Coronary artery bypass surgery in heart failure patients with chronic reversible and irreversible myocardial dysfunction: effect on heart rate variability

Identification of Latent Risk Clinical Attributes for Children Born Under IUGR Condition Using Machine Learning Techniques

BACKGROUND AND OBJECTIVE

Intrauterine Growth Restriction (IUGR) is a condition in which a fetus does not grow to the expected weight during pregnancy. There are several well documented causes in the literature for this issue, such as maternal disorder, and genetic influences. Nevertheless, besides the risk during pregnancy and labour periods, in a long term perspective, the impact of IUGR condition during the child development is an area of research itself. The main objective of this work is to propose a machine learning solution to identify the most significant features of importance based on physiological, clinical or socioeconomic factors correlated with previous IUGR condition after 10 years of birth.

METHODS

In this work, 41 IUGR (18 male) and 34 Non-IUGR (22 male) children were followed up 9 years after the birth, in average (9.1786 ± 0.6784 years old). A group of machine learning algorithms is proposed to classify children previously identified as born under IUGR condition based on 24-hours monitoring of ECG (Holter) and blood pressure (ABPM), and other clinical and socioeconomic attributes. In additional, an algorithm of relevance determination based on the classifier is also proposed, to determine the level of importance of the considered features.

RESULTS

The proposed classification solution achieved accuracy up to 94.73%, and better performance than seven state-of-the-art machine learning algorithms. Also, relevant latent factors related to HRV and BP monitoring are proposed, such as: day-time heart rate (day-time HR), day-night systolic blood pressure (day-night SBP), 24-hour standard deviation (SD) of SBP, dropped, morning cortisol creatinine, 24-hour mean of SDs of all NN intervals for each 5 minutes segment (24-hour SDNNi), among others.

CONCLUSION

With outstanding accuracy of our proposed solutions, the classification system and the indication of relevant attributes may support medical teams on the clinical monitoring of IUGR children during their childhood development.

Heart rate variability in myocardial infarction and heart failure

The need to refine the identification of patients who might benefit from implantation of an implantable cardioverter defibrillator has been risen by the results of many clinical trials on ICD therapy. Traditional parameters such as left ventricular ejection fraction and the presence of non-sustained ventricular tachycardia were not strong enough to achieve this goal with reasonable cost-effectiveness. Heart rate variability (HRV) is one of the most popular parameters used to assess the autonomic tone. HRV has been reported as a strong predictor of cardiovascular mortality. Currently, three different categories of methods in HRV analysis are being used; the time domain, frequency domain, and non-linear dynamic analysis. Both time domain and frequency domain analyses of HRV have been investigated extensively regarding their use as a prognostic marker for cardiovascular mortality. The non-linear dynamic analysis is the latest tool that has shown to have an even higher predictive value than any of the traditional parameters. However, standardized and supporting evidence on this new technique is still lacking. In this article, the current role of HRV in the prediction of cardiovascular mortality in myocardial infarction and heart failure patients has been reviewed.

Assessment of cardiac autonomic regulation and ventricular repolarization after off-pump coronary artery bypass grafting

BACKGROUND

Altered autonomic regulation precipitates cardiac arrhythmias and increases the risk of sudden cardiac death. This risk is further increased by changes in ventricular repolarization. Autonomic regulation is deranged in patients after myocardial on-pump revascularization. We aimed to clarify how off-pump coronary artery bypass grafting (CABG) affects postoperative cardiac autonomic regulation and ventricular repolarization within 4 weeks after CABG.

METHODS

Forty-two patients (mean age, 61.9 +/- 9.3 years; mean EURO score 2.6 +/- 1.9) were electively admitted for off-pump CABG. The electrocardiographic and respiratory waveform recordings were performed in the afternoon in the supine position for 10 minutes. Autonomic modulation was assessed using heart rate variability analysis. Power spectra were computed from 5-minute stable RR intervals using Fourier Transform analysis. Total power of spectra was defined in the range of 0.01 to 0.40 Hz, high-frequency power within 0.15 to 0.40 Hz, and low-frequency power within 0.04 to 0.15 Hz. Normalized power was defined as a ratio of power in each band/total power. The high- and low-frequency power as well as their normalized values indicated cardiac vagal and sympathetic modulation, respectively. Ventricular repolarization was assessed using QT interval, QT interval variability, and QT-RR interdependence analysis. QT intervals were determined from the beginning of the 5-minute segments. QT interval variability was evaluated by a T-wave template-matching algorithm. Pearson correlation between length of RR and QT interval was applied to study QT-RR characteristics. The results were tested for significance using the Fisher exact test, nonpaired t test, and analysis of variance; a P <.05 was considered significant.

RESULTS

The frequency of arrhythmic events and heart rate increased from the fourth to the seventh postoperative day and returned to preoperative levels 4 weeks after CABG. Heart rate variability measures indicating autonomic modulation remained depressed even 4 weeks after the procedure. QT variability index increased from -1.2 +/- 0.5 to -0.8 +/- 0.4 on the fourth day after the operation (P <.05) and returned to -1.0 +/- 0.5 4 weeks after CABG (P = not significant). QT-RR correlation decreased from 0.41 to 0.23 (P <.05) and remained significantly impaired as long as 4 weeks after CABG.

CONCLUSIONS

Observed faster heart rates until 1 week after off-pump CABG imply excessive adrenergic activation, which is comparable to on-pump CABG procedure rates. The results indicate profound autonomic derangement and loss of rate-dependent regulation after off-pump CABG even 4 weeks after operation. Restituted repolarization as assessed by QT variability index 4 weeks postoperatively corresponded with decreased frequency of rhythm disturbances 4 weeks after CABG. The loss of coupling between QT and RR intervals shows increased electrical instability postoperatively, which may serve as an additional promoter for postoperative arrhythmias, especially at higher heart rates.