low Frequency Power/High Frequency Power (LF/HF) ratio showed negative correlations with E/e', LAVI and TR velocity which are representative indices for the diastolic function of the heart (P < 0.05). HRV parameters showed negative correlations with baPWV, CCS, and 24-h ABPM results as well (P < 0.05). Hemoglobin and serum albumin showed positive correlations with HRV parameters, and glucose, BUN, creatinine, and iPTH levels showed negative correlations (P < 0.05). CONCLUSION Continuous HRV monitoring may be a useful tool for the evaluation of CAN in ESRD.
Collapse
Affiliation(s)
- Ji Won Min
- Division of Nephrology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ji-Yeun Chang
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hanbi Lee
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yohan Park
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Eun Jeong Ko
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jae Hyoung Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Chul Woo Yang
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Byung Ha Chung
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
| |
Collapse
|
19
|
Roumeliotis A, Roumeliotis S, Chan C, Pierratos A. Cardiovascular Benefits of Extended-Time Nocturnal Hemodialysis. Curr Vasc Pharmacol 2021; 19:21-33. [PMID: 32234001 DOI: 10.2174/1570161118666200401112106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 01/09/2023]
Abstract
Hemodialysis (HD) remains the most utilized treatment for End-Stage Kidney Disease (ESKD) globally, mainly as conventional HD administered in 4 h sessions thrice weekly. Despite advances in HD delivery, patients with ESKD carry a heavy cardiovascular morbidity and mortality burden. This is associated with cardiac remodeling, left ventricular hypertrophy (LVH), myocardial stunning, hypertension, decreased heart rate variability, sleep apnea, coronary calcification and endothelial dysfunction. Therefore, intensive HD regimens closer to renal physiology were developed. They include longer, more frequent dialysis or both. Among them, Nocturnal Hemodialysis (NHD), carried out at night while asleep, provides efficient dialysis without excessive interference with daily activities. This regimen is closer to the physiology of the native kidneys. By providing increased clearance of small and middle molecular weight molecules, NHD can ameliorate uremic symptoms, control hyperphosphatemia and improve quality of life by allowing a liberal diet and free time during the day. Lastly, it improves reproductive biology leading to successful pregnancies. Conversion from conventional to NHD is followed by improved blood pressure control with fewer medications, regression of LVH, improved LV function, improved sleep apnea, and stabilization of coronary calcifications. These beneficial effects have been associated, among others, with better extracellular fluid volume control, improved endothelial- dependent vasodilation, decreased total peripheral resistance, decreased plasma norepinephrine levels and restoration of heart rate variability. Some of these effects represent improvements in outcomes used as surrogates of hard outcomes related to cardiovascular morbidity and mortality. In this review, we consider the cardiovascular effects of NHD.
Collapse
Affiliation(s)
- Athanasios Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stefanos Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christopher Chan
- University Health Network, Toronto General Hospital, Toronto, Canada
| | | |
Collapse
|
20
|
de Deus LA, Neves RVP, Corrêa HDL, Reis AL, Honorato FS, Silva VL, de Araújo TB, Souza MK, Sousa CV, Simões HG, Prestes J, Silva Neto LS, Rodrigues Santos CA, Melo GF, Stone WJ, Rosa TS. Improving the prognosis of renal patients: The effects of blood flow-restricted resistance training on redox balance and cardiac autonomic function. Exp Physiol 2021; 106:1099-1109. [PMID: 33586254 DOI: 10.1113/ep089341] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 01/28/2021] [Indexed: 12/28/2022]
Abstract
NEW FINDINGS What is the central question of this study? Can resistance training with and without blood flow restriction improve redox balance and positively impact the autonomic cardiac modulation in chronic kidney disease patients? What is the main finding and its importance? Resistance training with and without blood flow restriction improved antioxidant defence (paraoxonase 1), decreased the pro-oxidative myeloperoxidase, improved cardiac autonomic function and slowed the decrease in renal function. We draw attention to the important clinical implications for the management of redox balance and autonomic cardiac function in chronic kidney disease patients. ABSTRACT Patients with chronic kidney disease (CKD) are prone to cardiovascular diseases secondary to abnormalities in both autonomic cardiac function and redox balance [myeloperoxidase (MPO) to paraoxonase 1 (PON1) ratio]. Although aerobic training improves both autonomic balance and redox balance in patients with CKD, the cardioprotective effects of resistance training (RT), with and without blood flow restriction (BFR), remain unknown. We aimed to compare the effects of RT and RT+BFR on antioxidant defence (PON1), pro-oxidative status (MPO), cardiac autonomic function (quantified by heart rate variability analysis) and renal function. Conservative CKD (stages 1 to 5 who do not need hemodialysis) patients (n = 105, 33 female) of both sexes were randomized into three groups: control (CTL; 57.6 ± 5.2 years; body mass index, 33.23 ± 1.62 kg/m2 ), RT (58.09 ± 6.26 years; body mass index 33.63 ± 2.05 kg/m2 ) and RT+BFR (58.06 ± 6.47 years; body mass index, 33.32 ± 1.87 kg/m2 ). Patients completed 6 months of RT or RT+BFR on three non-consecutive days per week under the supervision of strength and conditioning professionals. Training loads were adjusted every 2 months. Heart rate variability was recorded with a Polar-RS800 and data were analysed for time and frequency domains using Kubios software. The redox balance markers were PON1 and MPO, which were analysed in plasma samples. Renal function was estimated as estimated glomerular filtration rate. The RT and RT+BFR decreased pro-oxidative MPO (RT, ∼34 ng/ml and RT+BFR, ∼27 ng/ml), improved both antioxidant defence (PON1: RT, ∼23 U/L and RT+BFR, ∼31 U/L) and cardiac autonomic function (R-R interval: RT, ∼120.4 ms and RT+BFR, ∼117.7 ms), and slowed the deterioration of renal function (P < 0.0001). Redox balance markers were inversely correlated with heart rate variability time-domain indices. Our data indicated that both training models were effective as non-pharmacological tools to increase the antioxidant defences, decrease oxidative stress and improve the cardiac autonomic function of CKD patients.
Collapse
Affiliation(s)
| | | | - Hugo de Luca Corrêa
- Graduate Program in Physical Education, Catholic University of Brasília, DF, Brazil
| | - Andrea Lucena Reis
- Graduate Program in Physical Education, Catholic University of Brasília, DF, Brazil
| | | | - Victor Lopes Silva
- Graduate Program in Physical Education, Catholic University of Brasília, DF, Brazil
| | | | - Michel Kendy Souza
- Graduate Program in Physical Education, Catholic University of Brasília, DF, Brazil
| | - Caio Victor Sousa
- Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | | | - Jonato Prestes
- Graduate Program in Physical Education, Catholic University of Brasília, DF, Brazil
| | | | | | | | - Whitley Jo Stone
- School of Kinesiology, Recreation, and Sport, Western Kentucky University, Bowling Green, Kentucky, USA
| | - Thiago Santos Rosa
- Graduate Program in Physical Education, Catholic University of Brasília, DF, Brazil
| |
Collapse
|
21
|
Yang L, Zhao Y, Qiao B, Wang Y, Zhang L, Cui T, Fu P. Heart Rate Variability and Prognosis in Hemodialysis Patients: A Meta-Analysis. Blood Purif 2020; 50:298-308. [PMID: 33291108 DOI: 10.1159/000511723] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 09/19/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Heart rate variability (HRV) means the variation in time of beat-to-beat interval. Lower HRV has been shown to be related with death and cardiovascular events in previous studies. In the last few years, the number of patients with ESRD has increased steadily. Maintenance hemodialysis is the most prevalent renal replacement therapy in patients with ESRD. This study aims to investigate if decreased HRV is an independent predictor of mortality in maintenance hemodialysis patients. METHODS Pubmed/Medline, EMBASE, Ovid, the Web of Science, and the Cochrane Central Register of Controlled Trials databases were searched up to October 1, 2019, for full-text articles in English. Cohort studies reporting the association between HRV and prognosis in hemodialysis patients were selected. Data extraction was performed by 2 reviewers independently, with adjudication by a third reviewer. Extracted data included the study characteristics, HRV measurement and research outcomes. Hazard ratios (HRs) and 95% confidence interval (CI) were pooled in a random-effects model for outcomes of all-cause and cardiovascular mortality. Heterogeneity assessment, subgroup analyses, and sensitivity analysis were conducted. RESULTS A total of 7 studies were eligible. HRV metrics consist of SDNN, SDANN, RMSSD, pNN50, HRVTI, ULF, VLF, LF, HF, LF/HF ratio, HRT, DC, and scaling exponents α1 and α2. Decreased HRV was associated with higher all-cause mortality (HR: 1.63, 95% CI: 1.11-2.39, p = 0.014) and cardiovascular mortality (HR: 1.07, 95% CI: 1.00-1.15, p = 0.045). Among the different HRV metrics, decreased SDANN (p < 0.001) and decreased LF/HF ratio (p = 0.001) were identified as predictors of all-cause death. Decreased SDNN, SDANN, and LF/HF ratio were identified as predictors of cardiovascular death (p = 0.004, p = 0.001, and p = 0.002). CONCLUSIONS Decreased HRV is associated with higher risk of all-cause and cardiovascular death in the hemodialysis population. Decreased SDANN and LF/HF were identified as predictors of both all-cause and cardiovascular mortality, while the utility of other HRV metrics requires further investigation. The protocol for this study was registered with PROSPERO (CRD42019141886).
Collapse
Affiliation(s)
- Letian Yang
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China.,Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
| | - Yuliang Zhao
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China, .,Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China,
| | - Baiyu Qiao
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Yating Wang
- Department of Internal Medicine, Louis A Weiss Memorial Hospital, Chicago, Illinois, USA
| | - Ling Zhang
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China.,Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
| | - Tianlei Cui
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China.,Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
| | - Ping Fu
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China.,Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
| |
Collapse
|
22
|
van Rijn MHC, van de Luijtgaarden M, van Zuilen AD, Blankestijn PJ, Wetzels JFM, Debray TPA, van den Brand JAJG. Prognostic models for chronic kidney disease: a systematic review and external validation. Nephrol Dial Transplant 2020; 36:1837-1850. [PMID: 33051669 DOI: 10.1093/ndt/gfaa155] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Accurate risk prediction is needed in order to provide personalized healthcare for chronic kidney disease (CKD) patients. An overload of prognosis studies is being published, ranging from individual biomarker studies to full prediction studies. We aim to systematically appraise published prognosis studies investigating multiple biomarkers and their role in risk predictions. Our primary objective was to investigate if the prognostic models that are reported in the literature were of sufficient quality and to externally validate them. METHODS We undertook a systematic review and appraised the quality of studies reporting multivariable prognosis models for end-stage renal disease (ESRD), cardiovascular (CV) events and mortality in CKD patients. We subsequently externally validated these models in a randomized trial that included patients from a broad CKD population. RESULTS We identified 91 papers describing 36 multivariable models for prognosis of ESRD, 50 for CV events, 46 for mortality and 17 for a composite outcome. Most studies were deemed of moderate quality. Moreover, they often adopted different definitions for the primary outcome and rarely reported full model equations (21% of the included studies). External validation was performed in the Multifactorial Approach and Superior Treatment Efficacy in Renal Patients with the Aid of Nurse Practitioners trial (n = 788, with 160 events for ESRD, 79 for CV and 102 for mortality). The 24 models that reported full model equations showed a great variability in their performance, although calibration remained fairly adequate for most models, except when predicting mortality (calibration slope >1.5). CONCLUSIONS This review shows that there is an abundance of multivariable prognosis models for the CKD population. Most studies were considered of moderate quality, and they were reported and analysed in such a manner that their results cannot directly be used in follow-up research or in clinical practice.
Collapse
Affiliation(s)
- Marieke H C van Rijn
- Department of Nephrology, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Moniek van de Luijtgaarden
- Department of Nephrology, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arjan D van Zuilen
- Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter J Blankestijn
- Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jack F M Wetzels
- Department of Nephrology, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thomas P A Debray
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jan A J G van den Brand
- Department of Nephrology, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
23
|
Ribeiro HS, Cunha VA, Baiao VM, Almeida LS, Dourado GÍ, Carvalho HL, Duarte MP, Inda‐Filho A, Viana JL, Nóbrega OT, Ferreira AP. Intradialytic isometric handgrip exercise does not cause hemodynamic instability: A randomized,
cross‐over
, pilot study. Ther Apher Dial 2020; 25:282-289. [DOI: 10.1111/1744-9987.13581] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/17/2020] [Accepted: 08/20/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Heitor S. Ribeiro
- Faculty of Physical Education University of Brasília Brasília Brazil
- Interdisciplinary Research Department University Center ICESP Brasília Brazil
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD) University Institute of Maia (ISMAI) Porto Portugal
| | | | - Victor M. Baiao
- Interdisciplinary Research Department University Center ICESP Brasília Brazil
| | - Lucas S. Almeida
- Faculty of Physical Education University of Brasília Brasília Brazil
| | | | - Helton L. Carvalho
- Interdisciplinary Research Department University Center ICESP Brasília Brazil
| | - Marvery P. Duarte
- Faculty of Physical Education University of Brasília Brasília Brazil
| | - Antônio Inda‐Filho
- Interdisciplinary Research Department University Center ICESP Brasília Brazil
| | - João L. Viana
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD) University Institute of Maia (ISMAI) Porto Portugal
| | | | | |
Collapse
|
24
|
Solís-Montufar EE, Gálvez-Coyt G, Muñoz-Diosdado A. Entropy Analysis of RR-Time Series From Stress Tests. Front Physiol 2020; 11:981. [PMID: 32903750 PMCID: PMC7438833 DOI: 10.3389/fphys.2020.00981] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 07/20/2020] [Indexed: 11/14/2022] Open
Abstract
The RR-interval time series or tachograms obtained from electrocardiograms have been widely studied since they reflect the cardiac variability, and this is an indicative of the health status of a person. The tachogram can be seen as a highly non-linear and complex time series, and therefore, should be analyzed with non-linear techniques. In this work, several entropy measures, Sample Entropy (SampEn), Approximate Entropy (ApEn), and Fuzzy Entropy (FuzzyEn) are used as a measure of heart rate variability (HRV). Tachograms belonging to thirty-nine subjects were obtained from a cardiac stress test consisting of a rest period followed by a period of moderate physical activity. Subjects are grouped according to their physical activity using the IPAQ sedentary and active questionnaire, we work with youth and middle-aged adults. The entropy measures for each group show that for the sedentary subjects the values are high at rest and decrease appreciably with moderate physical activity, This happens for both young and middle-aged adults. These results are highly reproducible. In the case of the subjects that exercise regularly, an increase in entropy is observed or they tend to retain the entropy value that they had at rest. It seems that there is a possible correlation between the physical condition of a person with the increase or decrease in entropy during moderate physical activity with respect to the entropy at rest. It was also observed that entropy during longer physical activity tests tends to decrease as fatigue accumulates, but this decrease is small compared to the change that occurs when going from rest to physical activity.
Collapse
Affiliation(s)
- Eric E. Solís-Montufar
- Unidad Profesional Interdisciplinaria de Biotecnología, Instituto Politécnico Nacional, Mexico City, Mexico
- Centro de Investigación en Computación, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Gonzalo Gálvez-Coyt
- Unidad Profesional Interdisciplinaria de Biotecnología, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Alejandro Muñoz-Diosdado
- Unidad Profesional Interdisciplinaria de Biotecnología, Instituto Politécnico Nacional, Mexico City, Mexico
| |
Collapse
|
25
|
Unruh ML, Arzhan S, Feldman HI, Looker HC, Nelson RG, Faber T, Johnson D, Son-Stone L, Pankratz VS, Myaskovsky L, Shah VO. American Indian chronic Renal insufficiency cohort study (AI-CRIC study). BMC Nephrol 2020; 21:291. [PMID: 32698776 PMCID: PMC7376925 DOI: 10.1186/s12882-020-01954-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/15/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is an increasing epidemic globally that is associated with adverse health outcomes including end stage kidney disease (ESKD), cardiovascular disease (CVD), and death. American Indians (AIs) have a higher prevalence of CKD than most other racial/ethnic groups, due in part to a high prevalence of type 2 diabetes. Other genetic and environmental factors not yet identified may also contribute to the disproportionate burden of CKD in AIs. METHOD We will establish 3 clinical centers to recruit AIs from the Southwest United States (US) to expand the Chronic Renal Insufficiency Cohort (CRIC) study. We will follow the current CRIC protocol for kidney and cardiovascular measures and outcomes, which include ambulatory monitoring of kidney function and the use of mobile health technologies for CVD sub-phenotyping, and compare the outcomes in AIs with those in other racial/ethnic groups in CRIC. DISCUSSION AI-CRIC will identify the role of various risk factors for rapid loss of kidney function among AIs of the Southwest US. In addition, to better understand the natural history of CKD and CVD in this high-risk population, we will identify unique risk factors for CKD and CVD progression in AIs. We will also compare event rates and risk factors for kidney and cardiovascular events in AIs with the other populations represented in CRIC.
Collapse
Affiliation(s)
- Mark L Unruh
- Department of Internal Medicine and Biochemistry, University of New Mexico, School of Medicine, MSC 10 5550, Albuquerque, NM, 87131, USA
| | - Soraya Arzhan
- Department of Internal Medicine and Biochemistry, University of New Mexico, School of Medicine, MSC 10 5550, Albuquerque, NM, 87131, USA
| | | | | | | | | | | | | | - Vernon S Pankratz
- Department of Internal Medicine and Biochemistry, University of New Mexico, School of Medicine, MSC 10 5550, Albuquerque, NM, 87131, USA
| | - Larissa Myaskovsky
- Department of Internal Medicine and Biochemistry, University of New Mexico, School of Medicine, MSC 10 5550, Albuquerque, NM, 87131, USA
| | - Vallabh O Shah
- Department of Internal Medicine and Biochemistry, University of New Mexico, School of Medicine, MSC 10 5550, Albuquerque, NM, 87131, USA.
| |
Collapse
|
26
|
Heart rate variability as an independent predictor for 8-year mortality among chronic hemodialysis patients. Sci Rep 2020; 10:881. [PMID: 31964940 PMCID: PMC6972735 DOI: 10.1038/s41598-020-57792-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 01/07/2020] [Indexed: 11/08/2022] Open
Abstract
The repeated measurements of heart rate variability (HRV) is more relevant than a single HRV measurement in predicting patient prognosis but is less addressed previously. This prospective study aimed to investigate the association between repeated measurements of HRV and long-term mortality in chronic hemodialysis patients. The 164 patients (65.0 ± 13.1 years; woman, 57.3%) were enrolled from June 1, 2010, to August 31, 2010, and received four HRV measurements (before and during the index hemodialysis session) after the enrollment. The baseline characteristic and clinical variables, including mortality, were documented. The joint modeling method and Cox regression were used for statistical analyses. After an 8-year follow-up, 79 patients expired, and 85 patients survived. We found that higher normalized high-frequency (nHF) (hazard ratio [HR] 1.033) as well as lower very-low-frequency (HR 0.990), Variance (HR 0.991), normalized low-frequency (HR 0.999, P = 0.006), and low-frequency/high-frequency ratio (HR 0.796) were independent predictors for cardiovascular mortality. Whereas the independent predictors for infection-associated mortality included higher nHF (HR 1.033) as well as higher age (HR 19.29) and lower serum albumin (HR 0.01, P = 0.001). (all P < 0.001 unless otherwise stated) In conclusion, HRV measurement predicts long-term mortality among hemodialysis patients.
Collapse
|
27
|
Tsai CH, Huang JW, Lin C, Ma HP, Lo MT, Liu LYD, Lin LY, Lin CT, Hung CS, Peng CK, Lin YH. Heart Rhythm Complexity Predicts Long-Term Cardiovascular Outcomes in Peritoneal Dialysis Patients: A Prospective Cohort Study. J Am Heart Assoc 2020; 9:e013036. [PMID: 31910780 PMCID: PMC7033842 DOI: 10.1161/jaha.119.013036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Cardiovascular disease is the leading cause of morbidity and mortality in patients with end-stage renal disease. Heart rhythm complexity analysis has been shown to be useful in predicting outcomes in various diseases; however, data on patients with end-stage renal disease are limited. In this study, we analyzed the association between heart rhythm complexity and long-term cardiovascular outcomes in patients with end-stage renal disease receiving peritoneal dialysis. Methods and Results We prospectively enrolled 133 patients receiving peritoneal dialysis and analyzed linear heart rate variability and heart rhythm complexity variables including detrended fluctuation analysis (DFA) and multiscale entropy. The primary outcome was cardiovascular mortality, and the secondary outcome was the occurrence of major adverse cardiovascular events. After a median of 6.37 years of follow-up, 21 patients (22%) died from cardiovascular causes. These patients had a significantly lower low-frequency band of heart rate variability, low/high-frequency band ratio, total power band of heart rate variability, heart rate turbulence slope, deceleration capacity, short-term DFA (DFAα1); and multiscale entropy slopes 1 to 5, scale 5, area 1 to 5, and area 6 to 20 compared with the patients who did not die from cardiovascular causes. Time-dependent receiver operating characteristic curve analysis showed that DFAα1 had the greatest discriminatory power for cardiovascular mortality (area under the curve: 0.763) and major adverse cardiovascular events (area under the curve: 0.730). The best cutoff value for DFAα1 was 0.98 to predict both cardiovascular mortality and major adverse cardiovascular events. Multivariate Cox regression analysis showed that DFAα1 (hazard ratio: 0.076; 95% CI, 0.016-0.366; P=0.001) and area 1 to 5 (hazard ratio: 0.645; 95% CI, 0.447-0.930; P=0.019) were significantly associated with cardiovascular mortality. Conclusions Heart rhythm complexity appears to be a promising noninvasive tool to predict long-term cardiovascular outcomes in patients receiving peritoneal dialysis.
Collapse
Affiliation(s)
- Cheng-Hsuan Tsai
- Department of Internal Medicine National Taiwan University Hospital JinShan Branch New Taipei Taiwan
| | - Jenq-Wen Huang
- Department of Internal Medicine National Taiwan University Hospital and National Taiwan University College of Medicine Taipei Taiwan
| | - Chen Lin
- Department of Biomedical Sciences and Engineering National Central University Taoyuan City Taiwan
| | - Hsi-Pin Ma
- Department of Electrical Engineering National Tsing Hua University Hsinchu Taiwan
| | - Men-Tzung Lo
- Department of Biomedical Sciences and Engineering National Central University Taoyuan City Taiwan
| | - Li-Yu Daisy Liu
- Biometry Division Department of Agronomy National Taiwan University Taipei Taiwan
| | - Lian-Yu Lin
- Department of Internal Medicine National Taiwan University Hospital and National Taiwan University College of Medicine Taipei Taiwan
| | - Chih-Ting Lin
- Graduate Institute of Biomedical Electronics and Bioinformatics National Taiwan University Taipei Taiwan
| | - Chi-Sheng Hung
- Department of Internal Medicine National Taiwan University Hospital and National Taiwan University College of Medicine Taipei Taiwan
| | - Chung-Kang Peng
- Division of Interdisciplinary Medicine and Biotechnology Beth Israel Deaconess Medical Center/Harvard Medical School Boston MA
| | - Yen-Hung Lin
- Department of Internal Medicine National Taiwan University Hospital and National Taiwan University College of Medicine Taipei Taiwan
| |
Collapse
|
28
|
Vincent GE, Jay SM, Preece H, Hall SJ, Aisbett B, Baumert M, Sprajcer M, Lack L, Ferguson SA. Overnight heart rate variability and next day cortisol response during simulated on-call conditions. Psychoneuroendocrinology 2019; 109:104406. [PMID: 31472434 DOI: 10.1016/j.psyneuen.2019.104406] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 08/09/2019] [Accepted: 08/12/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study had two specific objectives, 1) to investigate the impact of being on-call on overnight heart rate variability during sleep and; 2) to examine whether being on-call overnight impacted next-day salivary cortisol concentrations. METHODS Data are reported from three within-subject laboratory studies (n = 24 in each study) that assessed varying on-call conditions. Healthy male participants (n = 72 total) completed a four-night laboratory protocol, comprising an adaptation night, a control night, and two counterbalanced on-call nights with varying on-call conditions. These on-call conditions were designed to determine the impact of, Study 1: the likelihood of receiving a call (definitely, maybe), Study 2: task stress (high-stress, low-stress), and Study 3: chance of missing the alarm (high-chance, low-chance), on measures of physiological stress. Overnight heart rate variability (HRV) (during sleep) was measured using two-lead electrocardiography, and time- and frequency-domain variables were analysed. Saliva samples were collected at 15-min time intervals from 0700-0800 h to determine cortisol awakening response outcomes and at four daily time points (0930 h, 1230 h, 1430 h, and 1730 h) to assess diurnal cortisol profiles. RESULTS There were few differences in HRV measures during sleep across all three studies. The only exception was in Study 1 where the standard deviation of the time interval between consecutive heartbeats and the root mean square of consecutive differences between heartbeats were lower across all sleep stages in the definitely condition, when compared to control. Across all three studies, being on-call overnight also had little impact on next-day cortisol awakening response (CAR), with the exception of Study 2 where the 1) CAR area under the curve with respect to increase was blunted in the high-stress condition, compared to the control and low-stress conditions and, 2) CAR reactivity was higher in low-stress condition, compared with the high-stress condition. In Study 1, diurnal cortisol area under the curve with respect to ground was lower in the on-call conditions (definitely and maybe) when compared to control. There were no differences in diurnal cortisol measures in Study 3. CONCLUSION This is the first study to investigate how different aspects of being on-call affect physiological stress responses. Overall, relatively little differences in measures of overnight heart rate variability and next-day cortisol response were recorded in all three studies. Further research utilising real on-call work tasks, not just on-call expectations (as in the current study) will help determine the impact of on-call work on the physiological stress response.
Collapse
Affiliation(s)
- Grace E Vincent
- Central Queensland University, Health, Medical and Applied Sciences, Adelaide, SA, Australia.
| | - Sarah M Jay
- Central Queensland University, Health, Medical and Applied Sciences, Adelaide, SA, Australia
| | - Helen Preece
- Central Queensland University, Health, Medical and Applied Sciences, Adelaide, SA, Australia
| | - Sarah J Hall
- Deakin University, Institute of Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Brad Aisbett
- Deakin University, Institute of Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Mathias Baumert
- School of Electrical and Electronic Engineering, The University of Adelaide, Australia
| | - Madeline Sprajcer
- Central Queensland University, Health, Medical and Applied Sciences, Adelaide, SA, Australia
| | - Leon Lack
- School of Psychology, Flinders University of South Australia, Adelaide, SA, Australia
| | - Sally A Ferguson
- Central Queensland University, Health, Medical and Applied Sciences, Adelaide, SA, Australia
| |
Collapse
|
29
|
Wu ECH, Huang YT, Chang YM, Chen IL, Yang CL, Leu SC, Su HL, Kao JL, Tsai SC, Jhen RN, Shiao CC. The Association between Nutritional Markers and Heart Rate Variability Indices in Patients Undergoing Chronic Hemodialysis. J Clin Med 2019. [PMCID: PMC6832240 DOI: 10.3390/jcm8101700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The associations between nutritional markers and heart rate variability (HRV) are poorly addressed. This study aimed to evaluate whether malnutrition is associated with the altered autonomic nervous system (ANS) function. This cross-sectional study was conducted enrolling 175 patients (100 women, mean age 65.1 ± 12.9 years) receiving chronic hemodialysis in a teaching hospital from June to August 2010. We performed HRV measurements before and during the index hemodialysis and compared these HRV values between two groups categorized by the individual nutritional marker. By using the multivariate generalized estimating equation with adjustment, we exhibited the independent associations between HRV and poor nutritional status defined by serum albumin < 3.8 g/dL, total cholesterol < 100 mg/dL, body mass index < 23 kg/m2, bodyweight loss within six months > 10%, bodyweight loss within three months > 5%, and normalized protein catabolic rate < 1.1 g/kg BW/day. The current study disclosed ANS impairment in hemodialysis patients with poor nutritional status. The impaired ANS function might be a potential mechanism linking malnutrition to subsequent adverse prognoses in hemodialysis patients. Further investigations are warranted to confirm these findings and clarify the causal association among this complex issue.
Collapse
Affiliation(s)
- Eric Chien-Hwa Wu
- Division of Nephrology, Department of Internal Medicine, Saint Mary’s Hospital Luodong, No. 160, Zhongheng S. Rd., Luodong, Yilan 26546, Taiwan (Y.-M.C.)
| | - Ya-Ting Huang
- Department of Nursing, Saint Mary’s Hospital Luodong, No. 160, Zhongheng S. Rd., Luodong, Yilan 26546, Taiwan
| | - Yu-Ming Chang
- Division of Nephrology, Department of Internal Medicine, Saint Mary’s Hospital Luodong, No. 160, Zhongheng S. Rd., Luodong, Yilan 26546, Taiwan (Y.-M.C.)
| | - I-Ling Chen
- Department of Nursing, Saint Mary’s Hospital Luodong, No. 160, Zhongheng S. Rd., Luodong, Yilan 26546, Taiwan
| | - Chuan-Lan Yang
- Department of Nursing, Saint Mary’s Hospital Luodong, No. 160, Zhongheng S. Rd., Luodong, Yilan 26546, Taiwan
| | - Show-Chin Leu
- Department of Nursing, Saint Mary’s Hospital Luodong, No. 160, Zhongheng S. Rd., Luodong, Yilan 26546, Taiwan
| | - Hung-Li Su
- Department of Nursing, Saint Mary’s Hospital Luodong, No. 160, Zhongheng S. Rd., Luodong, Yilan 26546, Taiwan
| | - Jsun-Liang Kao
- Division of Nephrology, Department of Internal Medicine, Saint Mary’s Hospital Luodong, No. 160, Zhongheng S. Rd., Luodong, Yilan 26546, Taiwan (Y.-M.C.)
| | - Shih-Ching Tsai
- Division of Nephrology, Department of Internal Medicine, Saint Mary’s Hospital Luodong, No. 160, Zhongheng S. Rd., Luodong, Yilan 26546, Taiwan (Y.-M.C.)
| | - Rong-Na Jhen
- Division of Nephrology, Department of Internal Medicine, Saint Mary’s Hospital Luodong, No. 160, Zhongheng S. Rd., Luodong, Yilan 26546, Taiwan (Y.-M.C.)
| | - Chih-Chung Shiao
- Division of Nephrology, Department of Internal Medicine, Saint Mary’s Hospital Luodong, No. 160, Zhongheng S. Rd., Luodong, Yilan 26546, Taiwan (Y.-M.C.)
- Saint Mary’s Junior College of Medicine, Nursing and Management, No.100, Ln. 265, Sec. 2, Sanxing Rd., Sanxing Township, Yilan County 266, Taiwan
- Correspondence: ; Tel.: +886-3-9544106 (ext. 7951)
| |
Collapse
|
30
|
Arce-Alvarez A, Melipillán C, Andrade DC, Toledo C, Marcus NJ, Del Rio R. Heart rate variability alterations in infants with spontaneous hypertonia. Pediatr Res 2019; 86:77-84. [PMID: 30755711 DOI: 10.1038/s41390-019-0318-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 01/23/2019] [Accepted: 01/23/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hypertonia is characterized by increased resting muscle tone. Previous studies have shown that adult patients with hypertonia displayed autonomic imbalance. However, cardiac sympatho-vagal control in infants with hypertonia have not been explored. The main aim was to estimate cardiac autonomic control in infants with hypertonia using heart rate variability (HRV). METHODS Thirty infants (0-2 years old) were studied. Heart rate (HR) and R-R interval time series were obtained in 15 Control and 15 Hypertonia infants. HRV was analyzed in time and frequency domains. Additionally, non-linear analysis and entropy measurements were performed. RESULTS Infants with hypertonia showed cardiac autonomic imbalance as evidenced by alterations in HRV, characterized by an increased power spectral density of low frequency (LF) over high frequency (HF) components of HRV. Indeed, a ∼7% increase in LF, and ∼30% reduction in HF, were found in infants with hypertonia vs. control infants. In addition, time domain and non-linear HRV analysis (Root-mean-square of successive normal sinus R-R interval difference, entropy, and R-R interval variability) were all significantly decreased in hypertonia vs. control subjects. CONCLUSIONS Our results showed that hypertonia infants displayed HRV disturbances, which suggest an alteration in overall autonomic cardiac modulation in infants with hypertonia compared with healthy condition.
Collapse
Affiliation(s)
- Alexis Arce-Alvarez
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile.,Facultad de Salud, Escuela de Kinesiología, Universidad Católica Silva Henríquez, Santiago, Chile
| | - Claudia Melipillán
- Corporación de Rehabilitación Club de Leones Cruz del Sur, Punta Arenas, Chile
| | - David C Andrade
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile.,Centro de Investigación en Fisiología del Ejercicio, Universidad Mayor, Santiago, Chile
| | - Camilo Toledo
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile.,Centro de Envejecimiento y Regeneración (CARE-UC), Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Noah J Marcus
- Department of Physiology and Pharmacology, Des Moines University, Des Moines, IA, USA
| | - Rodrigo Del Rio
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile. .,Centro de Envejecimiento y Regeneración (CARE-UC), Pontificia Universidad Católica de Chile, Santiago, Chile. .,Centro de Excelencia en Biomedicina de Magallanes (CEBIMA), Universidad de Magallanes, Punta Arenas, Chile.
| |
Collapse
|
31
|
Maia TO, Paiva DN, Sobral Filho DC, Cavalcanti FCB, Rocha LG, Andrade CCA, Macedo Júnior ARA, Marinho PEM. Does whole body vibration training improve heart rate variability in kidney transplants patients? A randomized clinical trial. J Bodyw Mov Ther 2019; 24:50-56. [PMID: 32507152 DOI: 10.1016/j.jbmt.2019.05.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 05/24/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Whole-body vibration (WBV) is an exercise modality that can promote improvements in heart rate variability (HRV) with lower patient overload, and consequently reduce cardiovascular risk in renal transplant patients. The aim of this study was to evaluate the effects of a 12-week WBV training program of two weekly sessions on HRV. METHODS A double-blind, randomized controlled clinical trial with 12 kidney transplant recipients of both genders who underwent WBV training (35 Hz) twice a week for 12 weeks on alternate days (WBV Group) and training with sub-therapeutic WBV (8 Hz) (Sham Group). Variables were evaluated in time and frequency domains of HRV through the 24-h Holter monitor, heart rate (HR), blood pressure (BP) and maximum oxygen consumption (VO2max) through an exercise stress test. RESULTS The delta between Sham and WBV groups showed an increase in the low frequency (Δ = 959.05 Hz; p = 0.01) and in the high frequency (Δ = 204.42 Hz; p = 0.04) of the HRV compared to Sham group. No changes in the ergometric variables were observed for any of the groups. CONCLUSION The present study evidenced an increase in the low and high frequency of HRV in individuals who participated in the Sham WBV group. There was no improvement in the autonomic balance in the groups, in the other HRV parameters, or the exercise test after the WBV training period.
Collapse
Affiliation(s)
- Tuíra O Maia
- Post-Graduation Program Health Sciences, Universidade Federal de Pernambuco, Recife, PE, Brazil.
| | - Dulciane N Paiva
- Post-Graduation Program in Health Promotion, Universidade de Santa Cruz do Sul, Santa Cruz do Sul, RS, Brazil.
| | - Dário C Sobral Filho
- Coronary Care Unit of Pernambuco Cardiac Emergency Hospital, Universidade de Pernambuco, Recife, PE, Brazil.
| | | | - Lívia G Rocha
- Post-Graduation Program in Physical Therapy, Universidade Federal de Pernambuco, Recife, Brazil.
| | - Camila C A Andrade
- Integrated Multiprofessional Residency Program in Health, Clinics Hospital of Universidade Federal de Pernambuco, Brazil.
| | | | - Patrícia E M Marinho
- Post-Graduation Program Health Sciences, Universidade Federal de Pernambuco, Recife, PE, Brazil; Post-Graduation Program in Physical Therapy, Universidade Federal de Pernambuco, Recife, Brazil.
| |
Collapse
|
32
|
Chou Y, Huang W, Chang C, Yang CCH, Kuo TBJ, Lin S, Chiang W, Chu T. Heart rate variability as a predictor of rapid renal function deterioration in chronic kidney disease patients. Nephrology (Carlton) 2019; 24:806-813. [DOI: 10.1111/nep.13514] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Yu‐Hsiang Chou
- Renal Division, Department of Internal MedicineNational Taiwan University Hospital Taipei Taiwan
- Department of Internal MedicineNational Taiwan University Hospital Jin‐Shan Branch New Taipei City Taiwan
- Graduate Institute of Physiology, College of MedicineNational Taiwan University Taipei Taiwan
| | - Wei‐Lieh Huang
- Department of PsychiatryNational Taiwan University Hospital Yunlin Branch, Yunlin County Taiwan
- Department of Psychiatry, College of MedicineNational Taiwan University Taipei Taiwan
- Graduate Institute of Clinical Medicine, College of MedicineNational Taiwan University Taipei Taiwan
| | - Chin‐Hao Chang
- Department of Medical ResearchNational Taiwan University Hospital Taipei Taiwan
| | - Cheryl C. H. Yang
- Institute of Brain Science, National Yang‐Ming University Taipei Taiwan
| | - Terry B. J. Kuo
- Institute of Brain Science, National Yang‐Ming University Taipei Taiwan
- Institute of Translational and Interdisciplinary Medicine, National Central University Taoyuan Taiwan
| | - Shuei‐Liong Lin
- Renal Division, Department of Internal MedicineNational Taiwan University Hospital Taipei Taiwan
- Graduate Institute of Physiology, College of MedicineNational Taiwan University Taipei Taiwan
- Department of Integrated Diagnostics &TherapeuticsNational Taiwan University Hospital Taipei Taiwan
- Research Center for Developmental Biology and Regenerative MedicineNational Taiwan University Taipei Taiwan
| | - Wen‐Chih Chiang
- Renal Division, Department of Internal MedicineNational Taiwan University Hospital Taipei Taiwan
| | - Tzong‐Shinn Chu
- Renal Division, Department of Internal MedicineNational Taiwan University Hospital Taipei Taiwan
| |
Collapse
|
33
|
Bhogal AS, De Rui M, Pavanello D, El-Azizi I, Rowshan S, Amodio P, Montagnese S, Mani AR. Which heart rate variability index is an independent predictor of mortality in cirrhosis? Dig Liver Dis 2019; 51:695-702. [PMID: 30293892 DOI: 10.1016/j.dld.2018.09.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 08/29/2018] [Accepted: 09/11/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Liver cirrhosis is associated with reduced heart rate variability (HRV), which indicates impaired integrity of cardiovascular control in this patient population. There are several different indices for HRV quantification. The present study was designed to: 1) determine which of the HRV indices is best at predicting mortality in patients with cirrhosis; 2) verify if such ability to predict mortality is independent of the severity of hepatic failure. METHODS Ten minutes electrocardiogram was recorded in 74 patients with cirrhosis. Heart rate fluctuations were quantified using statistical, geometrical and non-linear analysis. The patients were followed-up for 18months and information was collected on the occurrence of death/liver transplantation. RESULTS During the follow-up period, 24 patients (32%) died or were transplanted for hepatic decompensation. Cox's regression analysis showed that SDNN (total HRV), cSDNN (corrected SDNN), SD1 (short-term HRV), SD2 (long-terms HRV) and spectral indices could predict survival in these patients. However, only SD2 and cSDNN were shown to be independent of MELD in predicting survival. The prognostic value of HRV indices was independent of age, gender, use of beta blockers, and the aetiology of liver disease. CONCLUSION Two HRV indices were identified that could predict mortality in patients with cirrhosis, independently of MELD. These indices are potentially useful tools for survival prediction.
Collapse
Affiliation(s)
- Amar S Bhogal
- Division of Medicine, University College London, London, UK
| | - Michele De Rui
- Department of Medicine, University of Padova, Padova, Italy
| | | | - Ilias El-Azizi
- Division of Medicine, University College London, London, UK
| | - Sadia Rowshan
- Division of Medicine, University College London, London, UK
| | - Piero Amodio
- Department of Medicine, University of Padova, Padova, Italy
| | - Sara Montagnese
- Department of Medicine, University of Padova, Padova, Italy.
| | - Ali R Mani
- Division of Medicine, University College London, London, UK.
| |
Collapse
|
34
|
Bonjorno Junior JC, Caruso FR, Mendes RG, da Silva TR, Biazon TMPDC, Rangel F, Phillips SA, Arena R, Borghi-Silva A. Noninvasive measurements of hemodynamic, autonomic and endothelial function as predictors of mortality in sepsis: A prospective cohort study. PLoS One 2019; 14:e0213239. [PMID: 30856206 PMCID: PMC6411260 DOI: 10.1371/journal.pone.0213239] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 02/19/2019] [Indexed: 12/12/2022] Open
Abstract
Background and aim Sepsis is associated with marked alterations in hemodynamic responses, autonomic dysfunction and impaired vascular function. However, to our knowledge, analysis of noninvasive markers to identify greater risk of death has not yet been investigated. Thus, our aim was to explore the prognostic utility of cardiac output (CO), stroke volume (SV), indices of vagal modulation (RMSSD and SD1), total heart rate variability (HRV) indices and FMD of brachial artery (%FMD), all measured noninvasively, in the first 24 hours of the diagnosis of sepsis. Methods 60 patients were recruited at ICU between 2015 and 2017 and followed by 28 days. CO, SV, RR intervals were measurement. Doppler ultrasound was used to assess brachial artery FMD and the hyperemic response were obtained (%FMD). Patients were divided by survivors (SG) and nonsurvivors groups (NSG). Results A total of 60 patients were analysed (SG = 21 and NSG = 39). Survivors were younger (41±15 years vs. 55±11 years) and used less vasoactive drugs. As expected, APACHE and SOFA scores were lower in NSG compared to SG. In addition, higher SD1, triangular index, % FMD, velocity baseline and hyperemia flow velocity as well as lower HR values were observed in the SG, compared to NSG (P<0.05). Interestingly, RMSSD and SD1 indices were independent predictors of %FMD, ΔFMD and FMDpeak. RMSSD threshold of 10.8ms and %FMD threshold of -1 were optimal at discriminatomg survivors and nonsurvivors. Conclusion Noninvasive measurements of autonomic and endotelial function may be important markers of sepsis mortality, which can be easily obtained in the early stages of sepsis at the bedside.
Collapse
Affiliation(s)
- Jose Carlos Bonjorno Junior
- Bioengineering Interunities, USP, Campus São Carlos, Sao Carlos, SP, Brazil
- Department of Medicine—Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Flávia Rossi Caruso
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Renata Gonçalves Mendes
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil
| | | | | | - Francini Rangel
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Shane A. Phillips
- Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, United States of America
| | - Ross Arena
- Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, United States of America
| | - Audrey Borghi-Silva
- Bioengineering Interunities, USP, Campus São Carlos, Sao Carlos, SP, Brazil
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil
- * E-mail:
| |
Collapse
|
35
|
Hoye NA, Wilson LC, Jardine DL, Walker RJ. Sympathetic overactivity in dialysis patients-Underappreciated and clinically consequential. Semin Dial 2018; 32:255-265. [PMID: 30461070 DOI: 10.1111/sdi.12756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cardiovascular morbidity and mortality remain frustratingly common in dialysis patients. A dearth of established evidence-based treatment calls for alternative therapeutic avenues to be embraced. Sympathetic hyperactivity, predominantly due to afferent nerve signaling from the diseased native kidneys, has been established to be prognostic in the dialysis population for over 15 years. Despite this, tangible therapeutic interventions have, to date, been unsuccessful and the outlook for patients remains poor. This narrative review summarizes established experimental and clinical data, highlighting recent developments, and proposes why interventions to ameliorate sympathetic hyperactivity may well be beneficial for this high-risk population.
Collapse
Affiliation(s)
- Neil A Hoye
- Department of Renal Medicine, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Luke C Wilson
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - David L Jardine
- Department of Medicine, University of Otago, Christchurch, Otago, New Zealand
| | - Robert J Walker
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, Otago, New Zealand
| |
Collapse
|
36
|
Kuo G, Chen SW, Huang JY, Wu CY, Fu CM, Chang CH, Liu SH, Chan YH, Wu IW, Yang HY. Short-term heart rate variability as a predictor of long-term survival in patients with chronic hemodialysis: A prospective cohort study. J Formos Med Assoc 2018; 117:1058-1064. [PMID: 30293929 DOI: 10.1016/j.jfma.2018.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 07/31/2018] [Accepted: 09/05/2018] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Heart rate variability (HRV), a non-invasive measurement of the sympathetic-vagal balance, has been demonstrated as a predictor of long-term survival in various patient populations. However, its predictive value in patients with end-stage renal disease (ESRD) has not been evaluated in a long-term follow-up study. METHODS Prospective data collected for 41 patients with chronic hemodialysis (age 59 ± 10 years, men 51.3%, diabetes mellitus 31%, and duration of dialysis 64 ± 50 months) who underwent a 5-minute electrocardiogram (ECG) recording as a baseline for frequency domain HRV analysis. RESULTS During a median follow-up of 150.2 months from 2003 to 2014, 15 (35.7%) patients died (3 due to cardiac causes and 12 due to non-cardiac causes). The Cox proportional hazards model suggested that the low frequency versus high frequency signal (LF/HF) of a high ratio for the HRV and diabetes mellitus were two independent predictors of mortality (hazard ratios 3.028 and 3.494; p = 0.033 and 0.022, respectively). Less reduction in MAP during dialysis showed borderline significance of long-term survival than those with larger drop (p = 0.058). CONCLUSION A short ECG recording and an analysis of the frequency domain of the HRV is clinically predictive of the long-term survival of patients with chronic hemodialysis.
Collapse
Affiliation(s)
- George Kuo
- Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Szi-Wen Chen
- Department of Electronic Engineering, Chang Gung University, Taoyuan City, Taiwan; Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Jeng-Yi Huang
- Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chao-Yi Wu
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, 333, Taiwan
| | - Chung-Ming Fu
- Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Hsiang Chang
- Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Su-Hsun Liu
- Department of Family Medicine, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Hsin Chan
- Department of Cardiology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - I-Wen Wu
- Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Keelung, Taiwan
| | - Huang-Yu Yang
- Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States.
| |
Collapse
|
37
|
Riganello F, Larroque SK, Bahri MA, Heine L, Martial C, Carrière M, Charland-Verville V, Aubinet C, Vanhaudenhuyse A, Chatelle C, Laureys S, Di Perri C. A Heartbeat Away From Consciousness: Heart Rate Variability Entropy Can Discriminate Disorders of Consciousness and Is Correlated With Resting-State fMRI Brain Connectivity of the Central Autonomic Network. Front Neurol 2018; 9:769. [PMID: 30258400 PMCID: PMC6145008 DOI: 10.3389/fneur.2018.00769] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 08/24/2018] [Indexed: 12/20/2022] Open
Abstract
Background: Disorders of consciousness are challenging to diagnose, with inconsistent behavioral responses, motor and cognitive disabilities, leading to approximately 40% misdiagnoses. Heart rate variability (HRV) reflects the complexity of the heart-brain two-way dynamic interactions. HRV entropy analysis quantifies the unpredictability and complexity of the heart rate beats intervals. We here investigate the complexity index (CI), a score of HRV complexity by aggregating the non-linear multi-scale entropies over a range of time scales, and its discriminative power in chronic patients with unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS), and its relation to brain functional connectivity. Methods: We investigated the CI in short (CIs) and long (CIl) time scales in 14 UWS and 16 MCS sedated. CI for MCS and UWS groups were compared using a Mann-Whitney exact test. Spearman's correlation tests were conducted between the Coma Recovery Scale-revised (CRS-R) and both CI. Discriminative power of both CI was assessed with One-R machine learning model. Correlation between CI and brain connectivity (detected with functional magnetic resonance imagery using seed-based and hypothesis-free intrinsic connectivity) was investigated using a linear regression in a subgroup of 10 UWS and 11 MCS patients with sufficient image quality. Results: Higher CIs and CIl values were observed in MCS compared to UWS. Positive correlations were found between CRS-R and both CI. The One-R classifier selected CIl as the best discriminator between UWS and MCS with 90% accuracy, 7% false positive and 13% false negative rates after a 10-fold cross-validation test. Positive correlations were observed between both CI and the recovery of functional connectivity of brain areas belonging to the central autonomic networks (CAN). Conclusion: CI of MCS compared to UWS patients has high discriminative power and low false negative rate at one third of the estimated human assessors' misdiagnosis, providing an easy, inexpensive and non-invasive diagnostic tool. CI reflects functional connectivity changes in the CAN, suggesting that CI can provide an indirect way to screen and monitor connectivity changes in this neural system. Future studies should assess the extent of CI's predictive power in a larger cohort of patients and prognostic power in acute patients.
Collapse
Affiliation(s)
- Francesco Riganello
- Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
- Research in Advanced NeuroRehabilitation, Istituto S. Anna, Crotone, Italy
| | - Stephen Karl Larroque
- Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
| | - Mohamed Ali Bahri
- GIGA-Cyclotron Research Center in vivo Imaging, University of Liege, Liege, Belgium
| | - Lizette Heine
- Centre de Recherche en Neurosciences, Inserm U1028 - CNRS UMR5292, University of Lyon 1, Bron, France
| | - Charlotte Martial
- Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
| | - Manon Carrière
- Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
| | | | - Charlène Aubinet
- Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
| | - Audrey Vanhaudenhuyse
- Sensation & Perception Research Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
| | - Camille Chatelle
- Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
| | - Carol Di Perri
- Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| |
Collapse
|
38
|
Costa MD, Redline S, Davis RB, Heckbert SR, Soliman EZ, Goldberger AL. Heart Rate Fragmentation as a Novel Biomarker of Adverse Cardiovascular Events: The Multi-Ethnic Study of Atherosclerosis. Front Physiol 2018; 9:1117. [PMID: 30233384 PMCID: PMC6129761 DOI: 10.3389/fphys.2018.01117] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/25/2018] [Indexed: 02/04/2023] Open
Abstract
Background: A major objective of precision medicine is the elucidation of non-invasive biomarkers of cardiovascular (CV) risk. Recently, we introduced a new dynamical marker of sino-atrial instability, termed heart rate fragmentation (HRF), which outperformed traditional and nonlinear heart rate variability metrics in separating ostensibly healthy subjects from patients with coronary artery disease. Accordingly, we hypothesized that HRF may be a dynamical biomarker of adverse cardiovascular events (CVEs). Methods: This study employed data from a cohort of participants in the Multi-Ethnic Study of Atherosclerosis (MESA), a prospective study of sub-clinical heart disease. Interbeat interval time series (n = 1963), derived from the electrocardiographic channel of the polysomnogram study, were analyzed using the newly introduced metrics of fragmentation, as well as traditional heart rate variability (HRV) indices and the short-term detrended fluctuation analysis exponent. Cox regression analysis was used to assess the association between HR dynamic indices and CV outcomes in unadjusted and adjusted models. Results: The mean (± SD) follow-up time was 2.97 ± 0.63 years. In adjusted models, higher fragmentation was significantly associated with incident CVEs (number of events; hazard ratio [95% confidence interval]: n = 72, 1.43 [1.16-1.76]) and CV death (n = 21; 1.65 [1.15-2.36]). The traditional HRV and the fractal indices were not associated with CVEs or CV death. The most discriminatory fragmentation indices added significant value to Framingham and MESA CV risk indices in all analyses. Conclusion: Our findings show that HRF has promise as a non-invasive, automatable biomarker of CV risk. The basic mechanisms underlying fragmentation remain to be delineated. Its association with incident outcomes raises the possibility of connections to degenerative changes in the multisystem network controlling SAN function.
Collapse
Affiliation(s)
- Madalena D. Costa
- Margret and H. A. Rey Institute for Nonlinear Dynamics in Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, United States
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Roger B. Davis
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Susan R. Heckbert
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Elsayed Z. Soliman
- Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Winston-Salem, NC, United States
- Section on Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Ary L. Goldberger
- Margret and H. A. Rey Institute for Nonlinear Dynamics in Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| |
Collapse
|
39
|
Abstract
OBJECTIVE In the general population, reduced heart rate variability (HRV) has been associated with cardiovascular disease. However, its relation to chronic kidney disease (CKD) is debated. We therefore investigated the relation between low HRV and renal outcomes. METHODS In the population-based Prevention of REnal and Vascular ENdstage Disease study, renal outcomes (CKD, estimated glomerular filtration rate [eGFR], urinary albumin) were measured at baseline and three consecutive examinations. HRV measures (among which SDNN [standard deviation of normal-to-normal RR intervals]) were calculated from time series of beat-to-beat pulse wave recordings at baseline. The lowest (risk) quartile was compared with the upper three quartiles combined, in multivariable survival and linear mixed-effects analyses. RESULTS In 4605 participants (49% males, age range = 33-80, 0.6% blacks), we observed 341 new participants of CKD during a median follow-up duration of 7.4 years. Low SDNN was associated with higher incidence of CKD (crude HR = 1.66, 95% CI = 1.30 to 2.12, p < .001), but this association was no longer significant after adjustment for age, sex, and cardiovascular risk factors (adjusted HR = 1.13, 95% CI = 0.86 to 1.48, p = .40, similar for other HRV measures). No associations between SDNN and eGFR trajectories were found in the total sample. However, in a subgroup of participants with baseline CKD (n = 939), we found a significant association of low SDNN (but not other HRV measures) with lower baseline eGFR, even after multivariable adjustment (adjusted βlevel difference = -3.73 ml/min/1.73 m, 95% CI = -6.70 to -0.75, p = .014), but not with steeper eGFR decline. CONCLUSIONS These results suggest that reduced HRV may be a complication of CKD rather than a causal factor.
Collapse
|
40
|
Nguyen T, Waits G, Soliman EZ. The Role of Resting Electrocardiogram in Screening for Primary Prevention of Cardiovascular Diseases in High-Risk Groups. CURRENT CARDIOVASCULAR RISK REPORTS 2018. [DOI: 10.1007/s12170-018-0572-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
41
|
Entropy Analysis of Short-Term Heartbeat Interval Time Series during Regular Walking. ENTROPY 2017. [DOI: 10.3390/e19100568] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
42
|
Kim MK, Han K, Koh ES, Kim HS, Kwon HS, Park YM, Yoon KH, Lee SH. Variability in Total Cholesterol Is Associated With the Risk of End-Stage Renal Disease: A Nationwide Population-Based Study. Arterioscler Thromb Vasc Biol 2017; 37:1963-1970. [PMID: 28860222 DOI: 10.1161/atvbaha.117.309803] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 08/15/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Recent data suggest that visit-to-visit variability of cholesterol is associated with cardiovascular events. We evaluated the role of lipid variability as a determinant of end-stage renal disease (ESRD). APPROACH AND RESULTS Using nationally representative data from the Korean National Health Insurance System, 8 493 277 subjects who were free of ESRD and who underwent ≥3 health examinations during 2005 to 2010 were followed to the end of 2015. Total cholesterol (TC) variability was measured using the coefficient of variation, SD, and the variability independent of the mean. The primary outcome was the development of ESRD, defined as a combination of the relevant disease code and the initiation of renal replacement therapy. There were 11 247 cases of ESRD during a median follow-up of 6.1 years. There was a graded association between a higher TC variability and incident ESRD. In the multivariable adjusted model, the hazard ratios and 95% confidence intervals comparing the highest versus lowest quartiles of coefficient of variation of TC were 2.66 (95% confidence interval, 2.52-2.82). The results were consistent when the variability of TC was modeled using SD and variability independent of the mean and were independent of preexisting chronic kidney disease. CONCLUSIONS Increasing TC variability was associated with an increasing incidence of ESRD.
Collapse
Affiliation(s)
- Mee Kyoung Kim
- From the Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital (M.K.K., H.-S. Kwon), Department of Medical Statistics (K.H.), Division of Nephrology, Department of Internal Medicine, Yeouido St. Mary's Hospital (E.S.K.), Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital (H.-S. Kim, K.-H.Y., S.-H.L.), and Department of Medical Informatics (H.-S. Kim, K.-H.Y.), College of Medicine, The Catholic University of Korea, Seoul; and Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC (Y.-M.P.)
| | - Kyungdo Han
- From the Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital (M.K.K., H.-S. Kwon), Department of Medical Statistics (K.H.), Division of Nephrology, Department of Internal Medicine, Yeouido St. Mary's Hospital (E.S.K.), Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital (H.-S. Kim, K.-H.Y., S.-H.L.), and Department of Medical Informatics (H.-S. Kim, K.-H.Y.), College of Medicine, The Catholic University of Korea, Seoul; and Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC (Y.-M.P.)
| | - Eun Sil Koh
- From the Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital (M.K.K., H.-S. Kwon), Department of Medical Statistics (K.H.), Division of Nephrology, Department of Internal Medicine, Yeouido St. Mary's Hospital (E.S.K.), Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital (H.-S. Kim, K.-H.Y., S.-H.L.), and Department of Medical Informatics (H.-S. Kim, K.-H.Y.), College of Medicine, The Catholic University of Korea, Seoul; and Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC (Y.-M.P.)
| | - Hun-Sung Kim
- From the Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital (M.K.K., H.-S. Kwon), Department of Medical Statistics (K.H.), Division of Nephrology, Department of Internal Medicine, Yeouido St. Mary's Hospital (E.S.K.), Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital (H.-S. Kim, K.-H.Y., S.-H.L.), and Department of Medical Informatics (H.-S. Kim, K.-H.Y.), College of Medicine, The Catholic University of Korea, Seoul; and Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC (Y.-M.P.)
| | - Hyuk-Sang Kwon
- From the Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital (M.K.K., H.-S. Kwon), Department of Medical Statistics (K.H.), Division of Nephrology, Department of Internal Medicine, Yeouido St. Mary's Hospital (E.S.K.), Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital (H.-S. Kim, K.-H.Y., S.-H.L.), and Department of Medical Informatics (H.-S. Kim, K.-H.Y.), College of Medicine, The Catholic University of Korea, Seoul; and Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC (Y.-M.P.)
| | - Yong-Moon Park
- From the Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital (M.K.K., H.-S. Kwon), Department of Medical Statistics (K.H.), Division of Nephrology, Department of Internal Medicine, Yeouido St. Mary's Hospital (E.S.K.), Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital (H.-S. Kim, K.-H.Y., S.-H.L.), and Department of Medical Informatics (H.-S. Kim, K.-H.Y.), College of Medicine, The Catholic University of Korea, Seoul; and Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC (Y.-M.P.)
| | - Kun-Ho Yoon
- From the Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital (M.K.K., H.-S. Kwon), Department of Medical Statistics (K.H.), Division of Nephrology, Department of Internal Medicine, Yeouido St. Mary's Hospital (E.S.K.), Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital (H.-S. Kim, K.-H.Y., S.-H.L.), and Department of Medical Informatics (H.-S. Kim, K.-H.Y.), College of Medicine, The Catholic University of Korea, Seoul; and Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC (Y.-M.P.)
| | - Seung-Hwan Lee
- From the Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital (M.K.K., H.-S. Kwon), Department of Medical Statistics (K.H.), Division of Nephrology, Department of Internal Medicine, Yeouido St. Mary's Hospital (E.S.K.), Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital (H.-S. Kim, K.-H.Y., S.-H.L.), and Department of Medical Informatics (H.-S. Kim, K.-H.Y.), College of Medicine, The Catholic University of Korea, Seoul; and Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC (Y.-M.P.).
| |
Collapse
|
43
|
Abstract
Hyperkalemia is a potentially life-threatening electrolyte disorder appreciated with greater frequency in patients with renal disease, heart failure, and with use of certain medications such as renin angiotensin aldosterone inhibitors. The traditional views that hyperkalemia can be reliably diagnosed by electrocardiogram and that particular levels of hyperkalemia confer cardiotoxic risk have been challenged by several reports of patients with atypic presentations. Epidemiologic data demonstrate strong associations of morbidity and mortality in patients with hyperkalemia but these associations appear disconnected in certain patient populations and in differing clinical presentations. Physiologic adaptation, structural cardiac disease, medication use, and degree of concurrent illness might predispose certain patients presenting with hyperkalemia to a lower or higher threshold for toxicity. These factors are often overlooked; yet data suggest that the clinical context in which hyperkalemia develops is at least as important as the degree of hyperkalemia is in determining patient outcome. This review summarizes the clinical data linking hyperkalemia with poor outcomes and discusses how the efficacy of certain treatments might depend on the clinical presentation.
Collapse
Affiliation(s)
- John R Montford
- Division of Renal Disease and Hypertension, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado; .,Renal Section, Medicine Service, Veterans Affairs Eastern Colorado Health System, Denver, Colorado; and
| | - Stuart Linas
- Division of Renal Disease and Hypertension, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Division of Nephrology, Department of Medicine, Denver Health and Hospitals, Denver, Colorado
| |
Collapse
|
44
|
Karmali SN, Sciusco A, May SM, Ackland GL. Heart rate variability in critical care medicine: a systematic review. Intensive Care Med Exp 2017; 5:33. [PMID: 28702940 PMCID: PMC5507939 DOI: 10.1186/s40635-017-0146-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/03/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Heart rate variability (HRV) has been used to assess cardiac autonomic activity in critically ill patients, driven by translational and biomarker research agendas. Several clinical and technical factors can interfere with the measurement and/or interpretation of HRV. We systematically evaluated how HRV parameters are acquired/processed in critical care medicine. METHODS PubMed, MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (1996-2016) were searched for cohort or case-control clinical studies of adult (>18 years) critically ill patients using heart variability analysis. Duplicate independent review and data abstraction. Study quality was assessed using two independent approaches: Newcastle-Ottowa scale and Downs and Black instrument. Conduct of studies was assessed in three categories: (1) study design and objectives, (2) procedures for measurement, processing and reporting of HRV, and (3) reporting of relevant confounding factors. RESULTS Our search identified 31/271 eligible studies that enrolled 2090 critically ill patients. A minority of studies (15; 48%) reported both frequency and time domain HRV data, with non-normally distributed, wide ranges of values that were indistinguishable from other (non-critically ill) disease states. Significant heterogeneity in HRV measurement protocols was observed between studies; lack of adjustment for various confounders known to affect cardiac autonomic regulation was common. Comparator groups were often omitted (n = 12; 39%). This precluded meaningful meta-analysis. CONCLUSIONS Marked differences in methodology prevent meaningful comparisons of HRV parameters between studies. A standardised set of consensus criteria relevant to critical care medicine are required to exploit advances in translational autonomic physiology.
Collapse
Affiliation(s)
- Shamir N Karmali
- Translational Medicine & Therapeutics, William Harvey Research Institute, Queen Mary University of London, John Vane Science Centre, Charterhouse Square, London, EC1M 6BQ, UK
| | - Alberto Sciusco
- Translational Medicine & Therapeutics, William Harvey Research Institute, Queen Mary University of London, John Vane Science Centre, Charterhouse Square, London, EC1M 6BQ, UK
| | - Shaun M May
- Translational Medicine & Therapeutics, William Harvey Research Institute, Queen Mary University of London, John Vane Science Centre, Charterhouse Square, London, EC1M 6BQ, UK
| | - Gareth L Ackland
- Translational Medicine & Therapeutics, William Harvey Research Institute, Queen Mary University of London, John Vane Science Centre, Charterhouse Square, London, EC1M 6BQ, UK.
| |
Collapse
|
45
|
Wei L, Zhao WB, Ye HW, Chen YH, Zhang XP, Huang Y, Cai YF, Chen QF, Pan SY. Heart Rate Variability in Patients with Acute Ischemic Stroke at Different Stages of Renal Dysfunction: A Cross-sectional Observational Study. Chin Med J (Engl) 2017; 130:652-658. [PMID: 28303846 PMCID: PMC5358413 DOI: 10.4103/0366-6999.201599] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Renal function is associated with mortality and functional disabilities in stroke patients, and impaired autonomic function is common in stroke, but little is known regarding its effects on stroke patients with renal dysfunction. This study sought to evaluate the association between autonomic function and stroke in patients with renal dysfunction. Methods: This study comprised 232 patients with acute ischemic stroke consecutively enrolled from February 2013 to November 2014 at Guangdong Provincial Hospital of Chinese Medicine in China. All patients recruited underwent laboratory evaluation and 24 h Holter electrocardiography (ECG). Autonomic function was measured based on the heart rate variability (HRV) using 24 h Holter ECG. Renal damage was assessed through the estimated glomerular filtration rate (eGFR), and stroke severity was rated according to the National Institutes of Health Stroke Scale (NIHSS). The Barthel index and modified Rankin score were also determined following admission. All the clinical covariates that could potentially affect autonomic outcome variables were adjusted with linear regression. Results: In the patients with a mild or moderate decreased eGFR, the values for the standard deviation of the averaged normal-to-normal RR interval (SDANN) index (P = 0.022), very low frequency (VLF) (P = 0.043), low frequency (LF) (P = 0.023), and ratio of low-to-high frequency power (LF/HF) (P = 0.001) were significantly lower than those in the patients with a normal eGFR. A multinomial linear regression indicated that eGFR (t = 2.47, P = 0.014), gender (t = −3.60, P < 0.001), and a history of hypertension (t = −2.65, P = 0.008) were the risk factors of LF/HF; the NIHSS score (SDANN index: t = −3.83, P < 0.001; VLF: t = −3.07, P = 0.002; LF: t = −2.79, P = 0.006) and a history of diabetes (SDANN index: t = −3.58, P < 0.001; VLF: t = −2.54, P = 0.012; LF: t = −2.87, P = 0.004) were independent factors for the SDANN index, VLF, and LF; the Oxfordshire Community Stroke Project (t = −2.38, P = 0.018) was related to the SDANN index. Conclusions: Autonomic dysfunction is aggravated with the progression of eGFR stage in patients with acute ischemic stroke; the eGFR is an independent factor of LF/HF in the adjusted models. Stroke severity and a history of diabetes are more significantly associated with HRV in patients with acute ischemic stroke at different stages of renal dysfunction.
Collapse
Affiliation(s)
- Lin Wei
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515; Department of Neurology, Guangdong Province Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, China
| | - Wen-Bo Zhao
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510632, China
| | - Huan-Wen Ye
- Department of Cardiovascular Medicine, Guangdong Province Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, China
| | - Yan-Hua Chen
- Department of Cardiovascular Medicine, Guangdong Province Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, China
| | - Xiao-Pei Zhang
- Department of Cardiovascular Medicine, Guangdong Province Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, China
| | - Yan Huang
- Department of Cardiovascular Medicine, Guangdong Province Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, China
| | - Ye-Feng Cai
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Quan-Fu Chen
- Intensive Care Unit, Guangdong Province Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, China
| | - Su-Yue Pan
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| |
Collapse
|
46
|
O'Driscoll JM, Slee A, Sharma R. Body mass index mortality paradox in chronic kidney disease patients with suspected cardiac chest pain. JCSM CLINICAL REPORTS 2017. [DOI: 10.17987/jcsm-cr.v2i1.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Chronic kidney disease (CKD) is a silent clinical condition associated with adverse comorbidity and high cardiovascular disease (CVD) risk. An inverse relationship with body mass index (BMI) and mortality has been demonstrated in hemodialysis patients. However, it is unclear if this risk-factor paradox is evident in non-dialysis CKD patients. The aims of this study were to explore the relationship between, nutritional status, markers of inflammation, autonomic and cardiac function with BMI. Longitudinal follow-up explored the relationship between BMI and all-cause mortality. Methods: 211-consecutive CKD patients referred for dobutamine stress echocardiography to detect or exclude myocardial ischemia were recruited. BMI, albumin, C-reactive protein (CRP) and haemoglobin (Hb) were recorded as markers of nutritional and inflammatory status. Left ventricular ejection fraction (LVEF) and heart rate variability (HRV) as an indicator of cardiac function was recorded. All subjects were followed prospectively until November 2014 and study end-point was all-cause mortality. Results: BMI was inversely associated with CKD status. After covariate adjustment, this association remained. During a mean follow-up period of 3.3±0.9 years there were 35 deaths (17%). BMI was inversely associated with all-cause mortality (HR 0.81, 95% CI 0.71-0.9). Other important independent predictors of mortality were heart rate variability (HR 0.98, 95% CI 0.97-0.99), myocardial ischemia (HR 1.37, 95% CI 1.17-1.81), and albumin (HR 0.86, 95% CI 0.81-0.92). Conclusions: The presence of a body mass index paradox exists in non-dialysis CKD patients. This risk-factor paradox was an independent predictor of all-cause mortality and may have significant clinical implications relevant to screening, assessment and treatment and requires further study.
Collapse
|
47
|
Doulgerakis D, Moyssakis I, Kapelios CJ, Eleftheriadou I, Chorepsima S, Michail S, Tentolouris N. Cardiac Autonomic Neuropathy Predicts All-Cause and Cardiovascular Mortality in Patients With End-Stage Renal Failure: A 5-Year Prospective Study. Kidney Int Rep 2017; 2:686-694. [PMID: 29142986 PMCID: PMC5678628 DOI: 10.1016/j.ekir.2017.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 02/13/2017] [Accepted: 03/08/2017] [Indexed: 01/20/2023] Open
Abstract
Introduction Chronic renal disease is associated with increased cardiovascular (CV) mortality. Cardiac autonomic neuropathy (CAN) is predictive of mortality for diseases that affect the autonomic nervous system. We prospectively evaluated the prognostic value of indexes of left ventricular (LV) function and CAN in all-cause and CV mortality of patients with end-stage renal failure (ESRF). Methods A total of 133 patients with ESRF were recruited. LV function was evaluated by echocardiography, whereas cardiac autonomic function was assessed using the battery of the 4 standardized tests proposed by Ewing. Results A total of 123 of 133 (92.5%) patients completed the study and were followed for a mean of 4.9 ± 2.6 years. Mean LV ejection fraction (LVEF) was 50.9 ± 6.9%, whereas 70 (57.9%) patients had CAN. Sixty-nine all-cause and 36 CV deaths were recorded. The survival rates at 3, 5, and 7 years were 77.2%, 57.4%, and 33.7%, respectively. Multivariate analysis after adjustment for waist circumference, current smoking, history of diabetes, and coronary artery disease demonstrated that the only independent predictors of all-cause mortality during follow-up were age, serum triglycerides, LVEF, and presence of CAN. Competing risk regression analysis, after adjusting for waist circumference, coronary heart disease, serum glucose, and triglycerides, indicated that age and presence of CAN were independent risk factors for CV mortality. Discussion Age and presence of CAN are independent predictors of all-cause and CV mortality in patients with ESRF. The functionality of the cardiac autonomic nervous system activity can be used for the risk stratification in patients with ESRF.
Collapse
Affiliation(s)
- Dimitrios Doulgerakis
- First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Chris J Kapelios
- First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Eleftheriadou
- First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stamatia Chorepsima
- First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Michail
- Department of Nephrology, Laiko General Hospital, Athens, Greece
| | - Nikolaos Tentolouris
- First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
48
|
Cheah HY, Šarenac O, Arroyo JJ, Vasić M, Lozić M, Glumac S, Hoe SZ, Hindmarch CCT, Murphy D, Kiew LV, Lee HB, Vicent MJ, Chung LY, Japundžić-Žigon N. Hemodynamic effects of HPMA copolymer based doxorubicin conjugate: A randomized controlled and comparative spectral study in conscious rats. Nanotoxicology 2017; 11:210-222. [PMID: 28098511 PMCID: PMC5964453 DOI: 10.1080/17435390.2017.1285071] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Conjugation of Doxorubicin (DOX) to N-(2-hydroxypropyl) methylacrylamide copolymer (HPMA) has significantly reduced the DOX-associated cardiotoxicity. However, the reports on the impact of HPMA–DOX conjugates on the cardiovascular system such as blood pressure (BP) and heart rate (HR) were in restrained animals using tail cuff and/or other methods that lacked the resolution and sensitivity. Herein, we employed radiotelemetric-spectral-echocardiography approach to further understand the in vivo cardiovascular hemodynamics and variability post administration of free DOX and HPMA–DOX. Rats implanted with radio-telemetry device were administered intravenously with DOX (5 mg/kg), HPMA–DOX (5 mg DOX equivalent/kg) and HPMA copolymer and subjected to continuous cardiovascular monitoring and echocardiography for 140 days. We found that DOX-treated rats had ruffled fur, reduced body weight (BW) and a low survival rate. Although BP and HR were normal, spectral analysis indicated that their BP and HR variabilities were reduced. All rats exhibited typical signs of cardiotoxicity at histopathology. In contrast, HPMA–DOX rats gained weight over time and survived. Although BP, HR and related variabilities were unaffected, the left ventricular end diastolic volume (EDV) of these rats, as well as of the HPMA copolymer-treated rats, was found increased at the end of observation period. Additionally, HPMA copolymer caused microscopic injury of the heart tissue. All of these suggest the necessity of caution when employing HPMA as carrier for prolonged drug delivery. The current study also indicates the potential of radiotelemetric-spectral-echocardiography approach for improved preclinical cardiovascular risk assessment of polymer–drug conjugate and other nano-sized-drug constructs.
Collapse
Affiliation(s)
- Hoay Yan Cheah
- a Department of Pharmacology, Faculty of Medicine , University of Malaya , Kuala Lumpur , Malaysia
| | - Olivera Šarenac
- b Institute of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine , University of Belgrade , Republic of Serbia
| | - Juan J Arroyo
- c Polymer Therapeutics Lab , Centro de Investigación Príncipe Felipe , Valencia , Spain
| | - Marko Vasić
- b Institute of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine , University of Belgrade , Republic of Serbia
| | - Maja Lozić
- b Institute of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine , University of Belgrade , Republic of Serbia
| | - Sofija Glumac
- b Institute of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine , University of Belgrade , Republic of Serbia
| | - See Ziau Hoe
- d Department of Physiology, Faculty of Medicine , University of Malaya , Kuala Lumpur , Malaysia
| | - Charles Colin Thomas Hindmarch
- d Department of Physiology, Faculty of Medicine , University of Malaya , Kuala Lumpur , Malaysia.,e Department of Biomedical and Molecular Sciences , School of Medicine, Queen's, University , Kingston, ON , Canada , UK
| | - David Murphy
- f Molecular Neuroendocrinology Research Group , The Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, University of Bristol , Bristol , England, UK
| | - Lik Voon Kiew
- a Department of Pharmacology, Faculty of Medicine , University of Malaya , Kuala Lumpur , Malaysia
| | - Hong Boon Lee
- g Department of Pharmacy, Faculty of Medicine , University of Malaya , Kuala Lumpur , Malaysia
| | - María J Vicent
- c Polymer Therapeutics Lab , Centro de Investigación Príncipe Felipe , Valencia , Spain
| | - Lip Yong Chung
- g Department of Pharmacy, Faculty of Medicine , University of Malaya , Kuala Lumpur , Malaysia
| | - Nina Japundžić-Žigon
- b Institute of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine , University of Belgrade , Republic of Serbia
| |
Collapse
|
49
|
Association between autonomic nervous dysfunction and cellular inflammation in end-stage renal disease. BMC Cardiovasc Disord 2016; 16:210. [PMID: 27809785 PMCID: PMC5094069 DOI: 10.1186/s12872-016-0385-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 10/26/2016] [Indexed: 01/20/2023] Open
Abstract
Background Alterations in autonomic nervous function are common in hemodialysis (HD) patients. Sympathetic as well as parasympathetic activation may be associated with immune and inflammatory responses. We intended to confirm a role of autonomous dysregulation for inflammation in HD patients. Methods 30 HD patients (including 15 diabetics) and 15 healthy controls were studied for heart rate variability (HRV) using 5 min ECG recordings. Heart rate variability was estimated by time-domain parameters (the standard deviation of the RR intervals (SDNN) and the percentage of pairs of adjacent RR intervals differing by >50 ms (pNN50)) and frequency-domain-analysis (high- and low-frequency variation of RR intervals, HF and LF). Inflammation was detected as serum C-reactive Protein (CRP), IL-6 and circulating monocyte subpopulation numbers. Immune cells were characterized by ACh receptor expression. Results Patients differed from controls in terms of age (68.0 [14.8] yrs vs. 58.0 [13.0] yrs, p < 0.001; Median [IQR]) and sex. However, HRV parameters were different in controls and HD patients (SDNN controls 34.0 [14.0] ms, HD patients 15.5 [14.8] ms, p < 0.01). This finding was not restricted to patients with diabetes mellitus (diab), although diabetes is an important cause of autonomous dysfunction (SDNN, diab 13.0 [14.0] ms, non-diab 18.0 [15.3] ms, p = 0.8). LF and HF were reduced by the same magnitude to 1/3 of those in controls. Patients suffered from chronic inflammation (CRP 9.4 [12.9] mg/l, controls 1.6 [2.4] mg/l, p < 0.001) and expanded proinflammatory monocyte subpopulations (CD14++/CD16+ cells: patients 41 [27]/μl, controls 24 [18]/μl, p < 0.01). ECG parameters did not correlate with inflammation in patients, but monocyte ACh receptor expression was enhanced, indicating potentially elevated responsiveness of this cell type to parasympathetic regulation. Conclusions HD patients have strongly impaired HRV. Chronic inflammation is not related to autonomous dysfunction, although monocytes express the ACh receptor at enhanced density making them potentially more sensitive to parasympathetic effects. Trial registration This study was listed with ClinicalTrials.gov (NCT00878033). Electronic supplementary material The online version of this article (doi:10.1186/s12872-016-0385-1) contains supplementary material, which is available to authorized users.
Collapse
|
50
|
Schmaderer C, Tholen S, Hasenau AL, Hauser C, Suttmann Y, Wassertheurer S, Mayer CC, Bauer A, Rizas KD, Kemmner S, Kotliar K, Haller B, Mann J, Renders L, Heemann U, Baumann M. Rationale and study design of the prospective, longitudinal, observational cohort study "rISk strAtification in end-stage renal disease" (ISAR) study. BMC Nephrol 2016; 17:161. [PMID: 27784272 PMCID: PMC5080708 DOI: 10.1186/s12882-016-0374-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 10/15/2016] [Indexed: 01/14/2023] Open
Abstract
Background The ISAR study is a prospective, longitudinal, observational cohort study to improve the cardiovascular risk stratification in endstage renal disease (ESRD). The major goal is to characterize the cardiovascular phenotype of the study subjects, namely alterations in micro- and macrocirculation and to determine autonomic function. Methods/design We intend to recruit 500 prevalent dialysis patients in 17 centers in Munich and the surrounding area. Baseline examinations include: (1) biochemistry, (2) 24-h Holter Electrocardiography (ECG) recordings, (3) 24-h ambulatory blood pressure measurement (ABPM), (4) 24 h pulse wave analysis (PWA) and pulse wave velocity (PWV), (5) retinal vessel analysis (RVA) and (6) neurocognitive testing. After 24 months biochemistry and determination of single PWA, single PWV and neurocognitive testing are repeated. Patients will be followed up to 6 years for (1) hospitalizations, (2) cardiovascular and (3) non-cardiovascular events and (4) cardiovascular and (5) all-cause mortality. Discussion/conclusion We aim to create a complex dataset to answer questions about the insufficiently understood pathophysiology leading to excessively high cardiovascular and non-cardiovascular mortality in dialysis patients. Finally we hope to improve cardiovascular risk stratification in comparison to the use of classical and non-classical (dialysis-associated) risk factors and other models of risk stratification in ESRD patients by building a multivariable Cox-Regression model using a combination of the parameters measured in the study. Clinical trials identifier ClinicalTrials.gov NCT01152892 (June 28, 2010)
Collapse
Affiliation(s)
- Christoph Schmaderer
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany.
| | - Susanne Tholen
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Anna-Lena Hasenau
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Christine Hauser
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Yana Suttmann
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Siegfried Wassertheurer
- Health & Environment Department, AIT Austrian Institute of Technology GmbH, Biomedical Systems, Donau-City-Str. 1, 1220, Vienna, Austria
| | - Christopher C Mayer
- Health & Environment Department, AIT Austrian Institute of Technology GmbH, Biomedical Systems, Donau-City-Str. 1, 1220, Vienna, Austria
| | - Axel Bauer
- Medizinische Klinik und Poliklinik I, Department of Cardiology, Klinikum Großhadern, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany
| | - Kostantinos D Rizas
- Medizinische Klinik und Poliklinik I, Department of Cardiology, Klinikum Großhadern, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany
| | - Stephan Kemmner
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Konstantin Kotliar
- FH Aachen, University of applied sciences, Heinrich-Mussmann-Str. 1, 52428, Jülich, Germany
| | - Bernhard Haller
- Institute of medical statistics and epidemiology (IMSE), Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Johannes Mann
- Städtisches Klinikum Schwabing, KFH Dialysezentrum Schwabing, Kölner Platz 1, 80804, Munich, Germany
| | - Lutz Renders
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Uwe Heemann
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Marcus Baumann
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| |
Collapse
|