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Pieringer F, Suleiman MN, Kaemmerer-Suleiman AS, Dewald O, Freiberger A, Huntgeburth M, Nagdyman N, Neidenbach R, von Scheidt F, Kaemmerer H, Ewert P, Weyand M, Freilinger S, Harig F. Continuous Long-Term Assessment of Heart Rate Variability in Adults with Cyanotic Congenital Heart Disease after Surgical Repair. J Clin Med 2024; 13:2062. [PMID: 38610825 PMCID: PMC11012901 DOI: 10.3390/jcm13072062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/27/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Heart rate variability (HRV) is an established, non-invasive parameter for the assessment of cardiac autonomic nervous activity and the health status in general cardiology. However, there are few studies on HRV in adults with congenital heart defects (CHDs). The aim of the present study was to evaluate the use of long-term continuous HRV measurement for the assessment of global health status in adults with cyanotic CHD. Methods: This prospective study included 45 adults (40% female, mean age = 35.2 ± 9.2 [range: 19-58] years) after cardiac surgical repair. HRV parameters were calculated from continuous 24 h measurements using a Bittium Faros 180 sensor (Bittium Corp., Oulu, Finland). Results: Postoperative patients with transposition of the great arteries (TGA) (n = 18) achieved significantly higher values of standard deviation of NN intervals (SDNN) (175.4 ± 59.9 ms vs. 133.5 ± 40.6 ms; p = 0.013) compared with patients with other conotruncal anomalies (n = 22). Comparing patients with TGA after a Senning-Brom or Mustard operation (n = 13) with all other heart surgery patients (n = 32), significantly higher HRV parameters were found after atrial switch (root mean square of successive RR interval differences: 53.6 ± 20.7 ms vs. 38.4 ± 18.3 ms; p = 0.019; SDNN: 183.5 ± 58.4 ms vs. 136.3 ± 45.3 ms; p = 0.006). A higher SDNN was also measured after Senning-Brom or Mustard operations than after a Rastelli operations (n = 2) (SDNN: 183.5 ± 58.4 ms vs. 84.5 ± 5.2 ms; p = 0.037). When comparing atrial switch operations (n = 3) with Rastelli operations, the SDNN value was significantly shorter in the Rastelli group (p = 0.004). Conclusions: Our results suggest that continuous HRV monitoring may serve as a marker of cardiac autonomic dysfunction in adults with cyanotic CHD after surgical repair. Impaired cardiac autonomic nervous activity may be associated with an increased risk of adverse reactions in patients with repaired CHD. Therefore, a longitudinal assessment of HRV patterns and trends may provide a deeper insight into dynamic changes in their autonomic regulation and disease progression, lifestyle changes, or treatments. As each person has individual variability in heart rate, HRV may be useful in assessing intra-individual disease progression and may help to improve personalized medicine. Further studies are needed to better understand the underlying mechanisms and to explore the full potential of HRV analysis to optimize medical care for ACHDs.
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Affiliation(s)
- Felix Pieringer
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- International Center for Adults with Congenital Heart Disease, Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, 80636 Munich, Germany
| | - Mathieu N. Suleiman
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Ann-Sophie Kaemmerer-Suleiman
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Oliver Dewald
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Annika Freiberger
- International Center for Adults with Congenital Heart Disease, Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, 80636 Munich, Germany
| | - Michael Huntgeburth
- International Center for Adults with Congenital Heart Disease, Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, 80636 Munich, Germany
| | - Nicole Nagdyman
- International Center for Adults with Congenital Heart Disease, Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, 80636 Munich, Germany
| | - Rhoia Neidenbach
- International Center for Adults with Congenital Heart Disease, Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, 80636 Munich, Germany
- Department of Sport and Health Sciences, Technical University Munich, 80992 Munich, Germany
| | - Fabian von Scheidt
- International Center for Adults with Congenital Heart Disease, Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, 80636 Munich, Germany
| | - Harald Kaemmerer
- International Center for Adults with Congenital Heart Disease, Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, 80636 Munich, Germany
| | - Peter Ewert
- International Center for Adults with Congenital Heart Disease, Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, 80636 Munich, Germany
| | - Michael Weyand
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Sebastian Freilinger
- International Center for Adults with Congenital Heart Disease, Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, 80636 Munich, Germany
- Department of Sport and Health Sciences, Technical University Munich, 80992 Munich, Germany
| | - Frank Harig
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
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F Pinto F. Changes in heart rate variability after ventricular septal defect closure in children. Where do we stand? Adaptation mechanism, sequela or complications? Rev Port Cardiol 2023; 42:49-52. [PMID: 36460272 DOI: 10.1016/j.repc.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Fátima F Pinto
- Professora Auxiliar Convidada da Universidade NOVA de Lisboa, Lisboa, Portugal; Serviço de Cardiologia Pediátrica, CHULC, EPE - Hospital de Santa Marta, Lisboa, Portugal; Centro de Referência de Cardiopatias Congénitas, CHULC, EPE - Hospital de Santa Marta, Lisboa, Portugal; European Network Reference Heart Diseases (Guard-Heart).
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Muacevic A, Adler JR. Autonomic Nervous System Monitoring: Cardiac Magnetic Resonance Imaging Data as a Surrogate for Autonomic Data in Children. Cureus 2022; 14:e32014. [PMID: 36589173 PMCID: PMC9797874 DOI: 10.7759/cureus.32014] [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] [Accepted: 11/15/2022] [Indexed: 11/30/2022] Open
Abstract
Perioperative autonomic nervous system (ANS) measurements are evolving toward increasing import and utility. We present a three-year-old male with Down Syndrome who underwent ambulatory autonomic monitoring during surgery followed by cardiac magnetic resonance (CMR) imaging. Autonomic data from both environments are compared to age-related norms. We are the first to describe a method for acquiring and trending autonomic data from clinically indicated CMR scans in order to monitor autonomic function. These data are proof of concept for the use of routinely collected CMR data as a surrogate for autonomic data in children, noting differences in the autonomic effects of anesthetic techniques.
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A word on netting of angiotensin-converting enzyme inhibitor therapy in hypoplastic left heart syndrome following stage-I. Cardiol Young 2021; 31:1323-1326. [PMID: 34318741 DOI: 10.1017/s1047951121002936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
NPC-QIC Registry data showed that angiotensin-converting enzyme inhibitors were described in almost 38% for patients with single ventricle physiology after stage-I Norwood palliation. However, mortality and ventricular dysfunction or atrioventricular valve insufficiency seems to be not improved by oral application of angiotensin-converting enzyme inhibitors. The final conclusion was that despite limited evidence of benefit for patients with hypoplastic left heart syndrome, prescription of angiotensin-converting enzyme inhibitors during interstage is still common. Taking into account of the predominant cardiovascular regulation in newborns and young infants by circulating catecholamines, no real improvement is to be expected from angiotensin-converting enzyme inhibitor monotherapy. The goals of drug therapy after stage-I Norwood palliation in hypoplastic left heart syndrome are prevention of systemic right ventricle failure, balancing pulmonary and systemic blood flow, and reduction of oxygen consumption with regard to limitations of oxygen supply by the single ventricle, furthermore, avoiding harmful effects of endogenous catecholamine production in the long term on somatic and cognitive development. In this light of knowledge, we want to recommend the use of a long-acting and highly specific ß1-adrenoreceptor blocker for almost all patients after stage-I Norwood palliation and a combination with angiotensin-converting enzyme inhibitors only by indication after exclusion of potential side effects.
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Mat Husin H, Schleger F, Bauer I, Fehlert E, Kiefer-Schmidt I, Weiss M, Kagan KO, Brucker S, Pauluschke-Fröhlich J, Eswaran H, Häring HU, Fritsche A, Preissl H. Maternal Weight, Weight Gain, and Metabolism are Associated with Changes in Fetal Heart Rate and Variability. Obesity (Silver Spring) 2020; 28:114-121. [PMID: 31858736 DOI: 10.1002/oby.22664] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/29/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Prepregnancy obesity and extensive weight gain can lead to diseases in the offspring later in life. The aim of this study was to evaluate the effect of anthropometric and metabolic factors on the fetal autonomic nervous system (ANS) in uncomplicated pregnancies. METHODS A total of 184 pregnant women in the second or third trimester were included, and for 104 women, maternal insulin sensitivity (ISI) was determined. Fetal heart rate (HR) and heart rate variability (HRV) were determined by magnetic recording. Associations of maternal prepregnancy BMI, weight gain, and ISI with fetal HR and HRV were evaluated by ANCOVA, partial correlation, and mediation analysis. RESULTS HR was increased and HRV decreased in fetuses of mothers with overweight or obesity in comparison to normal-weight mothers. Fetal HR was negatively correlated with maternal weight gain. Maternal prepregnancy BMI was positively correlated with fetal high frequency and was negatively correlated with low frequency and low/high frequency ratio. Maternal ISI showed a negative correlation with fetal HR. CONCLUSIONS The results show that the fetal ANS is sensitive to alterations of prepregnancy BMI, weight changes, and glucose metabolism. These findings highlight the importance of the intrauterine environment on the developing ANS and the possible programming of obesity.
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Affiliation(s)
- Haliza Mat Husin
- fMEG Center, Helmholtz Center Munich, University of Tübingen, Tübingen, Germany
- Graduate Training Centre of Neuroscience, International Max Planck Research School, University of Tübingen, Tübingen, Germany
| | - Franziska Schleger
- fMEG Center, Helmholtz Center Munich, University of Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich (IDM) at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), Tübingen, Germany
| | - Ilena Bauer
- fMEG Center, Helmholtz Center Munich, University of Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich (IDM) at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), Tübingen, Germany
| | - Ellen Fehlert
- Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Department of Internal Medicine, University Hospital, University of Tübingen, Tübingen, Germany
| | - Isabelle Kiefer-Schmidt
- Department of Obstetrics and Gynecology, University Hospital, University of Tübingen, Tübingen, Germany
| | - Magdalene Weiss
- Department of Obstetrics and Gynecology, University Hospital, University of Tübingen, Tübingen, Germany
| | - Karl Oliver Kagan
- Department of Obstetrics and Gynecology, University Hospital, University of Tübingen, Tübingen, Germany
| | - Sara Brucker
- Department of Obstetrics and Gynecology, University Hospital, University of Tübingen, Tübingen, Germany
| | - Jan Pauluschke-Fröhlich
- Department of Obstetrics and Gynecology, University Hospital, University of Tübingen, Tübingen, Germany
| | - Hari Eswaran
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Hans-Ulrich Häring
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich (IDM) at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), Tübingen, Germany
- Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Department of Internal Medicine, University Hospital, University of Tübingen, Tübingen, Germany
| | - Andreas Fritsche
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich (IDM) at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), Tübingen, Germany
- Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Department of Internal Medicine, University Hospital, University of Tübingen, Tübingen, Germany
| | - Hubert Preissl
- fMEG Center, Helmholtz Center Munich, University of Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich (IDM) at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), Tübingen, Germany
- Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Department of Internal Medicine, University Hospital, University of Tübingen, Tübingen, Germany
- Department of Pharmacy and Biochemistry, Interfaculty Centre for Pharmacogenomics and Pharma Research, University of Tübingen, Tübingen, Germany
- Institute for Diabetes and Obesity, Helmholtz Diabetes Centre, Helmholtz Centre Munich, German Research Centre for Environmental Health (GmbH), Neuherberg, Germany
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Liu H, Allen J, Zheng D, Chen F. Recent development of respiratory rate measurement technologies. Physiol Meas 2019; 40:07TR01. [PMID: 31195383 DOI: 10.1088/1361-6579/ab299e] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Respiratory rate (RR) is an important physiological parameter whose abnormality has been regarded as an important indicator of serious illness. In order to make RR monitoring simple to perform, reliable and accurate, many different methods have been proposed for such automatic monitoring. According to the theory of respiratory rate extraction, methods are categorized into three modalities: extracting RR from other physiological signals, RR measurement based on respiratory movements, and RR measurement based on airflow. The merits and limitations of each method are highlighted and discussed. In addition, current works are summarized to suggest key directions for the development of future RR monitoring methodologies.
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Affiliation(s)
- Haipeng Liu
- Faculty of Health, Education, Medicine, and Social Care, Anglia Ruskin University, Chelmsford, CM1 1SQ, United Kingdom. Department of Electrical and Electronic Engineering, Southern University of Science and Technology, Shenzhen 518055, People's Republic of China
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Harrison TM. Improving neurodevelopment in infants with complex congenital heart disease. Birth Defects Res 2019; 111:1128-1140. [PMID: 31099484 DOI: 10.1002/bdr2.1517] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 12/15/2022]
Abstract
Worldwide, more than 400,000 infants are born each year with complex congenital heart disease (CCHD) requiring surgical intervention within the first months of life. Although improvements in perioperative care have resulted in increased rates of survival, more than half of infants with CCHD have neurodevelopmental impairments affecting subsequent educational achievements, job opportunities, and mental health. Brain maturity and impaired outcomes in infants with CCHD are similar to those of prematurely born infants. Developmentally supportive care, including foundational application of kangaroo care (KC), improves neurodevelopment in premature infants. Provision of developmentally supportive care with KC during the early hospitalization of infants with CCHD has the potential to similarly improve neurodevelopment. The purposes of the article are to describe common congenital heart defects, describe developmentally supportive care with an emphasis on KC, and to offer specific recommendations for KC and research in infants with CCHD.
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Nederend I, de Geus EJC, Blom NA, Ten Harkel ADJ. Long-term follow-up after ventricular septal defect repair in children: cardiac autonomic control, cardiac function and exercise capacity. Eur J Cardiothorac Surg 2019; 53:1082-1088. [PMID: 29253118 DOI: 10.1093/ejcts/ezx438] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/12/2017] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES Survival after surgical repair of a ventricular septal defect (VSD) is good, but, as in almost all congenital heart diseases, late complications are frequent in adulthood. The exact mechanisms, timing and who is at risk are not fully understood. Altered cardiac autonomic nervous system (ANS) activity might play a role in these long-term sequelae. The aim of this study was to extensively evaluate children late after VSD repair including their cardiac ANS activity, cardiac function and exercise capacity. METHODS Thirty-three patients after surgical VSD repair and 66 healthy age-matched controls underwent 24-h monitoring of ANS control and cardiac output using impedance cardiography, detailed echocardiography and cardiopulmonary exercise testing. RESULTS Ambulatory cardiac ANS control was not different between the patients and the controls. Right ventricular function, exercise capacity and ambulatory cardiac output were decreased in patients compared with the controls. No relationships were found between cardiac ANS activity and cardiac function. CONCLUSIONS Long (average time after repair was 9.9 years) after successful surgical correction of a VSD, cardiac ANS control is not different from the controls. Right ventricular function and exercise capacity are impaired in VSD patients. Post-surgical outcome in these patients may be less benign than presently assumed; therefore, follow-up should be continued into adulthood to detect adverse outcomes in a timely fashion.
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Affiliation(s)
- Ineke Nederend
- Department of Biological Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Pediatric Cardiology, LUMC University Medical Center, Leiden, Netherlands
| | - Eco J C de Geus
- Department of Biological Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Nico A Blom
- Department of Pediatric Cardiology, LUMC University Medical Center, Leiden, Netherlands
| | - Arend D J Ten Harkel
- Department of Pediatric Cardiology, LUMC University Medical Center, Leiden, Netherlands
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