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Hu Z, Cao X, Jing P, Zhang B, Shi Y, Siegrist J, Li J, Zhang M. Work stress and changes in heart rate variability among employees after first acute coronary syndrome: a hospital-based longitudinal cohort study. Front Public Health 2024; 12:1336065. [PMID: 38601505 PMCID: PMC11005455 DOI: 10.3389/fpubh.2024.1336065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/12/2024] [Indexed: 04/12/2024] Open
Abstract
Background Work stress is considered as a risk factor for coronary heart disease, but its link with heart rate variability (HRV) among heart attack survivors is unknown yet. The aim of this study was to investigate associations between baseline work stress and the changes of HRV over one-year after onset of acute coronary syndrome (ACS). Methods Hundred and twenty-two patients with regular paid work before their first ACS episode were recruited into this hospital-based longitudinal cohort study. During hospitalization (baseline), all patients underwent assessments of work stress by job strain (JS) and effort-reward imbalance (ERI) models, and were assigned into low or high groups; simultaneously, sociodemographic and clinical data, as well depression, anxiety, and job burnout, were collected. Patients were followed up 1, 6, and 12 months after discharge, with HRV measurements at baseline and each follow-up point. Generalized estimating equations were used to analyze the effects of baseline work stress on HRV over the following 1 year. Results After adjusting for baseline characteristics and clinical data, anxiety, depression, and burnout scores, high JS was not associated with any HRV measures during follow-up (all p > 0.10), whereas high ERI was significantly related to slower recovery of 5 frequency domain HRV measures (TP, HF, LF, VLF, and ULF) (all p < 0.001), and marginally associated with one time domain measure (SDNN) (p = 0.069). When mutually adjusting for both work stress models, results of ERI remained nearly unchanged. Conclusion Work stress in terms of ERI predicted lower HRV during the one-year period after ACS, especially frequency domain measures.
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Affiliation(s)
- Zhao Hu
- Cardiology Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xingyu Cao
- Cardiology Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Pan Jing
- Cardiology Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Bangying Zhang
- Cardiology Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yunke Shi
- Cardiology Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Johannes Siegrist
- Institute of Medical Sociology, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Jian Li
- Departments of Environmental Health Sciences and Epidemiology, Fielding School of Public Health, School of Nursing, University of California, Los Angeles, Los Angeles, CA, United States
| | - Min Zhang
- Cardiology Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
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Mercer MA, Davis JL, McKenzie HC. The Clinical Pharmacology and Therapeutic Evaluation of Non-Steroidal Anti-Inflammatory Drugs in Adult Horses. Animals (Basel) 2023; 13:ani13101597. [PMID: 37238029 DOI: 10.3390/ani13101597] [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: 12/21/2022] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
This review firstly examines the underlying pathophysiology of pain and inflammation associated with orthopedic disease and endotoxemia. Then, it reviews the clinical pharmacology (pharmacokinetics and pharmacodynamics) of both conventional and non-conventional NSAIDs in the adult horse, and finally provides an overview of different modalities to evaluate the therapeutic efficacy of NSAIDs in research.
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Affiliation(s)
- Melissa A Mercer
- Department of Biological Sciences and Pathobiology, Virginia Maryland College of Veterinary Medicine, Blacksburg, VA 24061, USA
| | - Jennifer L Davis
- Department of Biological Sciences and Pathobiology, Virginia Maryland College of Veterinary Medicine, Blacksburg, VA 24061, USA
| | - Harold C McKenzie
- Department of Large Animal Clinical Sciences, Virginia Maryland College of Veterinary Medicine, Blacksburg, VA 24061, USA
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Ma Y, Chang MC, Litrownik D, Wayne PM, Yeh GY. Day-night patterns in heart rate variability and complexity: differences with age and cardiopulmonary disease. J Clin Sleep Med 2023; 19:873-882. [PMID: 36692177 PMCID: PMC10152358 DOI: 10.5664/jcsm.10434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 12/05/2022] [Accepted: 12/05/2022] [Indexed: 01/25/2023]
Abstract
STUDY OBJECTIVES Heart rate variability (HRV) measures provide valuable insights into physiology; however, gaps remain in understanding circadian patterns in heart rate dynamics. We aimed to explore day-night differences in heart rate dynamics in patients with chronic cardiopulmonary disease compared with healthy controls. METHODS Using 24-hour heart rate data from patients with chronic obstructive pulmonary disease (COPD) and/or heart failure (n = 16) and healthy adult controls (older group: ≥50 years, n = 42; younger group: 20-49 years, n = 136), we compared day-night differences in conventional time and frequency domain HRV indices and a multiscale-entropy-based complexity index (CI1-20) of HRV among the 3 groups. RESULTS Twenty-four-hour HRV showed significant day-night differences (marked with "△") among younger healthy (mean age: 34.5 years), older healthy (mean age: 61.6 years), and cardiopulmonary patients (mean age: 68.4 years), including change in percentage of adjacent intervals that differ > 50 ms (△pNN50), high frequency (△HF), normalized low frequency (△nLF), ratio (△LF/HF), and △CI1-20. Among these, △LF/HF (2.13 ± 2.35 vs 1.1 ± 2.47 vs -0.35 ± 1.25; P < .001) and △CI1-20 (0.15 ± 0.24 vs 0.02 ± 0.28 vs -0.21 ± 0.27; P < .001) were significant in each pairwise comparison following analysis of variance tests. Average CI1-20 was highest in younger healthy individuals and lowest in cardiopulmonary patients (1.37 ± 0.12 vs 1.01 ± 0.27; P < .001). Younger healthy patients showed a heart rate complexity dipping pattern (night < day), older healthy patients showed nondipping, and cardiopulmonary patients showed reverse dipping (night > day). CONCLUSIONS As measures of 24-hour variability, traditional and complexity-based metrics of HRV exhibit large day-night differences in healthy individuals; these differences are blunted, or even reversed, in individuals with cardiopulmonary pathology. Measures of diurnal dynamics may be useful indices of reduced adaptive capacity in patients with cardiopulmonary conditions. CITATION Ma Y, Chang M-C, Litrownik D, Wayne PM, Yeh GY. Day-night patterns in heart rate variability and complexity: differences with age and cardiopulmonary disease. J Clin Sleep Med. 2023;19(5):873-882.
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Affiliation(s)
- Yan Ma
- Osher Center for Integrative Medicine, Division of Preventive Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mei-Chu Chang
- Division of Interdisciplinary Medicine and Biotechnology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Daniel Litrownik
- Osher Center for Integrative Medicine, Division of Preventive Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Peter M. Wayne
- Osher Center for Integrative Medicine, Division of Preventive Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Gloria Y. Yeh
- Osher Center for Integrative Medicine, Division of Preventive Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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4
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Raghu A, Schlesinger D, Pomerantsev E, Devireddy S, Shah P, Garasic J, Guttag J, Stultz CM. ECG-guided non-invasive estimation of pulmonary congestion in patients with heart failure. Sci Rep 2023; 13:3923. [PMID: 36894601 PMCID: PMC9998622 DOI: 10.1038/s41598-023-30900-9] [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: 12/07/2022] [Accepted: 03/03/2023] [Indexed: 03/11/2023] Open
Abstract
Quantifying hemodynamic severity in patients with heart failure (HF) is an integral part of clinical care. A key indicator of hemodynamic severity is the mean Pulmonary Capillary Wedge Pressure (mPCWP), which is ideally measured invasively. Accurate non-invasive estimates of the mPCWP in patients with heart failure would help identify individuals at the greatest risk of a HF exacerbation. We developed a deep learning model, HFNet, that uses the 12-lead electrocardiogram (ECG) together with age and sex to identify when the mPCWP > 18 mmHg in patients who have a prior diagnosis of HF. The model was developed using retrospective data from the Massachusetts General Hospital and evaluated on both an internal test set and an independent external validation set, from another institution. We developed an uncertainty score that identifies when model performance is likely to be poor, thereby helping clinicians gauge when to trust a given model prediction. HFNet AUROC for the task of estimating mPCWP > 18 mmHg was 0.8 [Formula: see text] 0.01 and 0.[Formula: see text] 0.01 on the internal and external datasets, respectively. The AUROC on predictions with the highest uncertainty are 0.50 [Formula: see text] 0.02 (internal) and 0.[Formula: see text] 0.04 (external), while the AUROC on predictions with the lowest uncertainty were 0.86 ± 0.01 (internal) and 0.82 ± 0.01 (external). Using estimates of the prevalence of mPCWP > 18 mmHg in patients with reduced ventricular function, and a decision threshold corresponding to an 80% sensitivity, the calculated positive predictive value (PPV) is 0.[Formula: see text] 0.01when the corresponding chest x-ray (CXR) is consistent with interstitial edema HF. When the CXR is not consistent with interstitial edema, the estimated PPV is 0.[Formula: see text] 0.02, again at an 80% sensitivity threshold. HFNet can accurately predict elevated mPCWP in patients with HF using the 12-lead ECG and age/sex. The method also identifies cohorts in which the model is more/less likely to produce accurate outputs.
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Affiliation(s)
- Aniruddh Raghu
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Building 36-796, 77 Massachusetts Ave., Cambridge, MA, 02139, USA.,Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, 32 Vassar St., Cambridge, MA, 02139, USA.,Research Laboratory of Electronics, Massachusetts Institute of Technology, 77 Massachusetts Ave., Cambridge, MA, 02139, USA
| | - Daphne Schlesinger
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Building 36-796, 77 Massachusetts Ave., Cambridge, MA, 02139, USA.,Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, 32 Vassar St., Cambridge, MA, 02139, USA.,Research Laboratory of Electronics, Massachusetts Institute of Technology, 77 Massachusetts Ave., Cambridge, MA, 02139, USA.,Institute of Medical Engineering and Science, Massachusetts Institute of Technology, 77 Massachusetts Ave., Cambridge, MA, 02139, USA
| | - Eugene Pomerantsev
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.,Division of Cardiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA
| | - Srikanth Devireddy
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Pinak Shah
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.,Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Joseph Garasic
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.,Division of Cardiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA
| | - John Guttag
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Building 36-796, 77 Massachusetts Ave., Cambridge, MA, 02139, USA.,Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, 32 Vassar St., Cambridge, MA, 02139, USA
| | - Collin M Stultz
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Building 36-796, 77 Massachusetts Ave., Cambridge, MA, 02139, USA. .,Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, 32 Vassar St., Cambridge, MA, 02139, USA. .,Research Laboratory of Electronics, Massachusetts Institute of Technology, 77 Massachusetts Ave., Cambridge, MA, 02139, USA. .,Institute of Medical Engineering and Science, Massachusetts Institute of Technology, 77 Massachusetts Ave., Cambridge, MA, 02139, USA. .,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA. .,Division of Cardiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA.
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Tripska K, Draessler J, Pokladnikova J. Heart rate variability, perceived stress and willingness to seek counselling in undergraduate students. J Psychosom Res 2022; 160:110972. [PMID: 35728339 DOI: 10.1016/j.jpsychores.2022.110972] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 06/11/2022] [Accepted: 06/12/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The primary aim was to determine the level of stress in Czech pharmacy students using both subjective and physiological markers of stress throughout their study. The secondary aim was to investigate association of stress with sociodemographic and clinical characteristics, and to determine the predictors of the likelihood of enrolling in psychotherapy counselling. METHODS Design: A prospective observational study. SETTING Faculty of Pharmacy in Hradec Kralove, Czech Republic. SUBJECTS 175 s-year pharmacy students in 2016, 149 students in 2017, and 51 students in 2018. OUTCOME MEASURES Perceived stress scale (PSS-10), heart rate variability (HRV, emWavePro), a self-administered survey (sociodemographic and clinical data, likelihood of enrolling in psychotherapy counselling). RESULTS The average PSS score was 18.3 ± 6.7. There were no significant changes in PSS-10 and HRV parameters between 2016 and 2018. There was a significant negative correlation between PSS-10 and LF power (p = 0.012). Female gender and poor health status were more frequently observed among the respondents with impaired HRV (p = 0.026 for female gender and p = 0.025 and p = 0.042 for poor health status). Fifty-nine percent of students would be likely to enroll in psychotherapy counselling, with men being significantly less inclined to participate compared to women (p = 0.01). CONCLUSION Czech pharmacy students experience moderate levels of stress throughout their studies, which correlates with physiological markers of stress as well as their overall health. Push and pull factors of using mind-body interventions to manage stress should be further examined, especially in high risk groups.
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Affiliation(s)
- Katarina Tripska
- The Department of Biological and Medical Sciences, Faculty of Pharmacy in Hradec Kralove, Charles University, Czech Republic
| | - Jan Draessler
- The Department of Informatics and Quantitative Methods, Faculty of Informatics and Management, University of Hradec Kralove, Czech Republic
| | - Jitka Pokladnikova
- The Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Czech Republic.
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Mercer MA, McKenzie HC, Byron CR, Pleasant RS, Bogers SH, Council-Troche RM, Werre SR, Burns T, Davis JL. Pharmacokinetics and clinical efficacy of Acetaminophen (Paracetamol) in adult horses with mechanically induced lameness. Equine Vet J 2022; 55:524-533. [PMID: 35633196 DOI: 10.1111/evj.13601] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 05/11/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acetaminophen has been used clinically in horses alone or combined with traditional NSAIDs for treatment of musculoskeletal pain in horses. OBJECTIVES To determine the pharmacokinetics and efficacy of acetaminophen at two doses in horses with mechanically induced lameness compared to phenylbutazone or placebo control. STUDY DESIGN In vivo experiment. METHODS Nine healthy mares with mechanical lameness induced via a reversible sole pressure horseshoe model were treated with acetaminophen (20 mg/kg PO; A20), acetaminophen (30 mg/kg PO; A30), phenylbutazone (2.2 mg/kg, PO; PB) and oral placebo (C) in a randomised 4-way Latin square model. Plasma concentrations for A20 and A30 were analysed via LC-MS/MS and noncompartmental pharmacokinetic analysis. Heart rate and heart rate variability were measured using a portable telemetry. Lameness was scored by three blinded boarded equine surgeons using the AAEP and 10-point scales. RESULTS Mean maximum plasma concentration (Cmax ) for A20 was 20.01 ug/mL within 0.66h (Tmax ) after administration; The mean Cmax for A30 was 30.02 ug/mL with a Tmax of 0.43 h. Post-treatment heart rate for A30 was significantly lower than A20 at 1 and 7 h; lower than PB at 2, 3, 4.5, and 7 h; lower than C at 2, 3.5, 4.5, 6, 7, and 8 h. 10-point Lameness scores were significantly improved for A30 than C at 2 and 4 h post-treatment; PB was significantly improved than C at 8 h post treatment. There were no significant differences in lameness between A20, A30, and PB. MAIN LIMITATIONS Small sample size, lack of objective lameness measurement. CONCLUSIONS Acetaminophen at 30 mg/kg produced a more rapid improvement in lameness scores and heart rate compared to other treatments in this model. Further evaluation of the pharmacokinetics and safety of repeated oral dosing of acetaminophen at 30 mg/kg is needed to determine clinical utility.
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Affiliation(s)
- Melissa A Mercer
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine
| | - Harold C McKenzie
- Department of Large Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine
| | - Christopher R Byron
- Department of Large Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine
| | - Robert S Pleasant
- Department of Large Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine
| | - Sophie H Bogers
- Department of Large Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine
| | - Roberto M Council-Troche
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine
| | - Stephen R Werre
- Department of Population Health Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia, USA
| | - Travis Burns
- Department of Large Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine
| | - Jennifer L Davis
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine
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7
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Dor-Haim H, Horowitz M, Yaakobi E, Katzburg S, Barak S. Intermittent aerobic-resistance interval training versus continues aerobic training: Improvement in cardiac electrophysiologic and anthropometric measures in male patients post myocadiac infarction, a randomized control trial. PLoS One 2022; 17:e0267888. [PMID: 35503787 PMCID: PMC9064084 DOI: 10.1371/journal.pone.0267888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/14/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose Exercise is a valuable intervention modality for patients post-myocardial infarction (MI). Aerobic and resistance training are both commonly used separately in cardiac rehabilitation. However, the effect of aerobic interval exercise combined with alternating sets of resistance training (super-circuit training, SCT) on cardiac electrophysiologic and anthropometric measures had not been thoroughly investigated. Aim The primary objective of this study was to compare the effectiveness of moderate-intensity continuous-aerobic training (CAT) vs. SCT on cardiac electrical measures (resting electrocardiographic, ECG; a nd heart rate variability, HRV) in patients’ post-MI presenting reduced left ventricular function. Second, to examine its effect on anthropometric measures. Material and methods Twenty-nine men post-MI with reduced left ventricular function were assigned randomly to either 12 weeks of CAT (n = 15) or SCT (n = 14). CAT group performed moderate-intensity activity. SCT group performed high-intensity exercise, alternating between resistance and aerobic training. Differences between CAT and SCT groups were done using independent t-tests, paired t-tests and effect size (ES). Results Participants in both groups improved their HRV measures (increase in HFnu; p < 0.05; ES > 0.51) and ECG (reduction in QT-dispersion; p < 0.05; ES > 0.51). Only the SCT group had significant improvements in waist circumference (p < 0.05). Conclusion Exercise improves cardiac electrical measures post-MI. However, in comparison to CAT, SCT may yield greater anthropometric changes. In order to have improvements in cardiac electrical stability, clinicians working with post-MI patients may use both CAT and SCT. However, SCT might result in greater improvements.
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Affiliation(s)
- Horesh Dor-Haim
- O2 Health Promotion and Sports Medicine Department, Givat Ram, Jerusalem, Israel
| | - Michal Horowitz
- The laboratory of Environmental Physiology Department of Physiology, Faculty of Dentistry Hebrew University of Jerusalem, Hadassah Ein Kerem Campus Jerusalem, Jerusalem, Israel
| | - Eldad Yaakobi
- The Sagol Center for Hyperbaric Medicine and Research, Yitzhak Shamir Medical Center, Be’er Ya’akov, Israel
| | - Sara Katzburg
- O2 Health Promotion and Sports Medicine Department, Givat Ram, Jerusalem, Israel
- Department of Developmental Biology and Cancer Research, Israel-Canada Medical Research Institute, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sharon Barak
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children’s Hospital, The Chaim Sheba Medical Center, Ramat Gan, Israel
- Kaye Academic College of Education, Beer-Sheba, Israel
- * E-mail:
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8
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Automated Detection of Sudden Cardiac Death by Discrete Wavelet Transform of Electrocardiogram Signal. Symmetry (Basel) 2022. [DOI: 10.3390/sym14030571] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Sudden cardiac death (SCD) results in millions of deaths annually; as it is a fatal heart abnormality, early prediction of SCD could save peoples’ lives to the greatest extent. Symmetry and asymmetry play an important role in many fields. Electrocardiograms (ECG) as a noninvasive process for acquiring the electrical activity of the heart, has both asymmetric and non-stationary characteristics; it is frequently employed to diagnose and evaluate the heart’s condition. In this work, we have detected SCD 14 min (separately for each one-minute interval) prior to its occurrence by analyzing ECG signals using discrete wavelet transform (DWT) and locality preserving projection (LPP). In the experiment, we have performed DWT on ECG signals to obtain coefficients, then LPP as a reduction methodology was used to cut down these obtained coefficients. Then, the acquired LPP features were ranked using various methods, including the T-test, Bhattacharyya, Wilcoxon, and entropy. At last, the highly ranked LPP features were subjected to decision tree, k-nearest neighbor (KNN), and support vector machine classifiers for distinguishing normal from SCD ECG signals. Our proposed technique has achieved a highest accuracy of 97.6% for the detection of SCD 14 min prior using the KNN classifier, compared to the existing works. Our proposed method is capable of predicting the people at risk of developing SCD 14 min before its onset, and, hence, clinicians would have enough time to provide treatment in intensive care units (ICU) for a subject at risk of SCD. Thus, this proposed technique as a useful tool can increase the survival rate of many cardiac patients.
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9
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Nam EC, Chun KJ, Won JY, Kim JW, Lee WH. The differences between daytime and night-time heart rate variability may usefully predict the apnea-hypopnea index in patients with obstructive sleep apnea. J Clin Sleep Med 2022; 18:1557-1563. [PMID: 35088710 DOI: 10.5664/jcsm.9912] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The association between daytime/night-time heart rate variability (HRV) and the apnea-hypopnea index (AHI) remains unclear. We sought a relationship between AHI and the daytime-to night-time HRV ratio as measured by 24-h Holter monitoring in patients with obstructive sleep apnea (OSA). METHODS We prospectively enrolled 66 patients who visited our sleep clinic complaining of habitual snoring or sleep apnea. All underwent 24-h Holter monitoring (to measure HRV) combined with full-night polysomnography (PSG). Sixty-two met our enrolment criteria. We evaluated the associations between HRV frequency domains and the PSG indices. We also considered medical histories and anthropometric data. RESULTS The night-time very low frequency (VLF), low frequency (LF), and high frequency (HF) HRVs were significantly higher than the daytime values. On correlation analysis, the day/night VLF (r = 0.550, p < 0.001), LF (r = 0.556, p < 0.001), and HF (r = 0.303, p = 0.017) HRVs were significantly related to the AHI. Of the day/night HRV ratios, the VLF (p for trend = 0.003) and LF (p for trend = 0.013) ratios decreased significantly by OSA severity. Multivariable analysis showed that the day/night VLF (β = 16.387, p < 0.001) and day/night LF (β = 25.248, p < 0.001) were independently (and significantly) associated with the AHI. CONCLUSIONS Twenty-four-hour Holter monitoring may usefully predict AHI. The day/night VLF and day/night LF ratios tended to decrease by OSA severity and were independently associated with the AHI.
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Affiliation(s)
- Eui-Cheol Nam
- Departments of Otolaryngology, Kangwon National University Hospital, College of Medicine, Kangwon National University, Chuncheon, Korea
| | - Kwang Jin Chun
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, College of Medicine, Kangwon National University, Chuncheon, Korea
| | - Jun Yeon Won
- Departments of Otolaryngology, Kangwon National University Hospital, College of Medicine, Kangwon National University, Chuncheon, Korea
| | - Jeong-Whun Kim
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Woo Hyun Lee
- Departments of Otolaryngology, Kangwon National University Hospital, College of Medicine, Kangwon National University, Chuncheon, Korea
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10
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Cao R, Azimi I, Sarhaddi F, Niela-Vilen H, Axelin A, Liljeberg P, Rahmani AM. Accuracy Assessment of Oura Ring Nocturnal Heart Rate and Heart Rate Variability in Comparison With Electrocardiography in Time and Frequency Domains: Comprehensive Analysis. J Med Internet Res 2022; 24:e27487. [PMID: 35040799 PMCID: PMC8808342 DOI: 10.2196/27487] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 06/08/2021] [Accepted: 11/08/2021] [Indexed: 01/24/2023] Open
Abstract
Background Photoplethysmography is a noninvasive and low-cost method to remotely and continuously track vital signs. The Oura Ring is a compact photoplethysmography-based smart ring, which has recently drawn attention to remote health monitoring and wellness applications. The ring is used to acquire nocturnal heart rate (HR) and HR variability (HRV) parameters ubiquitously. However, these parameters are highly susceptible to motion artifacts and environmental noise. Therefore, a validity assessment of the parameters is required in everyday settings. Objective This study aims to evaluate the accuracy of HR and time domain and frequency domain HRV parameters collected by the Oura Ring against a medical grade chest electrocardiogram monitor. Methods We conducted overnight home-based monitoring using an Oura Ring and a Shimmer3 electrocardiogram device. The nocturnal HR and HRV parameters of 35 healthy individuals were collected and assessed. We evaluated the parameters within 2 tests, that is, values collected from 5-minute recordings (ie, short-term HRV analysis) and the average values per night sleep. A linear regression method, the Pearson correlation coefficient, and the Bland–Altman plot were used to compare the measurements of the 2 devices. Results Our findings showed low mean biases of the HR and HRV parameters collected by the Oura Ring in both the 5-minute and average-per-night tests. In the 5-minute test, the error variances of the parameters were different. The parameters provided by the Oura Ring dashboard (ie, HR and root mean square of successive differences [RMSSD]) showed relatively low error variance compared with the HRV parameters extracted from the normal interbeat interval signals. The Pearson correlation coefficient tests (P<.001) indicated that HR, RMSSD, average of normal heart beat intervals (AVNN), and percentage of successive normal beat-to-beat intervals that differ by more than 50 ms (pNN50) had high positive correlations with the baseline values; SD of normal beat-to-beat intervals (SDNN) and high frequency (HF) had moderate positive correlations, and low frequency (LF) and LF:HF ratio had low positive correlations. The HR, RMSSD, AVNN, and pNN50 had narrow 95% CIs; however, SDNN, LF, HF, and LF:HF ratio had relatively wider 95% CIs. In contrast, the average-per-night test showed that the HR, RMSSD, SDNN, AVNN, pNN50, LF, and HF had high positive relationships (P<.001), and the LF:HF ratio had a moderate positive relationship (P<.001). The average-per-night test also indicated considerably lower error variances than the 5-minute test for the parameters. Conclusions The Oura Ring could accurately measure nocturnal HR and RMSSD in both the 5-minute and average-per-night tests. It provided acceptable nocturnal AVNN, pNN50, HF, and SDNN accuracy in the average-per-night test but not in the 5-minute test. In contrast, the LF and LF:HF ratio of the ring had high error rates in both tests.
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Affiliation(s)
- Rui Cao
- Department of Electrical Engineering and Computer Science, University of California, Irvine, CA, United States
| | - Iman Azimi
- Department of Computing, University of Turku, Turku, Finland
| | | | | | - Anna Axelin
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Pasi Liljeberg
- Department of Computing, University of Turku, Turku, Finland
| | - Amir M Rahmani
- Department of Electrical Engineering and Computer Science, University of California, Irvine, CA, United States.,Department of Computer Science, University of California, Irvine, CA, United States.,School of Nursing, University of California, Irvine, CA, United States
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11
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Cavina AP, Silva NM, Biral TM, Lemos LK, Junior EP, Pastre CM, Vanderlei LC, Vanderlei FM. Effects of 12-week Pilates training program on cardiac autonomic modulation: a randomized controlled clinical trial. J Comp Eff Res 2021; 10:1363-1372. [PMID: 34672201 DOI: 10.2217/cer-2021-0195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Aim: To evaluate the effects of 12-week Pilates training program on cardiac autonomic modulation. Materials & methods: A randomized controlled trial of a 12-week Pilates training program was conducted. A total of 54 men were randomly allocated to either a control or a Pilates group. Initially, the RR intervals were captured for 20 min for later analysis of heart rate variability (HRV). The training protocol was then initiated, in which the Pilates group performed 36 sessions of the Pilates method for approximately 60 min each session, three-times a week, totaling 12 weeks. The control group was instructed to maintain their normal activities during this period. One week after the end of the training, the final evaluations were performed with the capture of RR intervals in both the groups. Linear indices in the time (SDNN and rMSSD) and frequency (low frequency [LF] and high frequency [HF]) domains, and the Poincaré plot (SD1 and SD2) were used. Nonlinear indices were also analyzed (approximate entropy and detrended fluctuation analysis). Descriptive statistics and generalized mixed models were performed. Results: There was a group effect for LF (ms2) and a time effect for SD2. There was a training effect observed by the time*group interactions in which an increase in global HRV indices was found for the Pilates group after 12 weeks (SDNN: mean difference [MD] = 9.82; standard deviation [SD] = 18.52; ES = -0.514; LF [ms2]: MD = 334.23; SD = 669.43; ES = -0.547; SD2: MD = 14.58; SD = 24.28; ES = -0.693). Conclusion: A 12-week Pilates training program promotes significant improvement in global modulation of HRV in the Pilates group considering the significant increase in SDNN, LF (ms2) and SD2 indices. Trial registration number: NCT03232866.
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Affiliation(s)
- Allysiê Ps Cavina
- Post-graduate Program in Physiotherapy, Universidade Estadual Paulista (FCT/UNESP), Presidente Prudente, SP, Brazil
| | - Natália M Silva
- Graduate in Physiotherapy, Universidade Estadual Paulista (FCT/UNESP), Presidente Prudente, SP, Brazil
| | - Taíse M Biral
- Post-graduate Program in Movement Sciences, Universidade Estadual Paulista (FCT/UNESP), Presidente Prudente, SP, Brazil
| | - Leonardo K Lemos
- Post-graduate Program in Physiotherapy, Universidade Estadual Paulista (FCT/UNESP), Presidente Prudente, SP, Brazil
| | - Eduardo Pizzo Junior
- Post-graduate Program in Movement Sciences, Universidade Estadual Paulista (FCT/UNESP), Presidente Prudente, SP, Brazil
| | - Carlos M Pastre
- Post-graduate Program in Movement Sciences, Universidade Estadual Paulista (FCT/UNESP), Presidente Prudente, SP, Brazil.,Department of Physiotherapy, Universidade Estadual Paulista (FCT/UNESP), Presidente Prudente, SP, Brazil
| | - Luiz Cm Vanderlei
- Post-graduate Program in Movement Sciences, Universidade Estadual Paulista (FCT/UNESP), Presidente Prudente, SP, Brazil.,Department of Physiotherapy, Universidade Estadual Paulista (FCT/UNESP), Presidente Prudente, SP, Brazil
| | - Franciele M Vanderlei
- Post-graduate Program in Movement Sciences, Universidade Estadual Paulista (FCT/UNESP), Presidente Prudente, SP, Brazil.,Department of Physiotherapy, Universidade Estadual Paulista (FCT/UNESP), Presidente Prudente, SP, Brazil
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12
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Carandina A, Rodrigues GD, Di Francesco P, Filtz A, Bellocchi C, Furlan L, Carugo S, Montano N, Tobaldini E. Effects of transcutaneous auricular vagus nerve stimulation on cardiovascular autonomic control in health and disease. Auton Neurosci 2021; 236:102893. [PMID: 34649119 DOI: 10.1016/j.autneu.2021.102893] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/24/2021] [Accepted: 10/04/2021] [Indexed: 01/01/2023]
Abstract
Autonomic nervous system (ANS) dysfunction is a well-known feature of cardiovascular diseases (CVDs). Studies on heart rate variability (HRV), a non-invasive method useful in investigating the status of cardiovascular autonomic control, have shown that a predominance of sympathetic modulation not only contributes to the progression of CVDs but has a pivotal role in their onset. Current therapies focus more on inhibition of sympathetic activity, but the presence of drug-resistant conditions and the invasiveness of some surgical procedures are an obstacle to complete therapeutic success. On the other hand, targeting the parasympathetic branch of the autonomic nervous system through invasive vagus nerve stimulation (VNS) has shown interesting results as alternative therapeutic approach for CVDs. However, the invasiveness and cost of the surgical procedure limit the clinical applicability of VNS and hinder the research on the physiological pathway involved. Transcutaneous stimulation of the auricular branch of the vagus nerve (tVNS) seems to represent an important non-invasive alternative with effects comparable to those of VNS with surgical implant. Thus, in the present narrative review, we illustrate the main studies on tVNS performed in healthy subjects and in three key examples of CVDs, namely heart failure, hypertension and atrial fibrillation, highlighting the neuromodulatory effects of this technique.
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Affiliation(s)
- Angelica Carandina
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Gabriel Dias Rodrigues
- Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, Brazil; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Pietro Di Francesco
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Annalisa Filtz
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Chiara Bellocchi
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Ludovico Furlan
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Stefano Carugo
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Nicola Montano
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - Eleonora Tobaldini
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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13
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Physiological and Behavioral Benefits for People and Horses during Guided Interactions at an Assisted Living Residence. Behav Sci (Basel) 2021; 11:bs11100129. [PMID: 34677222 PMCID: PMC8533143 DOI: 10.3390/bs11100129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 11/23/2022] Open
Abstract
Assisted living is a fast-growing living option for seniors who require residence-based activities for maintaining mental and physical health. Guided equine interactions may benefit seniors, so an on-site equine program was started at Hacienda at the River senior living community. For research purposes, twenty-four residents and associates, aged fifty-five or over, consented to physiological measurements before, during and after four guided sessions of stroking one of three horses for 10 min over 4–6 weeks. Heart rate variability (HRV) was measured simultaneously in humans and horses during interactions. We hypothesized that human heart rate (HR) and HRV would increase during stroking and HRV power would shift toward the very low frequency (VLF) range common in horses, indicative of healthy function. During stroking, human HR increased (p < 0.05) but HRV (SDRR) and %VLF of HRV power did not change. Diastolic blood pressure (DBP), an exploratory measure, significantly increased after stroking, consistent with arousal. Two horses showed no significant changes in HR or HRV, but one relaxed. Sixteen horse–human pairs demonstrated synchronized HRV peak frequencies during sessions, suggestive of social connection. Participants used more positive than negative words describing their experience during exit interviews (p < 0.05). These data show that horses animate seniors without causing emotional stress and provide opportunities for social bonding.
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14
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Autonomic dysfunction and heart rate variability with Holter monitoring: a diagnostic look at autonomic regulation. Herzschrittmacherther Elektrophysiol 2021; 32:315-319. [PMID: 34236476 DOI: 10.1007/s00399-021-00780-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/06/2021] [Indexed: 10/20/2022]
Abstract
Heart rate variability (HRV) refers to the beat-to-beat variation of the cardiac cycle. Since heart rate is modulated on a beat-to-beat basis by the combined influence of the sympathetic and parasympathetic nervous system at the sinus node level, HRV has been considered an indirect biomarker of cardiac autonomic control and widely exploited for the assessment of autonomic function in many pathological subjects. This focus article summarizes the main findings derived from HRV analysis applied to 24‑h Holter monitoring in both cardiac and non-cardiac diseases as well as in physiological conditions in the healthy population. Even if the prognostic role of HRV indices is well recognized and its use ever more widespread, its implementation in the diagnostic and prognostic processes in routine clinical practice remains limited. Several reasons for these limitations can be identified: first the lack of reliable reference values, and secondly, the low specificity of HRV indices in particular when considering the constant evolution of clinical practice and therapeutic approaches, making it difficult to refer to a specific and stable combination of clinical and HRV markers. Therefore, the clinical use of HRV should be further investigated. Finally, HRV represents a substantial tool for investigating the physiological conditions in healthy people that can have important implications in primary prevention and the understanding of gender differences, as well as in sport and occupational medicine.
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15
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Sinha M, Behera AK, Sinha R, Parganiha A, Pande B, Sharma R, Pati AK. Circadian rhythmicity of heart rate variability and its impact on cardiac autonomic modulation in asthma. Chronobiol Int 2021; 38:1631-1639. [PMID: 34121548 DOI: 10.1080/07420528.2021.1938595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The commonly observed nocturnal attack of asthma is accompanied by circadian variations in airway inflammation and other physiological variables. It is also documented to present with a significantly higher risk of adverse cardiovascular events that are associated with lower heart rate variability (HRV) and depressed sympathetic and enhanced parasympathetic modulations. However, available literature is scarce with regard to the impact of alteration in circadian rhythmicity of long-term HRV and its day-night variation in asthmatic patients. Thus, 72-h continuous recording of RR interval and oxygen saturation was done to study the circadian variability of HRV (in terms of time and frequency domain indices) and also to assess the pattern of alterations in sympathetic and parasympathetic tones at different times of the day in asthmatic patients (n = 32) and healthy control subjects (n = 31). Repeated-measure analysis of variance and independent-samples t-test revealed significantly increased parasympathetic tone [in terms of increased square root of the mean squared differences of successive NN intervals (RMSSD), percentage of number of pairs of adjacent RR interval differing by more than 50 ms (pNN50), standard deviation of NN intervals (SDNN), and high frequency (HF)] with reduced sympathetic activity [decreased low frequency (LF) and LF/HF ratio] at early morning hours (between 04:00 and 10:00 h) in the asthma patients in contrast to the healthy subjects who had opposite response. Also, significant phase delay (p<0.05) of all the HRV indices and SpO2, was evident by cosinor analysis. Therefore, disturbed circadian rhythm of HRV indices and early morning increased parasympathetic tone points toward the possible pathophysiological basis of exacerbated asthmatic symptoms at late night/early morning hours and susceptibility of future cardiovascular pathologies. This also necessitates the assessment of HRV rhythm while dealing with the therapeutic management of asthma patients.
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Affiliation(s)
- Meenakshi Sinha
- Department of Physiology, All India Institute of Medical Sciences, Raipur, India
| | - Ajoy K Behera
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Raipur, India
| | - Ramanjan Sinha
- Department of Physiology, All India Institute of Medical Sciences, Raipur, India
| | - Arti Parganiha
- School of Studies in Life Sciences, Pt. Ravishankar Shukla University, Raipur, India
| | - Babita Pande
- Department of Physiology, All India Institute of Medical Sciences, Raipur, India
| | - Richa Sharma
- Department of Physiology, All India Institute of Medical Sciences, Raipur, India
| | - Atanu K Pati
- Department of Zoology, Gangadhar Meher University, Odisha, India
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16
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Huang Y, Chen H, Su Y, Liu H, Hu J, Hong K. Increased blood alpha-carotene, all-trans-Beta-carotene and lycopene levels are associated with beneficial changes in heart rate variability: a CVD-stratified analysis in an adult population-based study. Nutr J 2021; 20:43. [PMID: 33971890 PMCID: PMC8111755 DOI: 10.1186/s12937-021-00700-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/26/2021] [Indexed: 01/08/2023] Open
Abstract
Background Although the associations of antioxidant micronutrients, such as carotenoids and vitamins, with cardiovascular diseases (CVDs) have been studied extensively, blood concentrations of antioxidant micronutrients and heart rate variability (HRV), which has been proven to be an indicator of cardiac autonomic control, has not been reported. We aimed to explore whether blood concentrations of antioxidant micronutrients, including carotenoids and vitamins, are associated with elevated heart rate variability (HRV (beneficial change) in a cross-sectional analysis. Methods Data were obtained from the Midlife in the United States (MIDUS) study that includes a general adult population. A total of 1074 (aged 34–84) individuals were included. Multivariable analyses were performed to investigate the association between main blood carotenoids (total lutein, zeaxanthin, beta-cryptoxanthin, 13-cis-beta-carotene, alpha-carotene, all-trans-beta-carotene and total lycopene) and vitamins A (retinol) and E (gamma-tocopherol and alpha-tocopherol) and HRV after adjustments were made for lifestyle factors and age-related confounders. Results Pearson correlation analyses showed that the increased levels of carotenoids and vitamins were positively correlated with higher HRV (all P < 0.05). After adjustments were made for age, gender, race, body mass index(BMI), ever-smoker, number of drinking years and exercise, blood alpha-carotene, all-trans-beta-carotene and total lycopene levels were independently associated with higher HRV in the linear regression model (all P < 0.05). Sensitivity analysis by adding “ever chronic respiratory diseases” as a covariate suggested that blood concentrations of these three carotenoids were still associated with higher low-frequency (LF)-HRV and high-frequency (HF)-HRV (all P < 0.05). Furthermore, stratified analyses suggested that the associations were affected by adding “heart disease” and “hypertension” as covariates. Conclusions We provide the first evidence that elevated blood concentrations of alpha-carotene, trans-beta-carotene and lycopene are associated with beneficial changes in HRV in the general population. Daily intake of fruit and vegetables may be beneficial to increase blood carotenoid status and further prevent autonomic dysfunction.
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Affiliation(s)
- Ying Huang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Donghu District, Nanchang, 330006, Jiangxi, China
| | - Hong Chen
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Donghu District, Nanchang, 330006, Jiangxi, China
| | - Yuhao Su
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Donghu District, Nanchang, 330006, Jiangxi, China
| | - Hualong Liu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Donghu District, Nanchang, 330006, Jiangxi, China
| | - Jinzhu Hu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Donghu District, Nanchang, 330006, Jiangxi, China.
| | - Kui Hong
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Donghu District, Nanchang, 330006, Jiangxi, China. .,Jiangxi Key Laboratory of Molecular Medicine, Nanchang, 330006, Jiangxi, China.
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17
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De Maria B, Dalla Vecchia LA, Maestri R, Pinna GD, Parati M, Perego F, Bari V, Cairo B, Gelpi F, La Rovere MT, Porta A. Lack of association between heart period variability asymmetry and respiratory sinus arrhythmia in healthy and chronic heart failure individuals. PLoS One 2021; 16:e0247145. [PMID: 33592077 PMCID: PMC7886158 DOI: 10.1371/journal.pone.0247145] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/02/2021] [Indexed: 12/02/2022] Open
Abstract
Temporal asymmetry is a peculiar aspect of heart period (HP) variability (HPV). HPV asymmetry (HPVA) is reduced with aging and pathology, but its origin is not fully elucidated. Given the impact of respiration on HPV resulting in the respiratory sinus arrhythmia (RSA) and the asymmetric shape of the respiratory pattern, a possible link between HPVA and RSA might be expected. In this study we tested the hypothesis that HPVA is significantly associated with RSA and asymmetry of the respiratory rhythm. We studied 42 middle-aged healthy (H) subjects, and 56 chronic heart failure (CHF) patients of whom 26 assigned to the New York Heart Association (NYHA) class II (CHF-II) and 30 to NYHA class III (CHF-III). Electrocardiogram and lung volume were monitored for 8 minutes during spontaneous breathing (SB) and controlled breathing (CB) at 15 breaths/minute. The ratio of inspiratory (INSP) to expiratory (EXP) phases, namely the I/E ratio, and RSA were calculated. HPVA was estimated as the percentage of negative HP variations, traditionally measured via the Porta’s index (PI). Departures of PI from 50% indicated HPVA and its significance was tested via surrogate data. We found that RSA increased during CB and I/E ratio was smaller than 1 in all groups and experimental conditions. In H subjects the PI was about 50% during SB and it increased significantly during CB. In both CHF-II and CHF-III groups the PI was about 50% during SB and remained unmodified during CB. The PI was uncorrelated with RSA and I/E ratio regardless of the experimental condition and group. Pooling together data of different experimental conditions did not affect conclusions. Therefore, we conclude that the HPVA cannot be explained by RSA and/or I/E ratio, thus representing a peculiar feature of the cardiac control that can be aroused in middle-aged H individuals via CB.
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Affiliation(s)
| | | | - Roberto Maestri
- IRCCS Istituti Clinici Scientifici Maugeri, Montescano, Pavia, Italy
| | | | - Monica Parati
- IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | | | - Vlasta Bari
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Beatrice Cairo
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Francesca Gelpi
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Alberto Porta
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- * E-mail:
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18
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Nardelli M, Valenza G, Greco A, Lanatá A, Scilingo EP, Bailón R. Quantifying the lagged Poincaré plot geometry of ultrashort heart rate variability series: automatic recognition of odor hedonic tone. Med Biol Eng Comput 2020; 58:1099-1112. [PMID: 32162243 DOI: 10.1007/s11517-019-02095-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 12/06/2019] [Indexed: 10/24/2022]
Abstract
The application of Poincaré plot analysis to characterize inter-beat interval dynamics has been successfully proposed in the scientific literature for the assessment of humans' physiological states and related aberrations. In this study, we proposed novel descriptors to trace the evolution of Poincaré plot shape over the lags. Their reliability in ultra-short cardiovascular series analysis was validated on synthetic inter-beat series generated through a physiologically plausible integral pulse frequency modulation model. Furthermore, we used the proposed approach for the investigation of the direct relationship between autonomic nervous system (ANS) dynamics and hedonic olfactory elicitation, in a group of 30 healthy subjects. Participants with a similar olfactory threshold were selected, and were asked to score 5-s stimuli in terms of arousal and valence levels according to the Russell's circumflex model of affect. Their ANS response was investigated in 35-s windows after the elicitation. Experimental results showed a gender-specific, high discriminant power of the proposed approach, discerning between pleasant and unpleasant odorants with an accuracy of 83.33% and 73.33% for men and for women, respectively. Graphical Abstract Olfaction plays a crucial role in our life and is strictly related to the Autonomic Nervous System (ANS) activity, which can be monitored studying Heart Rate Variability. We used the Lagged Poincare Plot approach to recognize gender-specific ANS response in 35-second windows after the elicitation through pleasant/unpleasant odorants.
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Affiliation(s)
- M Nardelli
- Department of Information Engineering, Research Centre E. Piaggio, University of Pisa, Via G. Caruso 16, Pisa, Italy.
| | - G Valenza
- Department of Information Engineering, Research Centre E. Piaggio, University of Pisa, Via G. Caruso 16, Pisa, Italy
| | - A Greco
- Department of Information Engineering, Research Centre E. Piaggio, University of Pisa, Via G. Caruso 16, Pisa, Italy
| | - A Lanatá
- Department of Information Engineering, Research Centre E. Piaggio, University of Pisa, Via G. Caruso 16, Pisa, Italy
| | - E P Scilingo
- Department of Information Engineering, Research Centre E. Piaggio, University of Pisa, Via G. Caruso 16, Pisa, Italy
| | - R Bailón
- BSICoS Group, Aragón Institute of Engineering Research (I3A), IIS Aragón, University of Zaragoza, Zaragoza, Spain.,CIBER of Bioengineering, Biomaterials and Nanomedicine (CIBER - BBN), Madrid, Spain
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19
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Shi M, He H, Geng W, Wu R, Zhan C, Jin Y, Zhu F, Ren S, Shen B. Early Detection of Sudden Cardiac Death by Using Ensemble Empirical Mode Decomposition-Based Entropy and Classical Linear Features From Heart Rate Variability Signals. Front Physiol 2020; 11:118. [PMID: 32158399 PMCID: PMC7052183 DOI: 10.3389/fphys.2020.00118] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 02/03/2020] [Indexed: 02/05/2023] Open
Abstract
Sudden cardiac death (SCD), which can deprive a person of life within minutes, is a destructive heart abnormality. Thus, providing early warning information for patients at risk of SCD, especially those outside hospitals, is essential. In this study, we investigated the performances of ensemble empirical mode decomposition (EEMD)-based entropy features on SCD identification. EEMD-based entropy features were obtained by using the following technology: (1) EEMD was performed on HRV beats to decompose them into intrinsic mode functions (IMFs), (2) five entropy parameters, namely Rényi entropy (RenEn), fuzzy entropy (FuEn), dispersion Entropy (DisEn), improved multiscale permutation entropy (IMPE), and Renyi distribution entropy(RdisEn), were computed from the first four IMFs obtained, which were named EEMD-based entropy features. Additionally, an automated scheme combining EEMD-based entropy and classical linear (time and frequency domains) features was proposed with the intention of detecting SCD early by analyzing 14 min (at seven successive intervals of 2 min) heart rate variability (HRV) in signals from a normal population and subjects at risk of SCD. Firstly, EEMD-based entropy and classical linear measurements were extracted from HRV beats, and then the integrated measurements were ranked by various methodologies, i.e., t-test, entropy, receiver-operating characteristics (ROC), Wilcoxon, and Bhattacharyya. Finally, these ranked features were fed into a k-Nearest Neighbor algorithm for classification. Compared with several state-of-the-art methods, the proposed scheme firstly predicted subjects at risk of SCD up to 14 min earlier with an accuracy of 96.1%, a sensitivity of 97.5%, and a specificity of 94.4% 14 min before SCD onset. The simulation results exhibited that EEMD-based entropy estimators showed significant difference between SCD patients and normal individuals and outperformed the classical linear estimators in SCD detection, the EEMD-based FuEn and IMPE indexes were particularly useful assessments for identification of patients at risk of SCD and can be used as novel indices to reveal the disorders of rhythm variations of the autonomic nervous system when affected by SCD.
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Affiliation(s)
- Manhong Shi
- Center for Systems Biology, Soochow University, Suzhou, China.,College of Information and Network Engineering, Anhui Science and Technology University, Fengyang, China
| | - Hongxin He
- Center for Systems Biology, Soochow University, Suzhou, China
| | - Wanchen Geng
- Applied Mathematical Sciences, University of Connecticut, Storrs, CT, United States
| | - Rongrong Wu
- Center for Systems Biology, Soochow University, Suzhou, China
| | - Chaoying Zhan
- Center for Systems Biology, Soochow University, Suzhou, China
| | - Yanwen Jin
- Center for Systems Biology, Soochow University, Suzhou, China
| | - Fei Zhu
- School of Computer Science & Technology, Soochow University, Suzhou, China
| | - Shumin Ren
- Institutes for Systems Genetics, West China Hospital, Sichuan University, Chengdu, China
| | - Bairong Shen
- Institutes for Systems Genetics, West China Hospital, Sichuan University, Chengdu, China
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20
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Aalders M, Kok W. Comparison of Hemodynamic Factors Predicting Prognosis in Heart Failure: A Systematic Review. J Clin Med 2019; 8:jcm8101757. [PMID: 31652650 PMCID: PMC6832156 DOI: 10.3390/jcm8101757] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/12/2019] [Accepted: 10/17/2019] [Indexed: 02/06/2023] Open
Abstract
Objectives: We systematically reviewed the literature to address the question of which of the three hemodynamic factors predicts prognosis best in heart failure patients when directly compared to each other: cardiac output, preload or afterload. Methods: Prognostic studies in heart failure (HF) were searched that included at least two of the three hemodynamic variables: (1) cardiac output or cardiac index (CI), (2) preload represented by pulmonary capillary wedge pressure (PCWP) and (3) afterload simplified to systolic blood pressure (SBP). Critical appraisal was done according to the QUIPS format for prognostic studies. The main endpoint was all-cause mortality, which could be combined with other endpoints. We report the number of studies in which CI, PCWP and SBP remained significant prognostic predictors in multivariate analysis. We also assessed whether hemodynamic predictors of prognosis varied in four different HF-populations. Results: Included were 18 studies containing a multivariate analysis. PCWP was an independent predictor of prognosis in 10 of 18 studies, SBP in 3 of 14 studies and CI in none of 18 studies. Results were not specific for any of the HF-populations. Conclusions: A higher PCWP and lower SBP are independent predictors of poor prognosis in HF. In spite of the frequently used concept behind HF, this review demonstrates that CI is not an independent predictor of prognosis in HF.
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Affiliation(s)
- Margot Aalders
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands.
| | - Wouter Kok
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands.
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Fang SC, Wu YL, Tsai PS. Heart Rate Variability and Risk of All-Cause Death and Cardiovascular Events in Patients With Cardiovascular Disease: A Meta-Analysis of Cohort Studies. Biol Res Nurs 2019; 22:45-56. [PMID: 31558032 DOI: 10.1177/1099800419877442] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Lower heart rate variability (HRV) is associated with a higher risk of cardiovascular events and mortality, although the extent of the association is uncertain. We performed a meta-analysis of cohort studies to elucidate the association between HRV and the risk of all-cause death or cardiovascular events in patients with cardiovascular disease (CVD) during a follow-up of at least 1 year. We searched four databases (PubMed, MEDLINE, Embase, and Cochrane Central Register of Controlled Trials) and extracted the adjusted hazard ratio (HR) from eligible studies. We included 28 cohort studies involving 3,094 participants in the meta-analysis. Results revealed that lower HRV was associated with a higher risk of all-cause death and cardiovascular events; the pooled HR was 2.27 (95% confidence interval [CI]: 1.72, 3.00) and 1.41 (95% CI: 1.16, 1.72), respectively. In subgroup analyses, the pooled HR of all-cause death was significant for patients with acute myocardial infarction (AMI) but not for those with heart failure. The pooled HR for cardiovascular events was significant for the subgroup of patients with AMI and acute coronary syndrome but not for those with coronary artery disease and heart failure. Additionally, both time and frequency domains of HRV were significantly associated with risk of all-cause death and cardiovascular events in patients with CVD.
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Affiliation(s)
- Su-Chen Fang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei
| | - Yu-Lin Wu
- Department of Nursing, St. Mary's Junior College of Medicine, Nursing and Management, Yilan
| | - Pei-Shan Tsai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei.,Department of Nursing and Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei.,Sleep Research Center, Taipei Medical University Hospital, Taipei
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22
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Short-term effects of a 3-week interval training program on heart rate variability in chronic heart failure. A randomised controlled trial. Ann Phys Rehabil Med 2019; 62:321-328. [DOI: 10.1016/j.rehab.2019.06.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 06/25/2019] [Accepted: 06/30/2019] [Indexed: 01/08/2023]
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23
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Lozano WM, Calvo CJ, Arias-Mutis OJ, Díaz A, Such-Miquel L, Zhao J, Alberola A, Chorro FJ, Zarzoso M. Diet-Induced Metabolic Syndrome Reduced Heart Rate Variability and Increased Irregularity and Complexity of Short-Term RR Time Series in Rabbits. Animals (Basel) 2019; 9:ani9080572. [PMID: 31426570 PMCID: PMC6719107 DOI: 10.3390/ani9080572] [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] [Received: 07/30/2019] [Revised: 08/11/2019] [Accepted: 08/16/2019] [Indexed: 12/27/2022] Open
Abstract
Simple Summary In recent years, obesity and metabolic syndrome (MetS) have become more prevalent, owing to increased unhealthy habits and sedentary lifestyles becoming public health problems. Both conditions are linked with a higher prevalence of sudden cardiac death (SCD), but the exact mechanisms are not known. An autonomic nervous system imbalance can produce atrial and ventricular arrhythmias, which cause SCD, and this can be quantified by analyzing heart rate variability (HRV). We investigated HRV using time-domain, frequency-domain and nonlinear analyses during the development of MetS in rabbits and found HRV modifications that could be associated with the higher prevalence of SCD in this pathological condition. Abstract Metabolic syndrome (MetS) has been linked to a higher prevalence of sudden cardiac death (SCD), but the mechanisms are not well understood. One possible underlying mechanism may be an abnormal modulation of autonomic activity, which can be quantified by analyzing heart rate variability (HRV). Our aim was to investigate the modifications of short-term HRV in an experimental rabbit model during the time-course of MetS development. NZW rabbits were randomly assigned to a control (n = 10) or a MetS group (n = 13), fed 28 weeks with control or high-fat, high-sucrose diets. After anesthesia, a 15-min ECG recording was acquired before diet administration and at weeks 14 and 28. We analyzed short RR time series using time-domain, frequency-domain and nonlinear analyses. A mixed-model factorial ANOVA was used for statistical analysis. Time-domain analysis showed a 52.4% decrease in the standard deviation of heart rate in animals from the MetS group at week 28, but no changes in the rest of parameters. In the frequency domain, we found a 9.7% decrease in the very low frequency and a 380.0% increase of the low frequency bands in MetS animals at week 28, whereas high frequency remained unchanged. Nonlinear analyses showed increased complexity and irregularity of the RR time series in MetS animals.
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Affiliation(s)
- Wilson M Lozano
- Department of Physiology, Universitat de València, 46010 Valencia, Spain
| | - Conrado J Calvo
- Department of Physiology, Universitat de València, 46010 Valencia, Spain
- Centro de Investigación Biomédica en red (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Oscar J Arias-Mutis
- Department of Physiology, Universitat de València, 46010 Valencia, Spain
- Centro de Investigación Biomédica en red (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Ana Díaz
- Unidad Central de Investigación de Medicina (UCIM), Universitat de València, 46010 Valencia, Spain
| | - Luis Such-Miquel
- Department of Physioterapy, Universitat de València, 46010 Valencia, Spain
| | - Jichao Zhao
- Auckland Bioengineering Institute, The Univeristy of Auckland, 1010 Auckland, New Zealand
| | - Antonio Alberola
- Department of Physiology, Universitat de València, 46010 Valencia, Spain
| | - Francisco J Chorro
- Centro de Investigación Biomédica en red (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Cardiology, Hospital Clínico Universitario, 46010 Valencia, Spain
| | - Manuel Zarzoso
- Department of Physioterapy, Universitat de València, 46010 Valencia, Spain.
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Jovic A, Brkic K, Krstacic G. Detection of congestive heart failure from short-term heart rate variability segments using hybrid feature selection approach. Biomed Signal Process Control 2019. [DOI: 10.1016/j.bspc.2019.101583] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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25
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Druzhkova T, Pochigaeva K, Yakovlev A, Kazimirova E, Grishkina M, Chepelev A, Guekht A, Gulyaeva N. Acute stress response to a cognitive task in patients with major depressive disorder: potential metabolic and proinflammatory biomarkers. Metab Brain Dis 2019; 34:621-629. [PMID: 30564974 DOI: 10.1007/s11011-018-0367-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 12/10/2018] [Indexed: 02/06/2023]
Abstract
Responses of the hypothalamic-pituitary-adrenal axis (HPAA), immune system and metabolic pathways are involved in adaptation to stress, while alterations in these responses have been implicated in the development of major depressive disorder (MDD). Multiple laboratory indices are known to react in response to the acute stress, however, no valid biomarkers have been reported, which can differentiate stress response in depressed individuals. The aim of this study was to assess changes in a set of laboratory parameters in patients with MDD in response to a moderate mental stress and to find potential markers of altered stress reactivity associated with depression. A group of 33 MDD patients and 43 control subjects underwent clinical evaluation to assess depression and anxiety symptoms, as well as heart rate variability (HRV) analysis. Participants were asked to perform a time constrained cognitive task, and selected hormones (cortisol, ACTH), cytokines (IL-6, IL-1β, TNF-α), neurotrophic factors (BDNF, CNTF) and metabolic parameters (glucose, cholesterol, triglycerides) were measured before and 60 min after the task performance. HRV analysis showed increased sympathetic input in MDD patients. The MDD group manifested an elevated HPAA activity as well as IL-6 and CNTF levels at baseline. A specific stress-induced increase in glucose and TNF-α was revealed in the MDD group, which was absent in control subjects. The data confirm the impairments of stress response in MDD and suggest that the reaction of simple metabolic and pro-inflammatory indices to a mild stressogenic challenge may be indicative of a depressive state.
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Affiliation(s)
- Tatiana Druzhkova
- Healthcare Department of Moscow, Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
| | - Ksenia Pochigaeva
- Healthcare Department of Moscow, Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
| | - Aleksander Yakovlev
- Healthcare Department of Moscow, Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
- Laboratory of Functional Biochemistry of the Nervous System, Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Butlerova street 5a, Moscow, Russian Federation, 117485
| | - Evdokia Kazimirova
- Healthcare Department of Moscow, Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
- Laboratory of Functional Biochemistry of the Nervous System, Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Butlerova street 5a, Moscow, Russian Federation, 117485
| | - Maria Grishkina
- Healthcare Department of Moscow, Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
| | - Aleksey Chepelev
- Healthcare Department of Moscow, Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
| | - Alla Guekht
- Healthcare Department of Moscow, Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
- Department of Neurology, Neurosurgery and Medical Genetics, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Natalia Gulyaeva
- Healthcare Department of Moscow, Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation.
- Laboratory of Functional Biochemistry of the Nervous System, Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Butlerova street 5a, Moscow, Russian Federation, 117485.
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Zhang M, Liu L, Shi Y, Yang Y, Yu X, Angerer P, Kristensen TS, Li J. Longitudinal associations of burnout with heart rate variability in patients following acute coronary syndrome: A one-year follow-up study. Gen Hosp Psychiatry 2018; 53:59-64. [PMID: 29859340 DOI: 10.1016/j.genhosppsych.2018.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/23/2018] [Accepted: 05/24/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate longitudinal associations of burnout with heart rate variability (HRV) in patients after their first events of acute coronary syndrome (ACS). METHODS In total, two hundred eight patients participated in this one-year follow-up study. On the day before discharge, their personal burnout level was assessed by the Copenhagen Burnout Inventory. HRV signals were collected at four time points: the day before discharge, one month, six month and one year after discharge. HRV was measured by 24-hour ambulatory electrocardiography and analyzed in time and frequency domains. Generalized estimating equations were applied to analyze the associations of burnout at baseline with longitudinal tracking of HRV during follow-up in format of natural logarithmic transformation. RESULTS After adjusting for relevant confounding factors, high burnout at baseline was significantly associated with low standard deviation of NN intervals (SDNN), a time domain measure of HRV (p < 0.05). Also, baseline burnout was inversely associated with five frequency domain measures, i.e., high frequency power (HF), low frequency power (LF), very low frequency power (VLF), and ultra low frequency power (ULF), and total power (TP) (all p < 0.05). CONCLUSION Personal burnout is longitudinally associated with decreased HRV during one-year period among patients after first ACS.
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Affiliation(s)
- Min Zhang
- Cardiology Department, 1st Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China.
| | - Ling Liu
- Cardiology Department, 1st Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Yunke Shi
- Cardiology Department, 1st Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Yanfei Yang
- Cardiology Department, Kunming Children's Hospital, Kunming, Yunnan 650228, China
| | - Xiaoju Yu
- Cardiology Department, 1st hospital of Yibin City, Yibin, Sichuan 644000, China
| | - Peter Angerer
- Institute of Occupational, Social and Environmental Medicine, Center for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf 40225, Germany
| | | | - Jian Li
- Institute of Occupational, Social and Environmental Medicine, Center for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf 40225, Germany
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Piccirillo G, Magrì D, D'Alessandro G, Fiorucci C, Moscucci F, Di Iorio C, Mastropietri F, Parrotta I, Ogawa M, Lin SF, Chen PS. Oscillatory behavior of P wave duration and PR interval in experimental congestive heart failure: a preliminary study. Physiol Meas 2018; 39:035010. [PMID: 29393857 DOI: 10.1088/1361-6579/aaacab] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The relationship between the autonomic nervous system (ANS) modulation of the sinus node and heart rate variability has been extensively investigated. The current study sought to evaluate, in an animal experimental model of pacing-induced tachycardia congestive heart failure (CHF), a possible ANS influence on the P wave duration and PR interval oscillations. APPROACH Short-term (5 min) time and frequency domain analysis has been obtained in six dogs for the following electrocardiographic intervals: P wave duration (P), from the onset to peak of P wave (P p), from the onset of P wave to the q onset (PR) and from the end of P wave to the onset of q wave (P e R). Direct vagal nerve activity (VNA), stellate ganglion nerve activity (SGNA) and electrocardiogram (ECG) intervals have been evaluated contextually by implantation of three bipolar recording leads. MAIN RESULTS At the baseline, multiple regression analysis pointed out that VNA was strongly positively associated with the standard deviation of PP and P e R intervals (r 2:0.997, p < 0.05). The same variable was also positively associated with high-frequency (HF) of P expressed in normalized units, of P p, and of P e R (b: 0.001) (r 2: 0.993; p < 0.05). During CHF, most of the time and frequency domain variability significantly decreased from 20% to 50% in comparison to the baseline values (p < 0.05) and SGNA correlated inversely with the low frequency (LF) obtained from P e R (p < 0.05) and PR (p < 0.05) (r 2:0.899, p < 0.05). LF components, expressed in absolute and normalized power, obtained from all studied intervals, were reduced significantly during CHF. Any difference between the RR and PP spectral components was observed. SIGNIFICANCE The data showed a significant relationship between ANS and atrial ECG variables, independent of the cycle duration. In particular, the oscillations were vagal mediated at the baseline, while sympathetic mediated during CHF. Whereas P wave variability might have a clinical utility in CHF management, it needs to be addressed in specific studies.
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Affiliation(s)
- Gianfranco Piccirillo
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Policlinico Umberto I, 'La Sapienza' University of Rome, Rome, Italy. Division of Cardiology, Department of Medicine, Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, United States of America
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Porta A, Colombo R, Marchi A, Bari V, De Maria B, Ranuzzi G, Guzzetti S, Fossali T, Raimondi F. Association between autonomic control indexes and mortality in subjects admitted to intensive care unit. Sci Rep 2018; 8:3486. [PMID: 29472594 PMCID: PMC5823868 DOI: 10.1038/s41598-018-21888-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 02/13/2018] [Indexed: 11/23/2022] Open
Abstract
This study checks whether autonomic markers derived from spontaneous fluctuations of heart period (HP) and systolic arterial pressure (SAP) and from their interactions with spontaneous or mechanical respiration (R) are associated with mortality in patients admitted to intensive care unit (ICU). Three-hundred consecutive HP, SAP and R values were recorded during the first day in ICU in 123 patients. Population was divided into survivors (SURVs, n = 83) and non-survivors (NonSURVs, n = 40) according to the outcome. SURVs and NonSURVs were aged- and gender-matched. All subjects underwent modified head-up tilt (MHUT) by tilting the bed back rest segment to 60°. Autonomic control indexes were computed using time-domain, spectral, cross-spectral, complexity, symbolic and causality techniques via univariate, bivariate and conditional approaches. SAP indexes derived from time-domain, model-free complexity and symbolic approaches were associated with the endpoint, while none of HP variability markers was. The association was more powerful during MHUT. Linear cross-spectral and causality indexes were useless to separate SURVs from NonSURVs, while nonlinear bivariate symbolic markers were successful. When indexes were combined with clinical scores, only SAP variance provided complementary information. Cardiovascular control variability indexes, especially when derived after an autonomic challenge such as MHUT, can improve mortality risk stratification in ICU.
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Affiliation(s)
- Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, Milan, 20133, Italy. .,Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan, 20097, Italy.
| | | | - Andrea Marchi
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milan, 20133, Italy
| | - Vlasta Bari
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan, 20097, Italy
| | - Beatrice De Maria
- IRCCS Istituti Clinici Scientifici Maugeri, Istituto di Milano, Milan, 20138, Italy
| | - Giovanni Ranuzzi
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan, 20097, Italy
| | | | - Tommaso Fossali
- Department of Emergency, L. Sacco Hospital, Milan, 20157, Italy
| | - Ferdinando Raimondi
- Department of Anesthesia and Intensive Care, IRCCS Humanitas Clinical and Research Center, Rozzano, 20089, Italy
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Wang SB, Mitchell P, Liew G, Wong TY, Phan K, Thiagalingam A, Joachim N, Burlutsky G, Gopinath B. A spectrum of retinal vasculature measures and coronary artery disease. Atherosclerosis 2017; 268:215-224. [PMID: 29050745 DOI: 10.1016/j.atherosclerosis.2017.10.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 09/07/2017] [Accepted: 10/06/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND AIMS We aimed to comprehensively describe a spectrum of retinal vessel measures including fractal dimension (Df) and their associations with indices of coronary artery disease (CAD) extent and severity, as well as hypertension and diabetes. METHODS The Australian Heart Eye Study (AHES) is an observational study that surveyed 1680 participants presenting to a tertiary referral hospital for the evaluation of potential CAD by coronary angiography. A range of newer retinal vessel geometric measures (Df, curvature tortuosity, and branching angle) were quantified from retinal photographs using semi-automated software, the Singapore 'I' Vessel Assessment (SIVA) tool. A combined retinal score was constructed, aiming to assess the joint effect of multiple retinal vessel parameters on CAD, comprising of those variables that were most strongly significant in multivariate analysis - Df, arteriolar curvature tortuosity, and retinal arteriolar calibre. CAD was objectively quantified using a range of measures obtained from coronary angiography. RESULTS A total of 1187 participants had complete data on retinal vessel measurements and coronary vessel evaluation. Retinal vascular Df and curvature tortuosity decreased with increasing age; women had significantly lower Df than men (p<0.003). Straighter retinal vessels were associated with CAD extent and Gensini scores in multivariable analysis (p<0.02). Accounting for media opacity by sub-group analysis in pseudophakic patients, the combined retinal score was associated with stenosis greater than 50% in any coronary artery segment (vessel score) and obstructive coronary stenosis in all three main coronary arteries (segment score) (p = 0.01). Lower Df and narrower arteriolar branching angle were associated with CAD vessel score (p<0.03). In sex-stratified multivariate analyses, straighter arterioles were associated with greater odds of CAD in men, and narrower venular branching angle was associated with CAD in women. CONCLUSIONS A range of retinal vessel measures were associated with CAD extent and severity. A sparser retinal microvascular network (smaller Df) was associated with older age and female gender. After accounting for the impact of media opacity, retinal vessel measures were associated with more diffuse and severe CAD.
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Affiliation(s)
- Sarah B Wang
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, NSW, Australia
| | - Paul Mitchell
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, NSW, Australia
| | - Gerald Liew
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, NSW, Australia
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Kevin Phan
- Centre for Heart Research, Westmead Institute for Medical Research, University of Sydney, NSW, Australia
| | - Aravinda Thiagalingam
- Centre for Heart Research, Westmead Institute for Medical Research, University of Sydney, NSW, Australia
| | - Nichole Joachim
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, NSW, Australia
| | - George Burlutsky
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, NSW, Australia
| | - Bamini Gopinath
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, NSW, Australia.
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Usui H, Nishida Y. The very low-frequency band of heart rate variability represents the slow recovery component after a mental stress task. PLoS One 2017; 12:e0182611. [PMID: 28806776 PMCID: PMC5555691 DOI: 10.1371/journal.pone.0182611] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 07/23/2017] [Indexed: 11/24/2022] Open
Abstract
The very low-frequency (VLF) band of heart rate variability (HRV) has different characteristics compared with other HRV components. Here we investigated differences in HRV changes after a mental stress task. After the task, the high-frequency (HF) band and ratio of high- to low-frequency bands (LF/HF) immediately returned to baseline. We evaluated the characteristics of VLF band changes after a mental stress task. We hypothesized that the VLF band decreases during the Stroop color word task and there would be a delayed recovery for 2 h after the task (i.e., the VLF change would exhibit a “slow recovery”). Nineteen healthy, young subjects were instructed to rest for 10 min, followed by a Stroop color word task for 20 min. After the task, the subjects were instructed to rest for 120 min. For all subjects, R-R interval data were collected; analysis was performed for VLF, HF, and LF/HF ratio. HRV during the rest time and each 15-min interval of the recovery time were compared. An analysis of the covariance was performed to adjust for the HF band and LF/HF ratio as confounding variables of the VLF component. HF and VLF bands significantly decreased and the LF/HF ratio significantly increased during the task compared with those during rest time. During recovery, the VLF band was significantly decreased compared with the rest time. After the task, the HF band and LF/HF ratio immediately returned to baseline and were not significantly different from the resting values. After adjusting for HF and LF/HF ratio, the VLF band had significantly decreased compared with that during rest. The VLF band is the “slow recovery” component and the HF band and LF/HF ratio are the “quick recovery” components of HRV. This VLF characteristic may clarify the unexplained association of the VLF band in cardiovascular disease prevention.
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Affiliation(s)
- Harunobu Usui
- Department of Rehabilitation, AICHI Medical College, Kiyosu City, Aichi, Japan
- * E-mail:
| | - Yusuke Nishida
- Department of Physical Therapy, International University in Health and Welfare, Narita City, Chiba, Japan
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Porta A, Bari V, De Maria B, Baumert M. A network physiology approach to the assessment of the link between sinoatrial and ventricular cardiac controls. Physiol Meas 2017; 38:1472-1489. [PMID: 28430108 DOI: 10.1088/1361-6579/aa6e95] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE A network physiology approach to evaluate the strength of the directed interactions among cardiac controls at sinoatrial and ventricular levels and respiration (R) is proposed. APPROACH The network is composed of three nodes (i.e. sinoatrial and ventricular cardiac controls and R) and their activity is exemplified by the variability of heart period (HP), the variability of the duration of the electrical activity of the heart approximated as the temporal distance between Q-wave onset and T-wave end or apex (i.e. QTe or QTa) and thoracic movements respectively. Model-based transfer entropy provided the estimate of the strength of the causal link from the source to the destination conditioned on the remaining node activity. The interactions were monitored in 15 healthy subjects aged from 24 to 54 years (9 males). Increasing levels of sympathetic activity were induced by graded head-up tilt with table inclination of 0, 15, 30, 45, 60, 75°. MAIN RESULTS We found that: (i) the strength of the causal link from HP to QTe gradually decreases with tilt table angle, while that in the reverse direction is weak, even though significant, and constant; (ii) the action of R on HP is stronger than that from R to QTe; (iii) the strength of the relation from R to HP is weakly related to tilt table inclination, while that from R to QTe does not depend on it; (iv) while QTe cannot affect R, a weak causal dependence of R on HP is detected; (v) the network computed over QTa is qualitatively similar to that over QTe, even though the strength of the causal relations might be different. SIGNIFICANCE The proposed network physiology approach provides a comprehensive picture of the directed links among relevant cardiac regulatory mechanisms and their evolution with sympathetic tone usable to identify pathological conditions.
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Affiliation(s)
- Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy. Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
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Nardelli M, Greco A, Bolea J, Valenza G, Scilingo EP, Bailon R. Reliability of Lagged Poincaré Plot Parameters in Ultrashort Heart Rate Variability Series: Application on Affective Sounds. IEEE J Biomed Health Inform 2017; 22:741-749. [PMID: 28436907 DOI: 10.1109/jbhi.2017.2694999] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The number of studies about ultrashort cardiovascular time series is increasing because of the demand for mobile applications in telemedicine and e-health monitoring. However, the current literature still needs a proper validation of heartbeat nonlinear dynamics assessment from ultrashort time series. This paper reports on the reliability of the Lagged Poincaré Plot (LPP) parameters-calculated from ultrashort cardiovascular time series. Reliability is studied on simulated as well as on real RR series. Simulated RR series are generated and LPP parameters estimated for ultrashort time series (from 15 to 60 s) are compared to those estimated from 1 h. All LPP parameters estimated from time series longer than 35 s presented a Spearman's correlation coefficient higher than 0.99. RR series acquired from 32 healthy subjects during 5-min resting state sessions are used to test the LPP approach in experimental data. The usefulness of ultrashort term parameters in real data is accomplished also studying their ability to discriminate positive and negative valence of auditory stimuli taken from the International Affective Digitized Sound System (IADS) dataset. The achieved accuracies in the recognition of elicitation along the valence dimension, using only the LPP parameters, were of 77.78% for 1 min 28 s series, and of 79.17% for 35 s series.
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[The exercise training restores the heart rate variability in heart failure patients. A systematic review]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2017; 87:326-335. [PMID: 28065709 DOI: 10.1016/j.acmx.2016.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/30/2016] [Accepted: 12/01/2016] [Indexed: 11/21/2022] Open
Abstract
Cardiovascular diseases are a significant cause of morbidity and mortality in the general population. In this sense, the autonomic imbalance is the cornerstone of the pathophysiology underlying the development of these diseases. The aim of this study was to determine the efficacy of exercise training on heart rate variability (HRV) in adult patients with chronic heart failure. METHODOLOGY A systematic literature review was conducted in electronic databases. The considered studies were randomised clinical trials, quasi-experimental studies with non-randomised control group, quasi-experimental studies with analysis of pre- and post- intervention, and crossover studies with randomly assigned training and non-training periods. The standardised mean differences were calculated between pre- and post-intervention in both the control and experimental group. RESULTS Within-subject analysis of the control group showed no statistical significance in the standardised mean differences of HRV. In the experimental group, the standardised mean differences were positive for the root mean square of successive difference (+0.468±0.215; P=.032), high frequency band (HF) (0.934±0.256; P < .001) and low frequency band (LF) (< 0.415±0.096; P=.001). Moreover, the standardised mean difference was negative for LF/HF (-0.747±0.369, P=<.044). On the other hand, only 3 studies entered the comparative meta-analysis. The effect of exercise training was favourable for the experimental group in LF/HF (-2.21±95% CI: -3.83 to -0.60), HF, and LF. CONCLUSION The exercise training was effective in increasing HRV and restoring the autonomic balance in patients with heart failure.
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Hsiao CC, Lee RG, Tien SC, Feng YY, Huang SF. EARLY CLINICAL PROGNOSIS FOR HIGH-RISK CHEST PAIN PATIENTS USING SMART TEXTILES. BIOMEDICAL ENGINEERING-APPLICATIONS BASIS COMMUNICATIONS 2016. [DOI: 10.4015/s101623721550057x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
According to statistics, up to 40% of emergency admissions are due to chest tightness or chest pain. However, merely based on the patient’s current symptoms such as chest pain, it is difficult for a physician to give an instant diagnosis as most cardiovascular diseases are chronic. To address this issue, it is necessary to provide a set of tools to indicate the patient’s status during hospitalization to help the physician in diagnosis. It is thus our primary objective to design and develop a wearable heart rate monitoring system and prediction tool that can measure the patient’s heart rate parameters, allow him/her to move around easily, and which also can effectively improve the medical personnel’s working efficiency. This research utilizes conductive filament to design textile to integrate electric circuit with clothing. Using a conductive vest and chest belt that can be worn comfortably, our system can continuously record patients’ physiological index parameters during their hospitalization. Physiological index parameters of multiple patients can then be transmitted wirelessly and recorded in a physician-end computer. At the end of their hospitalization, the patient’s original physiological indices together with the recorded heart rate variability (HRV) parameters can then be summarized to assess the risk score of their discharging from hospital. This paper adopts the concept of TIMI risk score, while adding every index of HRV measured when subjects are hospitalized. The risk score can hence be used to provide emergency physicians as a basis for an early prognosis and subsequently a better hospital-discharging assessment of patients with chest pain. The accuracy of the proposed prognosis has been verified with the 3-day and 30-day recall rate of the patients and the result has been shown to be promising for chest pain patients in emergency admission units.
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Affiliation(s)
- Chun-Chieh Hsiao
- Department of Electrical Engineering, National Taiwan University and Department of Computer Information and Network Engineering, Lunghwa University of Science and Technology, Taiwan
| | - Ren-Guey Lee
- Department of Electronic Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - Sheng-Chung Tien
- Department of Electronic Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - Yen-Yi Feng
- Department of Emergency, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shih-Feng Huang
- Department of Electronic Engineering, National Taipei University of Technology, Taipei, Taiwan
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Cygankiewicz I, Corino V, Vazquez R, Bayes-Genis A, Mainardi L, Zareba W, de Luna AB, Platonov PG. Reduced Irregularity of Ventricular Response During Atrial Fibrillation and Long-term Outcome in Patients With Heart Failure. Am J Cardiol 2015; 116:1071-5. [PMID: 26298305 DOI: 10.1016/j.amjcard.2015.06.043] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 06/18/2015] [Accepted: 06/18/2015] [Indexed: 11/16/2022]
Abstract
Reduced heart rate variability (HRV) is associated with poor outcome in patients with heart failure (HF). However, the data on predictive value of RR variability during atrial fibrillation (AF) are limited. Therefore, the aim of this study was to evaluate the association between ventricular response characteristics and long-term clinical outcome in the population of ambulatory patients with mild-to-moderate HF and AF at baseline. The study included 155 patients (mean age 69 ± 10 years) with AF at 20-minute Holter electrocardiographic (ECG) recordings at enrollment. HRV analysis included SDNN, rMSSD, and pNN50, whereas irregularity indexes included 2 nonlinear parameters: approximate entropy (ApEn) and Shannon entropy. After median 41 months of follow-up, 54 patients died, including 21 HF related and 16 sudden deaths. Patients with ApEn ≤1.68 (lower tertile) had 40% mortality versus 12% in others (p <0.001) at 2 years of follow-up. Only nonlinear HRV parameters (irregularity but not variability indexes) identified patients at higher risk during follow-up. Decreased ApEn ≤1.68 was an independent predictor of total mortality (hazard ratio [HR] 2.81, 95% confidence interval [CI] 1.61 to 4.89, p <0.001), sudden cardiac death (HR 3.83, 95% CI 1.31 to 11.25, p = 0.014), and HF death (HR 3.45, 95% CI 1.42 to 8.38, p = 0.006) in a multivariate Cox analysis. In conclusion, in a post hoc analysis of Muerte Subita en Insufficiencia Cardiaca study AF cohort, reduced irregularity of RR intervals during AF, likely caused by autonomic dysfunction, was an independent predictor of all-cause mortality and sudden death and HF progression in patients with mild-to-moderate HF, whereas traditional HRV indexes did not predict outcome.
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Affiliation(s)
- Iwona Cygankiewicz
- Department of Electrocardiology, Medical University of Lodz, Lodz, Poland.
| | - Valentina Corino
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Rafael Vazquez
- Cardiology Service, Hospital Universitario Puerta del Mar, Cadiz, Spain
| | | | - Luca Mainardi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Wojciech Zareba
- Heart Research Follow Up Program, University of Rochester Medical Center, Rochester, New York
| | - Antoni Bayes de Luna
- Catalan Institute of Cardiovascular Sciences, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Pyotr G Platonov
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden; Center for Integrative Electrocardiology at Lund University and Arrhythmia Clinic, Skåne University Hospital, Lund, Sweden
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Hilderman M, Qureshi AR, Al-Abed Y, Abtahi F, Lindecrantz K, Anderstam B, Bruchfeld A. Cholinergic anti-inflammatory pathway activity in dialysis patients: a role for neuroimmunomodulation? Clin Kidney J 2015; 8:599-605. [PMID: 26413288 PMCID: PMC4581391 DOI: 10.1093/ckj/sfv074] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 07/27/2015] [Indexed: 01/04/2023] Open
Abstract
Background The cholinergic anti-inflammatory pathway (CAP) modulates inflammatory responses through the vagus nerve and the α-7-nicotinic acetylcholine receptor (α7nAChR) on macrophages and immune cells. Sympathetic/parasympathetic imbalance and chronic inflammation are both linked to poor outcome in dialysis patients. The aim of this study was to investigate CAP activity in these patients. Methods Twenty dialysis patients, 12 hemodialysis (HD) and 8 peritoneal dialysis (PD) patients (12 male, 8 female; age range 47–83 years) and 8 controls (5 male, 3 female; age range 31–52 years) were analyzed for C-reactive protein (CRP), tumor necrosis factor (TNF), interleukin-1b (IL-1b), IL-6 and IL-10 at baseline. The cytokines were then assessed after whole blood stimulation ex vivo with lipopolysaccharide (LPS) (10 and 100 ng/mL) and again in the presence of 45 and 90 μmol/L GTS-21, a cholinergic α7nAChR agonist. Results CRP, TNF, IL-1 and IL-6 were significantly higher, whereas IL-10 was significantly lower at baseline in patients compared with controls. After LPS stimulation, TNF increased significantly more in patients than in controls but decreased to similar levels in both groups after addition of GTS-21. IL-6 attenuation was comparable with TNF and the IL-1b pattern was similar but remained significantly higher in patients. Interestingly, IL-10 increased after GTS-21 in a dose-dependent manner, but only in patients. Results in HD and PD patients did not differ. Conclusions The response of immune cells after LPS exposure and cholinergic stimulation suggests a functional CAP in dialysis patients. It may thus be possible to target the α7nAChR control of cytokine release as an anti-inflammatory strategy and thereby improve outcome in these patients.
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Affiliation(s)
- Marie Hilderman
- Renal Medicine and Baxter Novum , CLINTEC, Karolinska Institutet , Stockholm , Sweden
| | - Abdul R Qureshi
- Renal Medicine and Baxter Novum , CLINTEC, Karolinska Institutet , Stockholm , Sweden
| | - Yousef Al-Abed
- Center for Biomedical Science , Feinstein Institute for Medical Research , Manhasset, NY , USA
| | - Farhad Abtahi
- Royal Institute of Technology , School of Technology and Health , Stockholm , Sweden
| | - Kaj Lindecrantz
- Royal Institute of Technology , School of Technology and Health , Stockholm , Sweden
| | - Björn Anderstam
- Renal Medicine and Baxter Novum , CLINTEC, Karolinska Institutet , Stockholm , Sweden
| | - Annette Bruchfeld
- Renal Medicine and Baxter Novum , CLINTEC, Karolinska Institutet , Stockholm , Sweden
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Sassi R, Cerutti S, Lombardi F, Malik M, Huikuri HV, Peng CK, Schmidt G, Yamamoto Y. Advances in heart rate variability signal analysis: joint position statement by the e-Cardiology ESC Working Group and the European Heart Rhythm Association co-endorsed by the Asia Pacific Heart Rhythm Society. Europace 2015; 17:1341-53. [PMID: 26177817 DOI: 10.1093/europace/euv015] [Citation(s) in RCA: 374] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 01/13/2015] [Indexed: 12/18/2022] Open
Abstract
Following the publication of the Task Force document on heart rate variability (HRV) in 1996, a number of articles have been published to describe new HRV methodologies and their application in different physiological and clinical studies. This document presents a critical review of the new methods. A particular attention has been paid to methodologies that have not been reported in the 1996 standardization document but have been more recently tested in sufficiently sized populations. The following methods were considered: Long-range correlation and fractal analysis; Short-term complexity; Entropy and regularity; and Nonlinear dynamical systems and chaotic behaviour. For each of these methods, technical aspects, clinical achievements, and suggestions for clinical application were reviewed. While the novel approaches have contributed in the technical understanding of the signal character of HRV, their success in developing new clinical tools, such as those for the identification of high-risk patients, has been rather limited. Available results obtained in selected populations of patients by specialized laboratories are nevertheless of interest but new prospective studies are needed. The investigation of new parameters, descriptive of the complex regulation mechanisms of heart rate, has to be encouraged because not all information in the HRV signal is captured by traditional methods. The new technologies thus could provide after proper validation, additional physiological, and clinical meaning. Multidisciplinary dialogue and specialized courses in the combination of clinical cardiology and complex signal processing methods seem warranted for further advances in studies of cardiac oscillations and in the understanding normal and abnormal cardiac control processes.
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Usui H, Nishida Y. Relationship between Physical Activity and the Very Low-Frequency Component of Heart Rate Variability after Stroke. J Stroke Cerebrovasc Dis 2015; 24:840-3. [DOI: 10.1016/j.jstrokecerebrovasdis.2014.11.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 11/24/2014] [Indexed: 10/24/2022] Open
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Fisher AC, Groves D, Eleuteri A, Mesum P, Patterson D, Taggart P. Heart rate variability at limiting stationarity: evidence of neuro-cardiac control mechanisms operating at ultra-low frequencies. Physiol Meas 2014; 35:309-22. [PMID: 24451405 DOI: 10.1088/0967-3334/35/2/309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study considers the linkage of exogenously stimulated emotional stress with the neurogenic regulation of heart rate operating at very low frequencies. The objectives were three-fold: to consider the present evidence that such a linkage exists as a primary phenomenon; to compare the potential of a frequency-domain method and a time-domain method in revealing this phenomenon by characterizing heart rate variability (HRV) at frequencies of [0.0005...0.4] Hz and to design, implement and report a physiological experiment in which alternating periods of exposure to bland and high valence visual stimuli might reveal this phenomenon. A methodical challenge was to optimize the length of exposure to the stimulus such that subjects did not have time to habituate to stimuli, whilst acquiring sufficient data (heart beats) such that the ultra-low frequency (ULF) components of HRV could be described. With exposure times set to approximately 5 min, during which time the strength of the stimulus and the corresponding evoked response were considered stationary, the lowest HRV frequency component that could be characterized was 0.003 Hz. In trials with parametrically defined test data, the time-domain method based on the Ornstein–Uhlenbeck Gaussian process (OU-GP) was shown to be better than the frequency-domain method in describing the ULF components of the HRV. In an experimental cohort of 16 subjects, analysis using the OU-GP revealed evidence of cardiac regulatory mechanisms influenced by emotional valence operating in the bandwidth (ULF*) [0.002...0.01] Hz.
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Zannad F, De Ferrari GM, Tuinenburg AE, Wright D, Brugada J, Butter C, Klein H, Stolen C, Meyer S, Stein KM, Ramuzat A, Schubert B, Daum D, Neuzil P, Botman C, Castel MA, D'Onofrio A, Solomon SD, Wold N, Ruble SB. Chronic vagal stimulation for the treatment of low ejection fraction heart failure: results of the NEural Cardiac TherApy foR Heart Failure (NECTAR-HF) randomized controlled trial. Eur Heart J 2014; 36:425-33. [PMID: 25176942 PMCID: PMC4328197 DOI: 10.1093/eurheartj/ehu345] [Citation(s) in RCA: 238] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Aim The neural cardiac therapy for heart failure (NECTAR-HF) was a randomized sham-controlled trial designed to evaluate whether a single dose of vagal nerve stimulation (VNS) would attenuate cardiac remodelling, improve cardiac function and increase exercise capacity in symptomatic heart failure patients with severe left ventricular (LV) systolic dysfunction despite guideline recommended medical therapy. Methods Patients were randomized in a 2 : 1 ratio to receive therapy (VNS ON) or control (VNS OFF) for a 6-month period. The primary endpoint was the change in LV end systolic diameter (LVESD) at 6 months for control vs. therapy, with secondary endpoints of other echocardiography measurements, exercise capacity, quality-of-life assessments, 24-h Holter, and circulating biomarkers. Results Of the 96 implanted patients, 87 had paired datasets for the primary endpoint. Change in LVESD from baseline to 6 months was −0.04 ± 0.25 cm in the therapy group compared with −0.08 ± 0.32 cm in the control group (P = 0.60). Additional echocardiographic parameters of LV end diastolic dimension, LV end systolic volume, left ventricular end diastolic volume, LV ejection fraction, peak V02, and N-terminal pro-hormone brain natriuretic peptide failed to show superiority compared to the control group. However, there were statistically significant improvements in quality of life for the Minnesota Living with Heart Failure Questionnaire (P = 0.049), New York Heart Association class (P = 0.032), and the SF-36 Physical Component (P = 0.016) in the therapy group. Conclusion Vagal nerve stimulation as delivered in the NECTAR-HF trial failed to demonstrate a significant effect on primary and secondary endpoint measures of cardiac remodelling and functional capacity in symptomatic heart failure patients, but quality-of-life measures showed significant improvement.
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Affiliation(s)
- Faiez Zannad
- Inserm, CIC 1433, Centre Hospitalier Universitaire, Department of Cardiology, Nancy University, Université de Lorraine, Nancy, France
| | - Gaetano M De Ferrari
- Department of Cardiology and Cardiovascular Clinical Research Center, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy
| | - Anton E Tuinenburg
- Department of Cardiology, University Medical Center, Utrecht, The Netherlands
| | - David Wright
- Department of Cardiology, Liverpool Heart and Chest, Liverpool, UK
| | | | | | - Helmut Klein
- Division of Cardiology, Otto-von-Guericke Universität Magdeburg, Magdeburg, Germany
| | - Craig Stolen
- Boston Scientific Corporation, St. Paul, MN, USA
| | - Scott Meyer
- Boston Scientific Corporation, St. Paul, MN, USA
| | | | | | | | - Doug Daum
- Boston Scientific Corporation, St. Paul, MN, USA
| | - Petr Neuzil
- Department of Cardiology, Homolka Hospital, Prague, Czech Republic
| | - Cornelis Botman
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | | | | | - Scott D Solomon
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Zhu Y, Hanafy MA, Killingsworth CR, Walcott GP, Young ME, Pogwizd SM. Morning surge of ventricular arrhythmias in a new arrhythmogenic canine model of chronic heart failure is associated with attenuation of time-of-day dependence of heart rate and autonomic adaptation, and reduced cardiac chaos. PLoS One 2014; 9:e105379. [PMID: 25140699 PMCID: PMC4139365 DOI: 10.1371/journal.pone.0105379] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 07/23/2014] [Indexed: 01/08/2023] Open
Abstract
Patients with chronic heart failure (CHF) exhibit a morning surge in ventricular arrhythmias, but the underlying cause remains unknown. The aim of this study was to determine if heart rate dynamics, autonomic input (assessed by heart rate variability (HRV)) and nonlinear dynamics as well as their abnormal time-of-day-dependent oscillations in a newly developed arrhythmogenic canine heart failure model are associated with a morning surge in ventricular arrhythmias. CHF was induced in dogs by aortic insufficiency & aortic constriction, and assessed by echocardiography. Holter monitoring was performed to study time-of-day-dependent variation in ventricular arrhythmias (PVCs, VT), traditional HRV measures, and nonlinear dynamics (including detrended fluctuations analysis α1 and α2 (DFAα1 & DFAα2), correlation dimension (CD), and Shannon entropy (SE)) at baseline, as well as 240 days (240 d) and 720 days (720 d) following CHF induction. LV fractional shortening was decreased at both 240 d and 720 d. Both PVCs and VT increased with CHF duration and showed a morning rise (2.5-fold & 1.8-fold increase at 6 AM-noon vs midnight-6 AM) during CHF. The morning rise in HR at baseline was significantly attenuated by 52% with development of CHF (at both 240 d & 720 d). Morning rise in the ratio of low frequency to high frequency (LF/HF) HRV at baseline was markedly attenuated with CHF. DFAα1, DFAα2, CD and SE all decreased with CHF by 31, 17, 34 and 7%, respectively. Time-of-day-dependent variations in LF/HF, CD, DFA α1 and SE, observed at baseline, were lost during CHF. Thus in this new arrhythmogenic canine CHF model, attenuated morning HR rise, blunted autonomic oscillation, decreased cardiac chaos and complexity of heart rate, as well as aberrant time-of-day-dependent variations in many of these parameters were associated with a morning surge of ventricular arrhythmias.
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Affiliation(s)
- Yujie Zhu
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Mohamed A. Hanafy
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Cheryl R. Killingsworth
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Gregory P. Walcott
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Martin E. Young
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Steven M. Pogwizd
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- * E-mail:
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Pattini L, Sassi R, Cerutti S. Dissecting Heart Failure Through the Multiscale Approach of Systems Medicine. IEEE Trans Biomed Eng 2014; 61:1593-603. [DOI: 10.1109/tbme.2014.2307758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Prediction of heart rate variability on cardiac sudden death in heart failure patients: a systematic review. Int J Cardiol 2014; 174:857-860. [PMID: 24804906 DOI: 10.1016/j.ijcard.2014.04.176] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 04/14/2014] [Accepted: 04/17/2014] [Indexed: 01/08/2023]
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Chapa DW, Akintade B, Son H, Woltz P, Hunt D, Friedmann E, Hartung MK, Thomas SA. Pathophysiological Relationships Between Heart Failure and Depression and Anxiety. Crit Care Nurse 2014; 34:14-24; quiz 25. [DOI: 10.4037/ccn2014938] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Depression and anxiety are common comorbid conditions in patients with heart failure. Patients with heart failure and depression have increased mortality. The association of anxiety with increased mortality in patients with heart failure is not established. The purpose of this article is to illustrate the similarities of the underlying pathophysiology of heart failure, depression, and anxiety by using the Biopsychosocial Holistic Model of Cardiovascular Health. Depression and anxiety affect biological processes of cardiovascular function in patients with heart failure by altering neurohormonal function via activation of the hypothalamic-pituitary-adrenal axis, autonomic dysregulation, and activation of cytokine cascades and platelets. Patients with heart failure and depression or anxiety may exhibit a continued cycle of heart failure progression, increased depression, and increased anxiety. Understanding the underlying pathophysiological relationships in patients with heart failure who experience comorbid depression and/or anxiety is critical in order to implement appropriate treatments, educate patients and caregivers, and educate other health professionals.
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Affiliation(s)
- Deborah W. Chapa
- Deborah Chapa is an assistant professor and coordinator of bachelor of nursing science to doctor of nursing practice at George Washington University, School of Nursing, Washington, DC. She is also an acute care nurse practitioner
| | - Bimbola Akintade
- Bimbola Akintade is an assistant professor in the trauma, critical care, emergency department and clinical nurse specialist nurse practitioner program at the University of Maryland, School of Nursing, and an acute care nurse practitioner at Washington Hospital Center, Baltimore, Maryland
| | - Heesook Son
- Heesook Son is an assistant professor at Chung-Ang University School of Nursing, Seoul, South Korea
| | - Patricia Woltz
- Patricia Woltz is director of nursing research at the University of Maryland Medical Center in Baltimore
| | - Dennis Hunt
- Dennis Hunt is an assistant professor, physical therapy and human performance, and director of the exercise science program at Florida Gulf Coast University, Fort Meyers, Florida
| | - Erika Friedmann
- Erika Friedmann is a professor at the University of Maryland, School of Nursing
| | - Mary Kay Hartung
- Mary Kay Hartung was a health sciences librarian at Florida Gulf Coast University. She is now retired
| | - Sue Ann Thomas
- Sue Ann Thomas is a professor emeritus of nursing at the University of Maryland School of Nursing
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La Rovere MT, Pinna GD, Maestri R, Barlera S, Bernardinangeli M, Veniani M, Nicolosi GL, Marchioli R, Tavazzi L. Autonomic markers and cardiovascular and arrhythmic events in heart failure patients: still a place in prognostication? Data from the GISSI-HF trial. Eur J Heart Fail 2014; 14:1410-9. [DOI: 10.1093/eurjhf/hfs126] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Maria Teresa La Rovere
- Divisione di Cardiologia, e Bioingegneria, Fondazione ‘Salvatore Maugeri’, IRCCS; Istituto Scientifico di Montescano; Montescano Italy
| | - Gian Domenico Pinna
- Divisione di Cardiologia, e Bioingegneria, Fondazione ‘Salvatore Maugeri’, IRCCS; Istituto Scientifico di Montescano; Montescano Italy
| | - Roberto Maestri
- Divisione di Cardiologia, e Bioingegneria, Fondazione ‘Salvatore Maugeri’, IRCCS; Istituto Scientifico di Montescano; Montescano Italy
| | - Simona Barlera
- Dipartimento di Ricerca Cardiovascolare; Istituto Mario Negri; Milano Italy
| | | | | | | | | | - Luigi Tavazzi
- GVM Care and Research; Maria Cecilia Hospital Cotignola; (Ravenna) Italy
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Sabharwal R. The link between stress disorders and autonomic dysfunction in muscular dystrophy. Front Physiol 2014; 5:25. [PMID: 24523698 PMCID: PMC3905207 DOI: 10.3389/fphys.2014.00025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 01/12/2014] [Indexed: 01/16/2023] Open
Abstract
Muscular dystrophy is a progressive disease of muscle weakness, muscle atrophy and cardiac dysfunction. Patients afflicted with muscular dystrophy exhibit autonomic dysfunction along with cognitive impairment, severe depression, sadness, and anxiety. Although the psychological aspects of cardiovascular disorders and stress disorders are well known, the physiological mechanism underlying this relationship is not well understood, particularly in muscular dystrophy. Therefore, the goal of this perspective is to highlight the importance of autonomic dysfunction and psychological stress disorders in the pathogenesis of muscular dystrophy. This article will for the first time—(i) outline autonomic mechanisms that are common to both psychological stress and cardiovascular disorders in muscular dystrophy; (ii) propose therapies that would improve behavioral and autonomic functions in muscular dystrophy.
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Affiliation(s)
- Rasna Sabharwal
- Department of Internal Medicine, University of Iowa Carver College of Medicine Iowa City, IA, USA
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Voss A, Schroeder R, Vallverdú M, Schulz S, Cygankiewicz I, Vázquez R, Bayés de Luna A, Caminal P. Short-term vs. long-term heart rate variability in ischemic cardiomyopathy risk stratification. Front Physiol 2013; 4:364. [PMID: 24379785 PMCID: PMC3862074 DOI: 10.3389/fphys.2013.00364] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 11/23/2013] [Indexed: 01/08/2023] Open
Abstract
In industrialized countries with aging populations, heart failure affects 0.3–2% of the general population. The investigation of 24 h-ECG recordings revealed the potential of nonlinear indices of heart rate variability (HRV) for enhanced risk stratification in patients with ischemic heart failure (IHF). However, long-term analyses are time-consuming, expensive, and delay the initial diagnosis. The objective of this study was to investigate whether 30 min short-term HRV analysis is sufficient for comparable risk stratification in IHF in comparison to 24 h-HRV analysis. From 256 IHF patients [221 at low risk (IHFLR) and 35 at high risk (IHFHR)] (a) 24 h beat-to-beat time series (b) the first 30 min segment (c) the 30 min most stationary day segment and (d) the 30 min most stationary night segment were investigated. We calculated linear (time and frequency domain) and nonlinear HRV analysis indices. Optimal parameter sets for risk stratification in IHF were determined for 24 h and for each 30 min segment by applying discriminant analysis on significant clinical and non-clinical indices. Long- and short-term HRV indices from frequency domain and particularly from nonlinear dynamics revealed high univariate significances (p < 0.01) discriminating between IHFLR and IHFHR. For multivariate risk stratification, optimal mixed parameter sets consisting of 5 indices (clinical and nonlinear) achieved 80.4% AUC (area under the curve of receiver operating characteristics) from 24 h HRV analysis, 84.3% AUC from first 30 min, 82.2 % AUC from daytime 30 min and 81.7% AUC from nighttime 30 min. The optimal parameter set obtained from the first 30 min showed nearly the same classification power when compared to the optimal 24 h-parameter set. As results from stationary daytime and nighttime, 30 min segments indicate that short-term analyses of 30 min may provide at least a comparable risk stratification power in IHF in comparison to a 24 h analysis period.
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Affiliation(s)
- Andreas Voss
- Department of Medical Engineering and Biotechnology, University of Applied Sciences Jena, Germany
| | - Rico Schroeder
- Department of Medical Engineering and Biotechnology, University of Applied Sciences Jena, Germany
| | - Montserrat Vallverdú
- Biomedical Engineering Research Centre, Universitat Politècnica de Catalunya Barcelona, Spain
| | - Steffen Schulz
- Department of Medical Engineering and Biotechnology, University of Applied Sciences Jena, Germany
| | - Iwona Cygankiewicz
- Department of Electrocardiology, Sterling Memorial University Hospital Lodz, Poland
| | - Rafael Vázquez
- Servicio de Cardiología, Puerta del Mar University Hospital Cádiz, Spain
| | | | - Pere Caminal
- Biomedical Engineering Research Centre, Universitat Politècnica de Catalunya Barcelona, Spain
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Tobaldini E, Brugada J, Benito B, Molina I, Montserrat J, Kara T, Leinveber P, Porta A, Macedo PG, Montano N, Somers VK. Cardiac autonomic control in Brugada syndrome patients during sleep: the effects of sleep disordered breathing. Int J Cardiol 2013; 168:3267-72. [PMID: 23669108 PMCID: PMC3851035 DOI: 10.1016/j.ijcard.2013.04.137] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Revised: 12/28/2012] [Accepted: 04/06/2013] [Indexed: 01/08/2023]
Abstract
AIMS Brugada syndrome is characterized by typical ECG features, ventricular arrhythmias and sudden cardiac death (SCD), more frequent during nighttime. Autonomic cardiovascular control has been implicated in triggering the ventricular arrhythmias. Sleep-disordered breathing (SDB) elicits marked autonomic changes during sleep and is also associated with an increased risk of nighttime SCD. Brugada patients may have a higher likelihood of SDB compared to controls. However, no data are available on cardiac autonomic control in Brugada patients, particularly with regard to the comorbidity of SDB. METHODS We evaluated autonomic cardiovascular control in Brugada patients with SDB (BRU-SDB, n=9), without SDB (BRU, n=9), in controls (CON, n=8) and in non-Brugada patients with SDB (n=6), during wakefulness and sleep (N2, N3 and REM). Linear spectral and entropy-derived measures of heart rate variability (HRV) were performed during apnea-free stable breathing epochs. RESULTS Total HRV was attenuated in BRU-SDB compared to CON and BRU. During N2 and REM, in BRU-SDB patients sympathetic modulation decreased compared to BRU and CON, while during REM, they showed an increased parasympathetic modulation, compared to the other two groups. BRU-SDB and SDB were similar in terms of spectral components. Entropy-derived indices showed preserved dynamic changes in Brugada patients compared to controls through the different sleep stages. CONCLUSION Brugada syndrome per se does not appear associated with an altered autonomic cardiovascular control during wakefulness and sleep. The comorbidity with SDB may contribute to disrupted autonomic cardiovascular regulation during sleep, possibly predisposing to the increased likelihood of sleep-related ventricular tachyarrhythmias and SCD.
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Affiliation(s)
- Eleonora Tobaldini
- Department of Biomedical and Clinical Sciences, Internal Medicine II, L. Sacco Hospital, University of Milan, Italy
| | - Josep Brugada
- Cardiology Department, Thorax Institute, Hospital Clínic, Barcelona, Spain
| | - Begona Benito
- Cardiology Department, Thorax Institute, Hospital Clínic, Barcelona, Spain
| | - Irma Molina
- Cardiology Department, Thorax Institute, Hospital Clínic, Barcelona, Spain
| | - Josep Montserrat
- Pneumology Department, Hospital Clínic, IDIBAPS. Barcelona, CIBERES
| | - Tomas Kara
- Department of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, MN and St. Anne’s hospital, ICRC-Department of Cardiovascular Diseases, St. Anne’s University Hospital Brno, Czech Republic
| | - Pavel Leinveber
- International Clinical Research Center - Center of Biomedical Engineering, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Alberto Porta
- Department of Biomedical Sciences for Health, Galeazzi Orthopedic Institute, University of Milan, Milan, Italy
| | - Paula G. Macedo
- Department of Cardiology, Hospital de Base do Distrito Federal, Brasília, Brazil and Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, MN
| | - Nicola Montano
- Department of Biomedical and Clinical Sciences, Internal Medicine II, L. Sacco Hospital, University of Milan, Italy
| | - Virend K Somers
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, MN
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Ciszewski P, Tyczka J, Nadolski J, Roszak M, Dyszkiewicz W. Lower preoperative fluctuation of heart rate variability is an independent risk factor for postoperative atrial fibrillation in patients undergoing major pulmonary resection. Interact Cardiovasc Thorac Surg 2013; 17:680-6. [PMID: 23832838 DOI: 10.1093/icvts/ivt238] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The following study presents a special independent atrial fibrillation (AF) risk factor-preoperative fluctuation of heart rate variability (HRV), as well as other perioperative AF risk factors in patients qualified for pneumonectomy and undergoing pneumonectomy or lobectomy for lung cancer. METHODS The prospective study was performed in patients who had undergone anatomical resection for non-small-cell lung cancer. A total of 117 patients (92 men and 25 women) qualified for statistical research. In order to determine the risk factors, all patients were divided into two groups: Group A-98 patients without AF and Group B-19 patients with AF during the perioperative time. A number of different risk factors of AF have been analysed and further divided into preoperative, operative and postoperative. RESULTS Postoperative AF occurred in 19 patients (16%), all of them were male. The patients with higher short-term HRV parameters (SD1, RMSSD), slower mean heart rate and those with a lower fluctuation of HRV-related parameters (HRV Afternoon, Night, Day (A/N/D)) before the operation, were more prone to AF. Postoperative risk of AF was higher in patients with a higher number of ventricular ectopic beats before the operation, a higher number of supraventricular and ventricular ectopic beats and a higher maximal heart rate after the operation. Statistical analysis revealed that male gender and the extent of pulmonary resection, particularly left pneumonectomy, constituted significant risk factors. AF was more often observed in patients who had ASA physical status score of III, in comparison with ASAI and ASAII patients. CONCLUSIONS Along with other concomitant AF risk factors presented in this work, the evaluation of the fluctuation tendencies of HRV parameters should be taken into consideration before any major lung resection. The balance disturbance between the sympathetic and parasympathetic nervous systems is responsible for AF.
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Affiliation(s)
- Pawel Ciszewski
- Department of Anesthesiology and Intensive Care, Poznan University of Medical Sciences, Poznan, Poland
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Valencia JF, Vallverdú M, Porta A, Voss A, Schroeder R, Vázquez R, Bayés de Luna A, Caminal P. Ischemic risk stratification by means of multivariate analysis of the heart rate variability. Physiol Meas 2013; 34:325-38. [PMID: 23399982 DOI: 10.1088/0967-3334/34/3/325] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In this work, a univariate and multivariate statistical analysis of indexes derived from heart rate variability (HRV) was conducted to stratify patients with ischemic dilated cardiomyopathy (IDC) in cardiac risk groups. Indexes conditional entropy, refined multiscale entropy (RMSE), detrended fluctuation analysis, time and frequency analysis, were applied to the RR interval series (beat-to-beat series), for single and multiscale complexity analysis of the HRV in IDC patients. Also, clinical parameters were considered. Two different end-points after a follow-up of three years were considered: (i) analysis A, with 151 survivor patients as a low risk group and 13 patients that suffered sudden cardiac death as a high risk group; (ii) analysis B, with 192 survivor patients as a low risk group and 30 patients that suffered cardiac mortality as a high risk group. A univariate and multivariate linear discriminant analysis was used as a statistical technique for classifying patients in risk groups. Sensitivity (Sen) and specificity (Spe) were calculated as diagnostic criteria in order to evaluate the performance of the indexes and their linear combinations. Sen and Spe values of 80.0% and 72.9%, respectively, were obtained during daytime by combining one clinical parameter and one index from RMSE, and during nighttime Sen = 80% and Spe = 73.4% were attained by combining one clinical factor and two indexes from RMSE. In particular, relatively long time scales were more relevant for classifying patients into risk groups during nighttime, while during daytime shorter scales performed better. The results suggest that the left atrial size, indexed to body surface and RMSE indexes are those that allow enhanced classification of ischemic patients in their respective risk groups, confirming that a single measurement is not enough to fully characterize ischemic risk patients and the clinical relevance of HRV complexity measures.
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Affiliation(s)
- José F Valencia
- Department of Automatic Control, Centre for Biomedical Engineering Research, Universitat Politècnica de Catalunya, Barcelona, Spain.
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