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Niu J, Lu Y, Xu R, Fang F, Hong S, Huang L, Xue Y, Fei J, Zhang X, Zhou B, Zhang P, Jiang R. The prognostic value of intraoperative HRV during anesthesia in patients presenting for non-cardiac surgery. BMC Anesthesiol 2023; 23:160. [PMID: 37161402 PMCID: PMC10169477 DOI: 10.1186/s12871-023-02118-9] [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: 07/12/2022] [Accepted: 04/29/2023] [Indexed: 05/11/2023] Open
Abstract
OBJECTIVE To examine the prognostic value of HRV measurements during anesthesia for postoperative clinical outcomes prediction using machine learning models. DATA SOURCES VitalDB, a comprehensive database of 6388 surgical patients admitted to Seoul National University Hospital. ELIGIBILITY CRITERIA FOR STUDY SELECTION Cases with ECG lead II recording duration of less than one hour were excluded. Cases with more than 20% of missing HRV measurements were also excluded. A total of 5641 cases were eligible for the analyses. METHODS Six machine learning models including Logistic Regression (LR), Support Vector Machine (SVM), Random Forest (RF), Gradient Boosting Decision Trees (GBT), Extreme Gradient Boosting (XGB), and an ensemble of the five baseline models were developed to predict postoperative clinical outcomes. The prediction models were trained using only clinical information, and using both clinical information and HRV features, respectively. Feature importance based on the SHAP method was used to assess the contribution of the HRV measurements to the outcome predictions. Subgroup analysis was also performed to evaluate the risk association between postoperative ICU stay and various HRV measurements such as heart rate, low-frequency power (LFP), and short-term fluctuation DFA [Formula: see text]. RESULT The final cohort included 5641 unique cases, among whom 4678 (83.0%) cases had ages over 40, 2877 (51.0%) were male, 1073 (19.0%) stayed in ICU after surgery, 52 (0.9%) suffered in-hospital death, and 3167(56.1%) had a total length of hospital stay longer than 7 days. In the final test set, the highest AUROC performance with only clinical information was 0.79 for postoperative ICU stay, 0.58 for in-hospital mortality, and 0.76 for the total length of hospital stay prediction. Importantly, using both clinical information and HRV features, the AUROC performance was 0.83, 0.70, and 0.76 for the three clinical outcome predictions, respectively. Subgroup analysis found that patients with an average heart rate higher than 70, low-frequency power (LFP) < 33, and short-term fluctuation DFA [Formula: see text] < 0.95 during anesthesia, had a significantly higher risk of entering the ICU after surgery. CONCLUSION This study suggested that HRV measurements during anesthesia are feasible and effective for predicting postoperative clinical outcomes.
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Affiliation(s)
- Jiahe Niu
- Department of Automation, Tsinghua University, No. 168 Li Tang Road, Changping District, Beijing, 100084, China
| | - Yonghao Lu
- Department of Automation, Tsinghua University, No. 168 Li Tang Road, Changping District, Beijing, 100084, China
| | - Ruikun Xu
- Department of Automation, Tsinghua University, No. 168 Li Tang Road, Changping District, Beijing, 100084, China
| | - Fang Fang
- Department of Automation, Tsinghua University, No. 168 Li Tang Road, Changping District, Beijing, 100084, China
| | - Shikai Hong
- Department of Automation, Tsinghua University, No. 168 Li Tang Road, Changping District, Beijing, 100084, China
| | - Lexin Huang
- Department of Automation, Tsinghua University, No. 168 Li Tang Road, Changping District, Beijing, 100084, China
| | - Yajun Xue
- Department of Cardiology, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, No. 168 Li Tang Road, Changping District, Beijing, 102218, China
| | - Jintao Fei
- Department of Cardiology, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, No. 168 Li Tang Road, Changping District, Beijing, 102218, China
| | - Xuegong Zhang
- Department of Automation, Tsinghua University, No. 168 Li Tang Road, Changping District, Beijing, 100084, China
| | - Boda Zhou
- Department of Cardiology, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, No. 168 Li Tang Road, Changping District, Beijing, 102218, China.
| | - Ping Zhang
- Department of Cardiology, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, No. 168 Li Tang Road, Changping District, Beijing, 102218, China.
| | - Rui Jiang
- Department of Automation, Tsinghua University, No. 168 Li Tang Road, Changping District, Beijing, 100084, China.
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The DZHK research platform: maximisation of scientific value by enabling access to health data and biological samples collected in cardiovascular clinical studies. Clin Res Cardiol 2023:10.1007/s00392-023-02177-5. [PMID: 36884078 DOI: 10.1007/s00392-023-02177-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/20/2023] [Indexed: 03/09/2023]
Abstract
The German Centre for Cardiovascular Research (DZHK) is one of the German Centres for Health Research and aims to conduct early and guideline-relevant studies to develop new therapies and diagnostics that impact the lives of people with cardiovascular disease. Therefore, DZHK members designed a collaboratively organised and integrated research platform connecting all sites and partners. The overarching objectives of the research platform are the standardisation of prospective data and biological sample collections among all studies and the development of a sustainable centrally standardised storage in compliance with general legal regulations and the FAIR principles. The main elements of the DZHK infrastructure are web-based and central units for data management, LIMS, IDMS, and transfer office, embedded in a framework consisting of the DZHK Use and Access Policy, and the Ethics and Data Protection Concept. This framework is characterised by a modular design allowing a high standardisation across all studies. For studies that require even tighter criteria additional quality levels are defined. In addition, the Public Open Data strategy is an important focus of DZHK. The DZHK operates as one legal entity holding all rights of data and biological sample usage, according to the DZHK Use and Access Policy. All DZHK studies collect a basic set of data and biosamples, accompanied by specific clinical and imaging data and biobanking. The DZHK infrastructure was constructed by scientists with the focus on the needs of scientists conducting clinical studies. Through this, the DZHK enables the interdisciplinary and multiple use of data and biological samples by scientists inside and outside the DZHK. So far, 27 DZHK studies recruited well over 11,200 participants suffering from major cardiovascular disorders such as myocardial infarction or heart failure. Currently, data and samples of five DZHK studies of the DZHK Heart Bank can be applied for.
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Bruns B, Daub R, Schmitz T, Hamze-Sinno M, Spaich S, Dewenter M, Schwale C, Gass P, Vogt M, Katus H, Herzog W, Friederich HC, Frey N, Schultz JH, Backs J. Forebrain corticosteroid receptors promote post-myocardial infarction depression and mortality. Basic Res Cardiol 2022; 117:44. [PMID: 36068417 PMCID: PMC9448693 DOI: 10.1007/s00395-022-00951-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/19/2022] [Accepted: 08/07/2022] [Indexed: 01/31/2023]
Abstract
Myocardial infarction (MI) with subsequent depression is associated with increased cardiac mortality. Impaired central mineralocorticoid (MR) and glucocorticoid receptor (GR) equilibrium has been suggested as a key mechanism in the pathogenesis of human depression. Here, we investigate if deficient central MR/GR signaling is causative for a poor outcome after MI in mice. Mice with an inducible forebrain-specific MR/GR knockout (MR/GR-KO) underwent baseline and follow-up echocardiography every 2 weeks after MI or sham operation. Behavioral testing at 4 weeks confirmed significant depressive-like behavior and, strikingly, a higher mortality after MI, while cardiac function and myocardial damage remained unaffected. Telemetry revealed cardiac autonomic imbalance with marked bradycardia and ventricular tachycardia (VT) upon MI in MR/GR-KO. Mechanistically, we found a higher responsiveness to atropine, pointing to impaired parasympathetic tone of 'depressive' mice after MI. Serum corticosterone levels were increased but-in line with the higher vagal tone-plasma and cardiac catecholamines were decreased. MR/GR deficiency in the forebrain led to significant depressive-like behavior and a higher mortality after MI. This was accompanied by increased vagal tone, depleted catecholaminergic compensatory capacity and VTs. Thus, limbic MR/GR disequilibrium may contribute to the impaired outcome of depressive patients after MI and possibly explain the lack of anti-depressive treatment benefit.
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Affiliation(s)
- Bastian Bruns
- Institute of Experimental Cardiology, Heidelberg University, Heidelberg and DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Im Neuenheimer Feld 669, 69120 Heidelberg, Germany ,Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany ,Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Ricarda Daub
- Institute of Experimental Cardiology, Heidelberg University, Heidelberg and DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Im Neuenheimer Feld 669, 69120 Heidelberg, Germany ,Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Thomas Schmitz
- Institute of Experimental Cardiology, Heidelberg University, Heidelberg and DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Im Neuenheimer Feld 669, 69120 Heidelberg, Germany ,Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Maria Hamze-Sinno
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Sebastian Spaich
- Institute of Experimental Cardiology, Heidelberg University, Heidelberg and DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Im Neuenheimer Feld 669, 69120 Heidelberg, Germany ,Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany ,Department of Cardiology and Angiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Matthias Dewenter
- Institute of Experimental Cardiology, Heidelberg University, Heidelberg and DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Im Neuenheimer Feld 669, 69120 Heidelberg, Germany
| | - Chrysovalandis Schwale
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany ,Institute for Physiology and Pathophysiology, University of Heidelberg, Heidelberg, Germany
| | - Peter Gass
- Central Institute of Mental Health, RG Animal Models in Psychiatry, Medical Faculty of Mannheim/University of Heidelberg, Mannheim, Germany
| | - Miriam Vogt
- Central Institute of Mental Health, RG Animal Models in Psychiatry, Medical Faculty of Mannheim/University of Heidelberg, Mannheim, Germany
| | - Hugo Katus
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany ,DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg/Mannheim, Germany
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany ,DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg/Mannheim, Germany
| | - Jobst-Hendrik Schultz
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Johannes Backs
- Institute of Experimental Cardiology, Heidelberg University, Heidelberg and DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Im Neuenheimer Feld 669, 69120 Heidelberg, Germany
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Lu HY, Huang APH, Kuo LT. Prognostic value of variables derived from heart rate variability in patients with traumatic brain injury after decompressive surgery. PLoS One 2021; 16:e0245792. [PMID: 33539419 PMCID: PMC7861407 DOI: 10.1371/journal.pone.0245792] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/07/2021] [Indexed: 11/18/2022] Open
Abstract
Measurement of heart rate variability can reveal autonomic nervous system function. Changes in heart rate variability can be associated with disease severity, risk of complications, and prognosis. We aimed to investigate the prognostic value of heart rate variability measurements in patients with moderate-to-severe traumatic brain injury after decompression surgery. We conducted a prospective study of 80 patients with traumatic brain injury after decompression surgery using a noninvasive electrocardiography device for data collection. Assessment of heart rate variability parameters included the time and frequency domains. The correlations between heart rate variability parameters and one-year mortality and functional outcomes were analyzed. Time domain measures of heart rate variability, using the standard deviation of the RR intervals and the square root of the mean squared differences of successive RR intervals, were statistically significantly lower in the group of patients with unfavorable outcomes and those that died. In frequency domain analysis, very low-frequency and total power were significantly higher in patients with favorable functional outcomes. High-frequency, low-frequency, and total power were statistically significantly higher in patients who survived for more than one year. Multivariate analysis using a model combining age and the Glasgow Coma Scale score with variables derived from heart rate variability substantially improved the prognostic value for predicting long-term outcome. These findings reinforced the concept that traumatic brain injury impacts the brain-heart axis and cardiac autonomic modulation even after decompression surgery, and variables derived from heart rate variability may be useful predictors of outcome.
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Affiliation(s)
- Hsueh-Yi Lu
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Douliou, Yunlin County, Taiwan
| | - Abel Po-Hao Huang
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Lu-Ting Kuo
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
- * E-mail:
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Liu X, Xiang L, Tong G. Predictive values of heart rate variability, deceleration and acceleration capacity of heart rate in post-infarction patients with LVEF ≥35. Ann Noninvasive Electrocardiol 2020; 25:e12771. [PMID: 32633866 PMCID: PMC7679834 DOI: 10.1111/anec.12771] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/20/2020] [Accepted: 05/05/2020] [Indexed: 01/30/2023] Open
Abstract
Background and aims The aim was to investigate the predictive values of heart rate variability, deceleration, and acceleration capacity of heart rate in sudden cardiac death in postinfarction patients with left ventricular ejection fraction (LVEF) ≥ 35%. Methods We enrolled 138 acute myocardial infarction patients (MI) randomly in sinus rhythm with LVEF ≥ 35% after myocardial infarction. Data on heart rate variability, deceleration runs, deceleration, and acceleration capacity were obtained from 24h‐dynamic electrocardiogram recordings. Clinical characteristics, medications, and echocardiography data were noted. The endpoints were sudden cardiac arrhythmias (SCA), including malignant arrhythmias in the hospital and viewed sudden death out of the hospital. Relationships between autonomic parameters and endpoints were evaluated. Results During follow‐up for over 24 months in MI patients, 10 patients occurred sudden cardiac arrhythmias. Subjects with SCA showed lower levels of SDNN (p = .018), TP (p = .007), VLF (p < .001), DC (p < .001), and low‐risk DRs (p < .001) than those without SCA. A low SDNN level (HR: 8.888, p = .006), low VLF level (HR: 14.699, p = .016), low DC level (HR: 4.430, p = .045), and higher risk DRs (HR: 3.81, p = .040) were identified as independent risk factors of SCA for postinfarction patients with LVEF ≥ 35%. The area under the ROC curve (AUC) of SDNN, VLF, and DC for identification of SCA were, respectively, 0.724 (p = .019), 0.807 (p < .001), and 0.804 (p = .002). SDNN, VLF, and DC combined assessment area under the ROC curve were 0.828 (p < .001). Conclusion Decreased SDNN, VLF, DC, and abnormal DRs are independently associated with increased risks of sudden cardiac arrhythmias in post‐MI patients with LVEF ≥ 35%. Combined SDNN, VLF, and DC may help identify a high‐risk group of malignant arrhythmias in postinfarction patients.
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Affiliation(s)
- Xiang Liu
- Department of Cardiology, The Second Affiliated Hospital of Soochow University, Suzhou City, China
| | - Li Xiang
- Department of Cardiology, The Second Affiliated Hospital of Soochow University, Suzhou City, China
| | - Guangming Tong
- Department of Cardiology, The Second Affiliated Hospital of Soochow University, Suzhou City, China
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Shah AS, Lampert R, Goldberg J, Bremner JD, Li L, Thames MD, Vaccarino V, Shah AJ. Alterations in heart rate variability are associated with abnormal myocardial perfusion. Int J Cardiol 2020; 305:99-105. [PMID: 32024598 PMCID: PMC8019069 DOI: 10.1016/j.ijcard.2020.01.069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/24/2020] [Accepted: 01/27/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Abnormalities in the autonomic nervous system may occur in ischemic heart disease, but the mechanisms by which they are linked are not fully defined. The risk of cardiac events is increased during morning hours. Studying the contributions of autonomic mechanisms may yield insights into risk stratification and treatment. We hypothesize that autonomic dysfunction, measured by decreased heart rate variability (HRV), associates with abnormal stress myocardial perfusion imaging (MPI). METHODS We performed a cross-sectional study of the association between abnormal myocardial stress perfusion with HRV using 276 middle-aged veteran twins without known ischemic heart disease. The primary independent variable was cardiac autonomic regulation measured with 24-hour electrocardiogram (ECG) monitoring, using linear and non-linear (multipole density, or Dyx) HRV metrics. The primary outcome was abnormal perfusion (>5% affected myocardium) during adenosine stress on [13N]-ammonia myocardial perfusion imaging with positron emission tomography. RESULTS The mean (SD) age was 53 (3) years and 55 (20%) had abnormal perfusion. HRV (by Dyx) was reduced during morning hours in subjects with abnormal perfusion. At 7 AM, each standard deviation (SD) decrease in Dyx was associated a 4.8 (95% CI, 1.5 - 15.8) odds ratio (OR) for abnormal MPI. With Dyx < 2.0, the 7 AM OR for abnormal MPI was 11.8 (95% CI, 1.2 - 111.4). CONCLUSIONS Autonomic dysfunction, measured by non-linear HRV in the morning hours, was associated with an increased OR of abnormal MPI. These results suggest a potentially important role of ECG-based biomarkers in risk stratification for individuals with suspected ischemic heart disease.
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Affiliation(s)
- Anish S Shah
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Rachel Lampert
- Division of Cardiology, Department of Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - Jack Goldberg
- Vietnam Era Twin Registry, Seattle Epidemiologic Research and Information Center, US Department of Veterans Affairs, Seattle, WA, United States of America; Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, United States of America
| | - J Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America; Department of Radiology, Emory University School of Medicine, Atlanta, GA, United States of America; Atlanta Veterans Affairs Medical Center, Atlanta, GA, United States of America
| | - Lian Li
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, United States of America
| | - Marc D Thames
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Viola Vaccarino
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, United States of America; Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Amit J Shah
- Atlanta Veterans Affairs Medical Center, Atlanta, GA, United States of America; Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, United States of America; Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America.
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The Autonomic Regulation of Circulation and Adverse Events in Hypertensive Patients during Follow-Up Study. Cardiol Res Pract 2019; 2019:8391924. [PMID: 32082622 PMCID: PMC7012266 DOI: 10.1155/2019/8391924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 12/09/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose Comprehensive study of autonomic regulation assessed during follow-up could provide new detailed information about the risks stratification for hypertensive patients. Therefore, we investigated the associations of these indices with death, stroke, and revascularization during the follow-up observation of 55 patients. Methods All patients were with target organ damage, and 27 of them had associated clinical conditions (ACC). Mean age of patients with and without ACC was 62.6 ± 4.2 and 51.9 ± 9.9 (mean ± SD) years, respectively. Follow-up was from 66 to 95 months. At entry, autonomic regulation was assessed by the tilt test, Valsalva maneuver, hand-grip test, and cold-stress vasoconstriction. Hemodynamic parameters were measured by continuous blood pressure monitoring, occlusion plethysmography, and electrocardiography. Re-examination of patients was carried out by questioning and physical and laboratory examination. Results We found that fatal outcomes were associated with a lower Valsalva index (1.34 ± 0.16 vs. 1.69 ± 0.37, P < 0.05) and depressed cold vasoconstriction (0.20 ± 0.02 vs. 0.39 ± 0.16%, P < 0.05) and depressed cold vasoconstriction (0.20 ± 0.02 vs. 0.39 ± 0.16%, P < 0.05) and depressed cold vasoconstriction (0.20 ± 0.02 vs. 0.39 ± 0.16%, P < 0.05) and depressed cold vasoconstriction (0.20 ± 0.02 vs. 0.39 ± 0.16%, P < 0.05) and depressed cold vasoconstriction (0.20 ± 0.02 vs. 0.39 ± 0.16%, P < 0.05) and depressed cold vasoconstriction (0.20 ± 0.02 vs. 0.39 ± 0.16%, P < 0.05) and depressed cold vasoconstriction (0.20 ± 0.02 vs. 0.39 ± 0.16%. Conclusions This study shows that such autonomic regulation indices as Valsalva index, blood pressure dynamics in the tilt test, cold-stress vasomotor reactivity, and BPV are important for prognosis of hypertension course.
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Xenogiannis I, Gatzoulis KA, Flevari P, Ikonomidis I, Iliodromitis E, Trachanas K, Vlachos K, Arsenos P, Tsiachris D, Tousoulis D, Brilakis ES, Alexopoulos D. Temporal changes of noninvasive electrocardiographic risk factors for sudden cardiac death in post-myocardial infarction patients with preserved ejection fraction: Insights from the PRESERVE-EF study. Ann Noninvasive Electrocardiol 2019; 25:e12701. [PMID: 31605453 DOI: 10.1111/anec.12701] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/30/2019] [Accepted: 08/12/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Several noninvasive risk factors (NIRFs) have been proposed for sudden cardiac death risk stratification in post-myocardial infarction (post-MI) patients with preserved ejection fraction (EF). However, it remains unclear if these factors change over time. METHODS We evaluated seven electrocardiographic NIRFs as they were described in the PRESERVE-EF trial in 80 post-MI patients with EF ≥ 40%, at least 40 days after revascularization and 1 year later. RESULTS Mean patient age was 56 ± 10 years, and 88% were men. Mean EF was 50 ± 5%. The prevalence of (a) positive late potentials (27.5% vs. 28.8%, p = .860), (b) >30 premature ventricular complexes/hour (8.8% vs. 11.3%, p = .598), (c) nonsustained ventricular tachycardia (8.8% vs. 5%, p = .349), (d) standard deviation of normal RR intervals <75 ms (3.8% vs. 3.8%, p = 1.000), (e) QTc derived from 24-hr electrocardiography >440 ms (men) or >450 ms (women) (17.5% vs. 17.5%, p = 1.000), (f) deceleration capacity ≤4.5 ms and heart rate turbulence onset ≥0% and slope ≤2.5 ms (2.5% vs. 3.8%. p = 1.000), and (g) ambulatory T-wave alternans ≥65 μV in two Holter channels (6.3% vs. 6.3%, p = 1.000) were similar between the two measurements. However, five patients (6.3%) without any NIRFs during the first assessment had at least one positive NIRF at the second assessment and six patients (7.5%) with at least one NIRF at baseline had no positive NIRFs at 1 year. CONCLUSIONS While the prevalence of the examined electrocardiographic NIRFs between the two examinations was similar on a population basis, some patients without NIRFs at baseline developed NIRFs at 1 year and vice versa, highlighting the need for risk factor reassessment during follow-up.
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Affiliation(s)
- Iosif Xenogiannis
- Second Cardiology Department, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Konstantinos A Gatzoulis
- First Department of Cardiology, Hippokrateion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiota Flevari
- Second Cardiology Department, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ignatios Ikonomidis
- Second Cardiology Department, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstathios Iliodromitis
- Second Cardiology Department, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Konstantinos Vlachos
- Second State Cardiology Department, Evangelismos Hospital, Athens, Greece.,Electrophysiology Department, Hospital Haut Lévêque, Bordeaux, France
| | - Petros Arsenos
- First Department of Cardiology, Hippokrateion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Tsiachris
- First Department of Cardiology, Hippokrateion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, Hippokrateion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Dimitrios Alexopoulos
- Second Cardiology Department, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Ziemssen T, Siepmann T. The Investigation of the Cardiovascular and Sudomotor Autonomic Nervous System-A Review. Front Neurol 2019; 10:53. [PMID: 30809183 PMCID: PMC6380109 DOI: 10.3389/fneur.2019.00053] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 01/15/2019] [Indexed: 01/09/2023] Open
Abstract
The autonomic nervous system as operating system of the human organism permeats all organ systems with its pathways permeating that it is involved with virtually all diseases. Anatomically a central part, an afferent part and sympathetic and parasympathetic efferent system can be distinguished. Among the different functional subsystems of the autonomic nervous system, the cardiovascular autonomic nervous system is most frequently examined with easily recordable cardiovascular biosignals as heart rate and blood pressure. Although less widely established, sudomotor tests pose a useful supplement to cardiovascular autonomic assessment as impaired neurogenic sweating belongs to the earliest clinical signs of various autonomic neuropathies as well as neurodegenerative disorders and significantly reduces quality of life. Clinically at first, the autonomic nervous system is assessed with a detailed history of clinical autonomic function and a general clinical examination. As a lof of confounding factors can influence autonomic testing, subjects should be adequately prepared in a standardized way. Autonomic testing is usually performed in that way that the response of the autonomic nervous system to a well-defined challenge is recorded. As no single cardiovascular autonomic test is sufficiently reliable, it is recommended to use a combination of different approaches, an autonomic test battery including test to measure parasympathetic and sympathetic cardiovascular function (deep breathing test, Valsalva maneuver, tilt, or pressor test). More specialized tests include carotid sinus massage, assessment of baroreceptor reflex function, pharmacological tests or cardiac, and regional hemodynamic measurements. Techniques to measure functional integrity of sudomotor nerves include the quantitative sudomotor axon reflex sweat test, analysis of the sympathetic skin response as well as the thermoregulatory sweat test. In addition to these rather established techniques more recent developments have been introduced to reduce technical demands and interindividual variability such as the quantitative direct and indirect axon reflex testing or sudoscan. However, diagnostic accuracy of these tests remains to be determined. We reviewed the current literature on currently available autonomic cardiovascular and sudomotor tests with a focus on their physiological and technical mechanisms as well as their diagnostic value in the scientific and clinical setting.
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Affiliation(s)
- Tjalf Ziemssen
- Autonomic and Neuroendocrinological Functional Laboratory, Center of Clinical Neuroscience, Neurological University Clinic Carl Gustav Carus, Dresden, Germany
| | - Timo Siepmann
- Neurological University Clinic Carl Gustav Carus, Dresden, Germany
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The prevalence of cardiovascular autonomic neuropathy and its influence on post induction hemodynamic variables in patients with and without diabetes; A prospective cohort study. PLoS One 2018; 13:e0207384. [PMID: 30475825 PMCID: PMC6261040 DOI: 10.1371/journal.pone.0207384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 10/30/2018] [Indexed: 11/30/2022] Open
Abstract
Background Cardiovascular autonomic neuropathy (CAN) is a known complication of diabetes, but is also diagnosed in patients without diabetes. CAN may be related to perioperative hemodynamic instability. Our objective was to investigate if patients with diabetes would have a higher prevalence of CAN compared to patients without diabetes undergoing surgery. We further studied its relation to changes in post-induction hemodynamic variables. Methods We prospectively included 82 adult patients, 55 with DM, 27 without DM, scheduled for major abdominal or cardiac surgery. Patients performed four autonomic function tests on the day before surgery. Primary outcomes were the prevalence of CAN and the relation between CAN and severe post-induction hypotension, defined as mean arterial pressure (MAP) < 50 mmHg or ≥ 50% decrease from baseline. Secondary outcomes were the relation between CAN, intraoperative hypotension, MAP < 65 mmHg for more than 13 minutes, and the use of vasopressor therapy. Results The prevalence of CAN in patients with or without DM was 71% versus 63%, (p = 0.437). CAN was not associated with severe post induction hypotension (CAN+ vs. CAN–: 21% vs. 19.2%, p = 0.819) nor with intraoperative hypotension (16% vs. 15%, p = 0.937). Patients with definite CAN received more norepinephrine in the perioperative period compared to patients with mild CAN or no CAN (0.07 mcg kg-1 min-1 (0.05–0.08) vs. 0.03 (0.01–0.07) vs. 0.02 (0.01–0.06) respectively, p = 0.001). Conclusions The majority of patients studied had mild to moderate CAN, regardless of the presence of DM. Assessing CAN before surgery did not identify patients at risk for post induction and intraoperative hypotension in our cohort. Trial registration Dutch Trial Registry (www.trialregister.nl) NTR4976.
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