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Lin PY, Tsai CT, Hsu CF, Lee YH, Huang HP, Huang CC, Liu LYM, Hsu L, Yang TF, Lin PL. The Autonomic Imbalance of Myocardial Ischemia during Exercise Stress Testing: Insight from Short-Term Heart Rate Variability Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15096. [PMID: 36429812 PMCID: PMC9690482 DOI: 10.3390/ijerph192215096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/11/2022] [Accepted: 11/13/2022] [Indexed: 06/16/2023]
Abstract
Exercise stress testing (EST) has limited power in diagnosing obstructive coronary artery disease (CAD). The heart rate variability (HRV) analysis might increase the sensitivity of CAD detection. This study aimed to evaluate the correlation between short-term HRV and myocardial ischemia during EST, including the acceleration, maximum, and recovery stages of heart rate (HR). The HRV during EST from 19 healthy (RHC) subjects and 35 patients with CAD (25 patients with insignificant CAD (iCAD), and 10 patients with significant CAD (sCAD)) were compared. As a result, all HRV indices decreased at the maximum stage and no significant differences between iCAD and sCAD were found. The low-frequency power of heart rate signal (LF) of the RHC group recovered relatively quickly from the third to the sixth minutes after maximum HR, compared with that of the sCAD group. The relative changes of most HRV indices between maximum HR and recovery stage were lower in the sCAD group than in the RHC group, especially in LF, the standard deviation of all normal to normal intervals (SDNN), and the standard deviation in the long axis direction of the Poincaré plot analysis (SD2) indices (p < 0.05). The recovery slope of LF was significantly smaller in the sCAD group than in the RHC group (p = 0.02). The result suggests that monitoring short-term HRV during EST provides helpful insight into the cardiovascular autonomic imbalance in patients with significant CAD. The relative change of autonomic tone, especially the delayed sympathetic recovery, could be an additional marker for diagnosing myocardial ischemia.
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Affiliation(s)
- Ping-Yen Lin
- Department of Electrophyics, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
| | - Cheng-Ting Tsai
- Cardiovascular Center, MacKay Memorial Hospital, Taipei 104217, Taiwan
- Department of Cosmetic Applications and Management, MacKay Junior College of Medicine, Nursing and Management, Taipei 25245, Taiwan
| | | | - Ying-Hsiang Lee
- Cardiovascular Center, MacKay Memorial Hospital, Taipei 104217, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan
- Department of Artificial Intelligence and Medical Application, MacKay Junior College of Medicine, Nursing and Management, Taipei 25245, Taiwan
| | | | - Chun-Che Huang
- Department of Healthcare Administration, I-Shou University, Kaohsiung 82445, Taiwan
| | - Lawrence Yu-Min Liu
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan
- Division of Cardiology, Hsinchu MacKay Memorial Hospital, Hsinchu 30071, Taiwan
| | - Long Hsu
- Department of Electrophyics, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
| | - Ten-Fang Yang
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
- Graduate Institute of Medical Informatics, Taipei Medical University Hospital, Taipei 110301, Taiwan
| | - Po-Lin Lin
- Division of Cardiology, Hsinchu MacKay Memorial Hospital, Hsinchu 30071, Taiwan
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
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Silva LRB, Gentil P, Seguro CS, de Oliveira GT, Silva MS, Zamunér AR, Beltrame T, Rebelo ACS. High Fasting Glycemia Predicts Impairment of Cardiac Autonomic Control in Adults With Type 2 Diabetes: A Case-Control Study. Front Endocrinol (Lausanne) 2021; 12:760292. [PMID: 34858333 PMCID: PMC8630737 DOI: 10.3389/fendo.2021.760292] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/22/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Type 2 diabetes (T2D) is characterized by a metabolic disorder that elevates blood glucose concentration. Chronic hyperglycemia has been associated with several complications in patients with T2D, one of which is cardiac autonomic dysfunction that can be assessed from heart rate variability (HRV) and heart rate recovery (HRR) response, both associated with many aspects of health and fitness, including severe cardiovascular outcomes. OBJECTIVE To evaluate the effects of T2D on cardiac autonomic modulation by means of HRV and HRR measurements. MATERIALS AND METHODS This study has an observational with case-control characteristic and involved ninety-three middle-aged adults stratified into two groups (control group - CG, n = 34; diabetes group - DG, n = 59). After signing the free and informed consent form, the patients were submitted to the evaluation protocols, performed biochemical tests to confirm the diagnosis of T2D, collection of R-R intervals for HRV analysis and cardiopulmonary effort test to quantify HRR. RESULTS At rest, the DG showed a reduction in global HRV (SDNN= 19.31 ± 11.72 vs CG 43.09 ± 12.74, p < 0.0001), lower parasympathetic modulation (RMSSD= 20.49 ± 14.68 vs 52.41 ± 19.50, PNN50 = 4.76 ± 10.53 vs 31.24 ± 19.24, 2VD%= 19.97 ± 10.30 vs 28.81 ± 9.77, p < 0.0001 for both indices) and higher HRrest when compared to CG. After interruption of physical exercise, a slowed heart rate response was observed in the DG when compared to the CG. Finally, a simple linear regression showed that fasting glycemia was able to predict cardiac autonomic involvement in volunteers with T2D. CONCLUSION Patients with T2D presented lower parasympathetic modulation at rest and slowed HRR after physical exercise, which may be associated with higher cardiovascular risks. The findings show the glycemic profile as an important predictor of impaired cardiac autonomic modulation.
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Affiliation(s)
- Lucas Raphael Bento Silva
- Department of Physical Education, Araguaia University Center, Goiânia, Brazil
- Post-Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Goias, Goiânia, Brazil
- *Correspondence: Lucas Raphael Bento Silva,
| | - Paulo Gentil
- Post-Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Goias, Goiânia, Brazil
- Faculty of Physical Education and Dance, Federal University of Goias, Goiânia, Brazil
- Hypertension League, Federal University of Goias, Goiânia, Brazil
| | - Camila Simões Seguro
- Post-Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Goias, Goiânia, Brazil
| | | | - Maria Sebastiana Silva
- Post-Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Goias, Goiânia, Brazil
- Faculty of Physical Education and Dance, Federal University of Goias, Goiânia, Brazil
| | - Antônio Roberto Zamunér
- Laboratory of Clinical Research in Kinesiology, Department of Kinesiology, Universidad Católica del Maule, Talca, Chile
| | - Thomas Beltrame
- Institute of Computing, University of Campinas, São Paulo, Brazil
- Department of Physical Therapy, Federal University of São Carlos, São Paulo, Brazil
| | - Ana Cristina Silva Rebelo
- Post-Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Goias, Goiânia, Brazil
- Faculty of Physical Education and Dance, Federal University of Goias, Goiânia, Brazil
- Department of Morphology, Institute of Biological Sciences, Federal University of Goias, Goiânia, Brazil
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Yu Y, Hu L, Xu Y, Wu S, Chen Y, Zou W, Zhang M, Wang Y, Gu Y. Impact of blood glucose control on sympathetic and vagus nerve functional status in patients with type 2 diabetes mellitus. Acta Diabetol 2020; 57:141-150. [PMID: 31367992 PMCID: PMC6997255 DOI: 10.1007/s00592-019-01393-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/23/2019] [Indexed: 02/08/2023]
Abstract
AIMS Present study observed the impact of blood glucose control on sympathetic and vagus functional status in type 2 diabetes mellitus (DM) patients through observing the association between glycosylated hemoglobin (HbA1c) level and sympathetic and vagus functional status detected by heart rate recovery (HRR) and heart rate variability (HRV) assessments. METHODS Consecutive hospitalized DM patients were divided into well glycemic control group (HbA1c < 7.0%, group WGC, n = 100) and poor glycemic control group (HbA1c ≥ 7.0%, group PGC, n = 100), 100 hospitalized patients without DM served as control group (group C). All subjects underwent blood biochemistry test, treadmill exercise testing and 24-h Holter monitoring. RESULTS HRR and HRV parameters were significantly lower in group WGC and PGC than in group C. Standard deviation of NN intervals (SDNN), standard deviation of all 5-min average NN intervals (SDANN), very low frequency (VLF) values were significantly lower in group PGC than in group WGC. HbA1c level was negatively correlated with HRR1, SDNN, SDANN, VLF, low frequency and high frequency. Logistic regression analysis showed that lower SDNN, SDANN and VLF values were risk factors for high HbA1c levels in DM patients after adjusting for gender, age and beta-blocker use in the model 1, and for gender, age, beta-blocker use, coronary artery disease and hypertension in the model 2. CONCLUSIONS Present results indicate that sympathetic and vagal functional status are impaired independent of HbA1c level, while poor glycemic control is related to more significant neurocardiac dysfunction in DM patients.
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Affiliation(s)
- Yijun Yu
- Department of Cardiology, Wuhan Fourth Hospital; Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, HanZheng Street 473#, QiaoKou District, Wuhan, 430033, China
| | - Liqun Hu
- Department of Cardiology, Wuhan Fourth Hospital; Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, HanZheng Street 473#, QiaoKou District, Wuhan, 430033, China
| | - Yanling Xu
- Department of Cardiology, Wuhan Fourth Hospital; Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, HanZheng Street 473#, QiaoKou District, Wuhan, 430033, China
| | - Shiwei Wu
- Department of Cardiology, Wuhan Fourth Hospital; Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, HanZheng Street 473#, QiaoKou District, Wuhan, 430033, China
| | - Yafei Chen
- Department of Cardiology, Wuhan Fourth Hospital; Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, HanZheng Street 473#, QiaoKou District, Wuhan, 430033, China
| | - Wusong Zou
- Department of Cardiology, Wuhan Fourth Hospital; Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, HanZheng Street 473#, QiaoKou District, Wuhan, 430033, China
| | - Mingjing Zhang
- Department of Cardiology, Wuhan Fourth Hospital; Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, HanZheng Street 473#, QiaoKou District, Wuhan, 430033, China
| | - Yuting Wang
- Department of Cardiology, Wuhan Fourth Hospital; Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, HanZheng Street 473#, QiaoKou District, Wuhan, 430033, China
| | - Ye Gu
- Department of Cardiology, Wuhan Fourth Hospital; Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, HanZheng Street 473#, QiaoKou District, Wuhan, 430033, China.
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Quantitative Assessment of Autonomic Regulation of the Cardiac System. JOURNAL OF HEALTHCARE ENGINEERING 2019; 2019:4501502. [PMID: 31178987 PMCID: PMC6501147 DOI: 10.1155/2019/4501502] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/27/2019] [Indexed: 12/16/2022]
Abstract
Autonomic neural system (ANS) regulates the circulation to provide optimal perfusion of every organ in accordance with its metabolic needs, and the quantitative assessment of autonomic regulation is crucial for personalized medicine in cardiovascular diseases. In this paper, we propose the Dystatis to quantitatively evaluate autonomic regulation of the human cardiac system, based on homeostatis and probabilistic graphic model, where homeostatis explains ANS regulation while the probability graphic model systematically defines the regulation process for quantitative assessment. The indices and measurement methods for three well-designed scenarios are also illustrated to evaluate the proposed Dystatis: (1) heart rate variability (HRV), blood pressure variability (BPV), and respiration synchronization (Synch) in resting situation; (2) chronotropic competence indices (CCI) in graded exercise testing; and (3) baroreflex sensitivity (BRS), sympathetic nerve activity (SNA), and parasympathetic nerve activity (PNA) in orthostatic testing. The previous clinical results have shown that the proposed method and indices for autonomic cardiac system regulation have great potential in prediction, diagnosis, and rehabilitation of cardiovascular diseases, hypertension, and diabetes.
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Kiviniemi AM, Kenttä TV, Lepojärvi S, Perkiömäki JS, Piira OP, Ukkola O, Huikuri HV, Junttila MJ, Tulppo MP. Recovery of rate-pressure product and cardiac mortality in coronary artery disease patients with type 2 diabetes. Diabetes Res Clin Pract 2019; 150:150-157. [PMID: 30872066 DOI: 10.1016/j.diabres.2019.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 03/05/2019] [Indexed: 01/09/2023]
Abstract
AIMS To investigate prognostic significance of post-exercise recovery of rate-pressure product (RPP) in patients with stable coronary artery disease (CAD) and type 2 diabetes (T2D). METHODS Patients with angiographically documented CAD and T2D (n = 697) underwent symptom-limited bicycle exercise test. Exercise capacity (EC), heart rate, blood pressure and RPP responses to peak exercise and recovery (2' and 5' after cessation of exercise) were analyzed. Cardiac death was the primary and sudden cardiac death (SCD) secondary endpoint. RESULTS During a median follow-up of 76 months, 49 cardiac deaths (7.0%) and 28 SCDs (4.0%) were observed. The recovery of RPP at 5' was the strongest univariate predictor of cardiac death (hazard ratio [HR]: 2.55 per SD decrease, 95%CI: 1.82-3.58, p < 0.001) and SCD (HR: 2.34, 95%CI: 1.51-3.62, p < 0.001). In multivariate analysis, it remained significantly associated to cardiac death and SCD without (HR: 1.66, 95%CI: 1.14-2.41, p < 0.01 and HR: 1.75, 95%CI: 1.08-2.85, p < 0.05, respectively) and with additional adjustment for EC and peak RPP (HR: 1.45, 95%CI: 1.09-1.92, p < 0.05 and HR: 1.52, 95%CI: 1.01-2.27, p < 0.05, respectively). CONCLUSIONS The recovery of RPP after exercise is a potent predictor of cardiac death in patients with CAD and T2D. It provides significant prognostic information beyond EC and peak RPP.
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Affiliation(s)
- Antti M Kiviniemi
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
| | - Tuomas V Kenttä
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Samuli Lepojärvi
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Juha S Perkiömäki
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Olli-Pekka Piira
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Olavi Ukkola
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Heikki V Huikuri
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - M Juhani Junttila
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Mikko P Tulppo
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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Sydó N, Sydó T, Gonzalez Carta KA, Hussain N, Farooq S, Murphy JG, Merkely B, Lopez-Jimenez F, Allison TG. Prognostic Performance of Heart Rate Recovery on an Exercise Test in a Primary Prevention Population. J Am Heart Assoc 2018; 7:e008143. [PMID: 29581219 PMCID: PMC5907593 DOI: 10.1161/jaha.117.008143] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 02/13/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Heart rate (HR) recovery has been investigated in specific patient cohorts, but there is less information about the role of HR recovery in general populations. We investigated whether HR recovery has long-term prognostic significance in primary prevention. METHODS AND RESULTS Exercise tests performed between 1993 and 2010 on patients aged 30 to 79 years without cardiovascular disease were included. Mortality was determined from Mayo Clinic records and Minnesota Death Index. Total, cardiovascular, and non-cardiovascular mortality was reported according to HR recovery <13 bpm using Cox regression. 19 551 patients were included, 6756 women (35%), age 51±10 years. There were 1271 deaths over follow-up of 12±5 years. HR recovery declined after age 60, and was also lower according to diabetes mellitus, hypertension, obesity, current smoking, and poor cardiorespiratory fitness but not sex or β-blockers. Adjusting for these factors, abnormal HR recovery was a significant predictor of total (hazard ratio [95% confidence interval]=1.56 [1.384-1.77]), cardiovascular (1.95 [1.57-2.42]), and non-cardiovascular death (1.41 [1.22-1.64]). Hazard ratios for cardiovascular death according to abnormal HR recovery were significant in all age groups (30-59, 60-69, 70-79), in both sexes, in patients with and without hypertension, obesity, and diabetes mellitus, but not in patients taking β-blockers, current smokers, and patients with normal cardiorespiratory fitness. CONCLUSIONS HR recovery is a powerful prognostic factor predicting total, cardiovascular, and non-cardiovascular death in a primary prevention cohort. It performs consistently well according to sex, age, obesity, hypertension, and diabetes mellitus but shows diminished utility in patients taking β-blockers, current smokers, and patients with normal cardiorespiratory fitness.
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Affiliation(s)
- Nóra Sydó
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Tibor Sydó
- Csolnoky Ferenc Hospital, Veszprém, Hungary
| | | | - Nasir Hussain
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Shausha Farooq
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Joseph G Murphy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Thomas G Allison
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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Wu J, Li J, Seely A, Zhu Y, Huang S, Wang X, Zhao L, Wang H, Christophe H. Chronotropic Competence Indices Extracted from Wearable Sensors for Cardiovascular Diseases Management. SENSORS 2017; 17:s17112441. [PMID: 29068357 PMCID: PMC5713041 DOI: 10.3390/s17112441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/07/2017] [Accepted: 10/19/2017] [Indexed: 11/30/2022]
Abstract
Chronotropic incompetence (CI) has been proven to be an important factor in the diagnosis and management of cardiovascular diseases. In this paper, we extend the existing CI parameters and propose chronotropic competence indices (CCI) to describe the exercise response of the cardiopulmonary system. A cardiac chronotropic competence Test (3CT), dedicated to CCI measurement using a wearable device, is also presented. Preliminary clinical trials are presented for the validation of 3CT measurement accuracy, and to show the potential of CCI in the prevention and rehabilitation of cardiovascular diseases.
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Affiliation(s)
- Jiankang Wu
- The University of Chinese Academy of Sciences, Beijing 100049, China.
| | - Jianan Li
- Jiangsu Province Hospital, No. 200 Guangzhou Road, Nanjing 210008, China.
| | - Andrew Seely
- Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON K1Y 4E9, Canada.
| | - Yi Zhu
- Jiangsu Province Hospital, No. 200 Guangzhou Road, Nanjing 210008, China.
| | - Sisi Huang
- Jiangsu Province Hospital, No. 200 Guangzhou Road, Nanjing 210008, China.
| | - Xiaoqin Wang
- Jiangsu Province Hospital, No. 200 Guangzhou Road, Nanjing 210008, China.
| | - Lei Zhao
- Jiangsu Province Hospital, No. 200 Guangzhou Road, Nanjing 210008, China.
| | - Hongliang Wang
- The University of Chinese Academy of Sciences, Beijing 100049, China.
| | - Herry Christophe
- Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON K1Y 4E9, Canada.
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Jae SY, Kurl S, Laukkanen JA, Zaccardi F, Choi YH, Fernhall B, Carnethon M, Franklin BA. Exercise Heart Rate Reserve and Recovery as Predictors of Incident Type 2 Diabetes. Am J Med 2016; 129:536.e7-536.e12. [PMID: 26844636 DOI: 10.1016/j.amjmed.2016.01.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 12/21/2015] [Accepted: 01/05/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND We tested the hypothesis that selected exercise heart rate responses, specifically those providing indices of autonomic dysfunction, may be associated with incident type 2 diabetes in 2231 apparently healthy men with normal baseline fasting glucose levels. METHODS Heart rate reserve was calculated as the difference between the maximal attained heart rate and the supine resting heart rate, whereas heart rate recovery was defined as the maximal heart rate minus the heart rate measured at 2 minutes of recovery after peak or symptom-limited cardiopulmonary exercise testing. Type 2 diabetes was defined as glycated hemoglobin >6.5% or fasting plasma glucose >126 mg/dL at the follow-up examination. RESULTS During a median follow-up interval of 5 years, 90 of the 2231 men (4.0%) developed type 2 diabetes. The relative risks of incident type 2 diabetes in men within the lowest quartiles of heart rate reserve and heart rate recovery versus men comprising the highest quartiles of heart rate reserve and heart rate recovery were 2.71 (95% confidence interval, 1.20-6.11) and 2.81 (95% confidence interval, 1.36-5.78) after adjusting for potential confounding variables. Each unit increment (1 beat/min) in heart rate reserve and heart rate recovery was associated with a 2% to 3% decreased incidence of type 2 diabetes. CONCLUSIONS Exercise heart rate reserve and recovery predicted incidence of type 2 diabetes in healthy men, suggesting that autonomic dysfunction may be associated with an increased likelihood for the development of this cardiometabolic risk factor.
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Affiliation(s)
- Sae Young Jae
- Department of Sport Science, University of Seoul, South Korea.
| | - Sudhir Kurl
- Department of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Jari A Laukkanen
- Department of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Francesco Zaccardi
- Diabetes Research Centre, Leicester General Hospital, Leicester, United Kingdom
| | - Yoon-Ho Choi
- Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Bo Fernhall
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Ill
| | - Mercedes Carnethon
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Barry A Franklin
- Preventive Cardiology and Cardiac Rehabilitation, William Beaumont Hospital, Royal Oak, Mich
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Zafrir B, Azencot M, Dobrecky-Mery I, Lewis BS, Flugelman MY, Halon DA. Resting heart rate and measures of effort-related cardiac autonomic dysfunction predict cardiovascular events in asymptomatic type 2 diabetes. Eur J Prev Cardiol 2015; 23:1298-306. [PMID: 26701872 DOI: 10.1177/2047487315624747] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 12/09/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Autonomic control of the cardiovascular system may be impaired in type 2 diabetes and is associated with increased morbidity and mortality. Parameters obtained during stress testing may reflect early stages of cardiac autonomic dysfunction and provide prognostic information in asymptomatic type 2 diabetes. METHODS We performed maximal exercise treadmill testing in 594 patients with type 2 diabetes without known coronary heart disease. The prognostic significance of physiological parameters associated with autonomic dysfunction was assessed, including chronotropic incompetence (<80% heart rate reserve), abnormal heart rate recovery at 1 minute <18 beats/minute, and resting tachycardia >100 beats/minute. Cox proportional hazards analysis was used to determine the association of exercise parameters with a composite outcome of all-cause mortality, myocardial infarction or stroke. RESULTS Resting heart rate >100 beats/minute was observed in 18% of patients, chronotropic incompetence in 30% and heart rate recovery at 1 minute <18 beats/minute in 35%. Over 79 ± 16 months, there were 72 (12%) events. Each parameter was significantly associated with event risk in an adjusted multivariate analysis: chronotropic incompetence (hazard ratio 1.89, 95% confidence interval 1.18-3.01; P = 0.008), resting heart rate ≥100 beats/minute (hazard ratio 1.97, 95% confidence interval 1.19-3.26; P = 0.008) and heart rate recovery at 1 minute <18 beats (hazard ratio 1.77, 95% confidence interval 1.12-2.81; P = 0.015). A progressive relationship between the number of abnormal parameters and event risk was observed (log rank P < 0.001). CONCLUSIONS Chronotropic incompetence, resting tachycardia and reduced heart rate recovery are independently and additively associated with long-term mortality, myocardial infarction or stroke in type 2 diabetes without known coronary heart disease.
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Affiliation(s)
- Barak Zafrir
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel; the Ruth and Bruce Rappaport School of Medicine, New York, USA
| | - Mali Azencot
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel; the Ruth and Bruce Rappaport School of Medicine, New York, USA
| | | | - Basil S Lewis
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel; the Ruth and Bruce Rappaport School of Medicine, New York, USA
| | - Moshe Y Flugelman
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel; the Ruth and Bruce Rappaport School of Medicine, New York, USA
| | - David A Halon
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel; the Ruth and Bruce Rappaport School of Medicine, New York, USA
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Effect of percutaneous coronary intervention on heart rate recovery in patients with coronary artery disease. Coron Artery Dis 2015; 26:442-7. [PMID: 25974268 DOI: 10.1097/mca.0000000000000264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to investigate the effect of percutaneous coronary intervention (PCI) on heart rate recovery (HRR) in patients with angiographically defined coronary artery disease, and to search for a noninvasive method for evaluating the effect of revascularization. METHODS From June 2012 to July 2013, 56 consecutive male patients with coronary artery disease were enrolled in the PCI group. Correspondingly, in the control group there were 56 consecutive male patients with chest pain but a normal coronary artery verified by angiography. The exercise treadmill test was performed 3 days before and 7 days after intervention in the PCI group, and 3 days before angiography in the control group. RESULTS The peak heart rate, metabolic equivalents, and the Duke score were notably lower in the PCI group before intervention compared with the control group (P<0.01). In contrast, preintervention ST depression in the PCI group was significantly higher than that in the control group (P<0.01). Preintervention HRR values from 1 to 6 min were much lower in the PCI group compared with the control group (P<0.01). HRR values from 1 to 6 min in the PCI group post intervention increased significantly compared with preintervention HRR values (P<0.01), especially at 3, 4, 5, and 6 min. HRR values at 1, 2, and 3 min increased sharply post intervention. CONCLUSION Successful revascularization through PCI could improve HRR in patients with major coronary artery involvement. Moreover, HRR measurement may be used as a noninvasive method for evaluating the effect of revascularization.
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Winata J, Panda AL, Azis RA. Does Albuminuria Correlate With Silent Myocardial Ischemia and Delayed Heart Rate Recovery in Hypertensive Men Without Diabetes Mellitus. High Blood Press Cardiovasc Prev 2015; 22:143-8. [DOI: 10.1007/s40292-015-0085-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 03/27/2015] [Indexed: 10/23/2022] Open
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Peçanha T, Silva-Júnior ND, Forjaz CLDM. Heart rate recovery: autonomic determinants, methods of assessment and association with mortality and cardiovascular diseases. Clin Physiol Funct Imaging 2013; 34:327-39. [DOI: 10.1111/cpf.12102] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 10/14/2013] [Indexed: 01/24/2023]
Affiliation(s)
- Tiago Peçanha
- Exercise Hemodynamic Laboratory; School of Physical Education and Sport; University of Sao Paulo; São Paulo Brazil
| | - Natan Daniel Silva-Júnior
- Exercise Hemodynamic Laboratory; School of Physical Education and Sport; University of Sao Paulo; São Paulo Brazil
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Karjalainen JJ, Kiviniemi AM, Hautala AJ, Piira OP, Lepojärvi ES, Mäkikallio TH, Huikuri HV, Tulppo MP. Determinants of heart rate recovery in coronary artery disease patients with and without type 2 diabetes. Auton Neurosci 2012; 171:79-84. [DOI: 10.1016/j.autneu.2012.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 08/21/2012] [Accepted: 08/29/2012] [Indexed: 10/27/2022]
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Okutucu S, Karakulak UN, Aytemir K, Oto A. Heart rate recovery: a practical clinical indicator of abnormal cardiac autonomic function. Expert Rev Cardiovasc Ther 2012; 9:1417-30. [PMID: 22059791 DOI: 10.1586/erc.11.149] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The autonomic nervous system (ANS) and cardiovascular function are intricately and closely related. One of the most frequently used diagnostic and prognostic tools for evaluating cardiovascular function is the exercise stress test. Exercise is associated with increased sympathetic and decreased parasympathetic activity and the period of recovery after maximum exercise is characterized by a combination of sympathetic withdrawal and parasympathetic reactivation, which are the two main arms of the ANS. Heart rate recovery after graded exercise is one of the commonly used techniques that reflects autonomic activity and predicts cardiovascular events and mortality, not only in cardiovascular system disorders, but also in various systemic disorders. In this article, the definition, applications and protocols of heart rate recovery and its value in various diseases, in addition to exercise physiology, the ANS and their relationship, will be discussed.
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Affiliation(s)
- Sercan Okutucu
- Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey
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Ribisl PM, Gaussoin SA, Lang W, Bahnson J, Connelly SA, Horton ES, Jakicic JM, Killean T, Kitzman DW, Knowler WC, Stewart KJ. Lifestyle intervention improves heart rate recovery from exercise in adults with type 2 diabetes: results from the Look AHEAD study. J Obes 2012; 2012:309196. [PMID: 23227314 PMCID: PMC3512322 DOI: 10.1155/2012/309196] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 09/14/2012] [Indexed: 12/30/2022] Open
Abstract
The primary aims of this paper were (1) to evaluate the influence of intensive lifestyle weight loss and exercise intervention (ILI) compared with diabetes support and education (DSE) upon Heart Rate Recovery (HRR) from graded exercise testing (GXT) and (2) to determine the independent and combined effects of weight loss and fitness changes upon HRR. In 4503 participants (45-76 years) who completed 1 year of intervention, HRR was measured after a submaximal GXT to compare the influence of (ILI) with (DSE) upon HRR. Participants assigned to ILI lost an average 8.6% of their initial weight versus 0.7% in DSE group (P < 0.001) while mean fitness increased in ILI by 20.9% versus 5.8% in DSE (P < 0.001). At Year 1, all exercise and HRR variables in ILI improved (P < 0.0001) versus DSE: heart rate (HR) at rest was lower (72.8 ± 11.4 versus 77.7 ± 11.7 b/min), HR range was greater (57.7 ± 12.1 versus 53.1 ± 12.4 b/min), HR at 2 minutes was lower (89.3 ± 21.8 versus 93.0 ± 12.1 b/min), and HRR was greater (41.25 ± 22.0 versus 37.8 ± 12.5 b/min). Weight loss and fitness gain produced significant separate and independent improvements in HRR.
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Affiliation(s)
- Paul M Ribisl
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC 27109, USA.
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Affiliation(s)
- Fadi G Hage
- Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, AL 35294-0007, USA.
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