The relationship between physical activity and heart rate variability in orthotopic heart transplant recipients

Decoding cardiac reinnervation from cardiac autonomic markers: A mathematical model approach

BACKGROUND

Although cardiac autonomic markers (CAMs) are commonly used to assess cardiac reinnervation in heart-transplant patients, their relationship to the degree of sympathetic and vagal cardiac reinnervation is not well understood yet. To study this relationship, we applied a mathematical model of the cardiovascular system and its autonomic control.

METHODS

By simulating varying levels of sympathetic and vagal efferent sinoatrial reinnervation, we analyzed the induced changes in CAMs including resting heart rate (HR), bradycardic and tachycardic HR response to Valsalva maneuver, root mean square of successive differences between normal heartbeats (RMSSD), low-frequency (LF), high-frequency (HF), and total spectral power (TSP).

RESULTS

For assessment of vagal cardiac reinnervation levels >20%, resting HR (ρ = 0.99, p < 0.05), RMSSD (ρ = 0.97, p < 0.05), and TSP (ρ = 0.96, p < 0.05) may be equally suitable as HF-power (ρ = 0.97, p < 0.05). To assess sympathetic reinnervation, LF/HF ratio (ρ = 0.87, p < 0.05) and tachycardic response to Valsalva maneuver (ρ = 0.9, p < 0.05) may be more suitable than LF-power (ρ = 0.77, p < 0.05).

CONCLUSIONS

Our model reports mechanistic relationships between CAMs and levels of efferent autonomic sinoatrial reinnervation. The results indicate differences in the suitability of these markers to assess vagal and sympathetic reinnervation. Although our analysis is purely conceptual, the developed model can help to gain important insights into the genesis of CAMs and their relationship to efferent sinoatrial reinnervation and, thus, provide indications for clinical study evaluation.

Physiological outcomes of calming behaviors support the resilience hypothesis in horses

To manage a stressful stimulus animals react both behaviorally and physiologically to restore the homeostasis. In stable horses, a stressful stimulus can be represented by social separation, riding discomfort or the presence of novel objects in their environment. Although Heart Rate Variability is a common indicator of stress levels in horses, the behavioral mechanisms concurrently occurring under stressful conditions are still unknown. The sudden inflation of a balloon was administered to 33 horses. Video-recording of self-directed behaviors (snore, vacuum chewing, snort, head/body shaking) and monitoring of heart activity (HR and SDRR) were conducted for five minutes before (Pre-test) and after the stimulus administration (Stress-test). During the Stress-test, only snore and vacuum chewing increased and a significant increase was also recorded in both HR and SDRR. Moreover, the snore variation between the two conditions showed a significant correlation with the variation of both HR and SDRR. With the snore acting as stress-releasing behavior to restore basal condition, the homeostasis recovered via the enactment of such behavior could be physiologically expressed by an increasing vagal activity. Hence, the capacity to maintain homeostasis (resilience) could correspond to a prevalence of parasympathetic control on heart activity, intervening when certain behaviors are performed.

Cardiac autonomic modulation impairments in advanced breast cancer patients

AIM

To compare cardiac autonomic modulation in early- versus advanced-stage breast cancer patients before any type of cancer treatment and investigate associated factors.

METHODS AND RESULTS

This cross-sectional study included women (30-69 years old) with primary diagnosis of breast cancer and women with benign breast tumors. We evaluated cardiac modulation by heart rate variability and assessed factors of anxiety, depression, physical activity, and other relevant medical variables. Patients were divided into three groups based on TNM staging of cancer severity: early-stage cancer (n = 42), advanced-stage cancer (n = 37), or benign breast tumors to serve as a control (n = 37). We analyzed heart rate variability in time and frequency domains. The advanced-stage cancer group had lower vagal modulation than early-stage and benign groups; also, the advance-stage group had lower overall heart rate variability when compared to benign conditions. Heart rate variability was influenced by age, menopausal status, and BMI.

CONCLUSIONS

Heart rate variability seems to be a promising, non-invasive tool for early diagnosis of autonomic dysfunction in breast cancer and detection of cardiovascular impairments at cancer diagnosis. Cardiac autonomic modulation is inversely associated with breast cancer staging.

Decomposition of Heart Rate Variability Spectrum into a Power-Law Function and a Residual Spectrum

The power spectral density (PSD) of heart rate variability (HRV) contains a power-law relationship that can be obtained by plotting the logarithm of PSD against the logarithm of frequency. The PSD of HRV can be decomposed mathematically into a power-law function and a residual HRV (rHRV) spectrum. Almost all rHRV measures are significantly smaller than their corresponding HRV measures except the normalized high-frequency power (nrHFP). The power-law function can be characterized by the slope and Y-intercept of linear regression. Almost all HRV measures except the normalized low-frequency power have significant correlations with the Y-intercept, while almost all rHRV measures except the total power [residual total power (rTP)] do not. Though some rHRV measures still correlate significantly with the age of the subjects, the rTP, high-frequency power (rHFP), nrHFP, and low-/high-frequency power ratio (rLHR) do not. In conclusion, the clinical significances of rHRV measures might be different from those of traditional HRV measures. The Y-intercept might be a better HRV measure for clinical use because it is independent of almost all rHRV measures. The rTP, rHFP, nrHFP, and rLHR might be more suitable for the study of age-independent autonomic nervous modulation of the subjects.

The use of heart rate variability measures as indicators of autonomic nervous modulation must be careful in patients after orthotopic heart transplantation

The precise relation between heart rate variability (HRV) and autonomic re-innervation has not been established explicitly in patients after orthotopic heart transplantation (OHT), but can be inferred from the fact that the HRV is reduced immediately after OHT and may increase gradually with time. The aim of this study was to investigate the residual HRV in patients about 1–2 years after OHT, as compared with patients after coronary artery bypass graft (CABG) surgery. Thirteen patients who had received OHT and 14 patients who had received CABG surgery were recruited. HRV analysis was performed and the HRV measures in supine position were compared between these two groups of patients. We found that the mean (mRRI), standard deviation and coefficient of variation of RR intervals, total power, very low frequency power (VLFP), low frequency power, high frequency power (HFP), normalized VLFP (nVLFP) and low-/high-frequency power ratio in the OHT group were all significantly decreased, while the heart rate (HR) and normalized HFP (nHFP) were significantly increased, as compared with the CABG group. The decrease in HRV was more severe in the VLFP region. A smaller nVLFP and a greater nHFP were associated with a smaller mRRI and a larger HR in the OHT patients. The slope of the power law relation of HRV became positive in OHT patients, instead of negative in CABG patients. We conclude that patients after OHT have residual HRV which were characterized by severely depressed time and frequency domain HRV, increased HR and nHFP, decreased nVLFP, and positive slope of the power-law relation of HRV. The use of nHFP as the indicator of vagal modulation and the use of nVLFP as the indicator of renin-angiotensin modulation, thermoregulation and vagal withdrawal must be careful in the OHT patients.