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Šišáková M, Helánová K, Hnatkova K, Andršová I, Novotný T, Malik M. Intra-Individual Relationship between Heart Rate Variability and the Underlying Heart Rate in Children and Adolescents. J Clin Med 2024; 13:2897. [PMID: 38792438 PMCID: PMC11121958 DOI: 10.3390/jcm13102897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/20/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objective: The relationship between heart rate and heart rate variability (HRV) indices has been repeatedly studied in adults but limited data are available on the relationship in paediatric populations. Methods: Continuous 12-lead electrocardiograms were recorded in 1016 healthy children and adolescents (534 females) aged 4 to 19 years during postural manoeuvres with rapid changes between 10-min positions of supine → sitting → standing → supine → standing → sitting → supine. In each position, the averaged RR interval was measured together with four HRV indices, namely the SDNN, RMSSD, quasi-normalised high-frequency components (qnHF), and the proportions of low- and high-frequency components (LF/HF). In each subject, the slope of the linear regression between the repeated HRV measurements and the corresponding RR interval averages was calculated. Results: The intra-subject regression slopes, including their confidence intervals, were related to the age and sex of the subjects. The SDNN/RR, RMSSD/RR, and qnHF/RR slopes were significantly steeper (p < 0.001) and the (LF/HF)/RR slopes were significantly shallower (p < 0.001) in younger children compared to older children and adolescents. Conclusions: The study suggests that sympathetic and vagal influences on heart rate are present in both younger and older children. With advancing age, the sympatho-vagal balance gradually develops and allows the vagal control to suppress the sympathetic drive towards higher heart rates seen in younger age children.
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Affiliation(s)
- Martina Šišáková
- Department of Internal Medicine and Cardiology, University Hospital Brno, Jihlavská 20, 625 00 Brno, Czech Republic; (M.Š.); (I.A.)
- Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, 62 500 Brno, Czech Republic
| | - Kateřina Helánová
- Department of Internal Medicine and Cardiology, University Hospital Brno, Jihlavská 20, 625 00 Brno, Czech Republic; (M.Š.); (I.A.)
- Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, 62 500 Brno, Czech Republic
| | - Katerina Hnatkova
- National Heart and Lung Institute, Imperial College, London SW3 6LY, UK; (K.H.); (M.M.)
| | - Irena Andršová
- Department of Internal Medicine and Cardiology, University Hospital Brno, Jihlavská 20, 625 00 Brno, Czech Republic; (M.Š.); (I.A.)
- Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, 62 500 Brno, Czech Republic
| | - Tomáš Novotný
- Department of Internal Medicine and Cardiology, University Hospital Brno, Jihlavská 20, 625 00 Brno, Czech Republic; (M.Š.); (I.A.)
- Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, 62 500 Brno, Czech Republic
| | - Marek Malik
- Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, 62 500 Brno, Czech Republic
- National Heart and Lung Institute, Imperial College, London SW3 6LY, UK; (K.H.); (M.M.)
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Taman H, Mageed N, Elmorsy M, Elfayoumy S, Elawady M, Farid A, Abdelmonem M, Abdelbaser I. Heart rate variability as an indicator of COVID-19 induced myocardial injury: a retrospective cohort study. BMC Anesthesiol 2023; 23:17. [PMID: 36627579 PMCID: PMC9830621 DOI: 10.1186/s12871-023-01975-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/05/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Heart rate variability (HRV) is a valuable indicator of autonomic nervous system integrity and can be a prognostic tool of COVID-19 induced myocardial affection. This study aimed to compare HRV indices between patients who developed myocardial injury and those without myocardial injury in COVID-19 patients who were admitted to intensive care unit (ICU). METHODS In this retrospective study, the data from 238 COVID-19 adult patients who were admitted to ICU from April 2020 to June 2021 were collected. The patients were assigned to myocardial injury and non-myocardial injury groups. The main collected data were R-R intervals, standard deviation of NN intervals (SDANN) and the root mean square of successive differences between normal heartbeats (RMSSD) that were measured daily during the first five days of ICU admission. RESULTS The R-R intervals, the SDANN and the RMSSD were significantly shorter in the myocardial injury group than the non-myocardial group at the first, t second, third, fourth and the fifth days of ICU admission. There were no significant differences between the myocardial injury and the non-myocardial injury groups with regard the number of patients who needed mechanical ventilation, ICU length of stay and the number of ICU deaths. CONCLUSIONS From the results of this retrospective study, we concluded that the indices of HRV were greatly affected in COVID-19 patients who developed myocardial injury.
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Affiliation(s)
- Hani Taman
- grid.10251.370000000103426662Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, 2 El-Gomhouria Street, Mansoura, 35516 Egypt
| | - Nabil Mageed
- grid.10251.370000000103426662Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, 2 El-Gomhouria Street, Mansoura, 35516 Egypt
| | - Mohamed Elmorsy
- grid.462079.e0000 0004 4699 2981Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Damietta University, Damietta, Egypt
| | - Sherif Elfayoumy
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Portsaid University, Portsaid, Egypt
| | - Mostafa Elawady
- grid.10251.370000000103426662Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, 2 El-Gomhouria Street, Mansoura, 35516 Egypt
| | - Ahmed Farid
- grid.10251.370000000103426662Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, 2 El-Gomhouria Street, Mansoura, 35516 Egypt
| | - Mohamed Abdelmonem
- grid.4827.90000 0001 0658 8800Swansea University Medical School, Swansea, UK
| | - Ibrahim Abdelbaser
- grid.10251.370000000103426662Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, 2 El-Gomhouria Street, Mansoura, 35516 Egypt
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Scala I, Rizzo PA, Bellavia S, Brunetti V, Colò F, Broccolini A, Della Marca G, Calabresi P, Luigetti M, Frisullo G. Autonomic Dysfunction during Acute SARS-CoV-2 Infection: A Systematic Review. J Clin Med 2022; 11:jcm11133883. [PMID: 35807167 PMCID: PMC9267913 DOI: 10.3390/jcm11133883] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 06/29/2022] [Accepted: 06/29/2022] [Indexed: 02/04/2023] Open
Abstract
Although autonomic dysfunction (AD) after the recovery from Coronavirus disease 2019 (COVID-19) has been thoroughly described, few data are available regarding the involvement of the autonomic nervous system (ANS) during the acute phase of SARS-CoV-2 infection. The primary aim of this review was to summarize current knowledge regarding the AD occurring during acute COVID-19. Secondarily, we aimed to clarify the prognostic value of ANS involvement and the role of autonomic parameters in predicting SARS-CoV-2 infection. According to the PRISMA guidelines, we performed a systematic review across Scopus and PubMed databases, resulting in 1585 records. The records check and the analysis of included reports’ references allowed us to include 22 articles. The studies were widely heterogeneous for study population, dysautonomia assessment, and COVID-19 severity. Heart rate variability was the tool most frequently chosen to analyze autonomic parameters, followed by automated pupillometry. Most studies found ANS involvement during acute COVID-19, and AD was often related to a worse outcome. Further studies are needed to clarify the role of autonomic parameters in predicting SARS-CoV-2 infection. The evidence emerging from this review suggests that a complex autonomic nervous system imbalance is a prominent feature of acute COVID-19, often leading to a poor prognosis.
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Affiliation(s)
- Irene Scala
- School of Medicine and Surgery, Catholic University of Sacred Heart, Largo Francesco Vito, 1, 00168 Rome, Italy; (I.S.); (P.A.R.); (S.B.); (F.C.); (A.B.); (G.D.M.); (P.C.)
| | - Pier Andrea Rizzo
- School of Medicine and Surgery, Catholic University of Sacred Heart, Largo Francesco Vito, 1, 00168 Rome, Italy; (I.S.); (P.A.R.); (S.B.); (F.C.); (A.B.); (G.D.M.); (P.C.)
| | - Simone Bellavia
- School of Medicine and Surgery, Catholic University of Sacred Heart, Largo Francesco Vito, 1, 00168 Rome, Italy; (I.S.); (P.A.R.); (S.B.); (F.C.); (A.B.); (G.D.M.); (P.C.)
| | - Valerio Brunetti
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e Della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.B.); (G.F.)
| | - Francesca Colò
- School of Medicine and Surgery, Catholic University of Sacred Heart, Largo Francesco Vito, 1, 00168 Rome, Italy; (I.S.); (P.A.R.); (S.B.); (F.C.); (A.B.); (G.D.M.); (P.C.)
| | - Aldobrando Broccolini
- School of Medicine and Surgery, Catholic University of Sacred Heart, Largo Francesco Vito, 1, 00168 Rome, Italy; (I.S.); (P.A.R.); (S.B.); (F.C.); (A.B.); (G.D.M.); (P.C.)
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e Della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.B.); (G.F.)
| | - Giacomo Della Marca
- School of Medicine and Surgery, Catholic University of Sacred Heart, Largo Francesco Vito, 1, 00168 Rome, Italy; (I.S.); (P.A.R.); (S.B.); (F.C.); (A.B.); (G.D.M.); (P.C.)
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e Della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.B.); (G.F.)
| | - Paolo Calabresi
- School of Medicine and Surgery, Catholic University of Sacred Heart, Largo Francesco Vito, 1, 00168 Rome, Italy; (I.S.); (P.A.R.); (S.B.); (F.C.); (A.B.); (G.D.M.); (P.C.)
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e Della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.B.); (G.F.)
| | - Marco Luigetti
- School of Medicine and Surgery, Catholic University of Sacred Heart, Largo Francesco Vito, 1, 00168 Rome, Italy; (I.S.); (P.A.R.); (S.B.); (F.C.); (A.B.); (G.D.M.); (P.C.)
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e Della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.B.); (G.F.)
- Correspondence: ; Tel.: +39-06-30154435
| | - Giovanni Frisullo
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e Della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.B.); (G.F.)
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Heart rate variability and cardiac autonomic functions in post-COVID period. J Interv Card Electrophysiol 2022; 63:715-721. [PMID: 35106678 PMCID: PMC8806134 DOI: 10.1007/s10840-022-01138-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/25/2022] [Indexed: 12/28/2022]
Abstract
Background The heart rate variability (HRV) is a non-invasive, objective and validated method for the assessment of autonomic nervous system. Although acute manifestations of COVID-19 were widely researched, long-term sequela of COVID-19 are still unknown. This study aimed to analyze autonomic function using HRV indices in the post-COVID period that may have a potential to enlighten symptoms of COVID long-haulers. Methods The 24-h ambulatory electrocardiography (ECG) recordings obtained >12 weeks after the diagnosis of COVID-19 were compared with age–gender-matched healthy controls. Patients who used drugs or had comorbidities that affect HRV and who were hospitalized with severe COVID-19 were excluded from the study. Results Time domain indices of HRV analysis (standard deviation of normal RR intervals in 24 h (SDNN 24 h) and root mean square of successive RR interval differences (RMSSD)) were significantly higher in post-COVID patients (p < 0.05 for all). Among frequency domain indices, high frequency and low frequency/high frequency ratio was significantly higher in post-COVID patients (p = 0.037 and p = 0.010, respectively). SDNN >60 ms [36 (60.0%) vs. 12 (36.4%), p = 0.028)] and RMSSD >40 ms [31 (51.7%) vs. 7 (21.2%), p = 0.003)] were more prevalent in post-COVID patients. Logistic regression models were created to evaluate parasympathetic overtone in terms of SDNN >60 ms and RMSSD >40 ms. After covariate adjustment, post-COVID patients were more likely to have SDNN >60 msn (OR: 2.4, 95% CI:1.2–12.8) and RMSSD >40 ms (OR: 2.5, 95% CI: 1.4–9.2). Conclusion This study revealed parasympathetic overtone and increased HRV in patients with history of COVID-19. This may explain the unresolved orthostatic symptoms occurring in post-COVID period which may be associated with autonomic imbalance. Supplementary Information The online version contains supplementary material available at 10.1007/s10840-022-01138-8.
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Shah B, Kunal S, Bansal A, Jain J, Poundrik S, Shetty MK, Batra V, Chaturvedi V, Yusuf J, Mukhopadhyay S, Tyagi S, Meenahalli Palleda G, Gupta A, Gupta MD. Heart rate variability as a marker of cardiovascular dysautonomia in post-COVID-19 syndrome using artificial intelligence. Indian Pacing Electrophysiol J 2022; 22:70-76. [PMID: 35101582 PMCID: PMC8800539 DOI: 10.1016/j.ipej.2022.01.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 12/29/2021] [Accepted: 01/20/2022] [Indexed: 01/03/2023] Open
Abstract
Introduction Cardiovascular dysautonomia comprising postural orthostatic tachycardia syndrome (POTS) and orthostatic hypotension (OH) is one of the presentations in COVID-19 recovered subjects. We aim to determine the prevalence of cardiovascular dysautonomia in post COVID-19 patients and to evaluate an Artificial Intelligence (AI) model to identify time domain heart rate variability (HRV) measures most suitable for short term ECG in these subjects. Methods This observational study enrolled 92 recently COVID-19 recovered subjects who underwent measurement of heart rate and blood pressure response to standing up from supine position and a 12-lead ECG recording for 60 s period during supine paced breathing. Using feature extraction, ECG features including those of HRV (RMSSD and SDNN) were obtained. An AI model was constructed with ShAP AI interpretability to determine time domain HRV features representing post COVID-19 recovered state. In addition, 120 healthy volunteers were enrolled as controls. Results Cardiovascular dysautonomia was present in 15.21% (OH:13.04%; POTS:2.17%). Patients with OH had significantly lower HRV and higher inflammatory markers. HRV (RMSSD) was significantly lower in post COVID-19 patients compared to healthy controls (13.9 ± 11.8 ms vs 19.9 ± 19.5 ms; P = 0.01) with inverse correlation between HRV and inflammatory markers. Multiple perceptron was best performing AI model with HRV(RMSSD) being the top time domain HRV feature distinguishing between COVID-19 recovered patients and healthy controls. Conclusion Present study showed that cardiovascular dysautonomia is common in COVID-19 recovered subjects with a significantly lower HRV compared to healthy controls. The AI model was able to distinguish between COVID-19 recovered patients and healthy controls.
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Affiliation(s)
- Bhushan Shah
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Shekhar Kunal
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Ankit Bansal
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Jayant Jain
- SBILab, Department of ECE, IIIT, Delhi, India
| | | | - Manu Kumar Shetty
- Department of Pharmacology, Maulana Azad Medical College, Delhi, India
| | - Vishal Batra
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Vivek Chaturvedi
- Senior Consultant Cardiologist and Director Cardiac Electrophysiology, Narayana Superspeciality Hospital, Gurugram, India
| | - Jamal Yusuf
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Saibal Mukhopadhyay
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Sanjay Tyagi
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Girish Meenahalli Palleda
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | | | - Mohit Dayal Gupta
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India.
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Cardiorespiratory alterations in a newborn ovine model of systemic viral inflammation. Pediatr Res 2022; 92:1288-1298. [PMID: 35110682 PMCID: PMC8809061 DOI: 10.1038/s41390-022-01958-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 12/21/2021] [Accepted: 01/02/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Respiratory viruses can be responsible for severe apneas and bradycardias in newborn infants. The link between systemic inflammation with viral sepsis and cardiorespiratory alterations remains poorly understood. We aimed to characterize these alterations by setting up a full-term newborn lamb model of systemic inflammation using polyinosinic:polycytidylic acid (Poly I:C). METHODS Two 6-h polysomnographic recordings were carried out in eight lambs on two consecutive days, first after an IV saline injection, then after an IV injection of 300 μg/kg Poly I:C. RESULTS Poly I:C injection decreased locomotor activity and increased NREM sleep. It also led to a biphasic increase in rectal temperature and heart rate. The latter was associated with an overall decrease in heart-rate variability, with no change in respiratory-rate variability. Lastly, brainstem inflammation was found in the areas of the cardiorespiratory control centers 6 h after Poly I:C injection. CONCLUSIONS The alterations in heart-rate variability induced by Poly I:C injection may be, at least partly, of central origin. Meanwhile, the absence of alterations in respiratory-rate variability is intriguing and noteworthy. Although further studies are obviously needed, this might be a way to differentiate bacterial from viral sepsis in the neonatal period. IMPACT Provides unique observations on the cardiorespiratory consequences of injecting Poly I:C in a full-term newborn lamb to mimic a systemic inflammation secondary to a viral sepsis. Poly I:C injection led to a biphasic increase in rectal temperature and heart rate associated with an overall decrease in heart-rate variability, with no change in respiratory-rate variability. Brainstem inflammation was found in the areas of the cardiorespiratory control centers.
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Liviero F, Campisi M, Mason P, Pavanello S. Transient Receptor Potential Vanilloid Subtype 1: Potential Role in Infection, Susceptibility, Symptoms and Treatment of COVID-19. Front Med (Lausanne) 2021; 8:753819. [PMID: 34805220 PMCID: PMC8599155 DOI: 10.3389/fmed.2021.753819] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/08/2021] [Indexed: 12/20/2022] Open
Abstract
The battle against the new coronavirus that continues to kill millions of people will be still long. Novel strategies are demanded to control infection, mitigate symptoms and treatment of COVID-19. This is even more imperative given the long sequels that the disease has on the health of the infected. The discovery that S protein includes two ankyrin binding motifs (S-ARBMs) and that the transient receptor potential vanilloid subtype 1 (TRPV-1) cation channels contain these ankyrin repeat domains (TRPs-ARDs) suggest that TRPV-1, the most studied member of the TRPV channel family, can play a role in binding SARS-CoV-2. This hypothesis is strengthened by studies showing that other respiratory viruses bind the TRPV-1 on sensory nerves and epithelial cells in the airways. Furthermore, the pathophysiology in COVID-19 patients is similar to the effects generated by TRPV-1 stimulation. Lastly, treatment with agonists that down-regulate or inactivate TRPV-1 can have a beneficial action on impaired lung functions and clearance of infection. In this review, we explore the role of the TRPV-1 channel in the infection, susceptibility, pathogenesis, and treatment of COVID-19, with the aim of looking at novel strategies to control infection and mitigate symptoms, and trying to translate this knowledge into new preventive and therapeutic interventions.
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Affiliation(s)
| | | | | | - Sofia Pavanello
- Occupational Medicine, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University Hospital of Padua, Padova, Italy
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Hottenrott L, Gronwald T, Hottenrott K, Wiewelhove T, Ferrauti A. Utilizing Heart Rate Variability for Coaching Athletes During and After Viral Infection: A Case Report in an Elite Endurance Athlete. Front Sports Act Living 2021; 3:612782. [PMID: 34541520 PMCID: PMC8446376 DOI: 10.3389/fspor.2021.612782] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 06/28/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Viral diseases have different individual progressions and can lead to considerable risks/long-term consequences. Therefore, it is not suitable to give general recommendations on a time off from training for athletes. This case report aims to investigate the relevance of detecting heart rate (HR) and HR variability (HRV) during an orthostatic test (OT) to monitor the progression and recovery process during and after a viral disease in an elite endurance athlete. Methods: A 30-year-old elite marathon runner contracted a viral infection (upper respiratory tract infection) 4 weeks after a marathon race. RR intervals in HR time series in supine and standing positions were monitored daily in the morning. Analyzed parameters included HR, the time-domain HRV parameter root mean square of successive difference (RMSSD), peak HR (HRpeak) in a standing position, and the time to HR peak (tHRpeak). Results: During the 6-day viral infection period, HR increased significantly by an average of 11 bpm in the supine position and by 22 bpm in the standing position. In addition, the RMSSD decreased from 20.8 to 4.2 ms, the HRpeak decreased by 13 bpm, and the tHRpeak increased by 18 s in the standing position significantly. There were no significant changes in the pre-viral infection RMSSD values in the supine position. The viral infection led to a significant change in HR and HRV parameters. The cardiac autonomic system reacted more sensitively in the standing position compared to the supine position after a viral infection in the present case study. Conclusion: These data have provided supportive rationale as to why the OT with a change from supine to standing body position and the detection of different indicators based on HR and a vagal driven time-domain HRV parameter (RMSSD) is likely to be useful to detect viral diseases early on when implemented in daily routine. Given the case study nature of the findings, future research has to be conducted to investigate whether the use of the OT might be able to offer an innovative, non-invasive, and time-efficient possibility to detect and evaluate the health status of (elite endurance) athletes.
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Affiliation(s)
- Laura Hottenrott
- Department of Training and Exercise Science, Faculty of Sports Science, Ruhr University Bochum, Bochum, Germany
| | - Thomas Gronwald
- Department of Performance, Neuroscience, Therapy and Health, Faculty of Health Sciences, Medical School Hamburg, Hamburg, Germany
| | - Kuno Hottenrott
- Institute of Sports Science, Department of Training Science and Sports Medicine, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Thimo Wiewelhove
- Department of Training and Exercise Science, Faculty of Sports Science, Ruhr University Bochum, Bochum, Germany
| | - Alexander Ferrauti
- Department of Training and Exercise Science, Faculty of Sports Science, Ruhr University Bochum, Bochum, Germany
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Mansanguan C, Hanboonkunupakarn B, Muangnoicharoen S, Huntrup A, Poolcharoen A, Mansanguan S, Piyaphanee W, Phumratanaprapin W. Cardiac evaluation in adults with dengue virus infection by serial echocardiography. BMC Infect Dis 2021; 21:940. [PMID: 34507547 PMCID: PMC8431916 DOI: 10.1186/s12879-021-06639-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/31/2021] [Indexed: 01/01/2023] Open
Abstract
Background Dengue virus infection (DVI) is a major health problem in many parts of the world. Its manifestations range from asymptomatic infections to severe disease. Although cardiac involvement has been reported in DVI, its incidence has not yet been well established. Methods From July 2016 to January 2018, patients hospitalized at the Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Thailand, with dengue virus infection confirmed by positive NS1 or positive dengue immunoglobulin M findings, participated in the study. We characterized the incidence and change in cardiac function by serial echocardiography and levels of troponin-T and creatine kinase-myocardial band (CK-MB) on the day of admission, the day of defervescence, the first day of hypotension (if any), and at 2 week follow-up. Results Of the 81 patients evaluated, 6 (7.41%) exhibited elevated biomarker levels. There was no difference in clinical presentation amongst dengue fever, dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS), except for the amount of bleeding. Cardiac involvement was found in 22.2% of patients: 3 (3.70%) had left ventricular systolic dysfunction, 3 (3.70%) had transient diastolic dysfunction, 6 (7.41%) had increased levels of at least one cardiac biomarker (troponin-T or CK-MB), and 6 (7.41%) had small pericardial effusion. Myocarditis was suspected in only two patients (with DHF); thus, myocarditis was uncommon in patients with dengue virus infection. Three patients developed DSS during admission and were transferred to the intensive care unit. Conclusion Cardiac involvement in adults with dengue infection was common, ranging from elevated cardiac biomarker to myocarditis. Abnormalities in cardiac function had resolved spontaneously by the day of follow-up, without specific treatment. We found that DHF was a significant risk factor for cardiac involvement. Echocardiography is the investigation of choice for evaluating the haemodynamic status of patients with DVI, especially in severe dengue. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06639-x.
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Affiliation(s)
- Chayasin Mansanguan
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Borimas Hanboonkunupakarn
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Sant Muangnoicharoen
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Arun Huntrup
- Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | | | - Watcharapong Piyaphanee
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Weerapong Phumratanaprapin
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Kaliyaperumal D, Rk K, Alagesan M, Ramalingam S. Characterization of cardiac autonomic function in COVID-19 using heart rate variability: a hospital based preliminary observational study. J Basic Clin Physiol Pharmacol 2021; 32:247-253. [PMID: 33705614 DOI: 10.1515/jbcpp-2020-0378] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/18/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The novel corona virus disease, which was initially reported in China in late 2019, has become a global pandemic affecting 330 million cases. COVID-19 affects predominantly the respiratory system, in addition to other organ systems, mainly the cardiovascular system. One of the hypotheses is that virus entering the target cells by binding to angiotensin converting enzyme 2 affecting hypothalamic pituitary axis could lead to dysautonomia which is measured by heart rate variability (HRV). HRV is a non-invasive measure of autonomic function that facilitates identification of COVID-19 patients at the risk of developing cardiovascular complications. So, we aimed to assess HRV in COVID patients and compare between COVID patients and normal controls. METHODS In a case control design, we compared 63 COVID-19 infected patients with 43 healthy controls matched for age and gender. Along with clinical characterization, heart rate variability was evaluated using ambulatory 5 min ECG in lead II and expressed in frequency and time domain measures. Statistical analysis was performed using SPSS 17.0. RESULTS Mean age of the study population was 49.1 ± 14.2 years and 71 (66.9%) were males. Frequency domain measures high (HF) and low (LF) frequency powers were significantly decreased in COVID-19 patients compared to controls. HF/LF and LF/HF ratios were not different between groups. Time domain measures rMSSD (root mean square of successive RR interval differences) and SDNN (standard deviation of NN intervals) were significantly increased among COVID-19 subjects. COVID-19 infection was associated with increased parasympathetic activity as defined by rMSSD>40 {adjusted odds ratio 7.609 (95% CI 1.61-35.94); p=0.01} and SDNN>60 {adjusted odds ratio 2.620 (95% CI 1.070-6.44); p=0.035} after adjusting for age, gender and comorbidities. CONCLUSIONS Our study results showed increased parasympathetic tone in COVID patients. Early diagnosis of autonomic imbalance in COVID patients is needed to plan management and limit progression of disease.
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Affiliation(s)
| | - Karthikeyan Rk
- Respiratory Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Murali Alagesan
- Internal Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Sudha Ramalingam
- Research and Innovation, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
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11
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Short time cardio-vascular pulses estimation for dengue fever screening via continuous-wave Doppler radar using empirical mode decomposition and continuous wavelet transform. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2020.102361] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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Nguyen CV, Le Quang T, Vu TN, Le Thi H, Van KN, Trong TH, Trong TD, Sun G, Ishibashi K. A non-contact infection screening system using medical radar and Linux-embedded FPGA: Implementation and preliminary validation. INFORMATICS IN MEDICINE UNLOCKED 2019; 16:100225. [PMID: 32289073 PMCID: PMC7103934 DOI: 10.1016/j.imu.2019.100225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objectives In this study, an infection screening system was developed to detect patients suffering from infectious diseases. In addition, the system was also designed to deal with the variability in age and gender, which would affect the accuracy of the detection. Furthermore, to enable a low-cost, non-contact and embedded system, multiple vital signs from a medical radar were measured and all algorithms were implemented on a Field Programmable Gate Array, named PYNQ-Z1. Methods The system consisted of two main stages: digital signal processing and data classification. In the former stage, Butterworth filters, with flexible cut-off frequencies depending on age and gender, and a time-domain peak detection algorithm were deployed to compute three vital signs, namely heart rate, respiratory rate, and standard deviation of heart beat-to-beat interval. For the classification problem, two machine learning models, Support Vector Machine and Quadratic Discriminant Analysis, were implemented. Results The Student's t-test showed that our proposed digital signal processing algorithms coped well with the variability of human cases in age and gender. Meanwhile, the f1-score of roughly 98.0% represented the high sensitivity and specificity of our proposed machine learning methods. Conclusion This study outlines the implementation of an infection screening system, which achieved competent performance. The system might be beneficial for fast screening of infected patients at public health centers in underdeveloped areas, where people have little access to healthcare.
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Affiliation(s)
- Cuong V Nguyen
- School of Electronics and Telecommunications, Hanoi University of Science and Technology, Hanoi, 100000, Viet Nam
| | - Truong Le Quang
- School of Electronics and Telecommunications, Hanoi University of Science and Technology, Hanoi, 100000, Viet Nam
| | - Trung Nguyen Vu
- National Hospital of Tropical Diseases, Hanoi, Viet Nam.,Hanoi Medical University, Hanoi, Vietnam, Hanoi, Viet Nam
| | - Hoi Le Thi
- National Hospital of Tropical Diseases, Hanoi, Viet Nam
| | | | - Thanh Han Trong
- School of Electronics and Telecommunications, Hanoi University of Science and Technology, Hanoi, 100000, Viet Nam
| | - Tuan Do Trong
- School of Electronics and Telecommunications, Hanoi University of Science and Technology, Hanoi, 100000, Viet Nam
| | - Guanghao Sun
- Graduate School of Informatics and Engineering, The University of Electro-Communications, Tokyo, 182-8585, Japan.,Center for Neuroscience and Biomedical Engineering, The University of Electro-Communications, Tokyo, 182-8585, Japan
| | - Koichiro Ishibashi
- Graduate School of Informatics and Engineering, The University of Electro-Communications, Tokyo, 182-8585, Japan
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13
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Malik M, Hnatkova K, Huikuri HV, Lombardi F, Schmidt G, Zabel M. CrossTalk proposal: Heart rate variability is a valid measure of cardiac autonomic responsiveness. J Physiol 2019; 597:2595-2598. [PMID: 31006862 DOI: 10.1113/jp277500] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Marek Malik
- National Heart and Lung Institute, Imperial College, London, UK
| | | | - Heikki V Huikuri
- Research Unit of Internal Medicine, University of Oulu and University Hospital, Oulu, Finland
| | | | - Georg Schmidt
- Klinik für Innere Medizin I, Technische Universität München, Munich, Germany
| | - Markus Zabel
- Department of Cardiology and Pneumology, Heart Center - University of Göttingen Medical Center, Göttingen, Germany
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14
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Mohanty B, Sunder A, Pathak S. Clinicolaboratory profile of expanded dengue syndrome - Our experience in a teaching hospital. J Family Med Prim Care 2019; 8:1022-1027. [PMID: 31041245 PMCID: PMC6482768 DOI: 10.4103/jfmpc.jfmpc_12_19] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Introduction: Classic dengue fever presentation has expanded its horizon by involving various organ systems and is named as expanded dengue syndrome. This changing presentation and rising burden across the globe may lead to delayed diagnosis and under reporting of this syndrome. Aim of Study: To analyze clinicolaboratory profile of patients with expanded dengue syndrome. Materials and Methods: About 520 cases of expanded dengue syndrome as per World Health Organization definition criteria 2012 were studied with their informed consent. Detailed history, thorough clinical examination, and relevant investigations were done. Their clinical and laboratory parameters were analyzed. Standard treatment guidelines were followed in all cases. Observation: About 301 patients were male and 219 were female with male-to-female ratio of 3:2. Their age varied from 12 to 76 years with the average age of 47.5 years. About 92% of cases presented with various gastro hepatic manifestations. The commonest gastrohepatic manifestation was transaminitis (57.5%) that is asymptomatic elevation of liver enzymes followed by acalculous cholecystitis (21%) and acute pancreatitis (13.9%). Twenty-nine patients presented with various neurological manifestations. Three patients presented with acute kidney injury and eight patients had coinfection with malaria. Fever with nausea and vomiting was the most common presentation. About 15% of patients presented with bleeding manifestations. About 40.6% of patients presenting as abdominal manifestations had platelet count <20,000/mm3 and needed platelet transfusion versus 9.8% with other system involvement (central nervous system, cardiovascular system (CVS), renal). Hepatomegaly was the most common ultrasonography (USG) finding being present in 57.5% of patients followed by acalculous cholecystitis in 21.3%. Total mortality was 1.9% in our series. We lost eight patients presenting with neurological manifestations and two patients with coinfection with malaria. Conclusion: Atypical presentations should prompt us to investigate for dengue especially during ongoing epidemics so that expanded dengue syndrome can be diagnosed and treated early.
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Affiliation(s)
- Bijaya Mohanty
- Department of Medicine, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | - Ashok Sunder
- Department of Medicine, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | - Saurabh Pathak
- Department of Gastroenterology, Tata Main Hospital, Jamshedpur, Jharkhand, India
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15
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Oishi K, Himeno Y, Miwa M, Anzai H, Kitajima K, Yasunaka Y, Kumagai H, Ieiri S, Hirooka H. Correcting the Activity-Specific Component of Heart Rate Variability Using Dynamic Body Acceleration Under Free-Moving Conditions. Front Physiol 2018; 9:1063. [PMID: 30131717 PMCID: PMC6091277 DOI: 10.3389/fphys.2018.01063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 07/17/2018] [Indexed: 11/13/2022] Open
Abstract
Heart rate variability (HRV) analysis is a widely used technique to assess sympatho-vagal regulation in response to various internal or external stressors. However, HRV measurements under free-moving conditions are highly susceptible to subjects’ physical activity levels because physical activity alters energy metabolism, which inevitably modulates the cardiorespiratory system and thereby changes the sympatho-vagal balance, regardless of stressors. Thus, researchers must simultaneously quantify the effect of physical activity on HRV to reliably assess sympatho-vagal balance under free-moving conditions. In the present study, dynamic body acceleration (DBA), which was developed in the field of animal ecology as a quantitative proxy for activity-specific energy expenditure, was used as a factor to correct for physical activity when evaluating HRV in freely moving subjects. Body acceleration and heart inter-beat intervals were simultaneously measured in cattle and sheep, and the vectorial DBA and HRV parameters were evaluated at 5-min intervals. Next, the effects of DBA on the HRV parameters were statistically analyzed. The heart rate (HR) and most of the HRV parameters were affected by DBA in both animal species, and the inclusion of the effect of DBA in the HRV analysis greatly influenced the frequency domain and nonlinear HRV parameters. By removing the effect of physical activity quantified using DBA, we could fairly compare the stress levels of animals with different physical activity levels under different management conditions. Moreover, we analyzed and compared the HRV parameters before and after correcting for the mean HR, with and without inclusion of DBA. The results were somewhat unexpected, as the effect of DBA was a highly significant source of HRV also in parameters corrected for mean HR. In conclusion, the inclusion of DBA as a physical activity index is a simple and useful method for correcting the activity-specific component of HRV under free-moving conditions.
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Affiliation(s)
- Kazato Oishi
- Laboratory of Animal Husbandry Resources, Division of Applied Biosciences, Graduate School of Agriculture, Kyoto University, Kyoto, Japan
| | - Yukiko Himeno
- Department of Bioinformatics, College of Life Sciences, Ritsumeikan University, Shiga, Japan
| | - Masafumi Miwa
- Laboratory of Animal Husbandry Resources, Division of Applied Biosciences, Graduate School of Agriculture, Kyoto University, Kyoto, Japan.,Division of Grassland Farming, Institute of Livestock and Grassland Science, National Agriculture and Food Research Organization (NARO), Tochigi, Japan
| | - Hiroki Anzai
- Laboratory of Animal Husbandry Resources, Division of Applied Biosciences, Graduate School of Agriculture, Kyoto University, Kyoto, Japan.,Department of Animal and Grassland Sciences, Faculty of Agriculture, University of Miyazaki, Miyazaki, Japan
| | - Kaho Kitajima
- Laboratory of Animal Husbandry Resources, Division of Applied Biosciences, Graduate School of Agriculture, Kyoto University, Kyoto, Japan
| | - Yudai Yasunaka
- Laboratory of Animal Husbandry Resources, Division of Applied Biosciences, Graduate School of Agriculture, Kyoto University, Kyoto, Japan
| | - Hajime Kumagai
- Laboratory of Animal Husbandry Resources, Division of Applied Biosciences, Graduate School of Agriculture, Kyoto University, Kyoto, Japan
| | - Seiji Ieiri
- Department of Animal and Grassland Sciences, Faculty of Agriculture, University of Miyazaki, Miyazaki, Japan
| | - Hiroyuki Hirooka
- Laboratory of Animal Husbandry Resources, Division of Applied Biosciences, Graduate School of Agriculture, Kyoto University, Kyoto, Japan
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16
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Gąsior JS, Sacha J, Jeleń PJ, Pawłowski M, Werner B, Dąbrowski MJ. Interaction Between Heart Rate Variability and Heart Rate in Pediatric Population. Front Physiol 2015; 6:385. [PMID: 26733878 PMCID: PMC4684141 DOI: 10.3389/fphys.2015.00385] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 11/30/2015] [Indexed: 11/17/2022] Open
Abstract
Background: Heart rate variability (HRV) is primarily heart rate (HR) dependent, and therefore, different HR may exert different impact on HRV. The objectives of the study were to evaluate the effect of HR on HRV in children and to determine whether HRV indices normalized to HR are sex- and age-related. Methods: Short-term ECG recordings were performed in 346 healthy children. Standard time and frequency domain HRV parameters and HR were analyzed in four age subgroups (6–7, 8–9, 10–11, and 12–13 years old). To investigate the HR impact on HRV, standard HRV parameters were normalized to prevailing HR. Results: Standard HRV measures did not differ between age subgroups, however, HR significantly decreased with subjects age and turned out to be the strongest determinant of HRV. The normalization of HRV to prevailing HR allowed to show that sex-related differences in standard HRV resulted from differences in HR between boys and girls. The normalized HRV significantly decreased with age—before the normalization this effect was masked by age-related HR alterations. Conclusions: HR significantly impacts HRV in pediatric population and turns out to be the strongest determinant of all standard HRV indices. The differences in standard HRV between boys and girls result from differences in their HR. The normalized HRV is decreasing with age in healthy children and it is accompanied by the reduction of HR—as a net result, the standard HRV is constant in children at different ages. This may reflect the maturation of the autonomic nervous system.
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Affiliation(s)
- Jakub S Gąsior
- Cardiology Clinic of Physiotherapy Division of the 2nd Faculty of Medicine, Medical University of Warsaw Warsaw, Poland
| | - Jerzy Sacha
- Faculty of Physical Education and Physiotherapy, Opole University of Technology Opole, Poland
| | - Piotr J Jeleń
- Department of Biophysics and Human Physiology, Medical University of Warsaw Warsaw, Poland
| | - Mariusz Pawłowski
- Cardiology Clinic of Physiotherapy Division of the 2nd Faculty of Medicine, Medical University of Warsaw Warsaw, Poland
| | - Bożena Werner
- Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw Warsaw, Poland
| | - Marek J Dąbrowski
- Cardiology Clinic of Physiotherapy Division of the 2nd Faculty of Medicine, Medical University of Warsaw Warsaw, Poland
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17
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Huang C, Alamili M, Rosenberg J, Gögenur I. Heart rate variability is reduced during acute uncomplicated diverticulitis. J Crit Care 2015; 32:189-95. [PMID: 26776154 DOI: 10.1016/j.jcrc.2015.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 09/30/2015] [Accepted: 12/07/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND The aim of the present study was to report the trajectory of heart rate variability (HRV) indices during a low-grade acute inflammation and their associations to biomarkers for infection. METHODS Twelve patients with uncomplicated acute diverticulitis completed this observational study, which composed of 3 sessions of continuous HRV recording from 9 PM to 8 AM during ongoing diverticulitis and at complete remission (baseline). The blood samples were collected at each study session measuring C-reactive protein (CRP) and leukocytes. RESULTS This study showed that the trajectories of the HRV indices were decreased both in time and frequency domains during acute diverticulitis compared to baseline. In particular, the indices reflecting the balance of sympathetic and parasympathetic activities were affected: standard deviation of normal-to-normal beats (P = .003), low-frequency power (P < .001), and total power (P = .001). These HRV changes indicate alterations in the autonomic nervous system during acute inflammation. All reductions of mean HRV indices had significant (P < .001) correlations to increased CRP correlations to increased CRP levels during diverticulitis suggesting inflammatory involvement in the observed HRV alterations. CONCLUSION We found substantial HRV depression in relation to acute uncomplicated diverticulitis, and this was associated with the elevated CRP levels.
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Affiliation(s)
- Chenxi Huang
- Department of Surgery, University of Copenhagen, Roskilde and Køge Hospitals, DK-4600, Køge, Denmark; Department of Surgical Gastroenterology, University of Copenhagen, Herlev Hospital, DK-2730, Herlev, Denmark.
| | - Mahdi Alamili
- Department of Surgery, University of Copenhagen, Roskilde and Køge Hospitals, DK-4600, Køge, Denmark
| | - Jacob Rosenberg
- Department of Surgical Gastroenterology, University of Copenhagen, Herlev Hospital, DK-2730, Herlev, Denmark
| | - Ismail Gögenur
- Department of Surgery, University of Copenhagen, Roskilde and Køge Hospitals, DK-4600, Køge, Denmark
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18
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Kirawittaya T, Yoon IK, Wichit S, Green S, Ennis FA, Gibbons RV, Thomas SJ, Rothman AL, Kalayanarooj S, Srikiatkhachorn A. Evaluation of Cardiac Involvement in Children with Dengue by Serial Echocardiographic Studies. PLoS Negl Trop Dis 2015; 9:e0003943. [PMID: 26226658 PMCID: PMC4520477 DOI: 10.1371/journal.pntd.0003943] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 07/01/2015] [Indexed: 11/29/2022] Open
Abstract
Background Infection with dengue virus results in a wide range of clinical manifestations from dengue fever (DF), a self-limited febrile illness, to dengue hemorrhagic fever (DHF) which is characterized by plasma leakage and bleeding tendency. Although cardiac involvement has been reported in dengue, the incidence and the extent of cardiac involvement are not well defined. Methods and Principal findings We characterized the incidence and changes in cardiac function in a prospective in-patient cohort of suspected dengue cases by serial echocardiography. Plasma leakage was detected by serial chest and abdominal ultrasonography. Daily cardiac troponin-T levels were measured. One hundred and eighty one dengue cases were enrolled. On the day of enrollment, dengue cases that already developed plasma leakage had lower cardiac index (2695 (127) vs 3188 (75) (L/min/m2), p = .003) and higher left ventricular myocardial performance index (.413 (.021) vs .328 (.026), p = .021) and systemic vascular resistance (2478 (184) vs 1820 (133) (dynes·s/cm5), p = .005) compared to those without plasma leakage. Early diastolic wall motion of the left ventricle was decreased in dengue cases with plasma leakage compared to those without. Decreased left ventricular wall motility was more common in dengue patients compared to non-dengue cases particularly in cases with plasma leakage. Differences in cardiac function between DF and DHF were most pronounced around the time of plasma leakage. Cardiac dysfunction was transient and did not require treatment. Transient elevated troponin-T levels were more common in DHF cases compared to DF (14.5% vs 5%, p = 0.028). Conclusions Transient left ventricular systolic and diastolic dysfunction was common in children hospitalized with dengue and related to severity of plasma leakage. The functional abnormality spontaneously resolved without specific treatment. Cardiac structural changes including myocarditis were uncommon. Dengue is a viral infection with a wide range of symptoms from a self-limiting fever called dengue fever (DF) to dengue hemorrhagic fever (DHF) which is characterized by leaky blood vessels and bleeding that can lead to shock in severe cases. Abnormal heart function has been reported but the frequencies and the progression of heart involvement are not well defined. In this study children with dengue had serial evaluation of their heart function during the course of the illness. Patients with DHF had comparatively low blood volume at the time of fever resolution and had decreased blood flow into the left lower heart chamber compared to DF cases. Relaxation and contraction of the left side of the heart were also relatively decreased in DHF. These abnormalities may contribute to the clinical response and complications of fluid replacement in dengue.
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Affiliation(s)
| | - In-Kyu Yoon
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Sineewanlaya Wichit
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Sharone Green
- Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Francis A Ennis
- Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Robert V Gibbons
- United States Army Institute of Surgical Research, Institute of Surgical Research, Houston, Texas, United States of America
| | - Stephen J Thomas
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Alan L Rothman
- Institute for Immunology and Informatics, University of Rhode Island, Providence, Rhode Island, United States of America
| | | | - Anon Srikiatkhachorn
- Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
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19
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Navinan MR, Yudhishdran J, Herath S, Liyanage I, Kugadas T, Kumara D, Kulatunga A. Complete heart block in dengue complicating management of shock due to both bleeding and leakage: a case report. BMC Res Notes 2015; 8:68. [PMID: 25884693 PMCID: PMC4351841 DOI: 10.1186/s13104-015-1036-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 02/24/2015] [Indexed: 12/20/2022] Open
Abstract
Background The spread of Dengue virus infection is reaching pandemic proportions. Dengue is usually dreaded for causing shock due to capillary leakage. However the clinical spectrum of dengue is vast and the newly incorporated expanded dengue syndrome introduces a wide range of presentations that are rarely observed and appreciated but nevertheless have the potential to cause significant morbidity and even mortality. Cardiac involvement in dengue is one such example. Case presentation A 26 year old South-Asian female presented in a state of haemodynamic shock with a history of fever and use of non-steroidal anti inflammatory drugs. Dengue was suspected clinically and later confirmed. Following stabilization and while still in the febrile phase the patient developed bradycardia with dynamic electrocardiogram changes which evolved into complete heart block. However there was no circulatory compromise. Clinical picture was further complicated by the development of dengue haemorhaghic fever and cautious fluid resuscitation was carried out in correlation to clinical and haematological parameters. Impaired coagulation profile necessitated administration of activated factor seven on the backdrop of low platelets and bleeding. Cardiac pacing could be avoided due to maintenance of vitals within acceptable parameters. Conclusion Expanded dengue syndrome should be given greater appreciation as not all may be benign. Cardiovascular system involvement in dengue has the potential to cause significant morbidity and mortality. Careful interpretation of clinical parameters will help in the institution of the appropriate management and help avoid unnecessary invasive interventions. Screening of dengue patients with timely electrocardiographs would be useful to detect cardiac involvement. Guidance on managing atypical manifestations of dengue expanded syndrome should available to help clinicians dictate treatment.
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20
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Billman GE, Huikuri HV, Sacha J, Trimmel K. An introduction to heart rate variability: methodological considerations and clinical applications. Front Physiol 2015; 6:55. [PMID: 25762937 PMCID: PMC4340167 DOI: 10.3389/fphys.2015.00055] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 02/09/2015] [Indexed: 11/13/2022] Open
Affiliation(s)
- George E Billman
- Department of Physiology and Cell Biology, The Ohio State University Columbus, OH, USA
| | - Heikki V Huikuri
- Division of Cardiology, Department of Internal Medicine, Institute of Clinical Medicine, University of Oulu Oulu, Finland
| | - Jerzy Sacha
- Department of Cardiology, Regional Medical Center Opole, Poland
| | - Karin Trimmel
- Department of Neurology, Medical University of Vienna Vienna, Austria
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