Cardiovascular variability is similarly altered in coronary patients with normal left ventricular function and in heart failure patients

Effect of coronary artery bypass grafting on blood pressure response to head-up tilting

Blood pressure response to head-up tilt (HUT) in 7 healthy subjects and 9 patients before and after coronary artery bypass grafting (CABG) was measured during supine and 15-min 60° HUT. Stroke volume (SV) and ejection fraction (EF) were assessed by echocardiography. Baseline mean arterial pressure (MAP) and heart rate (HR) in patients before CABG were similar to healthy subjects. MAP in patients decreased by 6 (4-9) mmHg [median (1st-3rd quartiles)] during 7-12 mmHg of HUT with decreased cardiac output (CO = SV × HR) while HR remained unchanged. MAP in healthy subjects remained unchanged during HUT with increased HR. Body weight decreased by 3.5 (2.5-3.7) kg and MAP decreased by 6 (2-13) mmHg during the last 3-min HUT while HR increased after CABG. Decreases in SV and CO during HUT disappeared after CABG. Blood pressure decreased during HUT in patients before and after CABG regardless of HR response.

Different estimation methods of spontaneous baroreflex sensitivity have different predictive value in heart failure patients

OBJECTIVE

Several methods have been developed so far to estimate cardiac baroreflex sensitivity (BRS) through the analysis of spontaneous fluctuations of systolic arterial pressure (SAP) and R-R interval. Their relative performance in predicting cardiac mortality in heart failure patients is not known. The aim of this study was to compare the prognostic value of a set of representative indexes of spontaneous BRS in these patients.

METHODS

We studied 228 stable, moderate-to-severe heart failure patients with reduced ejection fraction, in sinus rhythm, who underwent an 8-min supine recording of ECG, arterial blood pressure and respiration during paced breathing (15 breaths/min). BRS was estimated according to the following methods: sequence (BRSSeq); nonparametric transfer function in the low-frequency band (BRSTF_NP-LF); parametric spectral computed in the low-frequency and high-frequency bands (BRSPS-LF and BRSPS-HF); parametric transfer function computed in the low-frequency and high-frequency bands (BRSTF_P-LF and BRSTF_P-HF); model-based closed loop (BRSCL); and bivariate phase-rectified signal averaging (BRSPRSA).

RESULTS

During a median follow-up of 36 months, 45 patients experienced a cardiac event. Only BRSTF_NP-LF, BRSPS-LF, BRSTF_P-LF and BRSPRSA were significantly associated with the outcome (P < 0.01), and statistical significance remained (P ≤ 0.03) after adjusting for clinical covariates. BRSTF_NP-LF and BRSPRSA also significantly improved the risk classification.

CONCLUSION

This study shows that different spontaneous BRS indexes have different predictive value in patients with heart failure. It also shows that the prognostic information of BRS estimates is linked to SAP and RR oscillations in the low-frequency band.

Assessing mood symptoms through heartbeat dynamics: An HRV study on cardiosurgical patients

BACKGROUND

Heart Rate Variability (HRV) is reduced both in depression and in coronary heart disease (CHD) suggesting common pathophysiological mechanisms for the two disorders. Within CHD, cardiac surgery patients (CSP) with postoperative depression are at greater risk of adverse cardiac events. Therefore, CSP would especially benefit from depression early diagnosis. Here we tested whether HRV-multi-feature analysis discriminates CSP with or without depression and provides an effective estimation of symptoms severity.

METHODS

Thirty-one patients admitted to cardiac rehabilitation after first-time cardiac surgery were recruited. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression Scale (CES-D). HRV features in time, frequency, and nonlinear domains were extracted from 5-min-ECG recordings at rest and used as predictors of "least absolute shrinkage and selection" (LASSO) operator regression model to estimate patients' CES-D score and to predict depressive state.

RESULTS

The model significantly predicted the CES-D score in all subjects (the total explained variance of CES-D score was 89.93%). Also it discriminated depressed and non-depressed CSP with 86.75% accuracy. Seven of the ten most informative metrics belonged to non-linear-domain.

LIMITATIONS

A higher number of patients evaluated also with a structured clinical interview would help to generalize the present findings.

DISCUSSION

To our knowledge this is the first study using a multi-feature approach to evaluate depression in CSP. The high informative power of HRV-nonlinear metrics suggests their possible pathophysiological role both in depression and in CHD. The high-accuracy of the algorithm at single-subject level opens to its translational use as screening tool in clinical practice.

Longitudinal monitoring of heartbeat dynamics predicts mood changes in bipolar patients: A pilot study

OBJECTIVES

Recent research indicates that Heart Rate Variability (HRV) is affected in Bipolar Disorders (BD) patients. To determine whether such alterations are a mere expression of the current mood state or rather contain longitudinal information on BD course, we examined the potential influence of states adjacent in time upon HRV features measured in a target mood state.

METHODS

Longitudinal evaluation of HRV was obtained in eight BD patients by using a wearable monitoring system developed within the PSYCHE project. We extracted time-domain, frequency-domain and non-linear HRV-features and trained a Support Vector Machine (SVM) to classify HRV-features according to mood state. To evaluate the influence of adjacent mood states, we trained SVM with different HRV-feature sets: 1) belonging to each mood state considered alone; 2) belonging to each mood state and normalized using information from the preceding mood state; 3) belonging to each mood state and normalized using information from the preceding and subsequent mood states; 4) belonging to each mood state and normalized using information from two randomly chosen states.

RESULTS

SVM classification accuracy within a target state was significantly greater when HRV-features from the previous and subsequent mood states were considered.

CONCLUSIONS

Although preliminary and in need of replications our results suggest for the first time that psychophysiological states in BD contain information related to the subsequent ones. Such characteristic may be used to improve clinical management and to develop algorithms to predict clinical course and mood switches in individual patients.

Methamphetamine and HIV-Tat alter murine cardiac DNA methylation and gene expression

This study addresses the individual and combined effects of HIV-1 and methamphetamine (N-methyl-1-phenylpropan-2-amine, METH) on cardiac dysfunction in a transgenic mouse model of HIV/AIDS. METH is abused epidemically and is frequently associated with acquisition of HIV-1 infection or AIDS. We employed microarrays to identify mRNA differences in cardiac left ventricle (LV) gene expression following METH administration (10d, 3mg/kg/d, subcutaneously) in C57Bl/6 wild-type littermates (WT) and Tat-expressing transgenic (TG) mice. Arrays identified 880 differentially expressed genes (expression fold change>1.5, p<0.05) following METH exposure, Tat expression, or both. Using pathway enrichment analysis, mRNAs encoding polypeptides for calcium signaling and contractility were altered in the LV samples. Correlative DNA methylation analysis revealed significant LV DNA methylation changes following METH exposure and Tat expression. By combining these data sets, 38 gene promoters (27 related to METH, 11 related to Tat) exhibited differences by both methods of analysis. Among those, only the promoter for CACNA1C that encodes L-type calcium channel Cav1.2 displayed DNA methylation changes concordant with its gene expression change. Quantitative PCR verified that Cav1.2 LV mRNA abundance doubled following METH. Correlative immunoblots specific for Cav1.2 revealed a 3.5-fold increase in protein abundance in METH LVs. Data implicate Cav1.2 in calcium dysregulation and hypercontractility in the murine LV exposed to METH. They suggest a pathogenetic role for METH exposure to promote LV dysfunction that outweighs Tat-induced effects.

Good reproducibility of heart rate variability after orthostatic challenge in patients with a history of acute coronary syndrome

BACKGROUND

Several parameters of heart rate variability (HRV) have been shown to predict the risk of sudden cardiac death (SCD) in cardiac patients. There is consensus that risk prediction is increased when measuring HRV during specific provocations such as orthostatic challenge. For the first time, we provide data on reproducibility of such a test in patients with a history of acute coronary syndrome.

METHODS

Sixty male patients (65 ± 8 years) with a history of acute coronary syndrome on stable medication were included. HRV was measured in supine (5 min) and standing (5 min) position on 2 occasions separated by two weeks. For risk assessment relevant time-domain [standard deviation of all R-R intervals (SDNN) and root mean squared standard differences between adjacent R-R intervals (RMSSD)], frequency domain [low-frequency power (LF), high-frequency power (HF) and LF/HF power ratio] and short-term fractal scaling component (DF1) were computed. Absolute reproducibility was assessed with the standard errors of the mean (SEM) and 95% limits of random variation, and relative reproducibility by the intraclass correlation coefficient (ICC).

RESULTS

We found comparable SEMs and ICCs in supine position and after an orthostatic challenge test. All ICCs were good to excellent (ICCs between 0.636 and 0.869).

CONCLUSIONS

Reproducibility of HRV parameters during orthostatic challenge is good and comparable with supine position.