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Effects of long-acting bronchodilators on cardiac autonomic control in COPD. Respir Med Res 2022; 82:100968. [DOI: 10.1016/j.resmer.2022.100968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/25/2022] [Accepted: 10/08/2022] [Indexed: 11/05/2022]
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Use of a Wearable Biosensor to Study Heart Rate Variability in Chronic Obstructive Pulmonary Disease and Its Relationship to Disease Severity. SENSORS 2022; 22:s22062264. [PMID: 35336436 PMCID: PMC8952191 DOI: 10.3390/s22062264] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/05/2022] [Accepted: 03/10/2022] [Indexed: 12/19/2022]
Abstract
The purpose of this study was to explore the relationships between heart rate variability (HRV) and various phenotypic measures that relate to health and functional status in chronic obstructive pulmonary disease (COPD), and secondly, to demonstrate the feasibility of ascertaining HRV via a chest-worn wearable biosensor in COPD patients. HRV analysis was performed using SDNN (standard deviation of the mean of all normal R-R intervals), low frequency (LF), high frequency (HF), and LF/HF ratio. We evaluated the associations between HRV and COPD severity, class of bronchodilator therapy prescribed, and patient reported outcomes. Seventy-nine participants with COPD were enrolled. There were no differences in SDNN, HF, and LF/HF ratio according to COPD severity. The SDNN in participants treated with concurrent beta-agonists and muscarinic antagonists was lower than that in other participants after adjusting heart rate (beta coefficient −3.980, p = 0.019). The SDNN was positively correlated with Veterans Specific Activity Questionnaire (VSAQ) score (r = 0.308, p = 0.006) and handgrip strength (r = 0.285, p = 0.011), and negatively correlated with dyspnea by modified Medical Research Council (mMRC) questionnaire (r = −0.234, p = 0.039), health status by Saint George’s Respiratory Questionnaire (SGRQ) (r = −0.298, p = 0.008), symptoms by COPD Assessment Test (CAT) (r = −0.280, p = 0.012), and BODE index (r = −0.269, p = 0.020). When measured by a chest-worn wearable device, reduced HRV was observed in COPD participants receiving inhaled beta-sympathomimetic agonist and muscarinic antagonists. HRV was also correlated with various health status and performance measures.
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Tsou CH, Pon LS, Liang JZ, Chan YH, Chen KJ, Cheng FS, Kao T, Yang SW. Response of heart rate variability and cardiorespiratory phase synchronization to routine bronchodilator test in patients with asthma. CHINESE J PHYSIOL 2021; 64:177-185. [PMID: 34472448 DOI: 10.4103/cjp.cjp_19_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Heart rate variability (HRV) and cardiorespiratory phase synchronization (CRPS) were employed to study the cardio- and respiratory interactions in patients with asthma receiving inhalation of beta2-agonist (Berotec 200 mcg) for routine bronchodilator test. Both time- and frequency-domain parameters were used to analyze the HRV. A weighted G-index was introduced to study the quality of the CRPS. The HRV parameters, in both the time and frequency domains, exhibited significant changes pointing to a sympathetic activation of the autonomic balance immediately after the inhalation. On the other hand, the CRPS index barely changed throughout the entire process. This indicates that inhalation of beta2-agonist does not alter the CRPS appreciably, and that the CRPS, in contrast to HRV, is relatively stable in response to the inhalation of beta2-agonist in patients with asthma.
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Affiliation(s)
- Chih-Hsiang Tsou
- Division of Chest Medicine, Ren-Ai Branch, Taipei City Hospital, Taipei; Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taiwan
| | - Lin-Sen Pon
- Department of Electric Engineering, Chinese Culture University, Taipei, Taiwan
| | - Jun-Zhi Liang
- Department of Physics, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Yun-Hsiang Chan
- Division of Chest Medicine, Ren-Ai Branch, Taipei City Hospital, Taipei, Taiwan
| | - Kuan-Jung Chen
- Division of Chest Medicine, Ren-Ai Branch, Taipei City Hospital, Taipei, Taiwan
| | - Feng-Shiang Cheng
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
| | - Tsair Kao
- Medical Division, ACME Portable Machines, Inc., New Taipei City, Taiwan
| | - Sai-Wei Yang
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Safety of bronchodilator reversibility test in elderly subjects: a prospective study. Postepy Dermatol Alergol 2021; 38:256-261. [PMID: 34408593 PMCID: PMC8362750 DOI: 10.5114/ada.2020.92515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 10/17/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction The reversibility test measures an increase in ventilation parameters after the administration of 400 mg of a short-acting β-agonist (SABA). It is worth noting that a typical dosage, applied as a rescue medicine for bronchospastic dyspnoea, is significantly less, i.e., 100–200 mg. Aim To assess the effects of inhaled 400 mg fenoterol (in the bronchodilator reversibility test) on the heart rate and the development of tachyarrhythmias in subjects aged 65 and above. Material and methods A total of 53 subjects (45 women) aged 77; 68–82 (median; interquartile range) in stable clinical condition were included in the study. Data including medical history, physical examinations, blood biochemistry, chest X-ray, 12-lead electrocardiogram, 24-hour Holter ECG monitoring, bronchodilator test, and echocardiography were obtained. During the Holter ECG monitoring, the bronchodilator test using 400 mg fenoterol (Berotec pMDI) was performed. Results A slight but statistically significant (p = 0.02) increase in heart rate from 71 to 75 per min (median) was noted after the administration of fenoterol. No statistically significant differences were found in the number of extrasystolic beats of either supraventricular (p = 0.42) or ventricular origin (p = 0.50). In addition, the subjects did not show any potentially dangerous arrhythmias or significant signs of coronary artery disease. However, there was a significant increase in the number of supraventricular beats in the subjects who were not taking β-blockers. Conclusions The use of 400 mg fenoterol in a bronchodilator reversibility test in elderly subjects does not entail any significant cardiovascular risk.
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Bokov P, El Jurdi H, Denjoy I, Peiffer C, Medjahdi N, Holvoet L, Benkerrou M, Delclaux C. Salbutamol Worsens the Autonomic Nervous System Dysfunction of Children With Sickle Cell Disease. Front Physiol 2020; 11:31. [PMID: 32174840 PMCID: PMC7054439 DOI: 10.3389/fphys.2020.00031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/15/2020] [Indexed: 11/13/2022] Open
Abstract
Background Sickle cell disease (SCD) patients with asthma have an increased rate of vaso-occlusive crisis (VOC) and acute chest syndrome (ACS) episodes when compared to those without asthma. We hypothesized that either asthma diagnosis or bronchodilator treatment might aggravate SCD via their modulating effect on the autonomic nervous system (ANS). Methods Cross-sectional evaluation of heart rate variability (HRV) during pulmonary function tests, including salbutamol administration, in children with SCD receiving asthma treatment or not when compared to asthmatic children without SCD matched for ethnicity. Results SCD children with asthma (n = 30, median age of 12.9 years old) were characterized by a reduced FEV1/FVC ratio, an increased bronchodilator response, and a greater incidence of VOC and ACS when compared to SCD children without asthma (n = 30, 12.7 years). Children with asthma without SCD (n = 29, 11.4 years) were characterized by a higher exhaled NO fraction than SCD children. SCD children when compared to non-SCD children showed reduced HRV [total power, low (LF) and high (HF, vagal tone) frequencies], which was further worsened by salbutamol administration in all the groups: reduction in total power and HF with an increase in LF/HF ratio. After salbutamol, the LF/HF ratio of the SCD children was higher than that of the non-SCD children. The two groups of SCD children were similar, suggesting that asthma diagnosis per se did not modify ANS functions. Conclusion SCD children are characterized by impaired parasympathetic control and sympathetic overactivity that is worsened by salbutamol administration. Clinical Trial Registration www.ClinicalTrials.gov, identifier NCT04062409.
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Affiliation(s)
- Plamen Bokov
- Service de Physiologie Pédiatrique, AP-HP, Hôpital Robert Debré, Paris, France.,UMR 1141, Equipe NeoPhen, INSERM co-tutelle, Université de Paris, Paris, France
| | - Houmam El Jurdi
- Service de Physiologie Pédiatrique, AP-HP, Hôpital Robert Debré, Paris, France
| | - Isabelle Denjoy
- Service de Physiologie Pédiatrique, AP-HP, Hôpital Robert Debré, Paris, France
| | - Claudine Peiffer
- Service de Physiologie Pédiatrique, AP-HP, Hôpital Robert Debré, Paris, France
| | - Noria Medjahdi
- Service de Physiologie Pédiatrique, AP-HP, Hôpital Robert Debré, Paris, France
| | - Laurent Holvoet
- Service d'Hématologie Pédiatrique, AP-HP, Hôpital Robert Debré, Paris, France
| | - Malika Benkerrou
- Service d'Hématologie Pédiatrique, AP-HP, Hôpital Robert Debré, Paris, France
| | - Christophe Delclaux
- Service de Physiologie Pédiatrique, AP-HP, Hôpital Robert Debré, Paris, France.,UMR 1141, Equipe NeoPhen, INSERM co-tutelle, Université de Paris, Paris, France
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Melo JRD, Feitoza MDS, Cucato GG, Medeiros WM, Stelmach R, Cukier A, Carvalho CRFD, Mendes FAR. Efeito agudo do salbutamol no sistema cardiovascular durante o exercício físico em pacientes com asma moderada ou grave: estudo aleatorizado, duplo-cego e cruzado. FISIOTERAPIA E PESQUISA 2018. [DOI: 10.1590/1809-2950/17007725022018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Salbutamol é um β2-agonista de curta duração frequentemente utilizado em pacientes com asma para prevenir os sintomas durante ou após exercício físico. Alterações hemodinâmicas em repouso estão bem descritas. Contudo são escassos os dados sobre os efeitos na frequência cardíaca (FC) e pressão arterial (PA) durante o exercício e na fase de recuperação em pacientes com asma moderada ou grave. Foi realizado um estudo aleatorizado, duplo-cego e cruzado, em que foram inclusos 15 indivíduos com asma moderada e grave, com média de idade de 46,4±9,3 anos. Os pacientes realizaram um teste de esforço máximo em dois dias não consecutivos, com administração de 400mcg de salbutamol ou 4 “puffs” de placebo. Durante todo o protocolo foi monitorada a FC, a PA, a percepção de esforço e o pico de fluxo expiratório (PFE). Após o uso do salbutamol, o valor do PFE aumentou em média de 28,0±47,7L/m, permanecendo maior nos tempos de 5, 10 e 15 minutos de recuperação passiva em relação ao placebo (p<0,05). As variáveis FC, PA e percepção de esforço foram semelhantes entre as intervenções em todas as fases do protocolo (p>0,05). Esses resultados sugerem que o uso de salbutamol é seguro, e que a FC não necessita de ser ajustada para prescrever a intensidade do exercício após a administração de salbutamol em indivíduos com asma moderada ou grave.
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Garcia-Araújo AS, Pires Di Lorenzo VA, Labadessa IG, Jürgensen SP, Di Thommazo-Luporini L, Garbim CL, Borghi-Silva A. Increased sympathetic modulation and decreased response of the heart rate variability in controlled asthma. J Asthma 2014; 52:246-53. [PMID: 25158110 DOI: 10.3109/02770903.2014.957765] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To compare the autonomic modulation of heart rate (HR) in asthmatic and healthy volunteers to correlate it with the forced expiratory volume in the first second (FEV1). METHODS Ten healthy and 14 asthmatic volunteers were included in this cross-sectional study. The volunteers underwent a cardiopulmonary exercise test, spirometry and a register of both resting heart rate variability (HRV) in the supine and seated positions along with HRV during the respiratory sinus arrhythmia maneuver (M-RSA). RESULTS At rest in supine, asthmatic volunteers presented a higher HR (77.1 ± 9.9 vs. 68.7 ± 8.7 bpm), shorter interval between two R waves (R-Ri) (807.5 ± 107.2 vs. 887.5 ± 112.7 ms) when compared with the healthy volunteers, respectively. Moreover, in the frequency domain of HRV, there was increased low frequency (LF) index (50.4 ± 17.1 vs. 29.2 ± 11.1 n.u.) and decreased high frequency (HF) index (49.4 ± 17.1 vs. 70.7 ± 11.1 n.u.). During the M-RSA, the asthmatic presented higher HR (82.6 ± 10.0 vs. 72.4 ± 7.6 bpm) and lower values of R-Ri (746.4 ± 92.1 vs. 846.4 ± 81.4 ms) and approximate entropy (ApEn) (0.7 ± 0.0 vs. 0.8 ± 0.1). FEV1 was strongly correlated with the change of the continuous beat-to-beat variability of HR (SD2) index from the seated to the supine position (r = 0.78). CONCLUSION Controlled asthma in adults appears to induce an increased sympathetic modulation and attenuated response to the postural changes and the M-RSA. Furthermore, there is a correlation between the airways' obstruction and HRV, especially during postural changes.
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Sobhy K, El-Korashy R, Ahmed M, Fayed F. Right ventricular diastolic dysfunction in asthmatic patients. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2014. [DOI: 10.1016/j.ejcdt.2013.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Sekerel BE, Sahiner UM, Can M, Abali G, Alehan D, Aytemir K. The effects of inhaled formoterol on the autonomic nervous system in adolescents with asthma. Ann Allergy Asthma Immunol 2011; 107:266-72. [PMID: 21875547 DOI: 10.1016/j.anai.2011.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 05/24/2011] [Accepted: 06/10/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND The safety of long-acting beta-2-adrenergic agonists is increasingly questioned by physicians. Although formoterol is frequently used in childhood, its effects on the autonomic cardiovascular system have not been studied. OBJECTIVE To investigate the effects of inhaled formoterol on autonomic nervous system using heart rate variability in adolescents with persistent asthma. METHODS Electrocardiography of 20 asthmatic adolescents (12-20 years) was monitored for 5 specific days. The first day served as basal measurement, and the 2nd and 3rd days reflected the effects of a single and 2 doses of formoterol, respectively. From days 4 to 29, patients received regular treatment with formoterol/budesonide and were monitored on days 30 and 31 to evaluate the development of cardiac and respiratory tolerance after single-dose and 2 doses of formoterol, respectively. Electrocardiographs were analyzed for heart rate, heart rate variability (both time and frequency domain parameters), and spirometry tests were performed. RESULTS Inhalation of single-dose formoterol increased heart rate and decreased heart rate variability parameters (ratio of the normal-to-normal [NN] interals changing in excess of 50 ms to total of NN intervals [pNN50], total power [TP][ms], TP[ln]) compared with the corresponding baseline values during the first 12 hours of the day. The heart rate variability parameters (pNN50, TP[ms], TP[ln], root mean square of differences between adjacent NN intervals) during the first 12 hours were increased on the 30th day compared with the 2nd day and decreased on the 31st day compared with the 30th day. CONCLUSION Single-dose formoterol inhalation decreases cardiovagal responsiveness and increases the sympathetic tone in cardiac autonomous control, and regular use of formoterol causes development of tolerance to these effects. However, additive doses of formoterol cause loss of this tolerance.
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Affiliation(s)
- Bülent E Sekerel
- Department of Pediatric Allergy and Asthma, Hacettepe University, Ankara, Turkey.
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Bédard ME, Marquis K, Poirier P, Provencher S. Reduced Heart Rate Variability in Patients with Chronic Obstructive Pulmonary Disease Independent of Anticholinergic or β-agonist Medications. COPD 2010; 7:391-7. [DOI: 10.3109/15412555.2010.528083] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Cekici L, Valipour A, Kohansal R, Burghuber OC. Short-term effects of inhaled salbutamol on autonomic cardiovascular control in healthy subjects: a placebo-controlled study. Br J Clin Pharmacol 2009; 67:394-402. [PMID: 19371312 DOI: 10.1111/j.1365-2125.2009.03377.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
AIMS To investigate short-term effects of inhaled salbutamol on haemodynamic changes and cardiovascular autonomic control. METHODS A randomized, single-blinded, placebo-controlled study of 0.2 mg of inhaled salbutamol was conducted on 12 healthy nonsmoking volunteers with a mean age of 24 +/- 2 years at two different testing sessions. Non-invasively obtained continuous haemodynamic measurements of cardiac output, beat-to-beat arterial blood pressure, and total peripheral resistance were recorded prior to and for a total of 120 min after inhalation of the respective study drug. Continuous cardiovascular autonomic tone was recorded using power spectral analysis of heart rate and blood pressure variability. Spontaneous baroreceptor activity was assessed by the sequence method. RESULTS There were no significant changes in any of the baseline parameters between the different testing sessions. Inhalation of salbutamol caused a significant increase in cardiac output from 6.7 +/- 1.3 to 7.7 +/- 1.4 l min(-1) (P < 0.05), and a decrease in total peripheral resistance from 1076 +/- 192 to 905 +/- 172 dyne s(-1) cm(-5) (P < 0.05) within 15 min after inhalation. Moreover, salbutamol significantly increased sympathetically mediated low-frequency heart rate variability (P < 0.01), whereas parasympathetically mediated high-frequency heart rate variability decreased (P < 0.01). All changes persisted for approximately 30 min and were fully reversible at 120 min. There were no significant changes in systolic blood pressure variability or spontaneous baroreceptor activity. CONCLUSIONS Inhalation of therapeutic doses of salbutamol in healthy subjects resulted in significant haemodynamic changes and a shift of sympathovagal balance towards increased sympathetic tone in the absence of baroreceptor activation.
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Affiliation(s)
- Leyla Cekici
- Department of Respiratory and Critical Care Medicine, Ludwig-Boltzmann-Institute for COPD, Otto-Wagner Hospital, Vienna, Austria
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Abstract
Heart rate variability (HRV) is a reliable reflection of the many physiological factors modulating the normal rhythm of the heart. In fact, they provide a powerful means of observing the interplay between the sympathetic and parasympathetic nervous systems. It shows that the structure generating the signal is not only simply linear, but also involves nonlinear contributions. Heart rate (HR) is a nonstationary signal; its variation may contain indicators of current disease, or warnings about impending cardiac diseases. The indicators may be present at all times or may occur at random-during certain intervals of the day. It is strenuous and time consuming to study and pinpoint abnormalities in voluminous data collected over several hours. Hence, HR variation analysis (instantaneous HR against time axis) has become a popular noninvasive tool for assessing the activities of the autonomic nervous system. Computer based analytical tools for in-depth study of data over daylong intervals can be very useful in diagnostics. Therefore, the HRV signal parameters, extracted and analyzed using computers, are highly useful in diagnostics. In this paper, we have discussed the various applications of HRV and different linear, frequency domain, wavelet domain, nonlinear techniques used for the analysis of the HRV.
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Rajendra Acharya U, Paul Joseph K, Kannathal N, Lim CM, Suri JS. Heart rate variability: a review. Med Biol Eng Comput 2006; 44:1031-51. [PMID: 17111118 DOI: 10.1007/s11517-006-0119-0] [Citation(s) in RCA: 1222] [Impact Index Per Article: 67.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2005] [Accepted: 10/10/2006] [Indexed: 12/16/2022]
Abstract
Heart rate variability (HRV) is a reliable reflection of the many physiological factors modulating the normal rhythm of the heart. In fact, they provide a powerful means of observing the interplay between the sympathetic and parasympathetic nervous systems. It shows that the structure generating the signal is not only simply linear, but also involves nonlinear contributions. Heart rate (HR) is a nonstationary signal; its variation may contain indicators of current disease, or warnings about impending cardiac diseases. The indicators may be present at all times or may occur at random-during certain intervals of the day. It is strenuous and time consuming to study and pinpoint abnormalities in voluminous data collected over several hours. Hence, HR variation analysis (instantaneous HR against time axis) has become a popular noninvasive tool for assessing the activities of the autonomic nervous system. Computer based analytical tools for in-depth study of data over daylong intervals can be very useful in diagnostics. Therefore, the HRV signal parameters, extracted and analyzed using computers, are highly useful in diagnostics. In this paper, we have discussed the various applications of HRV and different linear, frequency domain, wavelet domain, nonlinear techniques used for the analysis of the HRV.
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Affiliation(s)
- U Rajendra Acharya
- Department of ECE, Ngee Ann Polytechnic, 535 Clementi Road, Singapore, Singapore 599 489.
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Rajendra Acharya U, Paul Joseph K, Kannathal N, Lim CM, Suri JS. Heart rate variability: a review. Med Biol Eng Comput 2006. [PMID: 17111118 DOI: 10.1007/s1151700601190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Heart rate variability (HRV) is a reliable reflection of the many physiological factors modulating the normal rhythm of the heart. In fact, they provide a powerful means of observing the interplay between the sympathetic and parasympathetic nervous systems. It shows that the structure generating the signal is not only simply linear, but also involves nonlinear contributions. Heart rate (HR) is a nonstationary signal; its variation may contain indicators of current disease, or warnings about impending cardiac diseases. The indicators may be present at all times or may occur at random-during certain intervals of the day. It is strenuous and time consuming to study and pinpoint abnormalities in voluminous data collected over several hours. Hence, HR variation analysis (instantaneous HR against time axis) has become a popular noninvasive tool for assessing the activities of the autonomic nervous system. Computer based analytical tools for in-depth study of data over daylong intervals can be very useful in diagnostics. Therefore, the HRV signal parameters, extracted and analyzed using computers, are highly useful in diagnostics. In this paper, we have discussed the various applications of HRV and different linear, frequency domain, wavelet domain, nonlinear techniques used for the analysis of the HRV.
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Affiliation(s)
- U Rajendra Acharya
- Department of ECE, Ngee Ann Polytechnic, 535 Clementi Road, Singapore, Singapore 599 489.
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Lewis MJ, Short AL, Lewis KE. Autonomic nervous system control of the cardiovascular and respiratory systems in asthma. Respir Med 2006; 100:1688-705. [PMID: 16524708 DOI: 10.1016/j.rmed.2006.01.019] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2005] [Revised: 01/19/2006] [Accepted: 01/25/2006] [Indexed: 12/01/2022]
Abstract
Patients with asthma have exaggerated bronchoconstriction of their airways in response to certain indirect (e.g. cold air, allergens, dust, exercise) or direct (e.g. inhaled methacholine) stimuli. This 'hyper-reactivity' usually co-exists with airway inflammation, although the pathophysiological mechanisms underlying these changes are not fully understood. It is likely that this hyper-reactivity is associated with abnormal autonomic nervous system (ANS) control. In particular, the parasympathetic (vagal) component of the ANS appears to be implicated in the pathogenesis of asthma. In addition, several studies have suggested the existence of differential alteration in ANS function following exercise in asthmatics compared with non-asthmatic individuals. Several early studies suggested that the altered autonomic control of airway calibre in asthma might be reflected by a parallel change in heart rate. Cardiac vagal reactivity does indeed appear to be increased in asthma, as demonstrated by the cardiac response to various autonomic functions tests. However, other studies have reported a lack of association between bronchial and cardiac vagal tone, and this is in accord with the concept of system-independent ANS control. This review provides a discussion of cardiovascular-autonomic changes associated with either the pathophysiology of asthma per se or with asthma pharmacotherapy treatment. Previous investigations are summarised suggesting an apparent association between altered autonomic-cardiovascular control and bronchial asthma. The full extent of autonomic dysfunction, and its clinical implications, has yet to be fully determined and should be the subject of future investigation.
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Affiliation(s)
- M J Lewis
- Department of Sports Science, University of Wales Swansea, Singleton Park, Swansea SA2 8PP, UK.
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Abstract
Heart rate monitoring is commonly used to provide an acute indicator of an individual's cardiovascular status and responsiveness. An increasingly popular technique involves quantifying the very small amounts by which the heart rate changes from one cardiac cycle to the next. This "heart rate variability (HRV) analysis" provides a substantial amount of additional information about the cardiovascular system and enables quantification of cardiac regulatory influences on the autonomic nervous system. The autonomic nervous system consists of two main components: the sympathetic system and the parasympathetic system. The relative influence of these two components on the sino-atrial node of the heart determines the heart rate. A number of physiological factors, including blood pressure and respiratory rate, can have a profound effect on this autonomic "balance." HRV analysis therefore provides a noninvasive method for investigating the dynamic influence of changing physiological parameters on cardiac regulation.
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Affiliation(s)
- Michael J Lewis
- Department of Sports Science, University of Wales-Swansea, Singleton Park, Swansea SA2 8PP, Wales, UK.
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Nickel C, Kettler C, Muehlbacher M, Lahmann C, Tritt K, Fartacek R, Bachler E, Rother N, Egger C, Rother WK, Loew TH, Nickel MK. Effect of progressive muscle relaxation in adolescent female bronchial asthma patients: a randomized, double-blind, controlled study. J Psychosom Res 2005; 59:393-8. [PMID: 16310021 DOI: 10.1016/j.jpsychores.2005.04.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2004] [Revised: 04/05/2005] [Accepted: 04/05/2005] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study is to examine the efficacy of progressive muscle relaxation (PMR) on change in blood pressure, lung parameters and heart rate in female adolescent asthmatics. METHOD In a prospective, randomized, double-blind, controlled study, adolescent female asthmatics (n=31) were tested to find out how the systolic blood pressure (SBP), forced expiratory volume in the first second (FEV(1)), peak expiratory flow (PEF) and heart rate change after PMR. The control group (CG; n=30) received a placebo intervention. RESULTS A significant reduction in SBP and a significant increase in the FEV(1) and PEF were observed after PMR. The heart rate showed a significant increase in the coefficient of variation (CV), root-mean-square of successive differences (RMSSD) and at the high frequency (HF) range, in addition to a significant reduction at the low and middle frequency (LF and MF, respectively) ranges. CONCLUSION PMR appears to be effective in improvement of blood pressure, lung parameter and heart rate in adolescent female asthmatics.
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Affiliation(s)
- Cerstin Nickel
- Clinic of Psychosomatic Medicine and Psychotherapy, Inntalklinik, Simbach am Inn, Germany
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Eryonucu B, Uzun K, Güler N, Tuncer M, Sezgi C. Comparison of the short-term effects of salmeterol and formoterol on heart rate variability in adult asthmatic patients. Chest 2005; 128:1136-9. [PMID: 16162698 DOI: 10.1378/chest.128.3.1136] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES We investigated the effects of beta2-adrenergic agonists salmeterol and formoterol on heart rate variability (HRV) in adult asthmatic patients using time-domain measures of HRV. PATIENTS Thirty-nine adult patients with asthma were studied. All patients showed a mild-to-moderate decrease in baseline FEV1. Any diseases that might have influenced the autonomic function were excluded. All patients underwent a complete physical examination and medical history that revealed no cardiovascular disease or medication. METHODS The beta2-adrenergic inhaled agonists salmeterol, 50 microg, and formoterol, 12 microg, were used in the study. HRV analysis was performed for each 5-min segment: 5 min and 10 min before inhalation of the study drug, and 5, 10, 15, 20, 25, and 30 min after inhalation. Time-domain parameters of HRV were calculated: (1) the SD all normal-to-normal intervals; (2) the SD of the mean of all normal-to-normal intervals in all 5-min segments of the entire recording; (3) the root mean square of differences between adjacent normal-to-normal intervals; (4) the mean of the SD of all normal-to-normal intervals in all the 5-min intervals; and (5) the SD of the SD of all normal-to-normal intervals in all the 5-min intervals. RESULTS Baseline HRV parameters were not significantly different between formoterol and salmeterol groups. There were no significant differences in HRV parameters after formoterol and salmeterol inhalation. The HRV parameters in each 5-min segment in the formoterol group were not statistically significant different when compared to the same segment in the salmeterol group. CONCLUSION Salmeterol and formoterol have no short-term adverse effects on HRV.
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Affiliation(s)
- Beyhan Eryonucu
- Department of Cardiology, Medical Faculty, Yüzüncü Yil University, Van, Turkey.
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Anthracopoulos MB, Karatza AA, Davlouros PA, Chiladakis JA, Manolis AS, Beratis NG. Effects of two nebulization regimens on heart rate variability during acute asthma exacerbations in children. J Asthma 2005; 42:273-9. [PMID: 16032936 DOI: 10.1081/jas-200057895] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Analysis of heart rate variability (HRV) has been used to evaluate changes in sympathovagal balance. The present study was designed to investigate the influence of two therapeutic regimens on autonomic cardiovascular regulation during acute asthma exacerbations (AAE). Twenty children, 7-13 years of age, with moderate or severe AAE were randomized in two equal groups to receive either 0.15 mg/kg/dose salbutamol (group 1) or a combination of lower-dose salbutamol (0.10 mg/kg/dose) and ipratropium bromide (5 mcg/kg/dose) (group 2). Exacerbations were treated with three nebulizations (Tx) of either regimen given 20 minutes apart. HRV indices [total power, high-frequency component (HF), low-frequency component (LF), and LF:HF ratio] were analyzed at specific time intervals during the management of AAE. Therapy had a significant time-dependent main effect on total power (p = 0.001), LF (p < 0.0001), and HF (p = 0.005) but reached only borderline significance for LF:HF ratio (p = 0.053). The decrease in LF was more pronounced in group 2 vs. group 1 at 10 minutes post-Tx1 (p = 0.034) and at 10 minutes post-Tx2 (p = 0.05), but there was no significant difference between groups at 10 and 20 minutes post-Tx3. There were no significant differences between groups in any of the other HRV indices. Both regimens improved FEV1 (p = 0.0001) to the same magnitude. During AAE, three consecutive inhalation treatments with either high-dose salbutamol-only or lower-dose salbutamol plus ipratropium bromide combination, resulting in similar FEV1 improvement, cause domination of sympathetic over parasympathetic nervous system of similar overall magnitude but distinct patterns of HRV indices.
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