1
|
Duca ȘT, Badescu MC, Costache AD, Chetran A, Miftode RȘ, Tudorancea I, Mitu O, Afrăsânie I, Ciorap RG, Șerban IL, Pavăl DR, Dmour B, Cepoi MR, Costache-Enache II. Harmony in Chaos: Deciphering the Influence of Ischemic Cardiomyopathy and Non-Cardiac Comorbidities on Holter ECG Parameters in Chronic Heart Failure Patients: A Pilot Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:342. [PMID: 38399629 PMCID: PMC10889994 DOI: 10.3390/medicina60020342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/06/2024] [Accepted: 02/17/2024] [Indexed: 02/25/2024]
Abstract
Background and Objective: In the landscape of heart failure, non-cardiac comorbidities represent a formidable challenge, imparting adverse prognostic implications. Holter ECG monitoring assumes a supplementary role in delineating myocardial susceptibility and autonomic nervous system dynamics. This study aims to explore the potential correlation between Holter ECG parameters and comorbidities in individuals with ischemic cardiomyopathy experiencing heart failure (HF), with a particular focus on the primary utility of these parameters as prognostic indicators. Materials and Methods: In this prospective inquiry, a cohort of 60 individuals diagnosed with heart failure underwent stratification into subgroups based on the presence of comorbidities, including diabetes, chronic kidney disease, obesity, or hyperuricemia. Upon admission, a thorough evaluation of all participants encompassed echocardiography, laboratory panel analysis, and 24 h Holter monitoring. Results: Significant associations were uncovered between diabetes and unconventional physiological indicators, specifically the Triangular index (p = 0.035) and deceleration capacity (p = 0.002). Pertaining to creatinine clearance, notable correlations surfaced with RMSSD (p = 0.026), PNN50 (p = 0.013), and high-frequency power (p = 0.026). An examination of uric acid levels and distinctive Holter ECG patterns unveiled statistical significance, particularly regarding the deceleration capacity (p = 0.045). Nevertheless, in the evaluation of the Body Mass Index, no statistically significant findings emerged concerning Holter ECG parameters. Conclusions: The identified statistical correlations between non-cardiac comorbidities and patterns elucidated in Holter ECG recordings underscore the heightened diagnostic utility of this investigative modality in the comprehensive evaluation of individuals grappling with HF. Furthermore, we underscore the critical importance of the thorough analysis of Holter ECG recordings, particularly with regard to subtle and emerging parameters that may be overlooked or insufficiently acknowledged.
Collapse
Affiliation(s)
- Ștefania-Teodora Duca
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (Ș.-T.D.); (A.C.); (R.Ș.M.); (O.M.); (I.A.); (B.D.); (M.-R.C.); (I.-I.C.-E.)
- Department of Cardiology, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania;
| | - Minerva Codruta Badescu
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (Ș.-T.D.); (A.C.); (R.Ș.M.); (O.M.); (I.A.); (B.D.); (M.-R.C.); (I.-I.C.-E.)
- Department of III Internal Medicine Clinic, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Alexandru-Dan Costache
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (Ș.-T.D.); (A.C.); (R.Ș.M.); (O.M.); (I.A.); (B.D.); (M.-R.C.); (I.-I.C.-E.)
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Adriana Chetran
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (Ș.-T.D.); (A.C.); (R.Ș.M.); (O.M.); (I.A.); (B.D.); (M.-R.C.); (I.-I.C.-E.)
- Department of Cardiology, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania;
| | - Radu Ștefan Miftode
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (Ș.-T.D.); (A.C.); (R.Ș.M.); (O.M.); (I.A.); (B.D.); (M.-R.C.); (I.-I.C.-E.)
- Department of Cardiology, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania;
| | - Ionuț Tudorancea
- Department of Cardiology, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania;
- Department of Morpho-Functional Science II-Physiology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
| | - Ovidiu Mitu
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (Ș.-T.D.); (A.C.); (R.Ș.M.); (O.M.); (I.A.); (B.D.); (M.-R.C.); (I.-I.C.-E.)
- Department of Cardiology, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania;
| | - Irina Afrăsânie
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (Ș.-T.D.); (A.C.); (R.Ș.M.); (O.M.); (I.A.); (B.D.); (M.-R.C.); (I.-I.C.-E.)
- Department of Cardiology, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania;
| | - Radu-George Ciorap
- Department of Biomedical Science, Faculty of Medical Bioengineering, University of Medicine and Pharmacy “Grigore T. Popa”, 700145 Iasi, Romania;
| | - Ionela-Lăcrămioara Șerban
- Department of Morpho-Functional Science II-Physiology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
| | - D. Robert Pavăl
- Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK;
| | - Bianca Dmour
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (Ș.-T.D.); (A.C.); (R.Ș.M.); (O.M.); (I.A.); (B.D.); (M.-R.C.); (I.-I.C.-E.)
| | - Maria-Ruxandra Cepoi
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (Ș.-T.D.); (A.C.); (R.Ș.M.); (O.M.); (I.A.); (B.D.); (M.-R.C.); (I.-I.C.-E.)
| | - Irina-Iuliana Costache-Enache
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (Ș.-T.D.); (A.C.); (R.Ș.M.); (O.M.); (I.A.); (B.D.); (M.-R.C.); (I.-I.C.-E.)
- Department of Cardiology, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania;
| |
Collapse
|
2
|
D'Addio G, De Felice A, Donisi L, Braghiroli A, Maniscalco M. Heart rate turbulence in obstructive sleep apnea syndrome: The effect of short-term CPAP therapy. Eur J Intern Med 2021; 86:111-114. [PMID: 33390320 DOI: 10.1016/j.ejim.2020.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/24/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Giovanni D'Addio
- Bioengineering Unit, Istituti Clinici Scientifici Maugeri IRCCS, Telese Terme (BN), Italy
| | - Alberto De Felice
- Pulmonary Rehabilitation Division, Istituti Clinici Scientifici Maugeri IRCCS, Telese Terme (BN), Italy
| | - Leandro Donisi
- Bioengineering Unit, Istituti Clinici Scientifici Maugeri IRCCS, Telese Terme (BN), Italy; Department of Advanced Biomedical Sciences, University of Naples "Federico II", Napoli, Italy
| | - Alberto Braghiroli
- Pulmonary Rehabilitation Division, Istituti Clinici Scientifici Maugeri IRCCS, Veruno, Italy
| | - Mauro Maniscalco
- Pulmonary Rehabilitation Division, Istituti Clinici Scientifici Maugeri IRCCS, Telese Terme (BN), Italy.
| |
Collapse
|
3
|
Blesius V, Schölzel C, Ernst G, Dominik A. HRT assessment reviewed: a systematic review of heart rate turbulence methodology. Physiol Meas 2020; 41:08TR01. [PMID: 32485688 DOI: 10.1088/1361-6579/ab98b3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Heart rate turbulence (HRT) is a biphasic reaction to a ventricular premature contraction (VPC) mainly mediated by the baroreflex. It can be used for risk stratification in different disease patterns. Despite existing standards there is a lot of variation in terms of measuring and calculating HRT, which complicates research and application. OBJECTIVE This systematic review outlines and evaluates the methodological spectrum of HRT research, especially filtering criteria, parameter calculation and thresholds. APPROACH The analysis includes all research papers written in English that have been published before 12.10.2018, are listed on PubMed and involve calculation of HRT parameter values. MAIN RESULTS HRT assessment is still being performed in various ways and important specifications of the methodology are not given in many articles. Nevertheless, some suggestions regarding HRT methodology can be made: a normalised turbulence slope should be used to uncouple the parameter from heart rate and frequency of extrasystoles. Filtering criteria as formerly reviewed in the guidelines should be met and mentioned. The minimal number of VPC snippets (VPCSs) as well as new cut-off values for different risks need to be further evaluated. Most importantly, the exact and complete methodology must be described to ensure reproducibility and comparability. SIGNIFICANCE Methodical variation hinders comparability of research and medical application. Our continuing questions help to further standardise the measurement and calculation of HRT and increase its value for medical risk stratification.
Collapse
|
4
|
Zandstra T, Kiès P, Man SC, Maan A, Bootsma M, Vliegen H, Egorova A, Holman E, Schalij M, Jongbloed M. QT interval variability and heart rate turbulence are associated with clinical characteristics in congenital heart disease patients with a systemic right ventricle. J Cardiol 2020; 76:514-520. [PMID: 32665161 DOI: 10.1016/j.jjcc.2020.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/09/2020] [Accepted: 05/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND QT interval variability (QTV) and heart rate turbulence (HRT) are measures of cardiac autonomic function, which, when abnormal, are correlated with ventricular arrhythmias and worse clinical outcome. This study aims to evaluate QTV and HRT in patients with a systemic right ventricle (RV) and to assess correlations with clinical characteristics. METHODS In a retrospective cohort study, QTV and HRT were derived from 24-h Holter registrations of patients with a systemic RV and healthy controls. QTV and HRT were compared between groups. In patients, the association between QTV, HRT, and clinical characteristics was assessed. RESULTS Holter recordings from 40 patients (mean age 40 years, 16 females) and 37 healthy controls (mean age 42 years, 21 females) were analyzed. Groups were comparable in terms of age and sex. QTV was increased in patients compared with controls (p < 0.001), HRT did not differ significantly between the groups. Increased QTV and decreased HRT correlated with medication use, especially of diuretics, and with clinical events, particularly supraventricular arrhythmias. Increased QTV correlated with reduced systemic RV function. Decreased HRT was independently associated with a larger number of past clinical events (estimate -0.33, 95% CI -0.63 to -0.02, p = 0.037). QTV was higher in women in both patients and controls (p = 0.041 and p = 0.034, respectively). CONCLUSIONS QTV and HRT are associated with clinical factors and events in patients with a systemic RV. Further studies are mandatory to confirm their prognostic value.
Collapse
Affiliation(s)
- Tjitske Zandstra
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Philippine Kiès
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sum-Che Man
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arie Maan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marianne Bootsma
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hubert Vliegen
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anastasia Egorova
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Eduard Holman
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique Jongbloed
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands.
| |
Collapse
|
5
|
Obstructive Sleep Apnea as a Predictor of Abnormal Heart Rate Turbulence. J Clin Med 2019; 9:jcm9010001. [PMID: 31861257 PMCID: PMC7019662 DOI: 10.3390/jcm9010001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/09/2019] [Accepted: 12/17/2019] [Indexed: 11/16/2022] Open
Abstract
Obstructive sleep apnea (OSA) causes dysfunction of the autonomic nervous system, but the exact mechanism has not been fully understood. The aim of this study was to analyse the relationship between the incidence and severity of OSA and heart rate turbulence (HRT). Seventy one patients with clinical suspicion of OSA were qualified to participate in the study. All participants took part in a survey and were subjected to laboratory tests, 24-hour electrocardiogram (ECG) Holter monitoring with HRT analysis and polysomnography. The group with OSA manifested significantly higher turbulence onset (TO) and lower turbulence slope (TS) as compared to the group without OSA. Older age, diabetes, hypertension and higher apnea/hypopnea index (AHI) were found to be independent risk factors for increased TO, whereas older age, higher body mass index (BMI), higher blood glucose levels, hypertension and higher AHI were independent risk factors for TS reduction. The AHI ≥65 criterion indicates abnormal HRT in patients with OSA with 94.9% sensitivity and 50.0% specificity, which gives a prediction accuracy of 85.7%. In summary, OSA should be considered as a predictor of abnormal HRT.
Collapse
|
6
|
Reduced heart rate response after premature ventricular contraction depending on severity of atrial fibrillation symptoms - Analysis on heart rate turbulence in atrial fibrillation patients. IJC HEART & VASCULATURE 2018; 18:33-38. [PMID: 29876501 PMCID: PMC5988479 DOI: 10.1016/j.ijcha.2018.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 02/11/2018] [Accepted: 02/13/2018] [Indexed: 01/09/2023]
Abstract
Background The severity of symptoms during atrial fibrillation (AF) may be influenced by heart rate and blood pressure variation, due to irregular beats and the related adaptations in baroreflex sensitivity. This study investigated whether heart rate turbulence (HRT) as a reflection of baroreflex sensitivity is related to symptom severity during AF. Method Ninety-seven patients (pts) who underwent electrophysiological study were enrolled. Consecutive 56 pts had paroxysmal AF (21 with milder symptoms [EHRA I or II; Group-M], 35 with severe symptoms [EHRA III or IV; Group-S]), and 41 age-matched controls without AF were included. After delivering a single ventricular extrastimulus during sinus rhythm and repeating the process 10 times, the quantification of HRT was performed by measuring turbulence onset (TO: heart rate acceleration) and turbulence slope (TS: rate of heart rate deceleration). Results Group-M pts showed significantly diminished TO as compared to controls and Group-S pts (P = 0.012). There was no significant difference of the TS between the 3 groups. Given that a TO ≥ 0% or TS ≤ 2.5 ms/RR was considered abnormal, Group-M pts showed significantly higher incidences of abnormal HRT as compared to controls and Group-S pts (71% vs 40% vs 21%, respectively, P = 0.0012). Regression analysis demonstrated an independent and significant association between a diminished TO and milder AF symptoms (P < 0.05). Conclusions The usual heart rate acceleration after premature ventricular contraction is significantly diminished in pts with milder AF symptoms as compared to pts with severe AF symptoms. The mechanism of association between this diminished response and symptoms should be further investigated.
Collapse
|
7
|
Yuan MJ, Pan YS, Hu WG, Lu ZG, Zhang QY, Huang D, Huang XL, Wei M, Li JB. A pilot study of prognostic value of non-invasive cardiac parameters for major adverse cardiac events in patients with acute coronary syndrome treated with percutaneous coronary intervention. Int J Clin Exp Med 2015; 8:22440-22449. [PMID: 26885226 PMCID: PMC4730012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 11/11/2015] [Indexed: 06/05/2023]
Abstract
The objective of this study was to determine the combination of left ventricular ejection fraction (LVEF) and individual electrocardiographic parameters related to abnormal depolarization/repolarization or baroreceptor sensitivity that had the best predictive value for major adverse cardiac events (MACE) in patients with acute coronary syndrome (ACS). Patients with ACS who underwent coronary angiography and percutaneous coronary intervention (PCI) were included in this prospective study. Ventricular late potential (VLP), heart rate turbulence (HRT), heart rate variability (HRV), and T wave alternans (TWA) parameters were measured using 24 h Holter monitoring 2-4 weeks after onset of ACS. Initial and follow-up LVEF was measured by ultrasound. Patients were followed for at least 6 months to record the occurrence of MACE. Models using combinations of the individual independent prognostic factors found by multivariate analysis were then constructed to use for estimation of risk of MACE. In multivariate analysis, VLP measured as QRS duration, HRV measured as standard deviation of normal RR intervals, and followup LVEF, but none of the other parameters studied, were independent risk factors for MACE. Areas under ROC curve (AUCs) for combinations of 2 or all 3 factors ranged from 0.73 to 0.76. Combinations of any of the three independent risk factors for MACE in ACS patients with PCI improved prediction and, because these risk factors were obtained non-invasively, may have future clinical usefulness.
Collapse
Affiliation(s)
- Min-Jie Yuan
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai, China
| | - Ye-Sheng Pan
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai, China
| | - Wei-Guo Hu
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai, China
| | - Zhi-Gang Lu
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai, China
| | - Qing-Yong Zhang
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai, China
| | - Dong Huang
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai, China
| | - Xiao-Li Huang
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai, China
| | - Meng Wei
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai, China
| | - Jing-Bo Li
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai, China
| |
Collapse
|