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Hoshi R, Santos I, Bittencourt M, Dantas E, Andreão R, Mill J, Lotufo P, Benseñor I. Association of coronary artery calcium with heart rate variability in the Brazilian Longitudinal Study of Adult Health - ELSA-Brasil. Braz J Med Biol Res 2023; 56:e12364. [PMID: 36856251 PMCID: PMC9974082 DOI: 10.1590/1414-431x2023e12364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/27/2022] [Indexed: 03/02/2023] Open
Abstract
Current data shows that the autonomic and vascular systems can influence each other. However, only a few studies have addressed this association in the general population. We aimed to investigate whether heart rate variability (HRV) was associated with coronary artery calcium (CAC) in a cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). We examined baseline data from 3138 participants (aged 35 to 74 years) without previous cardiovascular disease who underwent CAC score assessment and had validated HRV recordings. Prevalent CAC was defined as a CAC score>0, and HRV analyses were performed over 5-min segments. We detected CAC score>0 in 765 (24.4%) participants. Subgroup analyses in older participants (≥49 years) adjusted for sociodemographic and clinical variables revealed that CAC score>0 was associated with lower values of standard deviation of NN intervals (SDNN) (odds ratio [OR]=1.32; 95%CI: 1.05,1.65), root mean square of successive differences between adjacent NN intervals (RMSSD) (OR=1.28; 95%CI: 1.02,1.61), and low frequency (LF) (OR=1.53, 95%CI: 1.21,1.92). Interaction analysis between HRV indices and sex in age-stratified groups revealed significant effect modification: women showed increased OR for prevalent CAC in the younger group, while for men, the associations were in the older group. In conclusion, participants aged ≥49 years with low SDNN, RMSSD, and LF values were more likely to present prevalent CAC, suggesting a complex interaction between these markers in the pathogenesis of atherosclerosis. Furthermore, our results suggested that the relationship between CAC and HRV might be sex- and age-related.
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Affiliation(s)
- R.A. Hoshi
- Centro de Estudos Clínicos e Epidemiológicos do Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - I.S. Santos
- Centro de Estudos Clínicos e Epidemiológicos do Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - M.S. Bittencourt
- Centro de Estudos Clínicos e Epidemiológicos do Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - E.M. Dantas
- Departamento de Ciências Biológicas, Universidade Federal do Vale do São Francisco, Petrolina, PE, Brasil
| | - R.V. Andreão
- Departamento de Engenharia Elétrica, Instituto Federal do Espírito Santo, Vitória, ES, Brasil
| | - J.G. Mill
- Departamento de Ciências Fisiológicas, Universidade Federal do Espírito Santo, Vitória, ES, Brasil
| | - P.A. Lotufo
- Centro de Estudos Clínicos e Epidemiológicos do Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - I.M. Benseñor
- Centro de Estudos Clínicos e Epidemiológicos do Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
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Cheng YC, Huang YC, Huang WL. Heart rate variability in patients with dementia or neurocognitive disorders: A systematic review and meta-analysis. Aust N Z J Psychiatry 2022; 56:16-27. [PMID: 33287558 DOI: 10.1177/0004867420976853] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Heart rate variability, a quantitative measure of mainly parasympathetic activity, has been applied in evaluating many types of psychiatric and neurological disorders, including dementia (or neurocognitive disorders). However, although dementia patients often showed significantly lower heart rate variability (various indices) than healthy controls, and different types of dementia had distinct heart rate variability features, the results were not identical across studies. We designed a systematic review and meta-analysis for incorporating data from different studies. METHODS We gathered studies comparing heart rate variability in patients with dementia and in healthy controls. Heart rate variability was analysed in several ways: parasympathetic function in hierarchical order (main analysis), total variability, comparison of heart rate variability between different subtypes of dementia, specific indices of heart rate variability and heart rate variability reactivity. RESULTS In the initial search, we found 3425 relevant articles, from which 24 studies with a total of 1107 dementia patients and 1017 control participants finally entered the main meta-analysis. The dementia patients had a significantly lower resting heart rate variability for parasympathetic function (Hedges' g = -0.3596, p = 0.0002) and total variability (Hedges' g = -0.3059, p = 0.0002) than the controls. For diagnostic subgroup analysis relative to the controls, heart rate variability was significantly lower in patients with mild cognitive impairment (Hedges' g = -0.3060) and in patients with dementia with Lewy bodies (Hedges' g = -1.4154, p < 0.0001). Relative to patients with Alzheimer's disease, heart rate variability in patients with dementia with Lewy bodies was significantly lower (Hedges' g = -1.5465, p = 0.0381). Meta-regression revealed that gender proportion was significantly associated with effect size. CONCLUSION Our results show that dementia patients (especially those with dementia with Lewy bodies and mild cognitive impairment) have lower parasympathetic activity than healthy people. The influence of gender on the results should be carefully interpreted.
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Affiliation(s)
- Ying-Chih Cheng
- Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Hsinchu.,Department of Public Health and Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei.,Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei
| | - Yu-Chen Huang
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei.,Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei.,Department of Dermatology, School of Medicine and College of Medicine, Taipei Medical University, Taipei
| | - Wei-Lieh Huang
- Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, Yunlin.,Department of Psychiatry, National Taiwan University Hospital, Taipei.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei
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Distress disorder histories predict HRV trajectories during and after stress. Psychoneuroendocrinology 2022; 135:105575. [PMID: 34741982 PMCID: PMC8670520 DOI: 10.1016/j.psyneuen.2021.105575] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Breast cancer survivors face a number of physical health threats including cardiovascular disease, the leading cause of death among breast cancer survivors. Low heart rate variability (HRV) represents one well-established risk factor for poor cardiovascular health. Among physically healthy adults and breast cancer survivors, distress disorders may contribute to lower HRV, enhancing morbidity and mortality. This study examined how a distress disorder history altered survivors' HRV trajectories during and after an experimental stressor. METHODS Breast cancer survivors (n = 178; mean age = 51.22) who finished treatment for stages 0-IIIa cancer within the past two years completed a diagnostic interview assessing lifetime presence of psychological disorders. They also participated in a Trier Social Stress Test (TSST). HRV data provided information on survivors' cardiovascular responses at baseline, during the TSST, and during recovery. HRV recovery data at 45 min and 120 min post-TSST was also collected. Survivors also completed questionnaires before and after the TSST assessing task performance, stress levels, ability to cope, and hopelessness. Covariates included body mass index, age, cancer stage, cardiovascular medications, exercise, menopause status, fatigue, current depressive and anxiety symptoms, and physical comorbidities. RESULTS Women with a distress disorder history had significantly lower HRV before, during, and after the TSST compared to women without such a history. Survivors with distress disorders found the TSST to be more threatening, and reported feeling less control over their performance than those without distress disorders. CONCLUSIONS Breast cancer survivors with a distress disorder history may have lower autonomic flexibility before, during, and after stress exposure. Distress disorder histories also heighten several stress-related risk perceptions leading up to and following the TSST. These findings highlight distress disorder histories as a unique correlate of poorer cardiovascular function among survivors.
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Nagata S, Fujiwara K, Kuga K, Ozaki H. Prediction of GABA receptor antagonist-induced convulsion in cynomolgus monkeys by combining machine learning and heart rate variability analysis. J Pharmacol Toxicol Methods 2021; 112:107127. [PMID: 34619314 DOI: 10.1016/j.vascn.2021.107127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 09/30/2021] [Accepted: 09/30/2021] [Indexed: 12/19/2022]
Abstract
Drug-induced convulsion is a severe adverse event; however, no useful biomarkers for it have been discovered. We propose a new method for predicting drug-induced convulsions in monkeys based on heart rate variability (HRV) and a machine learning technique. Because autonomic nervous activities are altered around the time of a convulsion and such alterations affect HRV, they may be predicted by monitoring HRV. In the proposed method, anomalous changes in multiple HRV parameters are monitored by means of a convulsion prediction model, and convulsion alarms are issued when abnormal changes in HRV are detected. The convulsion prediction model is constructed based on multivariate statistical process control (MSPC), a well-known anomaly detection algorithm in machine learning. In this study, HRV data were collected from four cynomolgus monkeys administered with multiple doses of pentylenetetrazol (PTZ) and picrotoxin (PTX), which are GABA receptor antagonists, as convulsant agents. In addition, low doses of pilocarpine (PILO) were administered as a negative control. Twelve HRV parameters in three hours after drug administration were monitored by means of the prediction model. The number and duration of convulsion alarms from HRV increased at medium and high doses of PTZ and PTX (1/3 or 1/4 of convulsion dose). On the other hand, the frequency of convulsion alarms did not increase with PILO. Although vomiting was observed in all drugs, convulsion alarms were not associated with the vomiting. Thus, convulsion alarms can be used as a biomarker for convulsions induced by GABA receptor antagonists.
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Affiliation(s)
- Shoya Nagata
- Department of Material Process Engineering, Nagoya University, Nagoya, Japan
| | - Koichi Fujiwara
- Department of Material Process Engineering, Nagoya University, Nagoya, Japan.
| | - Kazuhiro Kuga
- Drug Safety Research and Evaluation, Takeda Pharmaceutical Company Ltd., Kanagawa, Japan
| | - Harushige Ozaki
- Drug Safety Research and Evaluation, Takeda Pharmaceutical Company Ltd., Kanagawa, Japan
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Abouassali O, Chang M, Chidipi B, Martinez JL, Reiser M, Kanithi M, Soni R, McDonald TV, Herweg B, Saiz J, Calcul L, Noujaim SF. In vitro and in vivo cardiac toxicity of flavored electronic nicotine delivery systems. Am J Physiol Heart Circ Physiol 2021; 320:H133-H143. [PMID: 33216635 PMCID: PMC7847071 DOI: 10.1152/ajpheart.00283.2020] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 10/17/2020] [Accepted: 11/09/2020] [Indexed: 01/06/2023]
Abstract
The usage of flavored electronic nicotine delivery systems (ENDS) is popular, specifically in the teen and young adult age-groups. The possible cardiac toxicity of the flavoring aspect of ENDS is largely unknown. Vaping, a form of electronic nicotine delivery, uses "e-liquid" to generate "e-vapor," an aerosolized mixture of nicotine and/or flavors. We report our investigation into the cardiotoxic effects of flavored e-liquids. E-vapors containing flavoring aldehydes such as vanillin and cinnamaldehyde, as indicated by mass spectrometry, were more toxic in HL-1 cardiomyocytes than fruit-flavored e-vapor. Exposure of human induced pluripotent stem cell-derived cardiomyocytes to cinnamaldehyde or vanillin-flavored e-vapor affected the beating frequency and prolonged the field potential duration of these cells more than fruit-flavored e-vapor. In addition, vanillin aldehyde-flavored e-vapor reduced the human ether-à-go-go-related gene (hERG)-encoded potassium current in transfected human embryonic kidney cells. In mice, inhalation exposure to vanillin aldehyde-flavored e-vapor for 10 wk caused increased sympathetic predominance in heart rate variability measurements. In vivo inducible ventricular tachycardia was significantly longer, and in optical mapping, the magnitude of ventricular action potential duration alternans was significantly larger in the vanillin aldehyde-flavored e-vapor-exposed mice than in controls. We conclude that the widely popular flavored ENDS are not harm free, and they have a potential for cardiac harm. More studies are needed to further assess their cardiac safety profile and long-term health effects.NEW & NOTEWORTHY The use of electronic nicotine delivery systems (ENDS) is not harm free. It is not known whether ENDS negatively affect cardiac electrophysiological function. Our study in cell lines and in mice shows that ENDS can compromise cardiac electrophysiology, leading to action potential instability and inducible ventricular arrhythmias. Further investigations are necessary to assess the long-term cardiac safety profile of ENDS products in humans and to better understand how individual components of ENDS affect cardiac toxicity.
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Affiliation(s)
- Obada Abouassali
- Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Mengmeng Chang
- Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Bojjibabu Chidipi
- Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | | | - Michelle Reiser
- Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Manasa Kanithi
- Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Ravi Soni
- Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Thomas V McDonald
- Division of Cardiology, Department of Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Bengt Herweg
- Division of Cardiology, Department of Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Javier Saiz
- Ci2 B, Universitat Politècnica de València, Valencia, Spain
| | - Laurent Calcul
- Department of Chemistry, College of Arts and Sciences, University of South Florida, Tampa, Florida
| | - Sami F Noujaim
- Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida
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Macartney MJ, Notley SR, Herry CL, Seely AJE, Sigal RJ, Kenny GP. Cardiac autonomic modulation in type 1 diabetes during exercise-heat stress. Acta Diabetol 2020; 57:959-963. [PMID: 32144491 DOI: 10.1007/s00592-020-01505-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/14/2020] [Indexed: 12/30/2022]
Abstract
AIMS Cardiac autonomic modulation, as assessed by heart rate variability (HRV), is independently attenuated by both type 1 diabetes (T1D) and exercise-heat stress, although their combined effects remain unclear. We therefore assessed HRV during exercise-heat stress in young individuals (18-37 years) with (n = 14) and without type 1 diabetes (n = 14). METHODS Participants completed 30-min seated rest and three, 30-min bouts of semi-recumbent cycling at light, moderate, and vigorous metabolic heat productions (200, 250, 300 W/m2, respectively), each followed by 30-min recovery. Body core temperature (Tcore) and electrocardiogram were recorded throughout and analyzed during the final 5-min of rest and each exercise period. RESULTS Relative to baseline, Tcore was increased in both groups, albeit to a greater extent in type 1 diabetes during vigorous exercise (T1D, 1.1 ± 0.3 °C; control, 0.8 ± 0.3 °C; P < 0.05). Overall HRV (as reflected by entropy) was attenuated throughout exercise relative to baseline in both groups, with the magnitude of the reduction greater in type 1 diabetes during vigorous exercise (T1D, - 108%; control, - 70%; P < 0.05). CONCLUSIONS Given the negative correlations between decreased HRV and cardiac risk, our novel observations indicate that vigorous exercise in hot environments may pose a health concern for individuals with type 1 diabetes.
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Affiliation(s)
- Michael J Macartney
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Sean R Notley
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, 125 University, Room 367, Montpetit Hall, Ottawa, ON, K1N 6N5, Canada
| | - Christophe L Herry
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Andrew J E Seely
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Thoracic Surgery and Critical Care Medicine, The Ottawa Hospital, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Ronald J Sigal
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, 125 University, Room 367, Montpetit Hall, Ottawa, ON, K1N 6N5, Canada
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
- Departments of Medicine, Cardiac Sciences and Community Health Sciences, Cumming School of Medicine, Faculties of Medicine and Kinesiology, University of Calgary, Calgary, Canada
| | - Glen P Kenny
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, 125 University, Room 367, Montpetit Hall, Ottawa, ON, K1N 6N5, Canada.
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
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7
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Mendo DS, González SA, Bonaccorsi HA. [Association between autonomic disorders and subclinical atherosclerosis]. HIPERTENSION Y RIESGO VASCULAR 2020; 37:108-114. [PMID: 32362414 DOI: 10.1016/j.hipert.2020.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 01/02/2023]
Abstract
INTRODUCTION AND OBJECTIVES Alterations of the sympathetic and parasympathetic nervous system have been proposed as precursors of the genesis and perpetuation of atherosclerosis for a long time. The objective of this study is to determine if there is an association between the presence of carotid atherosclerosis and the reduction in heart rate variability. METHODS Using a prospective case-control design, the heart rate variability and the presence of carotid atherosclerosis was investigated in 54 patients, divided into 2groups according to the presence or absence of carotid atherosclerosis. An analysis was made of the heart rate variability variables of the frequency (spectral) domain in high frequency band, low frequency band, parasympathetic autonomic balance, and the total spectral band. RESULTS Of the 54 individuals evaluated without previous cardiovascular disease consecutively, 26 of them (48%) presented with subclinical carotid atherosclerosis (ATE+). A reduction in heart rate variability was observed in the ATE+group represented by the low frequency (LF) spectrum (P<.0001). The parasympathetic activity specifically represented in the high frequency (HF) band was also lower in the ATE+group in the univariate analysis (P<.0001), same as the total spectral power (P<.0001), an index of integral autonomic regulation. No significant differences were found in the LF/HF analysis (P=.1598). After analysing variables with significant differences in the univariate analysis with a logistic regression model, only systolic blood preassure and the total spectral power were shown to be independent predictors of ATE+. CONCLUSION A reduction in heart rate variability was found in subjects with carotid atherosclerosis. Some spectral components of heart rate variability, like low frequency or total spectral power, were better predictors of carotid atherosclerosis than the parasympathetic autonomic balance. In this study it seems that total spectral power is an adequate measurement for analysing autonomic function.
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Affiliation(s)
- D S Mendo
- Unidad de Hipertensión Arterial, Instituto Cardiovascular de Rosario Rosario (Santa Fe), Argentina.
| | - S A González
- Unidad Cardiometabólica, Servicio de Cardiología, Hospital Universitario Austral, Pilar (Buenos Aires), Argentina
| | - H A Bonaccorsi
- Unidad de Hipertensión Arterial, Instituto Cardiovascular de Rosario Rosario (Santa Fe), Argentina
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8
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Lu X, Zhao C. Exercise and Type 1 Diabetes. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1228:107-121. [PMID: 32342453 DOI: 10.1007/978-981-15-1792-1_7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Diabetes mellitus (DM) is the most common endocrine and metabolic disease caused by absolute or insufficient insulin secretion. Under the context of an aging population worldwide, the number of diabetic patients is increasing year by year. Most patients with diabetes have multiple complications that severely threaten their survival and living quality. DM is mainly divided into type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). T1DM is caused by absolute lack of insulin secretion, so the current treatment for T1DM patients is exogenous insulin replacement therapy. At present, exercise therapy has been widely recognized in the prevention and treatment of diabetes, and regular aerobic exercise has become an important part of T1DM treatment. At the same time, exercise therapy is also used in conjunction with other treatments in the prevention and treatment of diabetic complications. However, for patients with T1DM, exercise still has the risk of hypoglycemia or hyperglycemia. T1DM Patients and specialist physician need to fully understand the effects of exercise on metabolism and implement individualized exercise programs. This chapter reviews the related content of exercise and T1DM.
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Affiliation(s)
- Xiya Lu
- Division of Gastroenterology and Hepatology, Digestive Disease Institute, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Cuimei Zhao
- Department of Cardiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
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Gao L, Li P, Hu C, To T, Patxot M, Falvey B, Wong PM, Scheer FAJL, Lin C, Lo MT, Hu K. Nocturnal heart rate variability moderates the association between sleep-wake regularity and mood in young adults. Sleep 2020; 42:5307029. [PMID: 30722058 DOI: 10.1093/sleep/zsz034] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 01/03/2019] [Accepted: 01/29/2019] [Indexed: 01/06/2023] Open
Abstract
STUDY OBJECTIVES Sleep-wake regularity (SWR) is often disrupted in college students and mood disorders are rife at this age. Disrupted SWR can cause repetitive and long-term misalignment between environmental and behavioral cycles and the circadian system which may then have psychological and physical health consequences. We tested whether SWR was independently associated with mood and autonomic function in a healthy adult cohort. METHODS We studied 42 college students over a 3 week period using daily sleep-wake diaries and continuous electrocardiogram recordings. Weekly SWR was quantified by the interdaily stability of sleep-wake times (ISSW) and mood was assessed weekly using the Beck Depression Inventory-II. To assess autonomic function, we quantified the high-frequency (HF) power of heart rate variability (HRV). Linear mixed effects models were used to assess the relationship between repeated weekly measures of mood, SWR, and HF. RESULTS Low weekly ISSW predicted subsequent poor mood and worsening mood independently of age, sex, race, sleep duration, and physical activity. Although no association was found between ISSW and HF, the ISSW-mood association was significantly moderated by nocturnal HF, i.e. reported mood was lowest after a week with low ISSW and high HF. Prior week mood scores did not significantly predict the subsequent week's ISSW. CONCLUSIONS Irregular sleep-wake timing appears to precede poor mood in young adults. Further work is needed to understand the implications of high nocturnal HRV in those with low mood and irregular sleep-wake cycles.
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Affiliation(s)
- Lei Gao
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA.,Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Peng Li
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Chelsea Hu
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
| | - Tommy To
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
| | - Melissa Patxot
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
| | - Brigid Falvey
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
| | - Patricia M Wong
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | - Frank A J L Scheer
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Chen Lin
- Institute of Translational and Interdisciplinary Medicine and Department of Biomedical Sciences and Engineering, National Central University, Taoyuan, Taiwan
| | - Men-Tzung Lo
- Institute of Translational and Interdisciplinary Medicine and Department of Biomedical Sciences and Engineering, National Central University, Taoyuan, Taiwan
| | - Kun Hu
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA
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10
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Herman DA, Wingen LM, Johnson RM, Keebaugh AJ, Renusch SR, Hasen I, Ting A, Kleinman MT. Seasonal effects of ambient PM 2.5 on the cardiovascular system of hyperlipidemic mice. JOURNAL OF THE AIR & WASTE MANAGEMENT ASSOCIATION (1995) 2020; 70:307-323. [PMID: 31951803 DOI: 10.1080/10962247.2020.1717674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 11/15/2019] [Accepted: 11/19/2019] [Indexed: 06/10/2023]
Abstract
People in polluted communities are often exposed to both PM and ozone (O3), albeit not always simultaneously; an important question is whether exposure to particles with seasonal compositional differences can influence biological outcomes. We addressed this question using a mouse model of cardiovascular disease by contrasting the health outcomes of exposures to particles formed or aged during periods of relatively high photochemical activity (i.e. spring/summer), which has increased ambient O3 concentrations, with outcomes of exposures to fall/winter particles which are associated with lower O3 concentrations. Electrocardiographs (ECGs) and blood pressures (BPs) were acquired following exposures to concentrated ambient particles (CAPs). ECGs were analyzed to changes in specific waveform parameters and changes in heart rate variability (HRV). Exposures elicited several types of waveform abnormalities that were associated with seasonal differences in particle constituents. Alterations in R-R interval and P-R interval were seen following exposure to summer CAPs but not fall CAPs and differential responses were seen in the corrected Q-T interval following the two seasonal exposures. Measures of HRV increased after exposure to summer CAPs compared to air-exposed controls but not following the winter CAPs exposure. There were chemical differences with respect to the organic constituents in ambient particles between summer and fall aerosol. The oxygen to carbon ratios (O:C) were generally higher in the spring and summer than in the fall, consistent with seasonal differences in atmospheric photochemical activity. Seasonal differences in atmospheric photochemical activity can modify ambient aerosol composition and can alter biological responses in the cardiovascular system. The results from this study confirm that ambient photochemical activity can alter the toxicity of ambient PM. Regional and seasonal differences in PM2.5 composition should be important considerations when evaluating the effects of PM exposure on cardiovascular health.Implications: Particles formed during periods of high photochemical activity (e.g. spring/summer) elicit more adverse cardiovascular health effects than particles formed during periods of low photochemical activity (e.g. fall/winter). Seasonal differences in atmospheric photochemical activity modified ambient aerosol composition and worsened cardiovascular responses. These results can inform regulatory agencies and may help design air quality regulations for PM2.5 that consider seasonal and regional variations.
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Affiliation(s)
- David A Herman
- Division of Occupational and Environmental Medicine, University of California Irvine, Irvine, CA, USA
| | - Lisa M Wingen
- Department of Chemistry, University of California Irvine, Irvine, CA, USA
| | - Rebecca M Johnson
- Division of Occupational and Environmental Medicine, University of California Irvine, Irvine, CA, USA
| | - Andrew J Keebaugh
- Division of Occupational and Environmental Medicine, University of California Irvine, Irvine, CA, USA
| | - Samantha R Renusch
- Division of Occupational and Environmental Medicine, University of California Irvine, Irvine, CA, USA
| | - Irene Hasen
- Division of Occupational and Environmental Medicine, University of California Irvine, Irvine, CA, USA
| | - Amanda Ting
- Division of Occupational and Environmental Medicine, University of California Irvine, Irvine, CA, USA
| | - Michael T Kleinman
- Division of Occupational and Environmental Medicine, University of California Irvine, Irvine, CA, USA
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Sűdy ÁR, Ella K, Bódizs R, Káldi K. Association of Social Jetlag With Sleep Quality and Autonomic Cardiac Control During Sleep in Young Healthy Men. Front Neurosci 2019; 13:950. [PMID: 31555086 PMCID: PMC6742749 DOI: 10.3389/fnins.2019.00950] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/22/2019] [Indexed: 01/23/2023] Open
Abstract
Social jetlag (SJL), the difference in sleep timing between work and free days is a consequence of the discrepancy between the individual’s circadian rhythm and the social clock. SJL is considered a chronic stress factor and has been linked to various health problems. In this field study, we examined for the first time the association between SJL and cardiac regulation during sleep. 33 healthy young men aged 20–26 years participated in the study. The median SJL was used as a cut-off value to assign the participants into two groups with either lower or higher SJL. As a marker of autonomic control we analyzed heart rate variability (HRV) and addressed intra-individual differences between workdays and free days. In subjects with higher SJL, pNN50, an indicator of vagal activity was lower in the first 3 h of sleep on workday as compared to free day (day × sleep block × group, p = 0.015), indicating a more adaptable regulation on free days, when subjects slept according to their own preference. However, in subjects with lower SJL, no HRV differences were found between the two nights. SJL showed correlation with the free day-workday differences of both pNN50 and another vagal index, RMSSD in the first 2 h of sleep (p = 0.023 and 0.047, respectively). In subjects with higher SJL, a different HF power on workdays and free days (p = 0.031) also indicated that a shift in sleep timing is accompanied by an altered parasympathetic activity in the first few hours of sleep. Furthermore, subjective sleep quality on workdays was negatively associated with SJL (p = 0.02), and subjects with higher SJL reported worse sleep quality on workday than on free day (p = 0.027). Taken together, our data call attention on the potential effect of SJL on sleep quality and vagal activity during sleep.
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Affiliation(s)
- Ágnes Réka Sűdy
- Department of Physiology, Semmelweis University, Budapest, Hungary
| | - Krisztina Ella
- Department of Physiology, Semmelweis University, Budapest, Hungary
| | - Róbert Bódizs
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary.,National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Krisztina Káldi
- Department of Physiology, Semmelweis University, Budapest, Hungary.,Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary
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12
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França da Silva AK, Destro Christofaro DG, Manata Vanzella L, Marques Vanderlei F, Lopez Laurino MJ, Marques Vanderlei LC. Relationship of the Aggregation of Cardiovascular Risk Factors in the Parasympathetic Modulation of Young People with Type 1 Diabetes. ACTA ACUST UNITED AC 2019; 55:medicina55090534. [PMID: 31454959 PMCID: PMC6780872 DOI: 10.3390/medicina55090534] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/20/2019] [Accepted: 08/21/2019] [Indexed: 11/20/2022]
Abstract
Background and objectives: In healthy individuals, autonomic alterations are associated with the aggregation of cardiovascular risk factors. However, in individuals with type 1 diabetes, who are known to present autonomic alterations, mainly characterized by a reduction in parasympathetic modulation, these associations have not yet been investigated. We assess whether the aggregation of cardiovascular risk factors influences parasympathetic indices of heart rate variability in young people with type 1 diabetes. Materials and methods: This cross-sectional study included 39 individuals with type 1 diabetes (22.54 ± 4.31), evaluated in relation to the risk factors: blood pressure, fat percentage, and resting heart rate. For heart rate variability analysis, heart rate was recorded beat-to-beat using a cardio frequency meter (PolarS810i) for 30 min with the volunteers in dorsal decubitus. The parasympathetic heart rate variability indices were calculated: rMSSD, pNN50, high frequency (HF) n.u (normalized units), SD1, 2LV, and 2ULV. Data collection was carried out in 2014 and analyzed in 2017. Results: Individuals with two aggregate risk factors present a reduction in the values of the indices that reflect parasympathetic autonomic modulation compared to individuals without the risk factors analyzed, regardless of sex and age. Conclusion: In young people with type 1 diabetes, the aggregation of cardiovascular risk factors is associated with parasympathetic autonomic impairment.
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Affiliation(s)
- Anne Kastelianne França da Silva
- Department of Physical Therapy, Faculty of Science and Technology, São Paulo State University (UNESP), Roberto Simonsen Street, 305, Presidente Prudente, São Paulo 19060-900, Brazil.
| | - Diego Giulliano Destro Christofaro
- Department of Physical Education, Faculty of Science and Technology, São Paulo State University (UNESP), Roberto Simonsen Street, 305, Presidente Prudente, São Paulo 19060-900, Brazil
| | - Laís Manata Vanzella
- Department of Physical Therapy, Faculty of Science and Technology, São Paulo State University (UNESP), Roberto Simonsen Street, 305, Presidente Prudente, São Paulo 19060-900, Brazil
| | - Franciele Marques Vanderlei
- Department of Physical Therapy, Faculty of Science and Technology, São Paulo State University (UNESP), Roberto Simonsen Street, 305, Presidente Prudente, São Paulo 19060-900, Brazil
| | - Maria Júlia Lopez Laurino
- Department of Physical Therapy, Faculty of Science and Technology, São Paulo State University (UNESP), Roberto Simonsen Street, 305, Presidente Prudente, São Paulo 19060-900, Brazil
| | - Luiz Carlos Marques Vanderlei
- Department of Physical Therapy, Faculty of Science and Technology, São Paulo State University (UNESP), Roberto Simonsen Street, 305, Presidente Prudente, São Paulo 19060-900, Brazil
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13
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Chou Y, Huang W, Chang C, Yang CCH, Kuo TBJ, Lin S, Chiang W, Chu T. Heart rate variability as a predictor of rapid renal function deterioration in chronic kidney disease patients. Nephrology (Carlton) 2019; 24:806-813. [DOI: 10.1111/nep.13514] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Yu‐Hsiang Chou
- Renal Division, Department of Internal MedicineNational Taiwan University Hospital Taipei Taiwan
- Department of Internal MedicineNational Taiwan University Hospital Jin‐Shan Branch New Taipei City Taiwan
- Graduate Institute of Physiology, College of MedicineNational Taiwan University Taipei Taiwan
| | - Wei‐Lieh Huang
- Department of PsychiatryNational Taiwan University Hospital Yunlin Branch, Yunlin County Taiwan
- Department of Psychiatry, College of MedicineNational Taiwan University Taipei Taiwan
- Graduate Institute of Clinical Medicine, College of MedicineNational Taiwan University Taipei Taiwan
| | - Chin‐Hao Chang
- Department of Medical ResearchNational Taiwan University Hospital Taipei Taiwan
| | - Cheryl C. H. Yang
- Institute of Brain Science, National Yang‐Ming University Taipei Taiwan
| | - Terry B. J. Kuo
- Institute of Brain Science, National Yang‐Ming University Taipei Taiwan
- Institute of Translational and Interdisciplinary Medicine, National Central University Taoyuan Taiwan
| | - Shuei‐Liong Lin
- Renal Division, Department of Internal MedicineNational Taiwan University Hospital Taipei Taiwan
- Graduate Institute of Physiology, College of MedicineNational Taiwan University Taipei Taiwan
- Department of Integrated Diagnostics &TherapeuticsNational Taiwan University Hospital Taipei Taiwan
- Research Center for Developmental Biology and Regenerative MedicineNational Taiwan University Taipei Taiwan
| | - Wen‐Chih Chiang
- Renal Division, Department of Internal MedicineNational Taiwan University Hospital Taipei Taiwan
| | - Tzong‐Shinn Chu
- Renal Division, Department of Internal MedicineNational Taiwan University Hospital Taipei Taiwan
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14
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Wilson LC, Peebles KC, Hoye NA, Manning P, Sheat C, Williams MJA, Wilkins GT, Wilson GA, Baldi JC. Resting heart rate variability and exercise capacity in Type 1 diabetes. Physiol Rep 2018; 5:5/8/e13248. [PMID: 28420762 PMCID: PMC5408283 DOI: 10.14814/phy2.13248] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 03/16/2017] [Accepted: 03/18/2017] [Indexed: 01/27/2023] Open
Abstract
People with type 1 diabetes (T1D) have lower exercise capacity (V̇O2max) than their age‐matched nondiabetic counterparts (CON), which might be related to cardiac autonomic dysfunction. We examined whether Heart Rate Variability (HRV; indicator of cardiac autonomic modulation) was associated with exercise capacity in those with and without T1D. Twenty‐three participants with uncomplicated T1D and 17 matched CON were recruited. Heart rate (HR; ECG), blood pressure (BP; finger photo‐plethysmography), and respiratory rate (respiratory belt) were measured during baseline, paced‐breathing and clinical autonomic reflex tests (CARTs); deep breathing, lying‐to‐stand, and Valsalva maneuver. Baseline and paced‐breathing ECG were analyzed for HRV (frequency‐domain). Exercise capacity was determined during an incremental cycle ergometer test while V̇O2, 12‐lead ECG, and BP were measured. In uncomplicated T1D, resting HR was elevated and resting HRV metrics were reduced, indicative of altered cardiac parasympathetic modulation; this was generally undetected by the CARTs. However, BP and plasma catecholamines were not different between groups. In T1D, V̇O2max tended to be lower (P = 0.07) and HR reserve was lower (P < 0.01). Resting Total Power (TP) had stronger positive associations with V̇O2max (R2 ≥ 0.3) than all other traditional indicators such as age, resting HR, and self‐reported exercise (R2 = 0.042–0.3) in both T1D and CON. Alterations in cardiac autonomic modulation are an early manifestation of uncomplicated T1D. Total Power was associated with reduced exercise capacity regardless of group, and these associations were generally stronger than traditional indicators.
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Affiliation(s)
- Luke C Wilson
- Department of Medicine, University of Otago, Dunedin, New Zealand .,HeartOtago, University of Otago, Dunedin, New Zealand
| | - Karen C Peebles
- Cardiovascular Systems Laboratory, University of Otago, Wellington, New Zealand.,Department of Physiology, University of Otago, Dunedin, New Zealand.,Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, New South Wales, Australia
| | - Neil A Hoye
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Patrick Manning
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Catherine Sheat
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Michael J A Williams
- Department of Medicine, University of Otago, Dunedin, New Zealand.,HeartOtago, University of Otago, Dunedin, New Zealand
| | - Gerard T Wilkins
- Department of Medicine, University of Otago, Dunedin, New Zealand.,HeartOtago, University of Otago, Dunedin, New Zealand
| | - Genevieve A Wilson
- Department of Medicine, University of Otago, Dunedin, New Zealand.,HeartOtago, University of Otago, Dunedin, New Zealand
| | - James C Baldi
- Department of Medicine, University of Otago, Dunedin, New Zealand.,HeartOtago, University of Otago, Dunedin, New Zealand
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15
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Utzinger ML. Enhancing Heart Rate Variability. Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00096-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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16
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Mala S, Potockova V, Hoskovcova L, Pithova P, Brabec M, Kulhankova J, Keil R, Riedlbauchova L, Broz J. Cardiac autonomic neuropathy may play a role in pathogenesis of atherosclerosis in type 1 diabetes mellitus. Diabetes Res Clin Pract 2017; 134:139-144. [PMID: 28993155 DOI: 10.1016/j.diabres.2017.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 08/22/2017] [Accepted: 10/02/2017] [Indexed: 01/21/2023]
Abstract
AIMS Cardiac autonomic neuropathy (CAN) is a frequent and severe complication of type 1 diabetes mellitus (T1DM). CAN diagnosis is associated with increased cardiovascular morbidity and mortality, often due to progressive atherosclerosis. Carotid intima media thickness (CIMT) is a surrogate marker of the atherosclerosis. The aim of our study was to evaluate the relationship between CIMT and CAN in T1DM patients. METHODS Total of 49 T1DM patients and 45 healthy controls were examined for CAN presence and CIMT. CAN was diagnosed based on the results of Ewing test battery and spectral analysis of heart rate variability. CIMT was measured by two-dimensional ultrasound. Biochemical, anthropometric and anamnestic risk markers of atherosclerosis were evaluated. We used logistic types of generalized additive models (GAM) for statistical analysis. RESULTS CAN was detected in 22 out of 49 T1DM patients (45%). All 45 healthy controls had normal cardiovascular autonomic tests results. CIMT was significantly positively associated with T1DM diagnosis (p=0.0251), CAN diagnosis (p=0.007), age (p<0.0001), BMI (p=0.0435) and systolic blood pressure (p=0.0098). CAN effect on CIMT interacted with the effect of T1DM. The combination of both factors significantly increased CIMT more than the sum of the individual T1DM and CAN status. CONCLUSIONS CAN is significantly associated with higher CIMT in T1DM patients. CAN may play a role in pathogenesis of atherosclerosis in type 1 diabetes mellitus.
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Affiliation(s)
- Sarka Mala
- Internal Medicine Department, University Hospital Motol, Prague, Czech Republic.
| | - Veronika Potockova
- Department of Neurology, University Hospital Motol, Prague, Czech Republic
| | - Lucie Hoskovcova
- Internal Medicine Department, University Hospital Motol, Prague, Czech Republic
| | - Pavlina Pithova
- Internal Medicine Department, University Hospital Motol, Prague, Czech Republic
| | - Marek Brabec
- Institute of Computer Science, Czech Academy of Science, Prague, Czech Republic; Czech Institute of Informatics, Robotics and Cybernetics, Czech Technical University in Prague, Czech Republic
| | | | - Radan Keil
- Internal Medicine Department, University Hospital Motol, Prague, Czech Republic
| | | | - Jan Broz
- Internal Medicine Department, University Hospital Motol, Prague, Czech Republic
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17
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Jaimes R, Swiercz A, Sherman M, Muselimyan N, Marvar PJ, Posnack NG. Plastics and cardiovascular health: phthalates may disrupt heart rate variability and cardiovascular reactivity. Am J Physiol Heart Circ Physiol 2017; 313:H1044-H1053. [PMID: 28842438 PMCID: PMC5792203 DOI: 10.1152/ajpheart.00364.2017] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/17/2017] [Accepted: 08/17/2017] [Indexed: 12/11/2022]
Abstract
Plastics have revolutionized medical device technology, transformed hematological care, and facilitated modern cardiology procedures. Despite these advances, studies have shown that phthalate chemicals migrate out of plastic products and that these chemicals are bioactive. Recent epidemiological and research studies have suggested that phthalate exposure adversely affects cardiovascular function. Our objective was to assess the safety and biocompatibility of phthalate chemicals and resolve the impact on cardiovascular and autonomic physiology. Adult mice were implanted with radiofrequency transmitters to monitor heart rate variability, blood pressure, and autonomic regulation in response to di-2-ethylhexyl-phthalate (DEHP) exposure. DEHP-treated animals displayed a decrease in heart rate variability (-17% SD of normal beat-to-beat intervals and -36% high-frequency power) and an exaggerated mean arterial pressure response to ganglionic blockade (31.5% via chlorisondamine). In response to a conditioned stressor, DEHP-treated animals displayed enhanced cardiovascular reactivity (-56% SD major axis Poincarè plot) and prolonged blood pressure recovery. Alterations in cardiac gene expression of endothelin-1, angiotensin-converting enzyme, and nitric oxide synthase may partly explain these cardiovascular alterations. This is the first study to show an association between phthalate chemicals that are used in medical devices with alterations in autonomic regulation, heart rate variability, and cardiovascular reactivity. Because changes in autonomic balance often precede clinical manifestations of hypertension, atherosclerosis, and conduction abnormalities, future studies are warranted to assess the downstream impact of plastic chemical exposure on end-organ function in sensitive patient populations. This study also highlights the importance of adopting safer biomaterials, chemicals, and/or surface coatings for use in medical devices.NEW & NOTEWORTHY Phthalates are widely used in the manufacturing of consumer and medical products. In the present study, di-2-ethylhexyl-phthalate exposure was associated with alterations in heart rate variability and cardiovascular reactivity. This highlights the importance of investigating the impact of phthalates on health and identifying suitable alternatives for medical device manufacturing.
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Affiliation(s)
- Rafael Jaimes
- 1Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Washington, District of Columbia; ,2Children’s National Heart Institute, Children’s National Health System, Washington, District of Columbia; and
| | - Adam Swiercz
- 3Department of Pharmacology and Physiology, George Washington University, Washington, District of Columbia
| | - Meredith Sherman
- 1Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Washington, District of Columbia;
| | - Narine Muselimyan
- 3Department of Pharmacology and Physiology, George Washington University, Washington, District of Columbia
| | - Paul J. Marvar
- 3Department of Pharmacology and Physiology, George Washington University, Washington, District of Columbia
| | - Nikki Gillum Posnack
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, District of Columbia; .,Children's National Heart Institute, Children's National Health System, Washington, District of Columbia; and.,Department of Pharmacology and Physiology, George Washington University, Washington, District of Columbia
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18
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Jae SY, Kurl S, Laukkanen JA, Yoon ES, Choi YH, Fernhall B, Franklin BA. Relation of heart rate recovery after exercise testing to coronary artery calcification. Ann Med 2017; 49:404-410. [PMID: 28166422 DOI: 10.1080/07853890.2017.1292044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We examined whether slow heart rate recovery (HRR) after exercise testing as an estimate of impaired autonomic function is related to coronary artery calcification (CAC), an emerging marker of coronary atherosclerosis. METHODS We evaluated 2088 men who participated in a health-screening program that included measures of CAC and peak or symptom-limited cardiopulmonary exercise testing. HRR was calculated as the difference between peak heart rate (HR) during exercise testing and the HR at 2 min of recovery after peak exercise. We measured CAC using multidetector computed tomography to calculate the Agatston coronary artery calcium score. Advanced CAC was defined as a mean CAC >75th percentile for each age group. RESULTS HRR was negatively correlated with CAC (r = -.14, p < .01). After adjusting for conventional risk factors, participants in the lowest quartile of HRR (<38 bpm) were 1.59 times (95% CI: 1.17-2.18; p < .05) more likely to have advanced CAC than their counterparts in the highest quartile of HRR (>52 bpm). Each 1 bpm decrease in HRR was associated with 1% increase in advanced CAC after adjusting for potential confounders. CONCLUSIONS An attenuated HRR after exercise testing is associated with advanced CAC, independent of coronary risk factors and other related hemodynamic response. KEY MESSAGES Slow heart rate recovery (HRR) after maximal exercise testing, indicating decreased autonomic function, is associated with an increased risk of cardiovascular event and mortality. Slow HRR has been linked with the occurrence of malignant ventricular arrhythmias, but it remains unclear whether slow HRR is associated with an increased risk of coronary artery calcification (CAC), an emerging marker of coronary atherosclerosis. An attenuated HRR after exercise testing was associated with advanced CAC, independent of coronary risk factors and other potential hemodynamic confounder, supporting the hypothesis that slow HRR is related to the burden of atherosclerotic coronary artery disease.
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Affiliation(s)
- Sae Young Jae
- a Department of Sport Science , University of Seoul , Seoul , South Korea
| | - Sudhir Kurl
- b Department of Medicine , Institute of Public Health and Clinical Nutrition, University of Eastern Finland , Kuopio , Finland
| | - Jari A Laukkanen
- b Department of Medicine , Institute of Public Health and Clinical Nutrition, University of Eastern Finland , Kuopio , Finland
| | - Eun Sun Yoon
- a Department of Sport Science , University of Seoul , Seoul , South Korea
| | - Yoon-Ho Choi
- c Center for Health Promotion, Samsung Medical Center , School of Medicine, Sungkyunkwan University , Seoul , South Korea
| | - Bo Fernhall
- d Department of Kinesiology and Nutrition , University of Illinois at Chicago , Chicago , IL , USA
| | - Barry A Franklin
- e Preventive Cardiology and Cardiac Rehabilitation , William Beaumont Hospital , Royal Oak , MI , USA
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19
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Nqwena Z, Naidoo R. The effect of therapeutic horseback riding on heart rate variability of children with disabilities. Afr J Disabil 2017; 5:248. [PMID: 28730056 PMCID: PMC5433461 DOI: 10.4102/ajod.v5i1.248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 06/21/2016] [Indexed: 12/05/2022] Open
Abstract
Background Heart rate variability (HRV) is the oscillation in the interval between consecutive heart beats, resulting from dynamic interplay between multiple physiologic mechanisms that regulate instantaneous heart rate. Short-term heart rate regulation is governed by sympathetic and parasympathetic neural activity and therefore HRV examination can be used as a non-invasive estimate of the functioning of the autonomic nervous system (ANS). Aim To determine the effects of therapeutic horseback riding (THR) intervention on the HRV of children with disabilities. The objective was to examine if THR intervention improves the HRV of children, hence improving the parasympathetic activity that is associated with a calm and relaxed state. Methods This is a quasi-experimental design. Heart rate variability components were measured over six intervention sessions of THR. Heart rate variability measures were recorded from 29 participants with various disabilities, and was assessed in both time and frequency domains. Results Over the six THR sessions, the time domain showed an increase in HRV for pre-THR indicating improved vagal activation, whereas frequency domain showed both increased sympathetic activity and increased parasympathetic activation during THR based on different components of frequency domain. Conclusion Therapeutic horseback riding intervention of six sessions demonstrated a change in HRV of children with disabilities. However, the changes obtained were not significant to make conclusive measures as to whether sympathetic or parasympathetic activity is predominantly increased after the six sessions. Further research involving more than six sessions of THR is required to yield more significant changes.
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Affiliation(s)
- Zingisa Nqwena
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Rowena Naidoo
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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20
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Zhang J, Liu Z, Umukoro PE, Cavallari JM, Fang SC, Weisskopf MG, Lin X, Mittleman MA, Christiani DC. An epigenome-wide association analysis of cardiac autonomic responses among a population of welders. Epigenetics 2017; 12:71-76. [PMID: 28075199 PMCID: PMC5330442 DOI: 10.1080/15592294.2016.1270486] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
DNA methylation is one of the potential epigenetic mechanisms associated with various adverse cardiovascular effects; however, its association with cardiac autonomic dysfunction, in particular, is unknown. In the current study, we aimed to identify epigenetic variants associated with alterations in cardiac autonomic responses. Cardiac autonomic responses were measured with two novel markers: acceleration capacity (AC) and deceleration capacity (DC). We examined DNA methylation levels at more than 472,506 CpG probes through the Illumina Infinium HumanMethylation450 BeadChip assay. We conducted separate linear mixed models to examine associations of DNA methylation levels at each CpG with AC and DC. One CpG (cg26829071) located in the GPR133 gene was negatively associated with DC values after multiple testing corrections through false discovery rate. Our study suggests the potential functional importance of methylation in cardiac autonomic responses. Findings from the current study need to be replicated in future studies in a larger population.
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Affiliation(s)
- Jinming Zhang
- a Department of Environmental Health , Harvard T. H. Chan School of Public Health , Boston , MA , USA
| | - Zhonghua Liu
- b Department of Biostatistics , Harvard T. H. Chan School of Public Health , Boston , MA , USA
| | - Peter E Umukoro
- a Department of Environmental Health , Harvard T. H. Chan School of Public Health , Boston , MA , USA
| | - Jennifer M Cavallari
- c Department of Community Medicine and Health Care , University of Connecticut Health Center , Farmington , CT , USA
| | - Shona C Fang
- d Department of Epidemiology , New England Research Institute , Watertown , NY , USA
| | - Marc G Weisskopf
- a Department of Environmental Health , Harvard T. H. Chan School of Public Health , Boston , MA , USA.,e Department of Epidemiology , Harvard T. H. Chan School of Public Health , Boston , MA , USA
| | - Xihong Lin
- b Department of Biostatistics , Harvard T. H. Chan School of Public Health , Boston , MA , USA
| | - Murray A Mittleman
- e Department of Epidemiology , Harvard T. H. Chan School of Public Health , Boston , MA , USA.,f Cardiovascular Epidemiology Research Unit , Beth Israel Deaconess Medical, Center/Harvard Medical School , Boston , MA , USA
| | - David C Christiani
- a Department of Environmental Health , Harvard T. H. Chan School of Public Health , Boston , MA , USA.,e Department of Epidemiology , Harvard T. H. Chan School of Public Health , Boston , MA , USA.,g Pulmonary and Critical Care Division , Massachusetts General Hospital/Harvard Medical School , Boston , MA , USA
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21
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Slepecky M, Kotianova A, Prasko J, Majercak I, Gyorgyova E, Kotian M, Zatkova M, Tonhajzerova I, Chupacova M, Popelkova M. Coping, schemas, and cardiovascular risks - study protocol. Neuropsychiatr Dis Treat 2017; 13:2599-2605. [PMID: 29075121 PMCID: PMC5648306 DOI: 10.2147/ndt.s148837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The aim of this article is to describe the protocol of a trial focusing on the psychological, anthropometric, cardiac, and psychophysiological factors contributing to increased risk of cardiovascular diseases (CVDs). As background, the article provides a short overview of research literature linking personal traits, maladaptive schemas, and coping styles with CVDs through reactivity of the autonomic nervous system.
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Affiliation(s)
- Milos Slepecky
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, Slovak Republic
| | - Antonia Kotianova
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, Slovak Republic
| | - Jan Prasko
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital Olomouc, Olomouc, Czech Republic
| | - Ivan Majercak
- 1st Department of Internal Medicine, Faculty of Medicine, Pavol Josef Safarik University in Košice
| | - Erika Gyorgyova
- Internal Medicine and Cardiology Private Practice MUDr Ivan Majercak, Košice
| | - Michal Kotian
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, Slovak Republic.,Psychagogia, Liptovsky Mikulas
| | - Marta Zatkova
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, Slovak Republic
| | - Ingrid Tonhajzerova
- Department of Physiology.,Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Michaela Chupacova
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, Slovak Republic.,Psychagogia, Liptovsky Mikulas
| | - Marta Popelkova
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, Slovak Republic
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22
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Association of cardiac autonomic modulation with physical and clinical features of young people with type 1 diabetes. Cardiol Young 2017; 27:37-45. [PMID: 26980053 DOI: 10.1017/s1047951116000044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The objective of this study was to verify possible associations between heart rate variability indices and physical activity, body composition, and metabolic and cardiovascular parameters in individuals with type 1 diabetes. METHOD A total of 39 young patients with type 1 diabetes were included. Body composition, physical activity, cardiovascular parameters, and metabolic parameters were assessed. For the heart rate variability analysis, heart rate was recorded beat-by-beat using a Polar S810i heart rate monitor for 30 minutes, with the volunteers in the supine position; subsequently, the following indices were considered: standard deviation of all normal RR intervals; root-mean square of differences between adjacent normal RR intervals in a time interval; percentage of adjacent RR intervals with a difference of duration >50 ms; high frequency component in milliseconds squared; high frequency component in normalised units; standard deviation of the instantaneous variability beat-to-beat; and standard deviation of the long-term variability. The association between the heart rate variability indices and independent variables was verified through linear regression in unadjusted and adjusted models (considering gender and age). The statistical significance was set at 5% and the confidence interval at 95%. RESULTS High values of at-rest heart rate were associated with reduced parasympathetic activity and global heart rate variability, and higher values of waist-to-hip ratio were related to lower parasympathetic activity, independent of age or gender. CONCLUSION For young patients with type 1 diabetes, increases in at-rest heart rate values are associated with reduced parasympathetic activity and global heart rate variability, whereas higher waist-to-hip ratio values are related to lower parasympathetic activity, both independent of age and gender.
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Slepecky M, Kotianova A, Prasko J, Majercak I, Gyorgyova E, Kotian M, Zatkova M, Popelkova M, Ociskova M, Tonhajzerova I. Which psychological, psychophysiological, and anthropometric factors are connected with life events, depression, and quality of life in patients with cardiovascular disease. Neuropsychiatr Dis Treat 2017; 13:2093-2104. [PMID: 28831258 PMCID: PMC5552144 DOI: 10.2147/ndt.s141811] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aim of the study was to determine psychological, psychophysiological, and anthropometric factors connected with life events, level of depression, and quality of life in people at risk for cardiovascular disease and healthy controls. METHODS This is a cross-sectional study involving arterial hypertension patients and healthy controls. There were several measurements including physical, anthropological, cardiovascular, and psychophysiological measurements and administration of questionnaires. RESULTS A total of 99 participants were recruited for this study, 54 healthy controls (mean age: 35.59±13.39 years) and 45 patients with cardiovascular disease (CVD) (mean age: 46.33±12.39 years). The healthy controls and the patients with CVD significantly differed in the mean total score of life events, level of depression, quality of life score, temperature, blood pressure (BP), pulse transit time, heart rate, high-frequency total power, heart rate variability total power, waist-to-height ratio (WHtR), body fat percentage, fat control, pulse wave velocity, and augmentation index. In healthy subjects, the total score of the life events was not correlated with any cardiovascular or anthropometric factor. A score of depression significantly correlated with the WHtR, augmentation index, body fat percentage, and fat control. The quality of life - visual scale correlated with the body temperature, BP, and percentage of body fat. In the group of the patients with CVD, the score of the life events did not correlate with any measured cardiovascular or anthropometric factor. The level of depression correlated with the augmentation index. The quality of life - visual scale significantly correlated with body temperature, WHtR, and fat control. CONCLUSION The patients with CVD reported higher scores of life events, worse quality of life, and a greater level of depressive symptoms than healthy controls. In healthy controls, a higher mean total score of life events significantly negatively correlated with high-frequency total power, and the degree of depression correlated with being overweight. In patients with CVD, a score of depression was linked to being overweight.
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Affiliation(s)
- Milos Slepecky
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra
| | - Antonia Kotianova
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra.,Psychagogia, Liptovsky Mikulas, Slovak Republic
| | - Jan Prasko
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra.,Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital Olomouc, Olomouc, Czech Republic
| | - Ivan Majercak
- First Department of Internal Medicine, Faculty of Medicine, Pavol Josef Safarik University in Kosice.,Internal Medicine and Cardiology Private Practice, MUDr Ivan Majercak, Kosice
| | - Erika Gyorgyova
- Internal Medicine and Cardiology Private Practice, MUDr Ivan Majercak, Kosice
| | - Michal Kotian
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra.,Psychagogia, Liptovsky Mikulas, Slovak Republic
| | - Marta Zatkova
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra
| | - Marta Popelkova
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra
| | - Marie Ociskova
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital Olomouc, Olomouc, Czech Republic
| | - Ingrid Tonhajzerova
- Department of Physiology and Biomedical Centre Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
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24
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Bissinger A. Cardiac Autonomic Neuropathy: Why Should Cardiologists Care about That? J Diabetes Res 2017; 2017:5374176. [PMID: 29214181 PMCID: PMC5682059 DOI: 10.1155/2017/5374176] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 05/06/2017] [Accepted: 05/21/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Cardiac autonomic neuropathy (CAN) is a frequent but underdiagnosed complication of diabetes mellitus. It has a strong influence on various cardiac disorders including myocardial ischemia and infarction, hypertension, orthostatic hypotonia, heart failure, and arrhythmias. CAN can lead to severe morbidity and mortality and increase the risk of sudden cardiac death. METHODS This review article summarizes the latest evidence regarding the epidemiology, pathogenesis, influence on the cardiovascular system, and diagnostic methods for CAN. The methodology of this review involved analyzing available data from recent papers relevant to the topic of diabetic autonomic neuropathy and cardiac disorders. CONCLUSIONS The early diagnosis of CAN can improve the prognosis and reduce adverse cardiac events. Methods based on heart rate variability enable the diagnosis of CAN even at a preclinical stage. These methods are simple and widely available for use in everyday clinical practice. According to the recently published Toronto Consensus Panel on Diabetic Neuropathy, all diabetic patients should be screened for CAN. Because diabetes mellitus often coexists with heart diseases and the most common methods used for diagnosis of CAN are based on ECG, not only diabetologists but also cardiologists should be responsible for diagnosis of CAN.
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Affiliation(s)
- Andrzej Bissinger
- Department of Interventional Cardiology and Arrhythmias, Medical University of Lodz, Lodz, Poland
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25
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von Scholten BJ, Hansen CS, Hasbak P, Kjaer A, Rossing P, Hansen TW. Cardiac Autonomic Function Is Associated With the Coronary Microcirculatory Function in Patients With Type 2 Diabetes. Diabetes 2016; 65:3129-38. [PMID: 27352886 DOI: 10.2337/db16-0437] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 06/22/2016] [Indexed: 11/13/2022]
Abstract
Cardiac autonomic dysfunction and cardiac microvascular dysfunction are diabetic complications associated with increased mortality, but the association between these has been difficult to assess. We applied new and sensitive methods to assess this in patients with type 2 diabetes mellitus (T2DM). In a cross-sectional design, coronary flow reserve (CFR) assessed by cardiac (82)Rb-positron emission tomography/computed tomography, cardiac autonomic reflex tests, and heart rate variability indices were performed in 55 patients with T2DM, without cardiovascular disease, and in 28 control subjects. Cardiac (123)I-metaiodobenzylguanidine scintigraphy was conducted in a subgroup of 29 patients and 14 control subjects and evaluated as the late heart-to-mediastinum ratio and washout rate. Impaired function of all the cardiac autonomic measures (except the washout rate) was associated with reduced CFR. A heart rate variability index, reflecting sympathetic and parasympathetic function (low-frequency power), and the late heart-to-mediastinum ratio, reflecting the function of adrenergic receptors and sympathetic activity, were positively correlated with CFR after adjustment for age and heart rate. The late heart-to- mediastinum ratio remained correlated with CFR after further adjustment. In patients with T2DM without cardiovascular disease, we demonstrate an independent association between cardiac autonomic function and CFR. We suggest that a reduced cardiac autonomic function and damage to the adrenergic receptors may contribute to the development of cardiac microvascular dysfunction.
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Affiliation(s)
| | | | - Philip Hasbak
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Kjaer
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Peter Rossing
- Steno Diabetes Center, Gentofte, Denmark University of Copenhagen, Copenhagen, Denmark Aarhus University, Aarhus, Denmark
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26
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Giles D, Kelly J, Draper N. Alterations in autonomic cardiac modulation in response to normobaric hypoxia. Eur J Sport Sci 2016; 16:1023-31. [DOI: 10.1080/17461391.2016.1207708] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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27
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Fazeli MS, Collet JP, MacNeily AE, Afshar K. Cardiac Autonomic Nervous System Activity in Children with Bladder and Bowel Dysfunction. J Urol 2016; 195:1245-9. [PMID: 26926551 DOI: 10.1016/j.juro.2015.11.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE Bladder and bowel dysfunction is a common reason for referral to pediatric urology. The role of the autonomic nervous system in the pathogenesis of bladder and bowel dysfunction has not been well investigated. We compared autonomic nervous system activity in children with bladder and bowel dysfunction to that in healthy controls. We hypothesized that children with dysfunction have a different autonomic profile as measured by parameters from spectral analysis of heart rate variability and impedance cardiography. MATERIALS AND METHODS We recruited 40 children, including 25 girls, with a median age of 10 years (range 5 to 18) in whom bladder and bowel dysfunction was clinically diagnosed by a validated questionnaire and 19 healthy controls, including 9 girls, with a median age of 8 years (range 5 to 16). Cardiac autonomic activity was assessed at baseline and during voiding. The primary outcome measures were the main parameters of heart rate variability, including total power and high frequency, as well as pre-ejection period and heart rate. RESULTS Comparison of outcomes at baseline showed significantly lower total power and high frequency heart rate variability in bladder and bowel dysfunction cases (p = 0.001 and 0.002, respectively). Children with dysfunction also showed a significantly smaller decrease in sympathetic nervous system activity during voiding (p = 0.05). CONCLUSIONS Our results demonstrate that compared to healthy controls children with bladder and bowel dysfunction show a different cardiac autonomic profile at rest and in response to voiding. This difference may be used in future studies to further clarify the pathophysiology of bladder and bowel dysfunction, and introduce novel treatment targets to manage the condition.
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Affiliation(s)
- Mir Sohail Fazeli
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Jean-Paul Collet
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Andrew E MacNeily
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Kourosh Afshar
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Child and Family Research Institute, Vancouver, British Columbia, Canada.
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28
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Dayem SMAE, Battah AA, Bohy AEME. Cardiovascular Autonomic Neuropathy and Early Atherosclerosis in Adolescent Type 1 Diabetic Patient. Open Access Maced J Med Sci 2015; 3:681-8. [PMID: 27275308 PMCID: PMC4877908 DOI: 10.3889/oamjms.2015.131] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/10/2015] [Accepted: 09/11/2015] [Indexed: 12/17/2022] Open
Abstract
AIM: To evaluate cardiovascular autonomic neuropathy (CAN) in type 1 Diabetics and to detect its relation to coronary artery calcification. PATIENTS AND METHODS: It is a cross sectional study included 62 diabetics and 30 controls. Clinical, laboratory assessment and 24 Hr holter were done for all patients and controls and coronary artery calcium (CAC) scoring by multisclice CT was done for all patients only. T-test, Mann Whitney U test, and stepwise multiple regression were used for statistical analyses. RESULTS: CAC score was positive in 8.1 % of patients. Heart rate variability (HRV) was significantly lower in diabetics. All parameters of HRV were insignificantly lower in diabetics with positive CAC score. Patients with microalbuminuria had a significantly lower HRV. HRV had a significant correlation with age of patients, duration of disease, HbA1, and Qtc in diabetics. CONCLUSION: Percentage of arrhythmia and early atherosclerosis is high in adolescent type 1 diabetic patients. CAN is associated with early atherosclerosis. Cardiac autonomic neuropathy is associated with older age, longer duration, and poor glycemic control and microalbuminuria.
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Affiliation(s)
| | - Ahmed A Battah
- Critical Care Department, Cairo University, Cairo, Egypt
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29
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Huang WL, Hwang BT, Lai CT, Li JY, Kuo TBJ, Yang CCH. Is Heart Rate Variability Related to Season of Birth? Clin Cardiol 2015. [PMID: 26212374 DOI: 10.1002/clc.22410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Season of birth (SOB) has been found to be related to cardiovascular mortality, but the mechanisms are unclear. It is suggested that birth in winter is a protective factor for the circulatory system, and this should be able to be observed using heart rate variability (HRV) measurements. The phenomenon may have a sex difference and is likely to be modulated by climatic factors. This study focused on this problem and investigates healthy school-age children to minimize confounding factors. HYPOTHESIS Birth in winter is protective to cardiovascular system via autonomic modulation. There is a gender difference in the relationship between SOB and autonomic activity. Climatic factors are the cause of SOB effects on autonomic system. METHODS A total of 381 healthy school-age children were recruited for this study. Their HRV profiles were measured once and climatic information related to their month of birth was gathered. The HRV profiles of the 2 sexes and 4 seasons of birth were compared. Correlation and regression analysis were performed to clarify the relationship between climatic factors and the HRV results. RESULTS Boys born in winter have higher high-frequency power (HF) but a lower ratio of low-frequency power to high-frequency power (LF/HF) than do males born in other seasons. This result is not found for girls. Age and the temperature of the SOB are predictive factors for HF among boys. The humidity of SOB is a predictive factor for normalized low-frequency power (LF%) and LF/HF among girls. CONCLUSIONS Season of birth is related to both parasympathetic and sympathetic activity among school-age children, especially boys. Temperature and humidity are potential causes of this SOB phenomenon.
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Affiliation(s)
- Wei-Lieh Huang
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.,Department of Psychiatry, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Be-Tau Hwang
- Department of Pediatrics, Taipei City Hospital, Taipei, Taiwan
| | - Chun-Ting Lai
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.,Sleep Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Jia-Yi Li
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.,Sleep Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Terry B J Kuo
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.,Sleep Research Center, National Yang-Ming University, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan.,Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
| | - Cheryl C H Yang
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.,Sleep Research Center, National Yang-Ming University, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan.,Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
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30
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Sánchez-Barajas M, Figueroa-Vega N, Ibarra-Reynoso LDR, Moreno-Frías C, Malacara JM. Influence of heart rate variability and psychosocial factors on carotid stiffness, elasticity and impedance at menopause. Arch Med Res 2015; 46:118-26. [PMID: 25747966 DOI: 10.1016/j.arcmed.2015.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 02/23/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS The risk for cardiovascular diseases (CVD) increases after menopause. Heart rate variability (HRV), a measure of autonomic control, is a strong predictor of CVD. We undertook this study to test the association of ultrasound indices of early carotid atherosclerosis with HRV, symptoms, hormonal conditions, metabolic state, indicators of stress, and psychosocial factors in women at peri- and postmenopause, registering ambulatory R-R interval monitoring. METHODS In a cross-sectional design we studied 100 women at peri- and early postmenopause collecting anthropometry, symptoms, stress-related measurements, metabolic variables, cortisol, FSH and estradiol. We evaluated carotid ultrasonographic indices, and HRV was recorded for 4 h calculating time (SDNN, pNN50, rMSSD) and frequency domains (LF, HF, LF/HF) in women according to menopausal stage, estradiol levels, body mass index and waist circumference. RESULTS Carotid indices were similar in peri- and postmenopausal women. For HRV measurements, SDNN was increased at postmenopause. Women with estradiol levels <109.2 pmol/L had increased intima-media thickness (IMT), resistive index, and systolic diameter. Using multivariate analysis, we found the associations of IMT positively with non-HDL-cholesterol, resistive index positively with LF-HRV, but negatively with effort/reward imbalance, carotid β stiffness index inversely with estradiol, and arterial distensibility positively with HF-HRV and creatinine concentrations, but negatively with non-HDL-cholesterol. CONCLUSIONS Carotid thickness was related mainly with lipid alterations. Indices of early carotid damage were related with various components of HRV as a manifestation of autonomic imbalance, indicating CVD risk. Other factors involved were time since last menses and psychological stress. Low creatinine was associated with diminished carotid distensibility. This suggests that estrogen, lifestyle, behavior and autonomic regulation participate in vascular damage.
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Affiliation(s)
- Mauricio Sánchez-Barajas
- Department of Medical Sciences, University of Guanajuato, León Campus, León, Gto., México; Department of Internal Medicine, General Hospital Zone/MF 21, León, Gto., México
| | - Nicté Figueroa-Vega
- Department of Medical Sciences, University of Guanajuato, León Campus, León, Gto., México
| | | | - Carmen Moreno-Frías
- Department of Medical Sciences, University of Guanajuato, León Campus, León, Gto., México
| | - Juan Manuel Malacara
- Department of Medical Sciences, University of Guanajuato, León Campus, León, Gto., México.
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31
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Iughetti L, Gavioli S, Bonetti A, Predieri B. Effects of Exercise in Children and Adolescent with Type 1 Diabetes Mellitus. Health (London) 2015. [DOI: 10.4236/health.2015.710150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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32
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Susceptibility Based Upon Chemical Interaction with Disease Processes: Potential Implications for Risk Assessment. Curr Environ Health Rep 2014. [DOI: 10.1007/s40572-014-0030-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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33
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Whinnett ZI, Sohaib SMA, Jones S, Kyriacou A, March K, Coady E, Mayet J, Hughes AD, Frenneaux M, Francis DP. British randomised controlled trial of AV and VV optimization ("BRAVO") study: rationale, design, and endpoints. BMC Cardiovasc Disord 2014; 14:42. [PMID: 24693953 PMCID: PMC3992145 DOI: 10.1186/1471-2261-14-42] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 03/21/2014] [Indexed: 11/25/2022] Open
Abstract
Background Echocardiographic optimization of pacemaker settings is the current standard of care for patients treated with cardiac resynchronization therapy. However, the process requires considerable time of expert staff. The BRAVO study is a non-inferiority trial comparing echocardiographic optimization of atrioventricular (AV) and interventricular (VV) delay with an alternative method using non-invasive blood pressure monitoring that can be automated to consume less staff resources. Methods/Design BRAVO is a multi-centre, randomized, cross-over, non-inferiority trial of 400 patients with a previously implanted cardiac resynchronization device. Patients are randomly allocated to six months in each arm. In the echocardiographic arm, AV delay is optimized using the iterative method and VV delay by maximizing LVOT VTI. In the haemodynamic arm AV and VV delay are optimized using non-invasive blood pressure measured using finger photoplethysmography. At the end of each six month arm, patients undergo the primary outcome measure of objective exercise capacity, quantified as peak oxygen uptake (VO2) on a cardiopulmonary exercise test. Secondary outcome measures are echocardiographic measurement of left ventricular remodelling, quality of life score and N-terminal pro B-type Natriuretic Peptide (NT-pro BNP). The study is scheduled to complete recruitment in December 2013 and to complete follow up in December 2014. Discussion If exercise capacity is non-inferior with haemodynamic optimization compared with echocardiographic optimization, it would be proof of concept that haemodynamic optimization is an acceptable alternative which has the potential to be more easily implemented. Trial registration Clinicaltrials.gov NCT01258829
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Affiliation(s)
- Zachary I Whinnett
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, 59-61 North Wharf Road, London W2 1LA, UK.
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Shin KO, Moritani T, Woo J, Jang KS, Bae JY, Yoo J, Kang S. Exercise training improves cardiac autonomic nervous system activity in type 1 diabetic children. J Phys Ther Sci 2014; 26:111-5. [PMID: 24567687 PMCID: PMC3927020 DOI: 10.1589/jpts.26.111] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 08/17/2013] [Indexed: 12/31/2022] Open
Abstract
[Purpose] We investigated the effect exercise training has on cardiac autonomic nervous
system (ANS) and cardiovascular risk profiles in children with type 1 diabetes mellitus
(DM). [Subjects] Fifteen type 1 DM children (all boys; 13.0±1.0 years of age) were
enrolled in the study. [Methods] The subjects received exercise training three times a
week in a 12-week program. Each child was asked to walk on a treadmill to achieve an
exercise intensity of VO2max 60%. ANS activity was measured by power spectral
analysis of the electrocardiogram (ECG). Blood samples were obtained for serum lipid
profiles. To evaluate Doppler-shifted Fourier pulsatility index (PI) analysis, a 5-MHz
continuous wave Doppler (VASCULAB D10) set was used to measure forward blood flow velocity
(FLOW) in the radial artery. [Results] Total and low-frequency (LF) power of heart rate
variability increased significantly after exercise intervention. Total cholesterol (TC)
levels were significant lower after exercise intervention. Total and high-frequency (HF)
power were significantly correlated with higher TC levels, but diastolic blood pressure
and HF was significantly correlated with lower TC levels. [Conclusion] Regular exercise
intervention should be prescribed for children with type 1 DM.
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Affiliation(s)
- Ki Ok Shin
- Laboratory of Exercise Biochemistry, Department of Physical Education, Dong-A University, Republic of Korea
| | - Toshio Moritani
- Laboratory of Applied Physiology, Graduate School of Human and Environmental Studies, Kyoto University, Japan
| | - Jinhee Woo
- Laboratory of Exercise Physiology, Department of Physical Education, Dong-A University, Republic of Korea
| | - Ki Soeng Jang
- Laboratory of Exercise Biochemistry, Department of Physical Education, Dong-A University, Republic of Korea
| | - Ju Yong Bae
- Laboratory of Exercise Biochemistry, Department of Physical Education, Dong-A University, Republic of Korea
| | - Jaeho Yoo
- Division of Endocrinology and Metabolism, Department of Pediatrics, Medical Center, Dong-A University, Republic of Korea
| | - Sunghwun Kang
- Laboratory of Exercise Physiology, Department of Physical Education, Dong-A University, Republic of Korea
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35
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Karayannis G, Giamouzis G, Cokkinos DV, Skoularigis J, Triposkiadis F. Diabetic cardiovascular autonomic neuropathy: clinical implications. Expert Rev Cardiovasc Ther 2013; 10:747-65. [PMID: 22894631 DOI: 10.1586/erc.12.53] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Diabetic cardiovascular autonomic neuropathy (DCAN), the impairment of the autonomic balance of the cardiovascular system in the setting of diabetes mellitus (DM), is frequently observed in both Type 1 and 2 DM, has detrimental effects on the quality of life and portends increased mortality. Clinical manifestations include: resting heart rate disorders, exercise intolerance, intraoperative cardiovascular lability, orthostatic alterations in heart rate and blood pressure, QT-interval prolongation, abnormal diurnal and nocturnal blood pressure variation, silent myocardial ischemia and diabetic cardiomyopathy. Clinical tests for autonomic nervous system evaluation, heart rate variability analysis, autonomic innervation imaging techniques, microneurography and baroreflex analysis are the main diagnostic tools for DCAN detection. Aldose reductase inhibitors and antioxidants may be helpful in DCAN therapy, but a regular, more generalized and multifactorial approach should be adopted with inclusion of lifestyle modifications, strict glycemic control and treatment of concomitant traditional cardiovascular risk factors, in order to achieve the best therapeutic results. In the present review, the authors provide aspects of DCAN pathophysiology, clinical presentation, diagnosis and an algorithm regarding the evaluation and management of DCAN in DM patients.
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Fakhrzadeh H, Yamini-Sharif A, Sharifi F, Tajalizadekhoob Y, Mirarefin M, Mohammadzadeh M, Sadeghian S, Badamchizadeh Z, Larijani B. Cardiac autonomic neuropathy measured by heart rate variability and markers of subclinical atherosclerosis in early type 2 diabetes. ISRN ENDOCRINOLOGY 2012; 2012:168264. [PMID: 23259073 PMCID: PMC3521488 DOI: 10.5402/2012/168264] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 11/04/2012] [Indexed: 11/23/2022]
Abstract
Cardiac autonomic neuropathy (CAN) is a critical complication of type 2 diabetes mellitus (T2DM). Heart rate variability (HRV) is a noninvasive tool to assess cardiac autonomic function. We aimed to evaluate whether CAN is associated with increased risk of atherosclerosis in T2DM. A total of 57 diabetic and 54 nondiabetic subjects, free of coronary heart disease, were recruited. Carotid intima media thickness (CIMT), coronary calcium score (CAC), and brachial Flow Mediated Dilation (FMD) were measured. Heart rate variability and vagal components of autonomic function were determined. Significant reduction of normalized HF power (P < 0.05) and total power (P < 0.01) was observed in T2DM. CIMT and CAC scores were significantly higher while FMD was significantly lower in diabetics (P < 0.01 for all). Median HbA(1c) levels were significantly higher in diabetics. CIMT was inversely and independently associated with total power both in diabetics and controls (P < 0.01 for both groups). There was also an inverse association between total power and median HbA(1c). Autonomic dysfunction, especially parasympathetic neuropathy, was present since early-stage T2DM. This was related to subclinical atherosclerosis. Early detection of cardiac autonomic neuropathy can help us detect the development of atherosclerosis earlier in T2DM to prevent unfavorable outcomes.
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Affiliation(s)
- Hossein Fakhrzadeh
- Elderly Health Research Center, Endocrinology & Metabolism Research Center, Tehran University of Medical Sciences, Dr Shariati University Hospital, North Kargar Avenue, Tehran, Iran ; Tehran Heart Center, Tehran University of Medical Sciences, North Kargar Avenue, Tehran, Iran
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Mogensen UM, Jensen T, Køber L, Kelbæk H, Mathiesen AS, Dixen U, Rossing P, Hilsted J, Kofoed KF. Cardiovascular autonomic neuropathy and subclinical cardiovascular disease in normoalbuminuric type 1 diabetic patients. Diabetes 2012; 61:1822-30. [PMID: 22498696 PMCID: PMC3379682 DOI: 10.2337/db11-1235] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 02/23/2012] [Indexed: 12/16/2022]
Abstract
Cardiovascular autonomic neuropathy (CAN) is associated with increased mortality in diabetes. Since CAN often develops in parallel with diabetic nephropathy as a confounder, we aimed to investigate the isolated impact of CAN on cardiovascular disease in normoalbuminuric patients. Fifty-six normoalbuminuric, type 1 diabetic patients were divided into 26 with (+) and 30 without (-) CAN according to tests of their autonomic nerve function. Coronary artery plaque burden and coronary artery calcium score (CACS) were evaluated using computed tomography. Left ventricular function was evaluated using echocardiography. Blood pressure and electrocardiography were recorded through 24 h to evaluate nocturnal drop in blood pressure (dipping) and pulse pressure. In patients +CAN compared with -CAN, the CACS was higher, and only patients +CAN had a CACS >400. A trend toward a higher prevalence of coronary plaques and flow-limiting stenosis in patients +CAN was nonsignificant. In patients +CAN, left ventricular function was decreased in both diastole and systole, nondipping was more prevalent, and pulse pressure was increased compared with -CAN. In multivariable analysis, CAN was independently associated with increased CACS, subclinical left ventricular dysfunction, and increased pulse pressure. In conclusion, CAN in normoalbuminuric type 1 diabetic patients is associated with distinct signs of subclinical cardiovascular disease.
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Affiliation(s)
- Ulrik Madvig Mogensen
- The Heart Centre, Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
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Enhancing Heart Rate Variability. Integr Med (Encinitas) 2012. [DOI: 10.1016/b978-1-4377-1793-8.00078-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Glavind K, Chancellor M. Antimuscarinics for the treatment of overactive bladder: understanding the role of muscarinic subtype selectivity. Int Urogynecol J 2011; 22:907-17. [PMID: 21468739 DOI: 10.1007/s00192-011-1411-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 03/10/2011] [Indexed: 12/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Antimuscarinic agents appear to exert their therapeutic activity in overactive bladder (OAB) via blockade of the M(3) muscarinic receptor subtype. Antimuscarinics are broadly similar in efficacy, but their safety and tolerability profiles vary, which may reflect differences in muscarinic receptor selectivity profiles. METHODS This review of available literature aims to determine whether antimuscarinic agents with greater M(3) selectivity have clinical advantages over less selective drugs. RESULTS Antimuscarinic agents differ widely in their propensity to cause cognitive and cardiovascular (CV) effects, which appear mainly to be related to differences in their relative selectivity for binding to non-M(3) receptors, including M(1) receptors in the brain and cardiac M(2) receptors. CONCLUSIONS Cognitive and CV effects are especially pertinent for the OAB patient who tends to be older with various comorbidities and is often taking multiple medications. Hence, it is important to consider the risk/benefit balance of antimuscarinic agents when selecting OAB treatment.
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Affiliation(s)
- Karin Glavind
- Department of Gynecology and Obstetrics, Aalborg Sygehus Nord, 9000 Aalborg, Denmark.
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40
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Rodrigues TC, Ehrlich J, Hunter CM, Kinney GL, Rewers M, Snell-Bergeon JK. Reduced heart rate variability predicts progression of coronary artery calcification in adults with type 1 diabetes and controls without diabetes. Diabetes Technol Ther 2010; 12:963-9. [PMID: 21128843 PMCID: PMC3014754 DOI: 10.1089/dia.2010.0070] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIM Reduced heart rate variability (HRV) is a manifestation of cardiac autonomic neuropathy, a known complication of type 1 diabetes (T1D). We evaluated whether HRV predicted coronary artery calcium (CAC) progression. METHODS Subjects between 19 and 56 years of age with T1D or those without diabetes from the Coronary Artery Calcification in Type 1 Diabetes study underwent supine deep breathing 12-lead electrocardiograms. The SD of consecutive RR intervals was used as a measure of HRV. CAC was measured at two visits 6.0 ± 0.5 years apart. Progression of CAC was defined as an increase in square root transformed CAC volume of ≥ 2.5 mm(3), excluding patients who had cardiovascular events during follow-up. RESULTS Reduced HRV was associated with older age, higher hemoglobin A1c, elevated albuminuria, CAC volume at baseline, and increased fibrinogen. Higher HRV at baseline was associated with lower likelihood CAC progression (odds ratio = 0.71, 95% confidence interval 0.56-0.90, P = 0.005), and the adjustment for known cardiovascular risk factors did not change this strong association, including adjustment for inflammatory markers. CONCLUSIONS Reduced HRV predicted progression of CAC in adults with and without T1D. This association further supports the participation of autonomic neuropathy in the atherosclerosis process.
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Affiliation(s)
- Ticiana C. Rodrigues
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, Colorado
- Division of Endocrinology, Clinical Hospital of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - James Ehrlich
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, Colorado
| | - Cortney M. Hunter
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, Colorado
| | - Gregory L. Kinney
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, Colorado
| | - Marian Rewers
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, Colorado
| | - Janet K. Snell-Bergeon
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, Colorado
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Bathula R, Hughes AD, Panerai R, Potter J, Thom SAM, Francis DP, Shore AC, Kooner J, Chaturvedi N. Indian Asians have poorer cardiovascular autonomic function than Europeans: this is due to greater hyperglycaemia and may contribute to their greater risk of heart disease. Diabetologia 2010; 53:2120-8. [PMID: 20549180 DOI: 10.1007/s00125-010-1818-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 05/11/2010] [Indexed: 01/21/2023]
Abstract
AIMS/HYPOTHESIS A high prevalence of diabetes contributes to excess CHD in Indian Asians, but the underlying mechanisms are unclear. Heart rate, heart rate variability (HRV) and baroreflex sensitivity (BRS) are measures of cardiac autonomic function that are disturbed by hyperglycaemia and predict CHD. We compared these measures in Indian Asians and Europeans, and sought explanations for the observed differences. METHODS A representative sample of 149 Europeans and 151 Indian Asians was recruited from primary care, 66% of them men (aged 35-75 years), 34% women (aged 55-75 years). Heart rate, HRV, BRS and cardio-metabolic profiles were measured over four successive 5 min periods with continuous ECG and blood pressure monitoring. RESULTS Indian Asians were hyperglycaemic compared with Europeans (HbA(1c) (mean +/- SD) 6.5 +/- 1.2% vs 5.9 +/- 1.0%, p = 0.001). They had shorter mean RR intervals ((mean +/- SE) 969 +/- 13 vs 1,022 +/- 12 ms, p = 0.002), lower total RR interval power ((geometric mean, 95% CI) 925 [796-1075] vs 1,224 [1,064-1,422] ms(2), p = 0.008) and lower BRS ((mean +/- SE) 5.7 +/- 1.0 vs 6.6 +/- 1.0 ms/mmHg, p = 0.01). All measures of cardiac autonomic dysfunction were significantly associated with hyperglycaemia (mean RR interval vs HbA(1c) r = -0.22; p < 0.001). Ethnic differences in cardiac autonomic function persisted after adjustment for age, blood pressure and medication (mean RR interval 973 vs 1,021 ms, p = 0.004), but were attenuated or abolished by adjusting for HbA(1c) (979 vs 1,014 ms, p = 0.06) or other markers of hyperglycaemia. CONCLUSIONS/INTERPRETATION Indian Asians from the general population have impaired cardiovascular autonomic function compared with Europeans. This is due to greater hyperglycaemia in Indian Asians and may determine their increased CHD risk.
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Affiliation(s)
- R Bathula
- National Heart and Lung Institute, Imperial College Academic Health Sciences Centre, 59-61 North Wharf Road, London W2 1PG, UK
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Neumann SA, Tingley WG, Conklin BR, Shrader CJ, Peet E, Muldoon MF, Jennings JR, Ferrell RE, Manuck SB. AKAP10 (I646V) functional polymorphism predicts heart rate and heart rate variability in apparently healthy, middle-aged European-Americans. Psychophysiology 2009; 46:466-72. [PMID: 19496216 DOI: 10.1111/j.1469-8986.2009.00802.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Previous evidence suggests that the dual-specific A kinase-anchoring protein 2 functional polymorphism (AKAP10 (A/G) I646V) influences heart rate (HR) and heart rate variability (HRV) in mice and humans (N=122) with cardiovascular disease. Here, we asked whether this AKAP10 variant predicts HR and HRV in a large sample of healthy humans. Resting HR and short-term time and frequency domain measures of HRV (5 min during paced and unpaced respiration conditions) were assessed in a U.S. community sample (N=1,033) of generally healthy men and women (age 30-54) of European ancestry. Each person was genotyped for the AKAP10 variant. As with previous work, the AKAP10 Val allele predicted greater resting HR (Paced p<.01; Unpaced p<.03) and diminished HRV (Paced ps <.05) suggesting that this variant may modulate the sensitivity of cardiac pacemaker cells to autonomic inputs, possibly conferring risk for arrhythmias and sudden cardiac death.
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Heart rate variability is related to self-reported physical activity in a healthy adolescent population. Eur J Appl Physiol 2009; 106:877-83. [PMID: 19479275 PMCID: PMC2718191 DOI: 10.1007/s00421-009-1089-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2009] [Indexed: 12/19/2022]
Abstract
This study investigated whether there is a relationship between heart rate variability (HRV) versus lifestyle and risk factors for cardiovascular disease in a population of healthy adolescents. HRV is as an index of tonic autonomic activity and in adults HRV is related to lifestyle and risk factors for cardiovascular disease, but it is not known if this is the case in adolescents. HRV was registered for 4 min in sitting position in 99 healthy adolescents (age range 15 years 11 months–17 years 7 months) and repeated after 6 months. On both occasions there were significant correlations (P < 0.05) between physical activity and HRV, with respective r values: high frequency (HF) 0.26, 0.30; low frequency power (LF) 0.35, 0.29 and the standard deviation of inter-beat intervals (SDNN) 0.28, 0.37. There was no significant interaction between first and second measurements. In contrast, there were no correlations to sleeping patterns, eating habits and smoking. Risk factors for cardiovascular disease [body mass index (BMI = weight (kg)/length in m2), systolic blood pressure and p-glucose] did not show any repeatable significant correlations to HRV. Multiple regression models showed that physical activity was a predictor for HF, LF and SDNN in both measurements. In conclusion HF, LF and SDNN were reproducible after 6 months and were related to physical activity on both occasions.
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Gombojav B, Park H, Kim JI, Ju YS, Sung J, Cho SI, Lee MK, Ohrr H, Radnaabazar J, Seo JS. Heritability and linkage study on heart rates in a Mongolian population. Exp Mol Med 2009; 40:558-64. [PMID: 18985014 DOI: 10.3858/emm.2008.40.5.558] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Elevated heart rate has been proposed as an independent risk factor for cardiovascular diseases, but their interrelationships are not well understood. In this study, we performed a genome-wide linkage scan in 1,026 individuals (mean age 30.6 years, 54.5% women) from 73 extended families of Mongolia and determined quantitative trait loci that influence heart rate. The DNA samples were genotyped using deCODE 1,039 microsatellite markers for 3 cM density genome-wide linkage scan. Correlation analysis was carried out to evaluate the correlation of the covariates and the heart rate. T-tests of the heart rate were also performed on sex, smoking and alcohol intake. Consequently, this model was used in a nonparametric genome-wide linkage analysis using variance component model to create a multipoint logarithm of odds (LOD) score and a corresponding P value. In the adjusted model, the heritability of heart rate was estimated as 0.32 (P<.0001) and a maximum multipoint LOD score of 2.03 was observed in 77 cM region at chromosome 18. The second largest LOD score of 1.52 was seen on chromosome 5 at 216 cM. Genes located on the specified locations in chromosomes 5 and 18 may be involved in the regulation of heart rate.
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Affiliation(s)
- Bayasgalan Gombojav
- Department of Public Health, The Graduate School, Yonsei University, Seoul 120-752, Korea
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45
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Schönauer M, Thomas A, Morbach S, Niebauer J, Schönauer U, Thiele H. Cardiac autonomic diabetic neuropathy. Diab Vasc Dis Res 2008; 5:336-44. [PMID: 18958844 DOI: 10.3132/dvdr.2008.047] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular autonomic diabetic neuropathy (CADN) is one of the most common diabetes-associated complications. Disturbed heart rate variability (HRV) is very often the earliest symptom, even in clinically asymptomatic patients. The following article offers a topical overview for those working or interested in the fields of diabetology and cardiology.
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Hanss R, Block D, Bauer M, Ilies C, Magheli A, Schildberg-Schroth H, Renner J, Scholz J, Bein B. Use of heart rate variability analysis to determine the risk of cardiac ischaemia in high-risk patients undergoing general anaesthesia. Anaesthesia 2008; 63:1167-73. [PMID: 18822095 DOI: 10.1111/j.1365-2044.2008.05602.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to investigate the use of pre-operative heart rate variability analysis to predict postoperative cardiac events (identified by 24 h Holter-ECG recording and an increase of creatine kinase MB) in high-risk cardiac patients. Length of hospital stay, the incidence of postoperative cardiac ischaemia and cardiac events after discharge were recorded. Fifty patients were assigned by the presence of cardiac events and the heart rate variability in 17 patients with an event was compared with 33 patients without. Total power was identified as a predictive parameter. The usefulness of this test was assessed in a second group of 50 patients. The incidence of cardiac events detected by Holter-ECG recording or an increased creatine kinase MB was greater and the duration of hospital stay longer in the 26 patients with total power < 400 ms(2).Hz(-1) compared with those with total power > 400 ms(2).Hz(-1) (eight and four patients and 10 (7) days (mean (SD)), vs 1 (p < 0.05) and 0 (p < 0.05) patients and 6 (2) days (p < 0.05), respectively). The total power of high-risk cardiac patients predicted postoperative cardiac events and extended length of hospital stay.
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Affiliation(s)
- R Hanss
- Department of Anaesthesiology and Intensive Care Medicine, University-Hospital Schleswig-Holstein, Campus Kiel.
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Chen SR, Lee YJ, Chiu HW, Jeng C. Impact of physical activity on heart rate variability in children with type 1 diabetes. Childs Nerv Syst 2008; 24:741-7. [PMID: 17901961 DOI: 10.1007/s00381-007-0499-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2006] [Revised: 07/19/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Children with type 1 diabetes are usually associated with cardiovascular autonomic neuropathy. The present study explored the influence of physical activity on their autonomic nervous function by measuring the heart rate variability (HRV). MATERIALS AND METHODS A total of 93 type 1 diabetic children and 107 healthy control subjects were enrolled. The Physical Activity Questionnaire for Children (PAQ-C) was adopted to determine the physical activity level as low, moderate, or high activity. HRV was determined by frequency analysis and measured in both resting and active states. RESULTS Children with type 1 diabetes had significantly lower HRV than that of healthy control subjects in resting state but not in active state. The decreased HRV in diabetic children was observed only in subjects with low physical activity. The HRV in diabetic children with moderate to high physical activity, however, was not different from that of their healthy controls. CONCLUSIONS Diabetic children should be encouraged to engage in physical activity with more intensity, which can benefit their autonomic nervous function. Nevertheless, the potential risk of vigorous activity still needs our concern.
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Affiliation(s)
- Su-Ru Chen
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Manisty CH, Willson K, Davies JER, Whinnett ZI, Baruah R, Mebrate Y, Kanagaratnam P, Peters NS, Hughes AD, Mayet J, Francis DP. Induction of oscillatory ventilation pattern using dynamic modulation of heart rate through a pacemaker. Am J Physiol Regul Integr Comp Physiol 2008; 295:R219-27. [PMID: 18463195 PMCID: PMC2494820 DOI: 10.1152/ajpregu.00064.2008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
For disease states characterized by oscillatory ventilation, an ideal dynamic therapy would apply a counteracting oscillation in ventilation. Modulating respiratory gas transport through the circulation might allow this. We explore the ability of repetitive alternations in heart rate, using a cardiac pacemaker, to elicit oscillations in respiratory variables and discuss the potential for therapeutic exploitation. By incorporating acute cardiac output manipulations into an integrated mathematical model, we observed that a rise in cardiac output should yield a gradual rise in end-tidal CO2 and, subsequently, ventilation. An alternating pattern of cardiac output might, therefore, create oscillations in CO2 and ventilation. We studied the effect of repeated alternations in heart rate of 30 beats/min with periodicity of 60 s, on cardiac output, respiratory gases, and ventilation in 22 subjects with implanted cardiac pacemakers and stable breathing patterns. End-tidal CO2 and ventilation developed consistent oscillations with a period of 60 s during the heart rate alternations, with mean peak-to-trough relative excursions of 8.4 +/- 5.0% (P < 0.0001) and 24.4 +/- 18.8% (P < 0.0001), respectively. Furthermore, we verified the mathematical prediction that the amplitude of these oscillations would depend on those in cardiac output (r = 0.59, P = 0.001). Repetitive alternations in heart rate can elicit reproducible oscillations in end-tidal CO2 and ventilation. The size of this effect depends on the magnitude of the cardiac output response. Harnessed and timed appropriately, this cardiorespiratory mechanism might be exploited to create an active dynamic responsive pacing algorithm to counteract spontaneous respiratory oscillations, such as those causing apneic breathing disorders.
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Affiliation(s)
- Charlotte H Manisty
- International Centre for Circulatory Health, St. Mary's Hospital and Imperial College, London, United Kingdom.
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Hsu CH, Chang SGN, Hwang KC, Kuo CF, Chang HH, Chou PHP. The impact of the menopause on coronary artery calcification examined by multislice computed tomography scanning. Nutr Metab Cardiovasc Dis 2008; 18:306-313. [PMID: 17433640 DOI: 10.1016/j.numecd.2006.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2006] [Revised: 11/07/2006] [Accepted: 11/20/2006] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS To examine whether there is a difference in coronary artery calcification (CAC) scores between males and females aged above 50 years. METHODS AND RESULTS A total of 479 subjects aged between 40 and 70 years with no clinical or family history of cardiovascular disease (CVD) were enrolled for this study. All subjects were assessed by multislice CT scanning (MCTS), and the CAC scores obtained were assigned to one of four quartiles for further assessment and comparison. The main outcome evaluated was the percentage of high CAC scores and mean CAC scores, comparing males and females of different age groups. This study found that the percentage of high CAC scores increased markedly from 5% (40-49 age group) to 21.2% (50-59 age group) among females. The increase was significantly less when comparing males from different age groups (from 25% in the 40-49 age group to 31.2% in the 50-59 age group). Females had higher odds ratios (ORs) postmenopausally (4.3 in the 50-59 age group) than males in the same age group (1.6). CONCLUSIONS These initial findings seem to indicate that above 50 years of age, CAC is more dependent on age in females than in males, which might be due to the effect of the menopause.
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Affiliation(s)
- Chung-Hua Hsu
- Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, 155 Li-Nong Street, Sec. 2, Peitou, Taipei, Taiwan
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Javorka M, Trunkvalterova Z, Tonhajzerova I, Javorkova J, Javorka K, Baumert M. Short-term heart rate complexity is reduced in patients with type 1 diabetes mellitus. Clin Neurophysiol 2008; 119:1071-81. [PMID: 18308624 DOI: 10.1016/j.clinph.2007.12.017] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Revised: 12/04/2007] [Accepted: 12/23/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to test whether new heart rate variability (HRV) complexity measures provide diagnostic information regarding early subclinical autonomic dysfunction in diabetes mellitus (DM). METHODS HRV in DM type 1 patients (n=17, 10f, 7m) aged 12.9-31.5 years (duration of DM 12.4+/-1.2 years) was compared to a control group of 17 healthy matched probands. The length of R-R intervals was measured over 1h using a telemetric ECG system. In addition to linear measures, we assessed HRV complexity measures, including multiscale entropy (MSE), compression entropy and various symbolic dynamic measures (Shannon and Renyi entropies, normalized complexity index (NCI), and pattern classification). RESULTS HRV magnitude was significantly reduced in patients with DM. Several HRV complexity parameters (MSE at scales 2-4, Renyi entropy, NCI) were also significantly reduced in diabetics. MSE indices and compression entropy did not correlate with linear measures. CONCLUSIONS The magnitude and complexity of HRV are reduced in young patients with DM, indicating vagal dysfunction. SIGNIFICANCE The quantification of HRV complexity in combination with its magnitude may provide an improved diagnostic tool for cardiovascular autonomic neuropathy in DM.
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Affiliation(s)
- Michal Javorka
- Institute of Physiology, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
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