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Abreu RMD, Cairo B, Rehder-Santos P, da Silva CD, Signini ÉDF, Milan-Mattos JC, Sakaguchi CA, Catai AM, Porta A. Cardiorespiratory coupling is associated with exercise capacity in athletes: A cross-sectional study. Respir Physiol Neurobiol 2024; 320:104198. [PMID: 37956746 DOI: 10.1016/j.resp.2023.104198] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/24/2023] [Accepted: 11/09/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE To determine the association between exercise capacity based on peak oxygen uptake (VO2peak) and resting cardiorespiratory coupling (CRC) levels in athletes and non-athletes' subjects. METHODS A cross-sectional study was carried out in 42 apparently healthy male subjects, aged between 20 and 40 years old. The participants were allocated into athletes (n = 21) and non-athletes (n = 21) groups. Resting electrocardiogram and respiratory movement (RESP) were simultaneously acquired during 15 min in supine position and quiet breathing. The beat-to-beat heart period (HP) and RESP series were determined from the recorded signals. Traditional analysis of HP based on frequency domain indexes was performed considering the high-frequency (0.15 - 0.45 Hz) components. To compute the CRC, the linear association between HP and RESP series was determined via squared coherence function and directionality of interaction was investigated through the causal extension of this approach. The exercise capacity was assessed through incremental cardiopulmonary exercise testing in order to determine the VO2peak. RESULTS Traditional analysis of HP based on high-frequency index was not correlated with exercise capacity in the athletes (r = -0.1, p = 0.5) and non-athletes (r = -0.1, p = 0.3) cohorts. However, resting CRC values was associated with exercise capacity in athletes (r = 0.4, p = 0.03), but not in the non-athletes group (r = -0.2, p = 0.3). CONCLUSION These results suggest that improved resting values of CRC is associated with higher exercise capacity (VO2peak) in endurance athletes. Moreover, frequency domain of HP was not sensitive to identifying this relationship, probably because effects of training on parasympathetic modulation might be affected by respiratory dynamics, and this influence has a directionality (i.e., from RESP to HP).
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Affiliation(s)
- Raphael Martins de Abreu
- LUNEX University, International University of Health, Exercise & Sports S.A. 50, Department of Physiotherapy, Differdange, Luxembourg; LUNEX ASBL Luxembourg Health & Sport Sciences Research Institute, Differdange, Luxembourg; Federal University of São Carlos, Department of Physical Therapy, São Carlos, São Paulo, Brazil.
| | - Beatrice Cairo
- University of Milan, Department of Biomedical Sciences for Health, Milan, Italy
| | - Patricia Rehder-Santos
- Federal University of São Carlos, Department of Physical Therapy, São Carlos, São Paulo, Brazil
| | | | - Étore De Favari Signini
- Federal University of São Carlos, Department of Physical Therapy, São Carlos, São Paulo, Brazil
| | | | - Camila Akemi Sakaguchi
- Appalachian State University, Department of Health, Leisure, and Exercise Science, NC, United States
| | - Aparecida Maria Catai
- Federal University of São Carlos, Department of Physical Therapy, São Carlos, São Paulo, Brazil
| | - Alberto Porta
- University of Milan, Department of Biomedical Sciences for Health, Milan, Italy; IRCCS Policlinico San Donato, Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, San Donato Milanese, Milan, Italy
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De Maria B, Dalla Vecchia LA, Bari V, Cairo B, Gelpi F, Perego F, Takahashi ACM, Milan-Mattos JC, Minatel V, Rehder-Santos P, Esler M, Lambert E, Baumert M, Catai AM, Porta A. The degree of engagement of cardiac and sympathetic arms of the baroreflex does not depend on the absolute value and sign of arterial pressure variations. Physiol Meas 2023; 44:114002. [PMID: 37922536 DOI: 10.1088/1361-6579/ad0976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/03/2023] [Indexed: 11/07/2023]
Abstract
Objective.The percentages of cardiac and sympathetic baroreflex patterns detected via baroreflex sequence (SEQ) technique from spontaneous variability of heart period (HP) and systolic arterial pressure (SAP) and of muscle nerve sympathetic activity (MSNA) burst rate and diastolic arterial pressure (DAP) are utilized to assess the level of the baroreflex engagement. The cardiac baroreflex patterns can be distinguished in those featuring both HP and SAP increases (cSEQ++) and decreases (cSEQ--), while the sympathetic baroreflex patterns in those featuring a MSNA burst rate decrease and a DAP increase (sSEQ+-) and vice versa (sSEQ-+). The present study aims to assess the modifications of the involvement of the cardiac and sympathetic arms of the baroreflex with age and postural stimulus intensity.Approach.We monitored the percentages of cSEQ++ (%cSEQ++) and cSEQ-- (%cSEQ--) in 100 healthy subjects (age: 21-70 years, 54 males, 46 females), divided into five sex-balanced groups consisting of 20 subjects in each decade at rest in supine position and during active standing (STAND). We evaluated %cSEQ++, %cSEQ--, and the percentages of sSEQ+- (%sSEQ+-) and sSEQ-+ (%sSEQ-+) in 12 young healthy subjects (age 23 ± 2 years, 3 females, 9 males) undergoing incremental head-up tilt.Main results.We found that: (i) %cSEQ++ and %cSEQ-- decreased with age and increased with STAND and postural stimulus intensity; (ii) %sSEQ+- and %sSEQ-+ augmented with postural challenge magnitude; (iii) the level of cardiac and sympathetic baroreflex engagement did not depend on either the absolute value of arterial pressure or the direction of its changes.Significance.This study stresses the limited ability of the cardiac and sympathetic arms of the baroreflex in controlling absolute arterial pressure values and the equivalent ability of both positive and negative arterial pressure changes in soliciting them.
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Affiliation(s)
| | | | - Vlasta Bari
- 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
| | - Beatrice Cairo
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Francesca Gelpi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | | | | | - Vinicius Minatel
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | | | - Murray Esler
- Human Neurotransmitters Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Elisabeth Lambert
- School of Health Science, Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, Australia
| | - Mathias Baumert
- Discipline of Biomedical Engineering, School of Electrical and Mechanical Engineering, The University of Adelaide, Adelaide, Australia
| | - Aparecida Maria Catai
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - 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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Cairo B, Bari V, Gelpi F, De Maria B, Porta A. Assessing cardiorespiratory interactions via lagged joint symbolic dynamics during spontaneous and controlled breathing. FRONTIERS IN NETWORK PHYSIOLOGY 2023; 3:1211848. [PMID: 37602202 PMCID: PMC10436098 DOI: 10.3389/fnetp.2023.1211848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/13/2023] [Indexed: 08/22/2023]
Abstract
Introduction: Joint symbolic analysis (JSA) can be utilized to describe interactions between time series while accounting for time scales and nonlinear features. JSA is based on the computation of the rate of occurrence of joint patterns built after symbolization. Lagged JSA (LJSA) is obtained from the more classical JSA by introducing a delay/lead between patterns built over the two series and combined to form the joint scheme, thus monitoring coordinated patterns at different lags. Methods: In the present study, we applied LJSA for the assessment of cardiorespiratory coupling (CRC) from heart period (HP) variability and respiratory activity (R) in 19 healthy subjects (age: 27-35 years; 8 males, 11 females) during spontaneous breathing (SB) and controlled breathing (CB). The R rate of CB was selected to be indistinguishable from that of SB, namely, 15 breaths·minute-1 (CB15), or slower than SB, namely, 10 breaths·minute-1 (CB10), but in both cases, very rapid interactions between heart rate and R were known to be present. The ability of the LJSA approach to follow variations of the coupling strength was tested over a unidirectionally or bidirectionally coupled stochastic process and using surrogate data to test the null hypothesis of uncoupling. Results: We found that: i) the analysis of surrogate data proved that HP and R were significantly coupled in any experimental condition, and coupling was not more likely to occur at a specific time lag; ii) CB10 reduced CRC strength at the fastest time scales while increasing that at intermediate time scales, thus leaving the overall CRC strength unvaried; iii) despite exhibiting similar R rates and respiratory sinus arrhythmia, SB and CB15 induced different cardiorespiratory interactions; iv) no dominant temporal scheme was observed with relevant contributions of HP patterns either leading or lagging R. Discussion: LJSA is a useful methodology to explore HP-R dynamic interactions while accounting for time shifts and scales.
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Affiliation(s)
- Beatrice Cairo
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Vlasta Bari
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato Milanese, Milan, Italy
| | - Francesca Gelpi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | - 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 Milanese, Milan, Italy
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Da Silva CD, Catai AM, Abreu RMD, Signini ÉDF, Galdino GAM, Lorevice L, Santos LM, Mendes RG. Cardiorespiratory coupling as an early marker of cardiac autonomic dysfunction in type 2 diabetes mellitus patients. Respir Physiol Neurobiol 2023; 311:104042. [PMID: 36858335 DOI: 10.1016/j.resp.2023.104042] [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: 11/12/2022] [Revised: 02/20/2023] [Accepted: 02/26/2023] [Indexed: 03/03/2023]
Abstract
The aim of this study was to assess cardiorespiratory coupling (CRC) in type 2 diabetes mellitus patients (T2DM) and apparently healthy individuals, in order to test the hypothesis that this method can provide additional knowledge to the information obtained through the heart rate variability (HRV). A cross-sectional study was conducted in T2DM patients(T2DMG=32) and health controls (CON=32). For CRC analysis, the electrocardiogram, arterial pressure, and thoracic respiratory movement were recorded at rest in supine position and during active standing. Beat-to-beat series of heart period and systolic arterial pressure were analyzed with the respiratory movement signal via a traditional non-causal approach, such as squared coherence function. In this sample of T2DM, no differences in HRV were observed when compared to the CON, but the T2DMG showed a reduction in resting CRC. We conclude that in CRC in T2DM, reflected by the squared coherence may already be compromised even before HRV changes.
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Affiliation(s)
- Claudio Donisete Da Silva
- Cardiopulmonary Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, Brazil
| | - Aparecida Maria Catai
- Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, Brazil
| | - Raphael Martins de Abreu
- LUNEX University, International University of Health, Exercise & Sports S.A. 50, Department of Physiotherapy, Differdange, Luxembourg. 50 Avenue du Parc des Sports, L-4671, Differdange, Luxembourg; LUNEX ASBL Luxembourg Health & Sport Sciences Research Institute, Differdange, Luxembourg. 50 Avenue du Parc des Sports, L-4671, Differdange, Luxembourg
| | - Étore De Favari Signini
- Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, Brazil
| | | | - Laura Lorevice
- Cardiopulmonary Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, Brazil
| | - Letícia Menegalli Santos
- Cardiopulmonary Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, Brazil
| | - Renata Gonçalves Mendes
- Cardiopulmonary Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, Brazil.
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Galdino GAM, Moura-Tonello SCG, Linares SN, Milan-Mattos JC, Spavieri DL, Oliveira SM, Porta A, Beltrame T, Catai AM. Intracranial compliance in type 2 diabetes mellitus and its relationship with the cardiovascular autonomic nervous control. Braz J Med Biol Res 2022; 55:e12150. [PMID: 36102416 PMCID: PMC9467282 DOI: 10.1590/1414-431x2022e12150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/11/2022] [Indexed: 11/29/2022] Open
Abstract
The intracranial compliance in type 2 diabetes mellitus (T2DM) patients and the association with cardiovascular autonomic control have not been fully elucidated. The aim of this study was to assess intracranial compliance using the noninvasive intracranial pressure (niICP) and the monitoring of waveform peaks (P1, P2, and P3) and the relationship with cardiovascular autonomic control in T2DM patients. Thirty-two men aged 40-60 years without cardiovascular autonomic neuropathy (CAN) were studied: T2DMG (n=16) and control group CG (n=16). The niICP was evaluated by a noninvasive extracranial sensor placed on the scalp. Cardiovascular autonomic control was evaluated by indices of the baroreflex sensitivity (BRS), from temporal series of R-R intervals of electrocardiogram and systolic arterial pressure, during supine and orthostatic positions. The participants remained in the supine position for 15 min and then 15 min more in orthostatism. T2DMG presented a decrease of the P2/P1 ratio during the orthostatic position (P<0.001). There was a negative moderate correlation between the P2 peak with cardiovascular coupling (K2HP-SAPLF) in supine (r=-0.612, P=0.011) and orthostatic (r=-0.568, P=0.020) positions in T2DMG. We concluded that T2DM patients without CAN and cardiovascular complications presented intracranial compliance similar to healthy subjects. Despite preserved intracranial adjustments, T2DM patients had a response of greater magnitude in orthostatism. In addition, the decoupling between the heart period and blood pressure signal oscillations in low frequency appeared to be related to the worsening of intracranial compliance due to the increased P2 peak.
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Affiliation(s)
- G A M Galdino
- Laboratório de Fisioterapia Cardiovascular, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - S C G Moura-Tonello
- Laboratório de Fisioterapia Cardiovascular, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - S N Linares
- Laboratório de Fisioterapia Cardiovascular, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - J C Milan-Mattos
- Laboratório de Fisioterapia Cardiovascular, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - D L Spavieri
- Divisão de Ciência de Dados, brain4care, São Carlos, SP, Brasil
| | - S M Oliveira
- Divisão de Ciência de Dados, brain4care, São Carlos, SP, Brasil.,Instituto de Física de São Carlos, Universidade de São Paulo, São Carlos, SP, Brasil
| | - A Porta
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.,Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - T Beltrame
- Laboratório de Fisioterapia Cardiovascular, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil.,Samsung R&D Institute Brazil (SRBR), Campinas, SP, Brasil
| | - A M Catai
- Laboratório de Fisioterapia Cardiovascular, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
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Abreu RMD, Porta A, Rehder-Santos P, Cairo B, Sakaguchi CA, da Silva CD, Signini ÉDF, Milan-Mattos JC, Catai AM. Cardiorespiratory coupling strength in athletes and non-athletes. Respir Physiol Neurobiol 2022; 305:103943. [PMID: 35835289 DOI: 10.1016/j.resp.2022.103943] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/21/2022] [Accepted: 07/07/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Despite the relevant presence of nonlinear components on heart period (HP) likely due to cardiorespiratory coupling (CRC), the HP is frequently analyzed in absence of concomitant recordings of respiratory movements (RESP). This study aims to assess the cardiovascular dynamics and CRC during postural challenge in athletes and non-athletes via joint symbolic analysis (JSA). METHODS A cross-sectional study was conducted in 50 men, aged between 20 and 40 yrs, divided into athletes (n = 25) and non-athletes (n = 25) groups. The electrocardiogram, blood pressure and RESP signals were recorded during 15 min in both supine position (REST) and after active postural maneuver (STAND). From the beat-to-beat series of HP, systolic arterial pressure (SAP) and RESP, we computed the time and frequency domain indexes and baroreflex sensitivity. The JSA was based on the definition of symbolic HP and RESP patterns and on the evaluation of the rate of their simultaneous occurrence in both HP and RESP series. RESULTS The JSA analysis was able to identify higher CRC strength at REST in athletes. Moreover, the response of CRC to STAND depended on the time scales of the analysis and was much more evident in athletes than in non-athletes, thus indicating a more reactive autonomic control in athletes. CONCLUSION Assessing CRC in athletes via JSA provides additional information compared to standard linear time and frequency domain tools likely due to the more relevant presence of nonlinearities in HP-RESP variability relationship.
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Affiliation(s)
- Raphael Martins de Abreu
- LUNEX University, International University of Health, Exercise & Sports S.A. 50, Department of Physiotherapy, Differdange, Luxembourg; LUNEX ASBL Luxembourg Health & Sport Sciences Research Institute, Differdange, Luxembourg; Federal University of São Carlos, Department of Physical Therapy, São Carlos, São Paulo, Brazil.
| | - Alberto Porta
- University of Milan, Department of Biomedical Sciences for Health, Milan, Italy; IRCCS Policlinico San Donato, Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, San Donato Milanese, Milan, Italy
| | - Patricia Rehder-Santos
- Federal University of São Carlos, Department of Physical Therapy, São Carlos, São Paulo, Brazil
| | - Beatrice Cairo
- University of Milan, Department of Biomedical Sciences for Health, Milan, Italy
| | - Camila Akemi Sakaguchi
- Appalachian State University, Department of Health, Leisure, and Exercise Science, NC, USA
| | | | - Étore De Favari Signini
- Federal University of São Carlos, Department of Physical Therapy, São Carlos, São Paulo, Brazil
| | | | - Aparecida Maria Catai
- Federal University of São Carlos, Department of Physical Therapy, São Carlos, São Paulo, Brazil
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Skytioti M, Elstad M. Respiratory Sinus Arrhythmia is Mainly Driven by Central Feedforward Mechanisms in Healthy Humans. Front Physiol 2022; 13:768465. [PMID: 35874518 PMCID: PMC9301041 DOI: 10.3389/fphys.2022.768465] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
Heart rate variability (HRV) has prognostic and diagnostic potential, however, the mechanisms behind respiratory sinus arrhythmia (RSA), a main short-term HRV, are still not well understood. We investigated if the central feedforward mechanism or pulmonary stretch reflex contributed most to RSA in healthy humans. Ventilatory support reduces the centrally mediated respiratory effort but remains the inspiratory stretch of the pulmonary receptors. We aimed to quantify the difference in RSA between spontaneous breathing and ventilatory support. Nineteen healthy, young subjects underwent spontaneous breathing and non-invasive intermittent positive pressure ventilation (NIV) while we recorded heart rate (HR, from ECG), mean arterial pressure (MAP) and stroke volume (SV) estimated from the non-invasive finger arterial pressure curve, end-tidal CO2 (capnograph), and respiratory frequency (RF) with a stretch band. Variability was quantified by an integral between 0.15–0.4 Hz calculated from the power spectra. Median and 95% confidence intervals (95%CI) were calculated as Hodges–Lehmann’s one-sample estimator. Statistical difference was calculated by the Wilcoxon matched-pairs signed-rank test. RF and end-tidal CO2 were unchanged by NIV. NIV reduced HR by 2 bpm, while MAP and SV were unchanged in comparison to spontaneous breathing. Variability in both HR and SV was reduced by 60% and 75%, respectively, during NIV as compared to spontaneous breathing, but their interrelationship with respiration was maintained. NIV reduced RSA through a less central respiratory drive, and pulmonary stretch reflex contributed little to RSA. RSA is mainly driven by a central feedforward mechanism in healthy humans. Peripheral reflexes may contribute as modifiers of RSA.
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Saul JP, Valenza G. Heart rate variability and the dawn of complex physiological signal analysis: methodological and clinical perspectives. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2021; 379:20200255. [PMID: 34689622 DOI: 10.1098/rsta.2020.0255] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/14/2021] [Indexed: 06/13/2023]
Abstract
Spontaneous beat-to-beat variations of heart rate (HR) have intrigued scientists and casual observers for centuries; however, it was not until the 1970s that investigators began to apply engineering tools to the analysis of these variations, fostering the field we now know as heart rate variability or HRV. Since then, the field has exploded to not only include a wide variety of traditional linear time and frequency domain applications for the HR signal, but also more complex linear models that include additional physiological parameters such as respiration, arterial blood pressure, central venous pressure and autonomic nerve signals. Most recently, the field has branched out to address the nonlinear components of many physiological processes, the complexity of the systems being studied and the important issue of specificity for when these tools are applied to individuals. When the impact of all these developments are combined, it seems likely that the field of HRV will soon begin to realize its potential as an important component of the toolbox used for diagnosis and therapy of patients in the clinic. This article is part of the theme issue 'Advanced computation in cardiovascular physiology: new challenges and opportunities'.
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Affiliation(s)
- J Philip Saul
- Department of Pediatrics, School of Medicine, West Virginia University, Morgantown, WV 25606, USA
| | - Gaetano Valenza
- Research Center E. Piaggio and Department of Information Engineering, University of Pisa, Pisa, Italy
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Porta A, Gelpi F, Bari V, Cairo B, De Maria B, May Panzetti C, Cornara N, Bertoldo EG, Fiolo V, Callus E, De Vincentiis C, Volpe M, Molfetta R, Ranucci M. Respiration is a Confounder of the Closed Loop Relationship Between Mean Arterial Pressure and Mean Cerebral Blood Flow. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:5403-5406. [PMID: 34892348 DOI: 10.1109/embc46164.2021.9630905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This study tested the hypothesis that respiration (RESP) is a confounder or suppressor of the closed loop relationship responsible for the cerebrovascular dynamical interactions as assessed from spontaneous variability of mean arterial pressure (MAP) and mean cerebral blood flow (MCBF). The evaluation was carried out in the information domain via transfer entropy (TE) estimated through a linear model-based approach comparing TE markers computed solely over MAP and MCBF series with TE indexes accounting for the eventual action of RESP over MAP and MCBF. We considered 11 patients (age: 76±5 yrs, 7 males) undergoing surgical aortic valve replacement (SAVR) at supine resting (REST) and during active standing (STAND) before and after SAVR surgery. The decrease of the predictive ability of MCBF to MAP when accounting for RESP compared to the one assessed when disregarding RESP suggested that RESP is a confounder of the link from MCBF to MAP along the Cushing reflex instead of being a suppressor. This result was more evident in POST when autonomic control was dramatically depressed and in an unchallenged condition such as REST. RESP did not affect significantly the link from MAP to MCBF along the pressure-to-flow relationship. Clarification of the type of RESP influence on the MAP-MCBF closed loop relationship could favor a deeper characterization of cerebrovascular interactions and the comprehension of cerebral autoregulation mechanisms.Clinical Relevance- This study suggests that respiration is a confounder of the closed loop relationship between MAP and MCBF, especially of the flow-to-pressure causal link. This result might open new possibilities in elucidating the mechanisms of cerebral autoregulation in healthy and pathological populations.
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Pernice R, Sparacino L, Nollo G, Stivala S, Busacca A, Faes L. Comparison of frequency domain measures based on spectral decomposition for spontaneous baroreflex sensitivity assessment after Acute Myocardial Infarction. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Wu MA, Catena E, Castelli A, Rech R, Borghi B, Ottolina D, Fossali T, Cogliati C, Colombo R. Autonomic biomarkers of shock in idiopathic systemic capillary leak syndrome. PLoS One 2021; 16:e0251775. [PMID: 34061871 PMCID: PMC8168872 DOI: 10.1371/journal.pone.0251775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 05/03/2021] [Indexed: 11/18/2022] Open
Abstract
Objective The term Idiopathic Systemic Capillary Leak Syndrome (ISCLS) refers to an uncommon condition of severe distributive shock, resulting from an abrupt shift of fluids and proteins from the intravascular to the interstitial compartment. We hypothesise that the autonomic nervous system (ANS) fails in regulating the response to hypovolemia in acute ISCLS and that ANS variables characterise the progression to the recovery. Design Prospective cohort study of patients admitted to ICU for severe ISCLS flares. Setting Single, referral center in Italy for ISCLS. Patients Analysis of cardiovascular signals recorded during seven severe ISCLS attacks and one prodromal period in five patients. Interventions ANS was studied non-invasively by means of heart rate variability (HRV) and blood pressure variability analysis, as an estimation of vagal and sympathetic modulation directed to the heart and vessels. Heart rate and systolic arterial pressure (SAP) variability were also used to assess baroreflex sensitivity. ANS variables were measured during the subsequent phases which characterise ISCLS flares, namely the acute phase, the post-acute phase, and the recovery phase. Measurements and main results HRV was severely depressed during the acute phase accounting for the loss of ANS modulation during massive capillary extravasation. This phase was characterised by shock and impaired baroreflex control, which allowed SAP to oscillate driven by respiratory activity. Impending shock and transition from shock to a post-acute phase were marked by change of baroreflex spectral variables. The baroreflex control was fully restored during recovery. Conclusions ANS modulation and baroreflex control are severely impaired during the acute haemodynamic instability which characterises ISCLS crises and their progressive restoration may be a clue of improvement. ANS indices during ISCLS flares might serve as useful biomarkers, able to timely announce the transition from one phase to the subsequent one, thus helping to adapt therapy accordingly.
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Affiliation(s)
- Maddalena Alessandra Wu
- Division of Internal Medicine, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital–Polo Universitario—University of Milan, Milan, Italy
| | - Emanuele Catena
- Division of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital–Polo Universitario—University of Milan, Milan, Italy
| | - Antonio Castelli
- Division of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital–Polo Universitario—University of Milan, Milan, Italy
| | - Roberto Rech
- Division of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital–Polo Universitario—University of Milan, Milan, Italy
| | - Beatrice Borghi
- Division of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital–Polo Universitario—University of Milan, Milan, Italy
| | - Davide Ottolina
- Division of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital–Polo Universitario—University of Milan, Milan, Italy
| | - Tommaso Fossali
- Division of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital–Polo Universitario—University of Milan, Milan, Italy
| | - Chiara Cogliati
- Division of Internal Medicine, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital–Polo Universitario—University of Milan, Milan, Italy
| | - Riccardo Colombo
- Division of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital–Polo Universitario—University of Milan, Milan, Italy
- * E-mail:
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12
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Marmarelis V, Shin D, Zhang R. Closed-Loop Dynamic Modeling of the Heart-Rate Reflex to Concurrent Spontaneous Changes of Arterial Blood Pressure and CO2 Tension: Quantification of the Effects of Mild Cognitive Impairment. IEEE Trans Biomed Eng 2021; 68:3347-3355. [PMID: 33819147 DOI: 10.1109/tbme.2021.3070900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To extend closed-loop modeling of the heart-rate reflex (HRR) by including the dynamic effects of concurrent changes in blood CO2 tension. This extended dynamic model can be used to generate physio-markers of "baroreflex gain" (BRG) and "chemoreflex gain" (CRG) that allow quantitative assessment of the possible impact of pathologies upon HRR. Mild Cognitive Impairment (MCI) is used as an example. METHODS The proposed data-based closed-loop modeling methodology estimates the forward and reverse dynamic components of the model via Laguerre kernel expansions of two open-loop models using spontaneous time-series data collected in 45 MCI patients and 15 controls. The BRG and CRG physio-markers are subsequently computed for each subject via simulation of the obtained closed-loop model for unit-step change of arterial pressure or blood CO2 tension, respectively. RESULTS Both open-loop and closed-loop HRR modeling revealed that MCI patients exhibit significantly smaller CRG relative to controls (p<0.001), but not significantly different BRG. Furthermore, the closed-loop model captured the dynamic effect of sympathetic activity as resonant peak around 0.1 Hz (Mayer wave) in the chemoreflex and baroreflex transfer functions (not captured via open-loop modeling). This may prove valuable in advancing our understanding of how sympathetic activity impacts HRR in various pathologies. CONCLUSION The extended HRR model, incorporating the dynamic effects of concurrent changes of blood CO2 tension, revealed significantly reduced chemoreflex gain (but not baroreflex gain) in MCI patients. Furthermore, the closed-loop model captured the sympathetic influence around 0.1 Hz. SIGNIFICANCE Multivariate closed-loop dynamic modeling is valuable for understanding physiological autoregulation.
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13
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Kathpalia A, Nagaraj N. Time-Reversibility, Causality and Compression-Complexity. ENTROPY 2021; 23:e23030327. [PMID: 33802138 PMCID: PMC8000281 DOI: 10.3390/e23030327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/04/2021] [Accepted: 03/07/2021] [Indexed: 12/30/2022]
Abstract
Detection of the temporal reversibility of a given process is an interesting time series analysis scheme that enables the useful characterisation of processes and offers an insight into the underlying processes generating the time series. Reversibility detection measures have been widely employed in the study of ecological, epidemiological and physiological time series. Further, the time reversal of given data provides a promising tool for analysis of causality measures as well as studying the causal properties of processes. In this work, the recently proposed Compression-Complexity Causality (CCC) measure (by the authors) is shown to be free of the assumption that the "cause precedes the effect", making it a promising tool for causal analysis of reversible processes. CCC is a data-driven interventional measure of causality (second rung on the Ladder of Causation) that is based on Effort-to-Compress (ETC), a well-established robust method to characterize the complexity of time series for analysis and classification. For the detection of the temporal reversibility of processes, we propose a novel measure called the Compressive Potential based Asymmetry Measure. This asymmetry measure compares the probability of the occurrence of patterns at different scales between the forward-time and time-reversed process using ETC. We test the performance of the measure on a number of simulated processes and demonstrate its effectiveness in determining the asymmetry of real-world time series of sunspot numbers, digits of the transcedental number π and heart interbeat interval variability.
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Affiliation(s)
- Aditi Kathpalia
- Department of Complex Systems, Institute of Computer Science of the Czech Academy of Sciences, Czech Academy of Sciences, Pod Vodárenskou věží 271/2, 182 07 Prague, Czech Republic
- Consciousness Studies Programme, National Institute of Advanced Studies (NIAS), Indian Institute of Science Campus, Bengaluru 560012, India;
- Correspondence:
| | - Nithin Nagaraj
- Consciousness Studies Programme, National Institute of Advanced Studies (NIAS), Indian Institute of Science Campus, Bengaluru 560012, India;
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14
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Porta A, Fantinato A, Bari V, Gelpi F, Cairo B, De Maria B, Bertoldo EG, Fiolo V, Callus E, De Vincentiis C, Volpe M, Molfetta R, Ranucci M. Evaluation of the impact of surgical aortic valve replacement on short-term cardiovascular and cerebrovascular controls through spontaneous variability analysis. PLoS One 2020; 15:e0243869. [PMID: 33301491 PMCID: PMC7728248 DOI: 10.1371/journal.pone.0243869] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/30/2020] [Indexed: 11/25/2022] Open
Abstract
We assessed the effect of surgical aortic valve replacement (SAVR) on cardiovascular and cerebrovascular controls via spontaneous variability analyses of heart period, approximated as the temporal distance between two consecutive R-wave peaks on the electrocardiogram (RR), systolic, diastolic and mean arterial pressure (SAP, DAP and MAP) and mean cerebral blood flow (MCBF). Powers in specific frequency bands, complexity, presence of nonlinear dynamics and markers of cardiac baroreflex and cerebral autoregulation were calculated. Variability series were acquired before (PRE) and after (POST) SAVR in 11 patients (age: 76±5 yrs, 7 males) at supine resting and during active standing. Parametric spectral analysis was performed based on the autoregressive model. Complexity was assessed via a local nonlinear prediction approach exploiting the k-nearest-neighbor strategy. The presence of nonlinear dynamics was checked by comparing the complexity marker computed over the original series with the distribution of the same index assessed over a set of surrogates preserving distribution and power spectral density of the original series. Cardiac baroreflex and cerebral autoregulation were estimated by assessing the transfer function from SAP to RR and from MAP to MCBF and squared coherence function via the bivariate autoregressive approach. We found that: i) orthostatic challenge had no effect on cardiovascular and cerebrovascular control markers in PRE; ii) RR variance was significantly reduced in POST; iii) complexity of SAP, DAP and MAP variabilities increased in POST with a greater likelihood of observing nonlinear dynamics over SAP compared to PRE at supine resting; iv) the amplitude of MCBF variations and MCBF complexity in POST remained similar to PRE; v) cardiac baroreflex sensitivity decreased in POST, while cerebrovascular autoregulation was preserved. SAVR induces important changes of cardiac and vascular autonomic controls and baroreflex regulation in patients exhibiting poor reactivity of cardiovascular regulatory mechanisms, while cerebrovascular autoregulation seems to be less affected.
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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, Milan, Italy
- * E-mail:
| | - Angela Fantinato
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Vlasta Bari
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Francesca Gelpi
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Beatrice Cairo
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | | | - Valentina Fiolo
- Clinical Psychology Service, IRCCS Policlinico San Donato, Milan, Italy
| | - Edward Callus
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Clinical Psychology Service, IRCCS Policlinico San Donato, Milan, Italy
| | | | - Marianna Volpe
- Department of Cardiac Rehabilitation, IRCCS Policlinico San Donato, Milan, Italy
| | - Raffaella Molfetta
- Department of Cardiac Rehabilitation, IRCCS Policlinico San Donato, Milan, Italy
| | - Marco Ranucci
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
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15
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Ishbulatov YM, Karavaev AS, Kiselev AR, Simonyan MA, Prokhorov MD, Ponomarenko VI, Mironov SA, Gridnev VI, Bezruchko BP, Shvartz VA. Mathematical modeling of the cardiovascular autonomic control in healthy subjects during a passive head-up tilt test. Sci Rep 2020; 10:16525. [PMID: 33020530 PMCID: PMC7536219 DOI: 10.1038/s41598-020-71532-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/18/2020] [Indexed: 01/10/2023] Open
Abstract
A mathematical model is proposed for the autonomic control of cardiovascular system, which takes into account two separated self-exciting sympathetic control loops of heart rate and peripheral vascular tone. The control loops are represented by self-exciting time-delay systems and their tone depends on activity of the aortic, carotid, and lower-body baroreceptors. The model is used to study the dynamics of the adaptive processes that manifest in a healthy cardiovascular system during the passive head-up tilt test. Computer simulation provides continuous observation of the dynamics of the indexes and variables that cannot be measured in the direct experiment, including the noradrenaline concentration in vessel wall and heart muscle, tone of the sympathetic and parasympathetic control, peripheral vascular resistance, and blood pressure. In the supine and upright positions, we estimated the spectral characteristics of the model variables, especially in the low-frequency band, and the original index of total percent of phase synchronization between the low-frequency oscillations in heart rate and blood pressure signals. The model demonstrates good quantitative agreement with the dynamics of the experimentally observed indexes of cardiovascular system that were averaged for 50 healthy subjects.
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Affiliation(s)
- Yurii M Ishbulatov
- Department of Innovative Cardiological Information Technology, Institute of Cardiological Research, Saratov State Medical University, Saratov, Russia.,Department of Surgical Treatment for Interactive Pathology, Bakulev Scientific Center for Cardiovascular Surgery, Moscow, Russia
| | - Anatoly S Karavaev
- Department of Innovative Cardiological Information Technology, Institute of Cardiological Research, Saratov State Medical University, Saratov, Russia.,Laboratory of Nonlinear Dynamics Modeling, Saratov Branch of the Institute of Radio Engineering and Electronics of Russian Academy of Sciences, Saratov, Russia.,Department of Dynamic Modeling and Biomedical Engineering, Saratov State University, Saratov, Russia
| | - Anton R Kiselev
- Department of Innovative Cardiological Information Technology, Institute of Cardiological Research, Saratov State Medical University, Saratov, Russia. .,Department of Surgical Treatment for Interactive Pathology, Bakulev Scientific Center for Cardiovascular Surgery, Moscow, Russia. .,Department of Dynamic Modeling and Biomedical Engineering, Saratov State University, Saratov, Russia.
| | - Margarita A Simonyan
- Department of Atherocslerosis and Chronic Ischemic Heart Disease, Institute of Cardiological Research, Saratov, Russia
| | - Mikhail D Prokhorov
- Laboratory of Nonlinear Dynamics Modeling, Saratov Branch of the Institute of Radio Engineering and Electronics of Russian Academy of Sciences, Saratov, Russia
| | - Vladimir I Ponomarenko
- Laboratory of Nonlinear Dynamics Modeling, Saratov Branch of the Institute of Radio Engineering and Electronics of Russian Academy of Sciences, Saratov, Russia.,Department of Dynamic Modeling and Biomedical Engineering, Saratov State University, Saratov, Russia
| | - Sergey A Mironov
- Department of Innovative Cardiological Information Technology, Institute of Cardiological Research, Saratov State Medical University, Saratov, Russia
| | - Vladimir I Gridnev
- Department of Innovative Cardiological Information Technology, Institute of Cardiological Research, Saratov State Medical University, Saratov, Russia.,Department of Dynamic Modeling and Biomedical Engineering, Saratov State University, Saratov, Russia
| | - Boris P Bezruchko
- Laboratory of Nonlinear Dynamics Modeling, Saratov Branch of the Institute of Radio Engineering and Electronics of Russian Academy of Sciences, Saratov, Russia.,Department of Dynamic Modeling and Biomedical Engineering, Saratov State University, Saratov, Russia
| | - Vladimir A Shvartz
- Department of Surgical Treatment for Interactive Pathology, Bakulev Scientific Center for Cardiovascular Surgery, Moscow, Russia
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16
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Mechanical somatosensory stimulation decreases blood pressure in patients with Parkinson's disease. J Hypertens 2020; 37:1714-1721. [PMID: 31107357 DOI: 10.1097/hjh.0000000000002084] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The current study aimed to assess the effects of five cycles of automated mechanical somatosensory stimulation (AMSS) of the fore-feet on blood pressure (BP) and cardiovascular autonomic control in Parkinson's Disease patients. METHODS Out of 23 patients, 16 underwent an AMSS session every 72 h, for a total of five sessions per patient. Electrocardiogram, noninvasive beat-to-beat blood pressure and respiratory activity were recorded for 20 min in supine position at baseline and after the AMSS sessions. Main outcomes were the changes in SBP and DBP, in the spectral indices of cardiac sympathetic (LFRRn.u.) and vagal (HFRR) modulatory activities, cardiac sympathovagal relationship (LF/HF), vascular sympathetic modulation (LFSAP) and arterial baroreflex sensitivity (sequence technique). Symbolic analysis of heart rate variability provided additional indices of cardiac sympathetic (0V%) and vagal (2UV%) modulation to the sinoatrial node. RESULTS After five AMSS trials a reduction in SBP (baseline: 131.2 ± 15.5 mmHg; post-AMSS: 122.4 ± 16.2 mmHg; P = 0.0004) and DBP (baseline: 73.2 ± 6.1 mmHg; post-AMSS: 68.9 ± 6.2 mmHg; P = 0.008) was observed. Post-AMSS, spectral and symbolic indices of cardiovascular sympathetic control decreased and arterial baroreflex sensitivity increased (baseline: 5.7 ± 1.3 ms/mmHg; post-AMSS: 11.27 ± 2.7 ms/mmHg). CONCLUSION AMSS sessions were effective in reducing BP, increasing baroreflex sensitivity and decreasing cardiovascular sympathetic modulation in Parkinson's disease patients. AMSS might be useful to control supine hypertension in Parkinson's disease.
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17
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La Rovere MT, Porta A, Schwartz PJ. Autonomic Control of the Heart and Its Clinical Impact. A Personal Perspective. Front Physiol 2020; 11:582. [PMID: 32670079 PMCID: PMC7328903 DOI: 10.3389/fphys.2020.00582] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 05/11/2020] [Indexed: 12/21/2022] Open
Abstract
This essay covers several aspects of the autonomic control of the heart, all relevant to cardiovascular pathophysiology with a direct impact on clinical outcomes. Ischemic heart disease, heart failure, channelopathies, and life-threatening arrhythmias are in the picture. Beginning with an overview on some of the events that marked the oscillations in the medical interest for the autonomic nervous system, our text explores specific areas, including experimental and clinical work focused on understanding the different roles of tonic and reflex sympathetic and vagal activity. The role of the baroreceptors, not just for the direct control of circulation but also because of the clinical value of interpreting alterations (spontaneous or induced) in their function, is discussed. The importance of the autonomic nervous system for gaining insights on risk stratification and for providing specific antiarrhythmic protection is also considered. Examples are the interventions to decrease sympathetic activity and/or to increase vagal activity. The non-invasive analysis of the RR and QT intervals provides additional information. The three of us have collaborated in several studies and each of us contributes with very specific and independent areas of expertise. Here, we have focused on those areas to which we have directly contributed and hence speak with personal experience. This is not an attempt to provide a neutral and general overview on the autonomic nervous system; rather, it represents our effort to share and provide the readers with our own personal views matured after many years of research in this field.
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Affiliation(s)
- Maria Teresa La Rovere
- Department of Cardiology, IRCCS Istituti Clinici Scientifici Maugeri, Montescano (Pavia), Italy
| | - 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, Milan, Italy
| | - Peter J Schwartz
- Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Istituto Auxologico Italiano, IRCCS, Milan, Italy
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18
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Colombo R, Wu MA, Perotti A, Saia L, Fossali T, Ottolina D, Borghi B, Castelli A, Rech R, Cogliati C, Catena E. Tethering role of the autonomic nervous system on cardioventilatory coupling. Respir Physiol Neurobiol 2020; 279:103466. [PMID: 32454241 DOI: 10.1016/j.resp.2020.103466] [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: 11/09/2019] [Revised: 04/10/2020] [Accepted: 05/10/2020] [Indexed: 11/28/2022]
Abstract
Hypovolemia and intermittent positive pressure ventilation are conditions that frequently characterize the state of critical illness, but their interaction and resulting cardioventilatory coupling is poorly understood even in healthy humans. We explored heart rate variability, baroreflex activity, and their interaction in an experimental protocol involving twelve mildly hypovolemic healthy subjects during spontaneous breathing and noninvasive positive-pressure ventilation. In seven subjects, an echocardiographic assessment was also performed. Correction of hypovolemia, raising cardiac preload, produced an increase in high-frequency spectral power density of heart rate, left low-frequency spectral power density unchanged but enhanced baroreflex sensitivity. Cardioventilatory coupling was affected by both central blood volume and ventilatory mode and was mainly entrained by the respiratory oscillation. In conclusion, the autonomic nervous system and baroreflex have a significant role in compensating the hemodynamic perturbation due to changes of volemia and ventilatory-induced fluctuations of venous return. They exert an integrative function on the adaptive pattern of cardioventilatory coupling.
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Affiliation(s)
- Riccardo Colombo
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital - Polo Universitario, University of Milan, Milan, Italy.
| | - Maddalena Alessandra Wu
- Department of Internal Medicine, ASST Fatebenefratelli Sacco, "Luigi Sacco" Hospital - Polo Universitario - University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy
| | - Andrea Perotti
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital - Polo Universitario, University of Milan, Milan, Italy
| | - Laura Saia
- School of Anesthesia and Intensive Care, University of Milan, Milan, Italy
| | - Tommaso Fossali
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital - Polo Universitario, University of Milan, Milan, Italy
| | - Davide Ottolina
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital - Polo Universitario, University of Milan, Milan, Italy
| | - Beatrice Borghi
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital - Polo Universitario, University of Milan, Milan, Italy
| | - Antonio Castelli
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital - Polo Universitario, University of Milan, Milan, Italy
| | - Roberto Rech
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital - Polo Universitario, University of Milan, Milan, Italy
| | - Chiara Cogliati
- Department of Internal Medicine, ASST Fatebenefratelli Sacco, "Luigi Sacco" Hospital - Polo Universitario - University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy
| | - Emanuele Catena
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital - Polo Universitario, University of Milan, Milan, Italy
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19
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Wessel N, Gapelyuk A, Kraemer JF, Berg K, Kurths J. Spontaneous baroreflex sensitivity: sequence method at rest does not quantify causal interactions but rather determines the heart rate to blood pressure variability ratio. Physiol Meas 2020; 41:03LT01. [PMID: 32160607 DOI: 10.1088/1361-6579/ab7edc] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- N Wessel
- Humboldt-Universität zu Berlin, Berlin, Germany
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20
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He Z. The control mechanisms of heart rate dynamics in a new heart rate nonlinear time series model. Sci Rep 2020; 10:4814. [PMID: 32179768 PMCID: PMC7075874 DOI: 10.1038/s41598-020-61562-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/21/2020] [Indexed: 12/19/2022] Open
Abstract
The control mechanisms and implications of heart rate variability (HRV) under the sympathetic (SNS) and parasympathetic nervous system (PNS) modulation remain poorly understood. Here, we establish the HR model/HRV responder using a nonlinear process derived from Newton's second law in stochastic self-restoring systems through dynamic analysis of physiological properties. We conduct model validation by testing, predictions, simulations, and sensitivity and time-scale analysis. We confirm that the outputs of the HRV responder can be accepted as the real data-generating process. Empirical studies show that the dynamic control mechanism of heart rate is a stable fixed point, rather than a strange attractor or transitions between a fixed point and a limit cycle; HR slope (amplitude) may depend on the ratio of cardiac disturbance or metabolic demand mean (standard deviation) to myocardial electrical resistance (PNS-SNS activity). For example, when metabolic demands remain unchanged, HR amplitude depends on PNS to SNS activity; when autonomic activity remains unchanged, HR amplitude during resting reflects basal metabolism. HR parameter alterations suggest that age-related decreased HRV, ultrareduced HRV in heart failure, and ultraelevated HRV in ST segment alterations refer to age-related decreased basal metabolism, impaired myocardial metabolism, and SNS hyperactivity triggered by myocardial ischemia, respectively.
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Affiliation(s)
- Zonglu He
- Faculty of Management and Economics, Kaetsu University, 2-8-4 Minami-cho, Hanakoganei, Kodaira-shi, Tokyo, 187-8578, Japan.
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21
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de Abreu RM, Catai AM, Cairo B, Rehder-Santos P, da Silva CD, Signini ÉDF, Sakaguchi CA, Porta A. A Transfer Entropy Approach for the Assessment of the Impact of Inspiratory Muscle Training on the Cardiorespiratory Coupling of Amateur Cyclists. Front Physiol 2020; 11:134. [PMID: 32158402 PMCID: PMC7052290 DOI: 10.3389/fphys.2020.00134] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 02/07/2020] [Indexed: 12/23/2022] Open
Abstract
The strength of cardiorespiratory interactions diminishes with age. Physical exercise can reduce the rate of this trend. Inspiratory muscle training (IMT) is a technique capable of improving cardiorespiratory interactions. This study evaluates the effect of IMT on cardiorespiratory coupling in amateur cyclists. Thirty male young healthy cyclists underwent a sham IMT of very low intensity (SHAM, n = 9), an IMT of moderate intensity at 60% of the maximal inspiratory pressure (MIP60, n = 10) and an IMT of high intensity at the critical inspiratory pressure (CIP, n = 11). Electrocardiogram, non-invasive arterial pressure, and thoracic respiratory movement (RM) were recorded before (PRE) and after (POST) training at rest in supine position (REST) and during active standing (STAND). The beat-to-beat series of heart period (HP) and systolic arterial pressure (SAP) were analyzed with the RM signal via a traditional non-causal approach, such as squared coherence function, and via a causal model-based transfer entropy (TE) approach. Cardiorespiratory coupling was quantified via the HP-RM squared coherence at the respiratory rate (K 2 HP-R M), the unconditioned TE from RM to HP (TER M → HP) and the TE from RM to HP conditioned on SAP (TER M → HP| SAP). In PRE condition we found that STAND led to a decrease of TER M → HP| SAP. After SHAM and CIP training this tendency was confirmed, while MIP60 inverted it by empowering cardiorespiratory coupling. This behavior was observed in presence of unvaried SAP mean and with usual responses of the baroreflex control and HP mean to STAND. TER M → HP and K 2 HP- RM were not able to detect the post-training increase of cardiorespiratory coupling strength during STAND, thus suggesting that conditioning out SAP is important for the assessment of cardiorespiratory interactions. Since the usual response of HP mean, SAP mean and baroreflex sensitivity to postural stressor were observed after MIP60 training, we conclude that the post-training increase of cardiorespiratory coupling during STAND in MIP60 group might be the genuine effect of some rearrangements at the level of central respiratory network and its interactions with sympathetic drive and vagal activity.
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Affiliation(s)
| | - Aparecida Maria Catai
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - Beatrice Cairo
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | | | | | | | - 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, Milan, Italy
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22
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Porta A, Elstad M. Editorial: Probing the Cardiac Arm of the Baroreflex and Complementary Branches. Front Neurosci 2020; 13:1422. [PMID: 31998069 PMCID: PMC6967736 DOI: 10.3389/fnins.2019.01422] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 12/16/2019] [Indexed: 11/19/2022] Open
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, Milan, Italy
| | - Maja Elstad
- Division of Physiology, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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23
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Abreu RM, Catai AM, Cairo B, Rehder-Santos P, Maria BD, Vaini E, Bari V, Porta A. Assessment of the Coupling Strength of Cardiovascular Control via Joint Symbolic Analysis during Postural Challenge in Recreational Athletes. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:2011-2014. [PMID: 31946295 DOI: 10.1109/embc.2019.8857213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Short-term cardiovascular control, comprising cardiac baroreflex and mechanisms governing cardiac contractility and vascular properties, links heart period (HP) and systolic arterial pressure (SAP) fluctuations. It is activated during postural challenge and this activation is traditionally quantified via linear tools such as HP-SAP squared coherence function. In this study the ability of a nonlinear bivariate tool based on joint symbolic analysis (JSA) approach was tested against HP-SAP coherence function during orthostatic challenge in recreational athletes. We studied 9 men healthy cycling practitioners (age: 20-40 yrs) at rest in supine condition (REST) and during active standing (STAND). The JSA method is based on the definition of symbolic HP and SAP patterns and on the evaluation of the rate of their simultaneous occurrence in both HP and SAP series. HP-SAP squared coherence was computed in the low frequency band (LF, from 0.04 to 0.15 Hz). We found the expected response to the postural stimulus, namely the increase of sympathetic modulation and the contemporaneous vagal withdrawal. However, only JSA was able to detect the expected increase of association between HP and SAP variability series over slow time scales. This result suggests that recreational athletes have more relevant nonlinear interactions between HP and SAP that might be missed by traditional linear tools and might require nonlinear tools to be efficiently described.
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Cairo B, Bari V, De Maria B, Vaini E, Guaraldi P, Lucini D, Pagani M, Provini F, Buonaura GC, Cortelli P, Porta A. Assessing Synergy/Redundancy of Baroreflex and Non-Baroreflex Components of the Cardiac Control during Sleep. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:4953-4956. [PMID: 31946971 DOI: 10.1109/embc.2019.8856887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cardiovascular regulation and autonomic function change across sleep stages and compared to wake. Little information is present in literature about cardiac control during sleep especially in relation to new information-theoretic quantities such as synergy and redundancy. In the present work we compute synergy and redundancy of baroreflex and non-baroreflex components of the cardiac control according to two information-theoretic approaches, namely predictive information decomposition (PID) and minimal mutual information (MMI) methods. We applied a bivariate approach to heart period (HP) and systolic arterial pressure (SAP) beat-to-beat variability series during sleep in a healthy subject. PID approach computes the net balance between synergy and redundancy, while MMI calculates the two quantities as separate entities. Results suggested that: i) redundancy was dominant over synergy during NREM phases; ii) redundancy increased during NREM phase; iii) synergy did not change across the sleep stages. We interpret this result as a consequence of the vagal enhancement, slowing and deepening of respiration during NREM phases. These preliminary findings support the potential of assessing redundancy/synergy of baroreflex-related and unrelated regulations during sleep to improve our knowledge about physiological mechanisms.
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Bari V, Vaini E, Pistuddi V, Fantinato A, Cairo B, De Maria B, Dalla Vecchia LA, Ranucci M, Porta A. Comparison of Causal and Non-causal Strategies for the Assessment of Baroreflex Sensitivity in Predicting Acute Kidney Dysfunction After Coronary Artery Bypass Grafting. Front Physiol 2019; 10:1319. [PMID: 31681021 PMCID: PMC6813722 DOI: 10.3389/fphys.2019.01319] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 09/30/2019] [Indexed: 01/07/2023] Open
Abstract
Coronary artery bypass graft (CABG) surgery may lead to postoperative complications such as the acute kidney dysfunction (AKD), identified as any post-intervention increase of serum creatinine level. Cardiovascular control reflexes like the baroreflex can play a role in the AKD development. The aim of this study is to test whether baroreflex sensitivity (BRS) estimates derived from non-causal and causal approaches applied to spontaneous systolic arterial pressure (SAP) and heart period (HP) fluctuations can help in identifying subjects at risk of developing AKD after CABG and which BRS estimates provide the best performance. Electrocardiogram and invasive arterial pressure were acquired from 129 subjects (67 ± 10 years, 112 males) before (PRE) and after (POST) general anesthesia induction with propofol and remifentanil. Subjects were divided into AKDs (n = 29) or no AKDs (noAKDs, n = 100) according to the AKD development after CABG. The non-causal approach assesses the transfer function from the HP-SAP cross-spectrum in the low frequency (LF, 0.04–0.15 Hz) band. BRS was estimated according to three strategies: (i) sampling of the transfer function gain at the maximum of the HP-SAP squared coherence in the LF band; (ii) averaging of the transfer function gain in the LF band; (iii) sampling of the transfer function gain at the weighted central frequency of the spectral components of the SAP series dropping in the LF band. The causal approach separated the two arms of cardiovascular control (i.e., from SAP to HP and vice versa) and accounted for the confounding influences of respiration via system identification and modeling techniques. The causal approach provided a direct estimate of the gain from SAP to HP by observing the HP response to a simulated SAP rise from the identified model structure. Results show that BRS was significantly lower in AKDs than noAKDs during POST regardless of the strategy adopted for its computation. Moreover, all the BRS estimates during POST remained associated with AKD even after correction for demographic and clinical factors. Non-causal and causal BRS estimates exhibited similar performances. Baroreflex impairment is associated with post-CABG AKD and both non-causal and causal methods can be exploited to improve risk stratification of AKD after CABG.
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Affiliation(s)
- Vlasta Bari
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Emanuele Vaini
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Valeria Pistuddi
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Angela Fantinato
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Beatrice Cairo
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | | | - Marco Ranucci
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Alberto Porta
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Martins de Abreu R, Porta A, Rehder-Santos P, Cairo B, Donisete da Silva C, De Favari Signini É, Sakaguchi CA, Catai AM. Effects of inspiratory muscle-training intensity on cardiovascular control in amateur cyclists. Am J Physiol Regul Integr Comp Physiol 2019; 317:R891-R902. [PMID: 31596110 DOI: 10.1152/ajpregu.00167.2019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Chronic effects of inspiratory muscle training (IMT) on autonomic function and baroreflex regulation are poorly studied. This study aims at evaluating chronic effects of different IMT intensities on cardiovascular control in amateur cyclists. A longitudinal, randomized, controlled blind study was performed on 30 recreational male cyclists undergoing IMT for 11 wk. Participants were randomly allocated into sham-trained group (SHAM, n = 9), trained group at 60% of the maximal inspiratory pressure (MIP60, n = 10), and trained group at critical inspiratory pressure (CIP, n = 11). Electrocardiogram, finger arterial pressure, and respiratory movements were recorded before (PRE) and after (POST) training at rest in supine position (REST) and during active standing (STAND). From the beat-to-beat series of heart period (HP) and systolic arterial pressure (SAP), we computed time domain markers, frequency domain indexes in the low frequency (0.04-0.15 Hz) and high frequency (HF, 0.15-0.4 Hz) bands, an entropy-based complexity index (CI), and baroreflex markers estimated from spontaneous HP-SAP sequences. Compared with SHAM, the positive effect of MIP60 over the HP series led to the HF power increase during REST (PRE: 521.2 ± 447.5 ms2; POST: 1,161 ± 878.9 ms2) and the CI rise during STAND (PRE: 0.82 ± 0.18; POST: 0.97 ± 0.13). Conversely, the negative effect of CIP took the form of the decreased HP mean during STAND (PRE: 791 ± 71 ms; POST: 737 ± 95 ms). No effect of IMT was visible over SAP and baroreflex markers. These findings suggest that moderate-intensity IMT might be beneficial when the goal is to limit cardiac sympathetic hyperactivity at REST and/or in response to STAND.
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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
| | - Patricia Rehder-Santos
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Beatrice Cairo
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Étore De Favari Signini
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Camila Akemi Sakaguchi
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Aparecida Maria Catai
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
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Brunetta E, Shiffer D, Mandelli P, Achenza S, Folci M, Zumbo A, Minonzio M, Cairo B, Jacob G, Boccassini L, Puttini PS, Porta A, Furlan R. Autonomic Abnormalities in Patients With Primary Sjogren's Syndrome - Preliminary Results. Front Physiol 2019; 10:1104. [PMID: 31551801 PMCID: PMC6736624 DOI: 10.3389/fphys.2019.01104] [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: 01/10/2019] [Accepted: 08/08/2019] [Indexed: 12/31/2022] Open
Abstract
Primary Sjögren's syndrome (pSS) is an autoimmune disease affecting exocrine glands and extra-glandular organs. There are conflicting reports on the presence of autonomic dysfunction in pSS and no data are available on the functional status of sympathetic outflow to the vessels and baroreceptor [baroreflex sensitivity (BRS)] control mechanisms. We investigated the cardiac (cBRS) and sympathetic (sBRS) baroreceptor modulation in both time and frequency domains and the cardiovascular autonomic profile in pSS patients compared to healthy controls. Autonomic symptoms were quantified by the Composite Autonomic Symptom Scale (COMPASS31) three-item questionnaire. The EULAR Sjogren's syndrome patient reported index (ESSPRI) questionnaire evaluated the magnitude of pSS clinical symptoms, i.e., fatigue, pain, and sicca symptoms. Electrocardiogram, beat-by-beat arterial pressure (AP) and respiratory activity were continuously recorded in 17 pSS patients and 16 healthy controls, while supine and during 75° head-up tilt. In seven patients and seven controls, muscle sympathetic nerve activity (MSNA) was measured. Spectrum analysis of RR variability provided markers of cardiac vagal modulation (HFRR nu) and sympatho-vagal balance [low frequency (LF)/high frequency (HF)]. The power of LF (0.1 Hz) oscillations of systolic arterial pressure (SAP) variability (LFSAP) evaluated the vasomotor response to sympathetic stimulation. Compared to controls, pSS patients scored higher in total COMPASS31 (p < 0.0001) and all ESSPRI subdomains (fatigue, p = 0.005; pain, p = 0.0057; dryness, p < 0.0001). Abnormal scialometry (<1.5 ml/15 min) and Schirmer tests (<5 mm/5 min) were found in pSS patients and salivary flow rate was negatively associated with ESSPRI dryness (p = 0.0014). While supine, pSS patients had lower SEQcBRS index of cardiac baroreceptor sensitivity, higher HFRRnu (p = 0.021), lower LF/HF (p = 0.007), and greater MSNA (p = 0.038) than controls. No differences were observed in LFSAP between groups. During orthostatic challenge, although LFSAP increased similarly in both groups, MSNA was greater in pSS patients (p = 0.003). At rest pSS patients showed lower cBR control and greater parasympathetic modulation. Furthermore, greater sympathetic nerve activity was observed in pSS patients while supine and in response to gravitational challenge. We hypothesized that such enhanced sympathetic vasoconstrictor activity might reflect an attempt to maintain blood pressure in a setting of likely reduced vascular responsiveness.
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Affiliation(s)
- Enrico Brunetta
- Department of Internal Medicine, Humanitas Clinical and Research Center - IRCCS, Milan University, Milan, Italy
| | - Dana Shiffer
- Department of Internal Medicine, Humanitas Clinical and Research Center - IRCCS, Milan University, Milan, Italy
| | - Pietro Mandelli
- Department of Pathophysiology and Transplantation, Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Sara Achenza
- Department of Nephrology, Humanitas Clinical and Research Center - IRCCS, Milan University, Milan, Italy
| | - Marco Folci
- Department of Internal Medicine, Humanitas Clinical and Research Center - IRCCS, Milan University, Milan, Italy
| | - Aurora Zumbo
- Department of Internal Medicine, Humanitas Clinical and Research Center - IRCCS, Milan University, Milan, Italy
| | - Maura Minonzio
- Department of Internal Medicine, Humanitas Clinical and Research Center - IRCCS, Milan University, Milan, Italy
| | - Beatrice Cairo
- Department of Biomedical Sciences for Health, Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Giris Jacob
- Department of Internal Medicine F, J. Recanati Autonomic Dysfunction Center, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Laura Boccassini
- Reumathology Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Piercarlo Sarzi Puttini
- Reumathology Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Alberto Porta
- Department of Biomedical Sciences for Health, Faculty of Medicine and Surgery, University of Milan, Milan, Italy.,Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Raffaello Furlan
- Department of Internal Medicine, Humanitas Clinical and Research Center - IRCCS, Milan University, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
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De Maria B, Bari V, Cairo B, Vaini E, Martins de Abreu R, Perseguini NM, Milan-Mattos J, Rehder-Santos P, Minatel V, Catai AM, Dalla Vecchia LA, Porta A. Cardiac baroreflex hysteresis is one of the determinants of the heart period variability asymmetry. Am J Physiol Regul Integr Comp Physiol 2019; 317:R539-R551. [PMID: 31365303 DOI: 10.1152/ajpregu.00112.2019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In heart period (HP) variability (HPV) recordings the percentage of negative HP variations tends to be greater than that of positive ones and this pattern is referred to as HPV asymmetry (HPVA). HPVA has been studied in several experimental conditions in healthy and pathological populations, but its origin is unclear. The baroreflex (BR) exhibits an asymmetric behavior as well given that it reacts more importantly to positive than negative arterial pressure (AP) variations. We tested the hypothesis that the BR asymmetry (BRA) is a HPVA determinant over spontaneous fluctuations of HP and systolic AP (SAP). We studied 100 healthy subjects (age from 21 to 70 yr, 54 men) comprising 20 subjects in each age decade. Electrocardiogram and noninvasive AP were recorded for 15 min at rest in supine position (REST) and during active standing (STAND). The HPVA was evaluated via Porta's index and Guzik's index, while the BRA was assessed as the difference, and normalized difference, between BR sensitivities computed over positive and negative SAP variations via the sequence method applied to HP and SAP variability. HPVA significantly increased during STAND and decreased progressively with age. BRA was not significantly detected both at REST and during STAND. However, we found a significant positive association between BRA and HPVA markers during STAND persisting even within the age groups. This study supports the use of HPVA indexes as descriptors of BRA and identified a challenge soliciting the BR response like STAND to maximize the association between HPVA and BRA markers.
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Affiliation(s)
- Beatrice De Maria
- Istituto di Ricovero e Cura a Carattere Scientifico Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Vlasta Bari
- Department of Cardiothoracic, Vascular Anesthesia, and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Beatrice Cairo
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Emanuele Vaini
- Department of Cardiothoracic, Vascular Anesthesia, and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | | | - Juliana Milan-Mattos
- Department of Physiotherapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Patricia Rehder-Santos
- Department of Physiotherapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Vinícius Minatel
- Department of Physiotherapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Aparecida Maria Catai
- Department of Physiotherapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | | | - Alberto Porta
- Department of Cardiothoracic, Vascular Anesthesia, and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, San Donato Milanese, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Multiscale Information Decomposition Dissects Control Mechanisms of Heart Rate Variability at Rest and During Physiological Stress. ENTROPY 2019; 21:e21050526. [PMID: 33267240 PMCID: PMC7515015 DOI: 10.3390/e21050526] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/19/2019] [Accepted: 05/21/2019] [Indexed: 12/21/2022]
Abstract
Heart rate variability (HRV; variability of the RR interval of the electrocardiogram) results from the activity of several coexisting control mechanisms, which involve the influence of respiration (RESP) and systolic blood pressure (SBP) oscillations operating across multiple temporal scales and changing in different physiological states. In this study, multiscale information decomposition is used to dissect the physiological mechanisms related to the genesis of HRV in 78 young volunteers monitored at rest and during postural and mental stress evoked by head-up tilt (HUT) and mental arithmetics (MA). After representing RR, RESP and SBP at different time scales through a recently proposed method based on multivariate state space models, the joint information transfer TRESP,SBP→RR is decomposed into unique, redundant and synergistic components, describing the strength of baroreflex modulation independent of respiration (USBP→RR), nonbaroreflex (URESP→RR) and baroreflex-mediated (RRESP,SBP→RR) respiratory influences, and simultaneous presence of baroreflex and nonbaroreflex respiratory influences (SRESP,SBP→RR), respectively. We find that fast (short time scale) HRV oscillations—respiratory sinus arrhythmia—originate from the coexistence of baroreflex and nonbaroreflex (central) mechanisms at rest, with a stronger baroreflex involvement during HUT. Focusing on slower HRV oscillations, the baroreflex origin is dominant and MA leads to its higher involvement. Respiration influences independent on baroreflex are present at long time scales, and are enhanced during HUT.
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Delliaux S, Delaforge A, Deharo JC, Chaumet G. Mental Workload Alters Heart Rate Variability, Lowering Non-linear Dynamics. Front Physiol 2019; 10:565. [PMID: 31156454 PMCID: PMC6528181 DOI: 10.3389/fphys.2019.00565] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 04/24/2019] [Indexed: 01/06/2023] Open
Abstract
Mental workload is known to alter cardiovascular function leading to increased cardiovascular risk. Nevertheless, there is no clear autonomic nervous system unbalance to be quantified during mental stress. We aimed to characterize the mental workload impact on the cardiovascular function with a focus on heart rate variability (HRV) non-linear indexes. A 1-h computerized switching task (letter recognition) was performed by 24 subjects while monitoring their performance (accuracy, response time), electrocardiogram and blood pressure waveform (finger volume clamp method). The HRV was evaluated from the beat-to-beat RR intervals (RRI) in time-, frequency-, and informational- domains, before (Control) and during the task. The task induced a significant mental workload (visual analog scale of fatigue from 27 ± 26 to 50 ± 31 mm, p < 0.001, and NASA-TLX score of 56 ± 17). The heart rate, blood pressure and baroreflex function were unchanged, whereas most of the HRV parameters markedly decreased. The maximum decrease occurred during the first 15 min of the task (P1), before starting to return to the baseline values reached at the end of the task (P4). The RRI dimension correlation (D2) decrease was the most significant (P1 vs. Control: 1.42 ± 0.85 vs. 2.21 ± 0.8, p < 0.001) and only D2 lasted until the task ended (P4 vs. Control: 1.96 ± 0.9 vs. 2.21 ± 0.9, p < 0.05). D2 was identified as the most robust cardiovascular variable impacted by the mental workload as determined by posterior predictive simulations (p = 0.9). The Spearman correlation matrix highlighted that D2 could be a marker of the generated frustration (R = -0.61, p < 0.01) induced by a mental task, as well as the myocardial oxygen consumption changes assessed by the double product (R = -0.53, p < 0.05). In conclusion, we showed that mental workload sharply lowered the non-linear RRI dynamics, particularly the RRI correlation dimension.
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Affiliation(s)
- Stéphane Delliaux
- Aix Marseille Univ, INSERM, INRA, C2VN, Marseille, France
- Pôle Cardio-Vasculaire et Thoracique, Service des Explorations Fonctionnelles Respiratoires, AP-HM, Hôpital Nord, Marseille, France
| | - Alexis Delaforge
- Service de Médecine et Santé au Travail, AP-HM, Hôpital de la Timone, Marseille, France
| | - Jean-Claude Deharo
- Aix Marseille Univ, INSERM, INRA, C2VN, Marseille, France
- Pôle Cardio-Vasculaire et Thoracique, Service de Cardiologie, AP-HM, Hôpital de la Timone, Marseille, France
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De Maria B, Bari V, Cairo B, Vaini E, Esler M, Lambert E, Baumert M, Cerutti S, Dalla Vecchia L, Porta A. Characterization of the Asymmetry of the Cardiac and Sympathetic Arms of the Baroreflex From Spontaneous Variability During Incremental Head-Up Tilt. Front Physiol 2019; 10:342. [PMID: 31001137 PMCID: PMC6454064 DOI: 10.3389/fphys.2019.00342] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 03/13/2019] [Indexed: 11/13/2022] Open
Abstract
Hysteresis of the baroreflex (BR) is the result of the different BR sensitivity (BRS) when arterial pressure (AP) rises or falls. This phenomenon has been poorly studied and almost exclusively examined by applying pharmacological challenges and static approaches disregarding causal relations. This study inspects the asymmetry of the cardiac BR (cBR) and vascular sympathetic BR (sBR) in physiological closed loop conditions from spontaneous fluctuations of physiological variables, namely heart period (HP) and systolic AP (SAP) leading to the estimation of cardiac BRS (cBRS) and muscle sympathetic nerve activity (MSNA) and diastolic AP (DAP) leading to the estimation of vascular sympathetic BRS (sBRS). The assessment was carried out in 12 young healthy subjects undergoing incremental head-up tilt with table inclination gradually increased from 0 to 60°. Two analytical methods were exploited and compared, namely the sequence (SEQ) and phase-rectified signal averaging (PRSA) methods. SEQ analysis is based on the detection of joint causal schemes representing the HP and MSNA burst rate delayed responses to spontaneous SAP and DAP modifications, respectively. PRSA analysis averages HP and MSNA burst rate patterns after aligning them according to the direction of SAP and DAP changes, respectively. Since cBRSs were similar when SAP went up or down, hysteresis of cBR was not detected. Conversely, hysteresis of sBR was evident with sBRS more negative when DAP was falling than rising. sBR hysteresis was no longer visible during sympathetic activation induced by the orthostatic challenge. These results were obtained via the SEQ method, while the PRSA technique appeared to be less powerful in describing the BR asymmetry due to the strong association between BRS estimates computed over positive and negative AP variations. This study suggests that cBR and sBR provide different information about the BR control, sBR exhibits more relevant non-linear features that are evident even during physiological changes of AP, and the SEQ method can be fruitfully exploited to characterize the BR hysteresis with promising applications to BR branches different from cBR and sBR.
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Affiliation(s)
| | - Vlasta Bari
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Beatrice Cairo
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Emanuele Vaini
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Murray Esler
- Human Neurotransmitters Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Elisabeth Lambert
- Human Neurotransmitters Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia.,Faculty of Health, Arts and Design, Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Mathias Baumert
- School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, SA, Australia
| | - Sergio Cerutti
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | | | - Alberto Porta
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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de Oliveira Gois M, Porta A, Simões RP, Kunz VC, Driusso P, Hirakawa HS, De Maria B, Catai AM. The additional impact of type 2 diabetes on baroreflex sensitivity of coronary artery disease patients might be undetectable in presence of deterioration of mechanical vascular properties. Med Biol Eng Comput 2019; 57:1405-1415. [PMID: 30843124 DOI: 10.1007/s11517-019-01966-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 02/21/2019] [Indexed: 01/14/2023]
Abstract
Both deterioration of the mechanical vascular properties of barosensitive vessels and autonomic derangement lead to modification of baroreflex sensitivity (BRS) in coronary artery disease (CAD) individuals. Type 2 diabetes (T2D) reduces BRS as well even in absence of cardiac autonomic neuropathy. The aim of the study is to clarify whether, assigned the degree of mechanical vascular impairment and without cardiac autonomic neuropathy, the additional autonomic dysfunction imposed in CAD patients by T2D (CAD-T2D) decreases BRS further. We considered CAD (n = 18) and CAD-T2D (n = 19) males featuring similar increases of average carotid intima media thickness (ACIMT) and we compared them to age- and gender-matched healthy (H, n = 19) subjects. BRS was computed from spontaneous beat-to-beat variability of heart period (HP) and systolic arterial pressure (SAP) at supine resting (REST) and during active standing (STAND). BRS was estimated via methods including time domain, spectral, cross-spectral, and model-based techniques. We found that (i) at REST BRS was lower in CAD and CAD-T2D groups than in H subjects but no difference was detected between CAD and CAD-T2D individuals; (ii) STAND induced an additional decrease of BRS visible in all the groups but again BRS estimates of CAD and CAD-T2D patients were alike; (iii) even though with different statistical power, BRS markers reached similar conclusions with the notable exception of the BRS computed via model-based approach that did not detect the BRS decrease during STAND. In presence of a mechanical vascular impairment, indexes estimating BRS from spontaneous HP and SAP fluctuations might be useless to detect the additional derangement of the autonomic control in CAD-T2D without cardiac autonomic neuropathy compared to CAD, thus limiting the applications of cardiovascular variability analysis to typify CAD-T2D individuals. Graphical abstract Graphical representation of the baroreflex sensitivity (BRS) estimated from spontaneous fluctuations of heart period and systolic arterial pressure via transfer function (TF) in low frequency (LF) band (from 0.04 to 0.15 Hz). BRS was reported as a function of the group (i.e., healthy (H), coronary artery disease (CAD) and CAD with type 2 diabetes (CAD-T2D) groups) at REST (black bars) and during STAND (white bars). Values are shown as mean plus standard deviation. The symbol "*" indicates a significant difference between conditions within the same group (i.e., H, CAD, or CAD-T2D) and the symbol "§" indicates a significant difference between groups within the same experimental condition (i.e., REST or STAND). BRS cannot distinguish CAD and CAD-T2D groups both at REST and during STAND, while it is useful to distinguish experimental conditions and separate pathological groups from H subjects.
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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.
| | | | - Vandeni Clarice Kunz
- Adventist University Center of São Paulo, Campus Engenheiro Coelho, São Paulo, Brazil
| | - Patricia Driusso
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | | | | | - Aparecida Maria Catai
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
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Bari V, Vaini E, De Maria B, Cairo B, Pistuddi V, Ranucci M, Porta A. Comparison of Different Strategies to Assess Cardiac Baroreflex Sensitivity Based on Transfer Function Technique in Patients Undergoing General Anesthesia. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:2780-2783. [PMID: 30440978 DOI: 10.1109/embc.2018.8512782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Baroreflex sensitivity (BRS) can be noninvasively assessed from heart period (HP) and arterial pressure (AP) variability series via the estimation of the gain of the transfer function (TF) in the low frequency (LF, 0.04-0.15 Hz) band. However, different strategies can be adopted to pick the value of the TF gain and different fiducial AP values can be considered. In this study we compared different strategies to reduce the TF gain into a unique maker: i) sampling the TF gain in correspondence of the maximum of the HP-AP squared coherence; ii) sampling the TF gain at the weighted average of the central frequencies of AP spectral components; iii) calculating the average of the TF gain in the LF band. Indexes were computed using alternatively systolic AP (SAP) or diastolic AP (DAP) series in combination with HP. Results were obtained in 129 patients undergoing coronary artery bypass graft surgery before (PRE) and after (POST) the induction of general anesthesia with propofol and remifentanil. The reduction of BRS during general anesthesia is expected as a result of overall depression of the cardiovascular control even in this group of pathological subjects already featuring a low BRS before general anesthesia induction. We found that the expected decrease of BRS was observed regardless of the strategy using DAP. Moreover, regardless of series (i.e., SAP or DAP), the sampling of TF gain at the weighted average of the central frequencies of the AP spectral components has the greatest statistical power in distinguishing the two experimental conditions. We recommend the use of this strategy in assessing BRS via TF analysis and a more frequent exploitation of the DAP series.
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Porta A, Bari V, Maria BD, Cairo B, Vaini E, Malacarne M, Pagani M, Lucini D. Peripheral Resistance Baroreflex During Incremental Bicycle Ergometer Exercise: Characterization and Correlation With Cardiac Baroreflex. Front Physiol 2018; 9:688. [PMID: 29922179 PMCID: PMC5996055 DOI: 10.3389/fphys.2018.00688] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 05/17/2018] [Indexed: 11/13/2022] Open
Abstract
The arm of the baroreflex (BR) controlling peripheral resistances (PR), labeled as BR of PR (prBR), was characterized through an extension of the cardiac BR (cBR) sequence analysis. The method exploits recordings of skin blood flow (SBF) from the palm of the non-dominant hand via a laser Doppler flowmeter and of arterial pressure (AP) from the middle finger of the same hand via a plethysmographic device. PR was estimated beat-by-beat as the ratio of mean AP to mean SBF computed over the same heart period (HP). Peripheral resistances-diastolic arterial pressure (PR-DAP) sequences featuring simultaneous increases of PR and decreases of diastolic AP (DAP) or vice versa were identified and the slope of the regression line in the (DAP, PR) plane was taken as an estimate of prBR sensitivity (BRSprBR). The percentage of prBR sequences (SEQ%prBR) was taken as a measure of prBR involvement and the prBR effectiveness index (EIprBR) was computed as the fraction of DAP sequences capable to drive antiparallel PR variations. Analogous markers were computed over cBR from HP and systolic AP (SAP) variability [i.e., cBR sensitivity (BRScBR), percentage of cBR sequences (SEQ%cBR), and effectiveness index of the cBR (EIcBR)]. prBR and cBR were typified during incremental light-to-moderate bicycle ergometer exercise at 10, 20, and 30% of the maximum effort in 16 healthy subjects (aged from 22 to 58 years, six males). We found that: (i) BRScBR decreased gradually with the challenge, while BRSprBR declined only at the heaviest workload; (ii) SEQ%cBR decreased solely at the lightest workload, while the decline of SEQ%prBR was significant regardless of the intensity of the challenge; (iii) EIprBR and EIcBR were not affected by exercise; (iv) after pooling together all the data regardless of the experimental conditions, BRSprBR and BRScBR were uncorrelated, while SEQ%cBR and SEQ%prBR as well as EIcBR and EIprBR, were significantly and positively correlated; (v) when the correlation between SEQ%cBR and SEQ%prBR and between EIcBR and EIprBR was assessed separately in each experimental condition, it was not systematically detected. This study suggests that prBR characterization provides information complementary to cBR that might be fruitfully exploited to improve patients' risk stratification.
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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, Milan, Italy
| | - Vlasta Bari
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | | | - Beatrice Cairo
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Emanuele Vaini
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Mara Malacarne
- Dipartimento di Biotecnologie Mediche e Medicina Traslazionale, University of Milan, Milan, Italy.,Exercise Medicine Unit, Humanitas Clinical and Research Center, Milan, Italy
| | - Massimo Pagani
- Dipartimento di Biotecnologie Mediche e Medicina Traslazionale, University of Milan, Milan, Italy
| | - Daniela Lucini
- Dipartimento di Biotecnologie Mediche e Medicina Traslazionale, University of Milan, Milan, Italy.,Exercise Medicine Unit, Humanitas Clinical and Research Center, Milan, Italy
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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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Lund MT, Salomonsson M, Jonassen TEN, Holstein-Rathlou NH. A method for assessment of the dynamic response of the arterial baroreflex. Acta Physiol (Oxf) 2018; 222. [PMID: 28872781 DOI: 10.1111/apha.12962] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 07/11/2017] [Accepted: 08/30/2017] [Indexed: 11/28/2022]
Abstract
AIM The baroreflex is a key mechanism in cardiovascular regulation, and alterations in baroreceptor function are seen in many diseases, including heart failure, obesity and hypertension. We propose a new method for analysing baroreceptor function from continuous blood pressure (BP) and heart rate (HR) in both health and disease. METHODS Forty-eight-hour data series of BP and HR were collected with telemetry. Sprague Dawley rats on standard chow (n = 11) served as controls, while rats on a high-fat, high-fructose (HFHC) diet (n = 6) constituted the obese-hypertensive model. A third group of rats underwent autonomic blockade (n = 6). An autoregressive-moving-average with exogenous inputs (ARMAX) model was applied to the data and compared with the α-coefficient. RESULTS Autonomic blockade caused a significant reduction in the strength of the baroreflex as estimated by ARMAX [ARMAX- baroreflex sensitivity (BRS)] -0.03 ± 0.01 vs. -0.19 ± 0.04 bpm heartbeat-1) . Both methods showed a ~50% reduction in BRS in the obese-hypertensive group compared with control (body weight 531 ± 27 vs. 458 ± 19 g, P < 0.05; mean arterial pressure 119 ± 3 vs. 102 ± 1 mmHg, P < 0.05; ARMAX-BRS -0.08 ± 0.01 vs. -0.15 ± 0.01 bpm heartbeat-1 , P < 0.05; α-coefficient BRS 0.51 ± 0.07 vs. 0.89 ± 0.07 ms mmHg-1 , P < 0.05). The ARMAX method additionally showed the open-loop gain of the baroreflex to be reduced by ~50% in the obese-hypertensive group (-2.3 ± 0.3 vs. -4.1 ± 0.3 bpm, P < 0.05), while the rate constant was similar between groups. CONCLUSION The ARMAX model represents an efficient method for estimating several aspects of the baroreflex. The open-loop gain of the baroreflex was attenuated in obese-hypertensive rats compared with control, while the time response was similar. The algorithm can be applied to other species including humans.
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Affiliation(s)
- M. T. Lund
- Department of Biomedical Sciences; University of Copenhagen; Copenhagen N Denmark
| | - M. Salomonsson
- Department of Biomedical Sciences; University of Copenhagen; Copenhagen N Denmark
| | - T. E. N. Jonassen
- Department of Biomedical Sciences; University of Copenhagen; Copenhagen N Denmark
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Milan-Mattos JC, Porta A, Perseguini NM, Minatel V, Rehder-Santos P, Takahashi ACM, Mattiello SM, Catai AM. Influence of age and gender on the phase and strength of the relation between heart period and systolic blood pressure spontaneous fluctuations. J Appl Physiol (1985) 2017; 124:791-804. [PMID: 29212671 DOI: 10.1152/japplphysiol.00903.2017] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aging affects baroreflex regulation. The effect of senescence on baroreflex control was assessed from spontaneous fluctuations of heart period (HP) and systolic arterial pressure (SAP) through the HP-SAP gain, while the HP-SAP phase and strength are usually disregarded. This study checks whether the HP-SAP phase and strength, as estimated, respectively, via the phase of the HP-SAP cross spectrum (PhHP-SAP) and squared coherence function (K2HP-SAP), vary with age in healthy individuals and trends are gender-dependent. We evaluated 110 healthy volunteers (55 males) divided into five age subgroups (21-30, 31-40, 41-50, 51-60, and 61-70 yr). Each subgroup was formed by 22 subjects (11 males). HP series was extracted from electrocardiogram and SAP from finger arterial pressure at supine resting (REST) and during active standing (STAND). PhHP-SAP and K2HP-SAP functions were sampled in low-frequency (LF, from 0.04 to 0.15 Hz) and in high-frequency (HF, above 0.15 Hz) bands. Both at REST and during STAND PhHP-SAP(LF) showed a negative correlation with age regardless of gender even though values were more negative in women. This trend was shown to be compatible with a progressive increase of the baroreflex latency with age. At REST K2HP-SAP(LF) decreased with age regardless of gender, but during STAND the high values of K2HP-SAP(LF) were more preserved in men than women. At REST and during STAND the association of PhHP-SAP(HF) and K2HP-SAP(HF) with age was absent. The findings points to a greater instability of baroreflex control with age that seems to affect to a greater extent women than men. NEW & NOTEWORTHY Aging increases cardiac baroreflex latency and decreases the degree of cardiac baroreflex involvement in regulating cardiovascular variables. These trends are gender independent but lead to longer delays and asmaller degree of cardiac baroreflex involvement in women than in men, especially during active standing, with important implications on the tolerance to an orthostatic stressor.
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Affiliation(s)
- Juliana C Milan-Mattos
- Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos , São Paulo , Brazil
| | - 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, Milan , Italy
| | - Natália M Perseguini
- Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos , São Paulo , Brazil
| | - Vinicius Minatel
- Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos , São Paulo , Brazil
| | - Patricia Rehder-Santos
- Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos , São Paulo , Brazil
| | - Anielle C M Takahashi
- Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos , São Paulo , Brazil
| | - Stela M Mattiello
- Articular Function Laboratory, Department of Physical Therapy, Federal University of São Carlos , São Paulo , Brazil
| | - Aparecida M Catai
- Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos , São Paulo , Brazil
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Laranjo S, Geraldes V, Oliveira M, Rocha I. Insights into the background of autonomic medicine. Rev Port Cardiol 2017; 36:757-771. [PMID: 29037833 DOI: 10.1016/j.repc.2017.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 12/12/2016] [Accepted: 01/08/2017] [Indexed: 12/27/2022] Open
Abstract
Knowledge of the physiology underlying the autonomic nervous system is pivotal for understanding autonomic dysfunction in clinical practice. Autonomic dysfunction may result from primary modifications of the autonomic nervous system or be secondary to a wide range of diseases that cause severe morbidity and mortality. Together with a detailed history and physical examination, laboratory assessment of autonomic function is essential for the analysis of various clinical conditions and the establishment of effective, personalized and precise therapeutic schemes. This review summarizes the main aspects of autonomic medicine that constitute the background of cardiovascular autonomic dysfunction.
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Affiliation(s)
- Sérgio Laranjo
- Instituto de Fisiologia da Faculdade de Medicina e Centro Cardiovascular, Universidade de Lisboa, Lisboa, Portugal
| | - Vera Geraldes
- Instituto de Fisiologia da Faculdade de Medicina e Centro Cardiovascular, Universidade de Lisboa, Lisboa, Portugal
| | - Mário Oliveira
- Instituto de Fisiologia da Faculdade de Medicina e Centro Cardiovascular, Universidade de Lisboa, Lisboa, Portugal
| | - Isabel Rocha
- Instituto de Fisiologia da Faculdade de Medicina e Centro Cardiovascular, Universidade de Lisboa, Lisboa, Portugal.
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Insights into the background of autonomic medicine. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2017.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Recursive Model Identification for the Evaluation of Baroreflex Sensitivity. Acta Biotheor 2016; 64:469-478. [PMID: 27757742 DOI: 10.1007/s10441-016-9295-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 10/11/2016] [Indexed: 10/20/2022]
Abstract
A method for the recursive identification of physiological models of the cardiovascular baroreflex is proposed and applied to the time-varying analysis of vagal and sympathetic activities. The proposed method was evaluated with data from five newborn lambs, which were acquired during injection of vasodilator and vasoconstrictors and the results show a close match between experimental and simulated signals. The model-based estimation of vagal and sympathetic contributions were consistent with physiological knowledge and the obtained estimators of vagal and sympathetic activities were compared to traditional markers associated with baroreflex sensitivity. High correlations were observed between traditional markers and model-based indices.
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Marchi A, Bari V, De Maria B, Esler M, Lambert E, Baumert M, Porta A. Simultaneous Characterization of Sympathetic and Cardiac Arms of the Baroreflex through Sequence Techniques during Incremental Head-Up Tilt. Front Physiol 2016; 7:438. [PMID: 27746741 PMCID: PMC5041323 DOI: 10.3389/fphys.2016.00438] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 09/14/2016] [Indexed: 11/17/2022] Open
Abstract
We propose a sympathetic baroreflex (sBR) sequence method for characterizing sBR from spontaneous beat-to-beat fluctuations of muscle sympathetic nerve activity (MSNA) and diastolic arterial pressure (DAP). The method exploits a previously defined MSNA variability quantifying the fluctuations of MSNA burst rate. The method is based on the detection of MSNA and DAP sequences characterized by the contemporaneous DAP increase and MSNA decrease or vice versa. The percentage of sBR sequences (SEQ%sBR) was taken as an indication of the degree of sBR solicitation and the average slope of the regression lines in the (DAP, MSNA) plane was taken as sBR sensitivity (sBRSSEQ) and expressed in bursts.s−1.mmHg−1. sBRSSEQ was compared to a more traditional estimate based on the baroreflex threshold analysis (sBRSBTA). An incremental head-up tilt protocol, carried out in 12 young healthy subjects (age: 20–36 yr, median = 22.5 yr, 9 females) sequentially tilted at 0, 20, 30, 40, 60° table inclinations, was utilized to set the sBR sequence method parameters. Traditional sequence analysis was exploited to estimate cardiac baroreflex (cBR) sensitivity (cBRSSEQ) and percentage of cBR sequences (SEQ%cBR). The head-up tilt induced the progressive increase of SEQ%sBR and SEQ%cBR and gradual decrease of both sBRSSEQ and cBRSSEQ, thus suggesting the gradual rise of the sBR and cBR solicitations and the progressive reduction of their effectiveness with the stimulus. sBRSSEQ was significantly associated with sBRSBTA. sBRSSEQ and cBRSSEQ were significantly correlated as well as SEQ%sBR and SEQ%cBR, even though the correlation was not strong, thus suggesting a certain degree of independence between the baroreflex arms. The proposed sBR sequence approach provides a dynamical characterization of the sBR alternative to more traditional static pharmacological and nonpharmacological methods and fully homogenous with the cBR sequence technique.
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Affiliation(s)
- Andrea Marchi
- Department of Electronics Information and Bioengineering, Politecnico di MilanoMilan, Italy; Department of Emergency and Intensive Care, San Gerardo HospitalMonza, Italy
| | - Vlasta Bari
- Department of Biomedical Sciences for Health, University of Milan Milan, Italy
| | - Beatrice De Maria
- Department of Electronics Information and Bioengineering, Politecnico di MilanoMilan, Italy; IRCCS Fondazione Salvatore MaugeriMilan, Italy
| | - Murray Esler
- Human Neurotransmitter Laboratory, Baker IDI Heart and Diabetes Institute Melbourne, VIC, Australia
| | - Elisabeth Lambert
- Human Neurotransmitter Laboratory, Baker IDI Heart and Diabetes Institute Melbourne, VIC, Australia
| | - Mathias Baumert
- School of Electrical and Electronic Engineering, University of Adelaide Adelaide, SA, Australia
| | - Alberto Porta
- Department of Biomedical Sciences for Health, University of MilanMilan, Italy; Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San DonatoMilan, Italy
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Porta A, Takahashi ACM, Catai AM. Cardiovascular coupling during graded postural challenge: comparison between linear tools and joint symbolic analysis. Braz J Phys Ther 2016; 20:461-470. [PMID: 27878227 PMCID: PMC5123266 DOI: 10.1590/bjpt-rbf.2014.0179] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 02/15/2016] [Indexed: 12/31/2022] Open
Abstract
Background A joint symbolic analysis (JSA) is applied to assess the strength of the
cardiovascular coupling from spontaneous beat-to-beat variability of the heart
period (HP) and the systolic arterial pressure (SAP) during an experimental
protocol inducing a gradual baroreflex unloading evoked by postural change (i.e.
graded head-up tilt). Method: The adopted JSA can quantify the degree of association between the HP and SAP
variabilities as a function of the time scale of the HP and SAP patterns.
Traditional linear tools assessing the HP-SAP coupling strength, such as squared
correlation coefficient, squared coherence function, and percentage of baroreflex
sequences, were computed as well for comparison. Results: We found that: i) JSA indicated that the strength of the cardiovascular coupling
at slow temporal scales gradually increased with the magnitude of the orthostatic
challenge, while that at fast temporal scales gradually decreased; ii) the squared
correlation coefficient and percentage of baroreflex sequences did not detect this
behavior; iii) even though squared coherence function could measure the magnitude
of the HP-SAP coupling as a function of the time scale, it was less powerful than
JSA owing to the larger dispersion of the frequency domain indexes. Conclusion: Due to its peculiar features and high statistical power, JSA deserves applications
to pathological groups in which the link between HP and SAP variabilities is lost
or decreased due to the overall depression or impairment of the cardiovascular
control.
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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, Milan, Italy
| | - Anielle C M Takahashi
- Departmento de Fisioterapia, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Aparecida M Catai
- Departmento de Fisioterapia, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
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Cardiovascular Variability Analysis and Baroreflex Estimation in Patients with Type 2 Diabetes in Absence of Any Manifest Neuropathy. PLoS One 2016; 11:e0148903. [PMID: 26987126 PMCID: PMC4795601 DOI: 10.1371/journal.pone.0148903] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 01/24/2016] [Indexed: 01/27/2023] Open
Abstract
Introduction Indexes derived from spontaneous heart period (HP) and systolic arterial pressure (SAP) fluctuations can detect autonomic dysfunction in individuals with type 2 diabetes mellitus (DM) associated to cardiovascular autonomic neuropathy (CAN) or other neuropathies. It is unknown whether HP and SAP variability indexes are sensitive enough to detect the autonomic dysfunction in DM patients without CAN and other neuropathies. Methods We evaluated 68 males aged between 40 and 65 years. The group was composed by DM type 2 DM with no manifest neuropathy (n = 34) and healthy (H) subjects (n = 34). The protocol consisted of 15 minutes of recording of HP and SAP variabilities at rest in supine position (REST) and after active standing (STAND). The HP power in the high frequency band (HF, from 0.15 to 0.5 Hz), the SAP power in the low frequency band (LF, from 0.04 to 0.15 Hz) and BRS estimated via spectral approach and sequence method were computed. Results The HF power of HP was lower in DM patients than in H subjects, while the two groups exhibited comparable HF power of HP during STAND. The LF power of SAP was similar in DM and H groups at REST and increased during STAND in both groups. BRSs estimated in the HF band and via baroreflex sequence method were lower in DM than in H and they decreased further during STAND in both populations. Conclusion Results suggest that vagal control of heart rate and cardiac baroreflex control was impaired in type 2 DM, while sympathetic control directed to vessels, sympathetic and baroreflex response to STAND were preserved. Cardiovascular variability indexes are sensitive enough to typify the early, peculiar signs of autonomic dysfunction in type-2 DM patients well before CAN becomes manifest.
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Azevedo LF, Perlingeiro P, Hachul DT, Gomes-Santos IL, Tsutsui JM, Negrao CE, De Matos LDNJ. Predominance of Intrinsic Mechanism of Resting Heart Rate Control and Preserved Baroreflex Sensitivity in Professional Cyclists after Competitive Training. PLoS One 2016; 11:e0148036. [PMID: 26812615 PMCID: PMC4727792 DOI: 10.1371/journal.pone.0148036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 01/12/2016] [Indexed: 12/02/2022] Open
Abstract
Different season trainings may influence autonomic and non-autonomic cardiac control of heart rate and provokes specific adaptations on heart’s structure in athletes. We investigated the influence of transition training (TT) and competitive training (CT) on resting heart rate, its mechanisms of control, spontaneous baroreflex sensitivity (BRS) and relationships between heart rate mechanisms and cardiac structure in professional cyclists (N = 10). Heart rate (ECG) and arterial blood pressure (Pulse Tonometry) were recorded continuously. Autonomic blockade was performed (atropine—0.04 mg.kg-1; esmolol—500 μg.kg-1 = 0.5 mg). Vagal effect, intrinsic heart rate, parasympathetic (n) and sympathetic (m) modulations, autonomic influence, autonomic balance and BRS were calculated. Plasma norepinephrine (high-pressure liquid chromatography) and cardiac structure (echocardiography) were evaluated. Resting heart rate was similar in TT and CT. However, vagal effect, intrinsic heart rate, autonomic influence and parasympathetic modulation (higher n value) decreased in CT (P≤0.05). Sympathetic modulation was similar in both trainings. The autonomic balance increased in CT but still showed parasympathetic predominance. Cardiac diameter, septum and posterior wall thickness and left ventricular mass also increased in CT (P<0.05) as well as diastolic function. We observed an inverse correlation between left ventricular diastolic diameter, septum and posterior wall thickness and left ventricular mass with intrinsic heart rate. Blood pressure and BRS were similar in both trainings. Intrinsic heart rate mechanism is predominant over vagal effect during CT, despite similar resting heart rate. Preserved blood pressure levels and BRS during CT are probably due to similar sympathetic modulation in both trainings.
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Affiliation(s)
- Luciene Ferreira Azevedo
- Cardiovascular Rehabilitation and Exercise Physiology Unit, Heart Institute (InCor), Medical School of University of Sao Paulo, Sao Paulo, Brazil
- * E-mail:
| | - Patricia Perlingeiro
- Cardiovascular Rehabilitation and Exercise Physiology Unit, Heart Institute (InCor), Medical School of University of Sao Paulo, Sao Paulo, Brazil
| | - Denise Tessariol Hachul
- Clinical Arrhythmia Unit, Heart Institute (InCor), Medical School of University of Sao Paulo, Sao Paulo, Brazil
| | - Igor Lucas Gomes-Santos
- Cardiovascular Rehabilitation and Exercise Physiology Unit, Heart Institute (InCor), Medical School of University of Sao Paulo, Sao Paulo, Brazil
| | - Jeane Mike Tsutsui
- Echocardiography Unit, Heart Institute (InCor), Medical School of University of Sao Paulo, Sao Paulo, Brazil
| | - Carlos Eduardo Negrao
- Cardiovascular Rehabilitation and Exercise Physiology Unit, Heart Institute (InCor), Medical School of University of Sao Paulo, Sao Paulo, Brazil
- Biodynamic of the Movement of the Human Body, School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil
| | - Luciana D. N. J. De Matos
- Cardiovascular Rehabilitation and Exercise Physiology Unit, Heart Institute (InCor), Medical School of University of Sao Paulo, Sao Paulo, Brazil
- Rehabilitation Center, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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Marchi A, Bari V, De Maria B, Cerutti S, Heusser K, Tank J, Jordan J, Barbic F, Furlan R, Porta A. Evaluation of the correlation between cardiac and sympathetic baroreflex sensitivity before orthostatic syncope. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:2063-6. [PMID: 26736693 DOI: 10.1109/embc.2015.7318793] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The study investigates the two different aspects of the baroreflex control resulting in two baroreflex sensitivity (BRS) indexes: i) sympathetic BRS (sBRS); ii) cardiac BRS (cBRS). sBRS was assessed as the slope of the regression line of the conditional probability of detecting a burst on the integrated muscle nerve sympathetic activity (MSNA) given an assigned diastolic arterial pressure (DAP) on DAP. cBRS was estimated from spontaneous heart period (HP) and systolic arterial pressure (SAP) via a spectral approach in the low (0.04-0-15 Hz) and high (0.15-0.5 Hz) frequency bands respectively. Both sBRS and cBRS were assessed in eight healthy subjects undergoing three experimental sessions: supine resting position (REST), 80 degrees head-up tilt test (TILT) and before the occurrence of pre-syncope symptoms (TILT_PRE). Results showed a decrease of both sBRS and cBRS during TILT and a baroreflex impairment during TILT_PRE. sBRS and cBRS were linearly correlated during TILT but became uncorrelated during TILT_PRE. Findings suggest a failure of both "baroreflexes" and their disassociation during TILT_PRE.
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Cottin F, Malcurat V, Zorgati H, Prieur F, Labsy Z, Do MC, Gagey O, Collomp K. Effect of oral glucocorticoid intake on autonomic cardiovascular control. SPRINGERPLUS 2015; 4:622. [PMID: 26543757 PMCID: PMC4627994 DOI: 10.1186/s40064-015-1378-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 09/25/2015] [Indexed: 11/10/2022]
Abstract
This study analyzed baroreflex sensitivity, heart rate and systolic blood pressure variabilities during an oral 1 week administration of prednisone. This study examined the hypothesis that prednisone might change both systolic blood pressure level and baroreflex sensitivity. Twelve physically active male subjects participated to a double-blind, randomized cross-over study consisting of two 1-week periods of treatment separated by a 4-week drug-free washout period: placebo (PLA) or prednisone (PRED). Trials were performed by each subject four times on the second (D2) and seventh (D7) day of each treatment period. ECG and blood pressure were continuously recorded to compute heart rate variability, systolic blood pressure variability and baroreflex sensitivity components with the smoothed pseudo Wigner Ville distribution and baroreflex analysis. Following D2 prednisone treatment, both HR (PLA: 60.8 ± 10.5 vs. PRED: 65.8 ± 9.1 beats min(-1), p = 0.008) and low frequency component of systolic blood pressure variability (D2: 3.09 ± 0.19 vs. D7: 2.34 ± 0.19, p < 0.041) increased whereas other components did not change. Over 7 days of treatment, LF-SBP amplitude increased (D2: 2.71 ± 0.89 vs. D7: 3.87 ± 0.6 mmHg, p = 0.037). A slight increase in both HR and LF-SBPV were observed suggesting a potential sympathetic cardiovascular stimulus. Although we found a significant effect of the 1-week prednisone treatment on heart rate and low frequency power of systolic blood pressure variability, we reported neither an increase in the systolic blood pressure level nor a decrease in the baroreflex sensitivity. Therefore, the fragility of our results cannot support a deleterious effect of 1-week administration of prednisone on the autonomic cardiovascular control which might be involved in cardiovascular diseases.
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Affiliation(s)
- F Cottin
- CIAMS, Université Paris-Sud, Université Paris-Saclay, 91405 Orsay Cedex, France ; CIAMS, Université d'Orléans, 45067 Orléans, France
| | - V Malcurat
- CIAMS, Université Paris-Sud, Université Paris-Saclay, 91405 Orsay Cedex, France ; CIAMS, Université d'Orléans, 45067 Orléans, France ; Ecole supérieure d'ostéopathie, ESO Paris SUPOSTEO, Champs sur Marne, France
| | - H Zorgati
- CIAMS, Université Paris-Sud, Université Paris-Saclay, 91405 Orsay Cedex, France ; CIAMS, Université d'Orléans, 45067 Orléans, France
| | - F Prieur
- CIAMS, Université Paris-Sud, Université Paris-Saclay, 91405 Orsay Cedex, France ; CIAMS, Université d'Orléans, 45067 Orléans, France
| | - Z Labsy
- CIAMS, Université Paris-Sud, Université Paris-Saclay, 91405 Orsay Cedex, France ; CIAMS, Université d'Orléans, 45067 Orléans, France
| | - M C Do
- CIAMS, Université Paris-Sud, Université Paris-Saclay, 91405 Orsay Cedex, France ; CIAMS, Université d'Orléans, 45067 Orléans, France
| | - O Gagey
- CIAMS, Université Paris-Sud, Université Paris-Saclay, 91405 Orsay Cedex, France ; CIAMS, Université d'Orléans, 45067 Orléans, France
| | - K Collomp
- CIAMS, Université Paris-Sud, Université Paris-Saclay, 91405 Orsay Cedex, France ; CIAMS, Université d'Orléans, 45067 Orléans, France ; Département des analyses, AFLD, Châtenay-Malabry, France
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Le Rolle V, Beuchee A, Praud JP, Samson N, Pladys P, Hernández AI. Recursive identification of an arterial baroreflex model for the evaluation of cardiovascular autonomic modulation. Comput Biol Med 2015; 66:287-94. [PMID: 26453759 DOI: 10.1016/j.compbiomed.2015.09.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/07/2015] [Accepted: 09/16/2015] [Indexed: 11/28/2022]
Abstract
The evaluation of the time-varying vagal and sympathetic contributions to heart rate remains a challenging task because the observability of the baroreflex is generally limited and the time-varying properties are difficult to take into account, especially in non-stationnary conditions. The objective is to propose a model-based approach to estimate the autonomic modulation during a pharmacological challenge. A recursive parameter identification method is proposed and applied to a mathematical model of the baroreflex, in order to estimate the time-varying vagal and sympathetic contributions to heart rate modulation during autonomic maneuvers. The model-based method was evaluated with data from five newborn lambs, which were acquired during injection of vasodilator and vasoconstrictor drugs, on normal conditions and under beta-blockers, so as to quantify the effect of the pharmacological sympathetic blockade on the estimated parameters. After parameter identification, results show a close match between experimental and simulated signals for the five lambs, as the mean relative root mean squared error is equal to 0.0026 (± 0.003). The error, between simulated and experimental signals, is significantly reduced compared to a batch identification of parameters. The model-based estimation of vagal and sympathetic contributions were consistent with physiological knowledge and, as expected, it was possible to observe an alteration of the sympathetic response under beta-blockers. The simulated vagal modulation illustrates a response similar to traditional heart rate variability markers during the pharmacological maneuver. The model-based method, proposed in the paper, highlights the advantages of using a recursive identification method for the estimation of vagal and sympathetic modulation.
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Affiliation(s)
- Virginie Le Rolle
- INSERM, U1099, Rennes F-35000, France; Campus de Beaulieu, Université de Rennes 1, LTSI, 263 Avenue du General Leclerc, CS 74205, 35042 Rennes Cedex, Rennes F-35000, France.
| | - Alain Beuchee
- INSERM, U1099, Rennes F-35000, France; Campus de Beaulieu, Université de Rennes 1, LTSI, 263 Avenue du General Leclerc, CS 74205, 35042 Rennes Cedex, Rennes F-35000, France; CHU Rennes, Pole de pdiatrie mdico-chirurgicale et gntique clinique - Service de pdiatrie, Rennes F-35000, France
| | - Jean-Paul Praud
- Department of Pediatrics, University of Sherbrooke, QC, Canada J1H5N4
| | - Nathalie Samson
- Department of Pediatrics, University of Sherbrooke, QC, Canada J1H5N4
| | - Patrick Pladys
- INSERM, U1099, Rennes F-35000, France; Campus de Beaulieu, Université de Rennes 1, LTSI, 263 Avenue du General Leclerc, CS 74205, 35042 Rennes Cedex, Rennes F-35000, France; CHU Rennes, Pole de pdiatrie mdico-chirurgicale et gntique clinique - Service de pdiatrie, Rennes F-35000, France
| | - Alfredo I Hernández
- INSERM, U1099, Rennes F-35000, France; Campus de Beaulieu, Université de Rennes 1, LTSI, 263 Avenue du General Leclerc, CS 74205, 35042 Rennes Cedex, Rennes F-35000, France
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Porta A, Faes L, Nollo G, Bari V, Marchi A, De Maria B, Takahashi ACM, Catai AM. Conditional Self-Entropy and Conditional Joint Transfer Entropy in Heart Period Variability during Graded Postural Challenge. PLoS One 2015; 10:e0132851. [PMID: 26177517 PMCID: PMC4503559 DOI: 10.1371/journal.pone.0132851] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 06/19/2015] [Indexed: 11/18/2022] Open
Abstract
Self-entropy (SE) and transfer entropy (TE) are widely utilized in biomedical signal processing to assess the information stored into a system and transferred from a source to a destination respectively. The study proposes a more specific definition of the SE, namely the conditional SE (CSE), and a more flexible definition of the TE based on joint TE (JTE), namely the conditional JTE (CJTE), for the analysis of information dynamics in multivariate time series. In a protocol evoking a gradual sympathetic activation and vagal withdrawal proportional to the magnitude of the orthostatic stimulus, such as the graded head-up tilt, we extracted the beat-to-beat spontaneous variability of heart period (HP), systolic arterial pressure (SAP) and respiratory activity (R) in 19 healthy subjects and we computed SE of HP, CSE of HP given SAP and R, JTE from SAP and R to HP, CJTE from SAP and R to HP given SAP and CJTE from SAP and R to HP given R. CSE of HP given SAP and R was significantly smaller than SE of HP and increased progressively with the amplitude of the stimulus, thus suggesting that dynamics internal to HP and unrelated to SAP and R, possibly linked to sympathetic activation evoked by head-up tilt, might play a role during the orthostatic challenge. While JTE from SAP and R to HP was independent of tilt table angle, CJTE from SAP and R to HP given R and from SAP and R to HP given SAP showed opposite trends with tilt table inclination, thus suggesting that the importance of the cardiac baroreflex increases and the relevance of the cardiopulmonary pathway decreases during head-up tilt. The study demonstrates the high specificity of CSE and the high flexibility of CJTE over real data and proves that they are particularly helpful in disentangling physiological mechanisms and in assessing their different contributions to the overall cardiovascular regulation.
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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, Milan, Italy
- * E-mail:
| | - Luca Faes
- BIOtech, Department of Industrial Engineering, University of Trento, Trento, Italy
- IRCS PAT-FBK, Trento, Italy
| | - Giandomenico Nollo
- BIOtech, Department of Industrial Engineering, University of Trento, Trento, Italy
- IRCS PAT-FBK, Trento, Italy
| | - Vlasta Bari
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Andrea Marchi
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Beatrice De Maria
- Department of Rehabilitation Medicine, IRCCS Fondazione Salvatore Maugeri, Milan, Italy
| | - Anielle C. M. Takahashi
- Department of Physiotherapy, Federal University of São Carlos, São Carlos, São Paulo State, Brazil
| | - Aparecida M. Catai
- Department of Physiotherapy, Federal University of São Carlos, São Carlos, São Paulo State, Brazil
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Pulse Photoplethysmographic Analysis Estimates the Sympathetic Activity Directed to Heart and Vessels. Anesthesiology 2015; 123:336-45. [PMID: 26035252 DOI: 10.1097/aln.0000000000000712] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Novel pulse photoplethysmographic-derived indices have been proposed as tools to measure autonomic nervous system (ANS) modulation in anesthetized and awake patients, but nowadays their experimental validation is lacking. The authors aimed to investigate the ability of pulse photoplethysmographic amplitude (PPGA), ANS state (ANSS), and ANSS index (ANSSi) to measure changes of ANS modulation in response to sympathetic stimulation. METHODS Ten awake healthy volunteers underwent two passive head-up tilts at 45° and 90°. The heart rate variability (HRV) and systolic arterial pressure variability were analyzed in the frequency domain as a measure of ANS modulation directed to the heart and the vessels. HRV, baroreflex sensitivity, and pulse photoplethysmographic indices were measured at baseline and after tilt maneuvers. The agreement between HRV-derived indices and pulse photoplethysmographic indices was assessed using Bland-Altman plots. RESULTS PPGA, ANSS, and ANSSi changed significantly during the study protocol. Head-up tilt decreased PPGA and ANSS and increased ANNSi. There was a good agreement between ANSSi and baroreflex sensitivity explored in the high-frequency band (bias, 0.23; 95% CI, -22.7 to 23.2 normalized units) and between ANSSi and the sympathovagal modulation directed to the heart (bias, 0.96; 95% CI, -8.7 to 10.8 normalized units). CONCLUSIONS In controlled experimental conditions, novel pulse plethysmographic indices seem to estimate the changes of the sympathetic outflow directed to the vessels and the sympathovagal balance modulating heart rate. These indices might be useful in the future to monitor the fluctuation of sympathetic activity in anesthetized patients.
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Runge J, Riedl M, Müller A, Stepan H, Kurths J, Wessel N. Quantifying the causal strength of multivariate cardiovascular couplings with momentary information transfer. Physiol Meas 2015; 36:813-25. [PMID: 25799083 DOI: 10.1088/0967-3334/36/4/813] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This article studies a recently introduced information-theoretic approach to detect and quantify the causal couplings in a complex cardiovascular system. In the first step a causal algorithm detects the coupling delays and in the second step the causal strength of each coupling mechanism is quantified using the recently introduced momentary information transfer. As an example, the method is applied to time series of respiration, systolic and diastolic blood pressure, and heart rate of pregnant healthy women and women suffering from pre-eclampsia. A possible explanation for the influence of heart rate on systolic blood pressure is found and some differences between healthy women and patients are discussed.
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Affiliation(s)
- Jakob Runge
- Department of Physics, Humbolt University Berlin, Berlin, Germany. Potsdam Institute for Climate Impact Research, Potsdam, Germany
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