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Lin HC, Yen CM, Chen WS, Hsu CC, Kung YY, Wu JH, Su YT, Chen KF, Chen HY, Lien CM, Wang MJ, Chang CM. Unveiling the age-related dynamics in Sjögren's syndrome: Insights from heart rate variability and autonomic function. Int J Rheum Dis 2024; 27:e15088. [PMID: 38454192 DOI: 10.1111/1756-185x.15088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/22/2024] [Accepted: 02/05/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Sjögren's Syndrome (SS), mainly affecting women in their midlife, is characterized by persistent inflammation in glands producing tears and saliva, often leading to significant complications. This study investigates the differences in autonomic system functioning between individuals with SS and healthy controls. METHODS From April 2019 to December 2022, 329 diagnosed primary SS (pSS) patients and 30 healthy controls were enrolled at Taipei Veterans General Hospital, Taipei, Taiwan. The study assessed autonomic nervous system functioning using various HRV metrics. Participants were divided based on age and AECG criteria, including salivary gland biopsy and autoantibody status. RESULTS Significant differences in Heart Rate Variability (HRV) were observed between pSS patients and healthy controls. The total power index was notably lower in pSS patients (4.98 ± 1.29) than in controls (5.54 ± 1.21, p = .022). Additionally, Vagal (VAG) activity was significantly reduced in the pSS group (4.95 ± 1.33) compared to the healthy control group (5.47 ± 1.19, p = .041). Age-stratified analysis highlighted that the ≤50 years pSS group had a higher heart rate (77.74 ± 10.42) compared to the >50 years group (73.86 ± 10.35, p = .005). This group also showed a higher total power index (5.78 ± 1.30) versus the >50 years group (4.68 ± 1.19, p < .001), and significantly lower VAG activity (4.70 ± 1.26, p = .007) compared to healthy controls. Furthermore, the Standard Deviation of Normal-to-Normal Intervals (SDNN) was greater in the ≤50 years SS group (44.45 ± 37.12) than in the >50 years group (33.51 ± 26.18, p = .007). In pSS patients, those positive for both salivary gland biopsy and autoantibodies demonstrated a lower Total Power (4.25 ± 1.32) and R-wave validity (93.50 ± 4.79, p < .05) than other groups, suggesting more severe autonomic imbalance. The R-R interval variation (RRIV) was also significantly higher in this dual-positive group (696.10 ± 975.41, p < .05). Additionally, the ESSPRI for dryness was markedly higher in the dual-positive group (8.10 ± 1.45, p < .05), indicating more severe symptoms. These findings reveal significant variations in autonomic function in SS patients, especially in those with dual-positive biopsy and autoantibody status. CONCLUSION This study demonstrates significant autonomic dysfunction in pSS patients compared to healthy controls, particularly in those positive for both salivary gland biopsy and autoantibodies. The age-stratified analysis further emphasizes the impact of aging on autonomic system functioning in pSS, suggesting a need for age-specific management approaches in pSS patient care.
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Affiliation(s)
- Hong-Chun Lin
- Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Traditional Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chien-Ming Yen
- Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Sheng Chen
- Division of Allergy, Immunology and Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Chien Hsu
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yen-Ying Kung
- Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Traditional Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jin-Huang Wu
- Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Ting Su
- Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kuo-Feng Chen
- Department of Chinese Medicine, Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan
| | - Hsin-Yuan Chen
- Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chien-Min Lien
- Institute of Traditional Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Section of Rehabilitation and Integrative Medicine, National Taiwan University Veterinary Hospital, Taipei, Taiwan
| | - Ming-Jen Wang
- Institute of Traditional Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Chinese Medicine, Taipei City Hospital Renai Branch, Taipei, Taiwan
| | - Ching-Mao Chang
- Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Traditional Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Zhou Y, Lindsey B, Snyder S, Bell E, Reider L, Vignos M, Bar-Kochba E, Mousavi A, Parreira J, Hanley C, Shim JK, Hahn JO. Sampling rate requirement for accurate calculation of heart rate and its variability based on the electrocardiogram. Physiol Meas 2024; 45:025007. [PMID: 38306663 DOI: 10.1088/1361-6579/ad252d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 02/02/2024] [Indexed: 02/04/2024]
Abstract
Objective. To develop analytical formulas which can serve as quantitative guidelines for the selection of the sampling rate for the electrocardiogram (ECG) required to calculate heart rate (HR) and heart rate variability (HRV) with a desired level of accuracy.Approach. We developed analytical formulas which relate the ECG sampling rate to conservative bounds on HR and HRV errors: (i) one relating HR and sampling rate to a HR error bound and (ii) the others relating sampling rate to HRV error bounds (in terms of root-mean-square of successive differences (RMSSD) and standard deviation of normal sinus beats (SDNN)). We validated the formulas using experimental data collected from 58 young healthy volunteers which encompass a wide HR and HRV ranges through strenuous exercise.Main results. The results strongly supported the validity of the analytical formulas as well as their tightness. The formulas can be used to (i) predict an upper bound of inaccuracy in HR and HRV for a given sampling rate in conjunction with HR and HRV as well as to (ii) determine a sampling rate to achieve a desired accuracy requirement at a given HR or HRV (or its range).Significance. HR and its variability (HRV) derived from the ECG have been widely utilized in a wide range of research in physiology and psychophysiology. However, there is no established guideline for the selection of the sampling rate for the ECG required to calculate HR and HRV with a desired level of accuracy. Hence, the analytical formulas may guide in selecting sampling rates for the ECG tailored to various applications of HR and HRV.
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Affiliation(s)
- Yuanyuan Zhou
- Mechanical Engineering, University of Maryland, College Park, MD 20742, United States of America
| | - Bryndan Lindsey
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, United States of America
| | - Samantha Snyder
- Kinesiology, University of Maryland, College Park, MD 20742, United States of America
| | - Elizabeth Bell
- Kinesiology, University of Maryland, College Park, MD 20742, United States of America
| | - Lucy Reider
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, United States of America
| | - Michael Vignos
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, United States of America
| | - Eyal Bar-Kochba
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, United States of America
| | - Azin Mousavi
- Mechanical Engineering, University of Maryland, College Park, MD 20742, United States of America
| | - Jesse Parreira
- Mechanical Engineering, University of Maryland, College Park, MD 20742, United States of America
| | - Casey Hanley
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, United States of America
| | - Jae Kun Shim
- Kinesiology, University of Maryland, College Park, MD 20742, United States of America
- Mechanical Engineering, Kyung Hee University, Yong-In Si, Gyeonggi-Do, Republic of Korea
| | - Jin-Oh Hahn
- Mechanical Engineering, University of Maryland, College Park, MD 20742, United States of America
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Wiediartini, Ciptomulyono U, Dewi RS. Evaluation of physiological responses to mental workload in n-back and arithmetic tasks. Ergonomics 2023:1-13. [PMID: 37970874 DOI: 10.1080/00140139.2023.2284677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023]
Abstract
Working memory tasks, such as n-back and arithmetic tasks, are frequently used in studying mental workload. The present study investigated and compared the sensitivity of several physiological measures at three levels of difficulty of n-back and arithmetic tasks. The results showed significant differences in fixation duration and pupil diameter among three task difficulty levels for both n-back and arithmetic tasks. Pupil diameters increase with increasing mental workload, whereas fixation duration decreases. Blink duration and heart rate (HR) were significantly increased as task difficulty increased in the n-back task, while root mean square of successive differences (RMSSD) and standard deviation of R-R intervals (SDNN) were significantly decreased in the arithmetic task. On the other hand, blink rate and Galvanic Skin Response (GSR) were not sensitive enough to assess the differences in task difficulty for both tasks. All significant physiological measures yielded significant differences between low and high task difficulty except for SDNN.Practitioner summary: This study aimed to assess the sensitivity levels of several physiological measures of mental workload in n-back and arithmetic tasks. It showed that pupil diameter was the most sensitive in both tasks. This study also found that most physiological indices are sensitive to an extreme change in task difficulty levels.
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Affiliation(s)
- Wiediartini
- Department of Industrial and Systems Engineering, Institut Teknologi Sepuluh Nopember, Surabaya, Indonesia
- Safety and Health Engineering Study Program, Politeknik Perkapalan Negeri Surabaya, Surabaya, Indonesia
| | - Udisubakti Ciptomulyono
- Department of Industrial and Systems Engineering, Institut Teknologi Sepuluh Nopember, Surabaya, Indonesia
| | - Ratna Sari Dewi
- Department of Industrial and Systems Engineering, Institut Teknologi Sepuluh Nopember, Surabaya, Indonesia
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Odinaev I, Wong KL, Chin JW, Goyal R, Chan TT, So RHY. Robust Heart Rate Variability Measurement from Facial Videos. Bioengineering (Basel) 2023; 10:851. [PMID: 37508878 PMCID: PMC10376629 DOI: 10.3390/bioengineering10070851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/30/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
Remote Photoplethysmography (rPPG) is a contactless method that enables the detection of various physiological signals from facial videos. rPPG utilizes a digital camera to detect subtle changes in skin color to measure vital signs such as heart rate variability (HRV), an important biomarker related to the autonomous nervous system. This paper presents a novel contactless HRV extraction algorithm, WaveHRV, based on the Wavelet Scattering Transform technique, followed by adaptive bandpass filtering and inter-beat-interval (IBI) analysis. Furthermore, a novel method is introduced to preprocess noisy contact-based PPG signals. WaveHRV is bench-marked against existing algorithms and public datasets. Our results show that WaveHRV is promising and achieves the lowest mean absolute error (MAE) of 10.5 ms and 6.15 ms for RMSSD and SDNN on the UBFCrPPG dataset.
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Affiliation(s)
| | - Kwan Long Wong
- PanopticAI Ltd., Hong Kong, China
- Department of Chemical and Biological Engineering, Hong Kong University of Science and Technology, Hong Kong, China
| | | | - Raghav Goyal
- PanopticAI Ltd., Hong Kong, China
- Department of Computer Science and Engineering, Hong Kong University of Science and Technology, Hong Kong, China
| | | | - Richard H Y So
- PanopticAI Ltd., Hong Kong, China
- Department of Chemical and Biological Engineering, Hong Kong University of Science and Technology, Hong Kong, China
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Suh HW, Kwon CY, Lee B. Long-Term Impact of COVID-19 on Heart Rate Variability: A Systematic Review of Observational Studies. Healthcare (Basel) 2023; 11:healthcare11081095. [PMID: 37107929 PMCID: PMC10137929 DOI: 10.3390/healthcare11081095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) sequelae (or long COVID) has become a clinically significant concern. Several studies have reported the relationship between heart rate variability (HRV) parameters and COVID-19. This review investigates the long-term association between COVID-19 and HRV parameters. Four electronic databases were searched up to 29 July 2022. We included observational studies comparing HRV parameters (measurement durations: 1 min or more) in participants with and without a history of COVID-19. We used assessment tools developed by the National Heart, Lung, and Blood Institute group to evaluate the methodological quality of included studies. Eleven cross-sectional studies compared HRV parameters in individuals who recovered from acute COVID-19 infection to controls (n = 2197). Most studies reported standard deviation of normal-to-normal intervals (SDNN) and root mean square of the successive differences. The methodological quality of the included studies was not optimal. The included studies generally found decreased SDNN and parasympathetic activity in post-COVID-19 individuals. Compared to controls, decreases in SDNN were observed in individuals who recovered from COVID-19 or had long COVID. Most of the included studies emphasized parasympathetic inhibition in post-COVID-19 conditions. Due to the methodological limitations of measuring HRV parameters, the findings should be further validated by robust prospective longitudinal studies.
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Affiliation(s)
- Hyo-Weon Suh
- Health Policy Research Team, Division of Healthcare Research, National Evidence-Based Healthcare Collaborating Agency, 400 Neungdong-ro, Gwangjin-gu, Seoul 04933, Republic of Korea
| | - Chan-Young Kwon
- Department of Oriental Neuropsychiatry, College of Korean Medicine, Dong-Eui University, Busan 47227, Republic of Korea
| | - Boram Lee
- KM Science Research Division, Korea Institute of Oriental Medicine, 1672 Yuseong-daero, Yuseong-gu, Daejeon 34054, Republic of Korea
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Zhang B, Zhou C, Liu J, Zhang J, Jiang C, Tang M, Xie J, Wu Y, Xie X, Li X, Yu J, Wang X, Cheng D, Zhou J, Chen Z, Fan F, Zhou X, Tao A, Yang B. Impaired heart rate variability in patients with arrhythmogenic cardiomyopathy: A multicenter retrospective study in China. Front Cardiovasc Med 2022; 9:1044797. [PMID: 36386351 PMCID: PMC9659603 DOI: 10.3389/fcvm.2022.1044797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/10/2022] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Cardiac sympathetic nerve system (SNS) might play an important role in arrhythmogenesis of arrhythmogenic cardiomyopathy (ACM). This study aims to assess the activity of cardiac SNS in ACM patients by heart rate variability (HRV), and to investigate its predictive value for sustained ventricular tachycardia (sVT). METHODS A total of 88 ACM patients and 65 sex- and age- matched healthy participants were enrolled. The time domain measures were used to evaluate the activity of cardiac SNS. An independent cohort with 48 ACM patients was as the validation cohort. RESULTS ACM patients had lower levels of standard deviation of all NN intervals (SDNN) [118.0 (90.3, 136.8) vs. 152.0 (132.5, 174.5) ms, p < 0.001] compared with healthy participants. Further analysis showed ACM patients with sVT had lower levels of SDNN than those without sVT (105.0 ± 28.1 vs. 131.8 ± 33.1 ms, p < 0.001). Multivariate logistic regression analysis showed SDNN was independently associated with sVT in ACM patients [odds ratio (OR) 0.59, 95% confidence interval (CI) (0.45-0.78), p < 0.001]. Receiver operating characteristics curve demonstrated SDNN had clinical values in predicting sVT in ACM patients [area under the curve (AUC) = 0.73, 95% CI (0.63-0.84), p < 0.001], which was verified in the validation cohort. CONCLUSION The present study suggests that HRV is impaired in patients with ACM, and the SDNN level has a moderate value in risk stratification for sVT in ACM patients. In addition, the finding might provide new target for the further management of ACM with integrated traditional Chinese and western medicine.
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Affiliation(s)
- Baowei Zhang
- Center of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chunjiang Zhou
- Center of Cardiology, Shanghai East Hospital, Nanjing Medical University, Shanghai, China
| | - Jinqiu Liu
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jinlin Zhang
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China
| | - Chenyang Jiang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Min Tang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiaxi Xie
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yizhang Wu
- Center of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xin Xie
- Center of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaorong Li
- Center of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jinbo Yu
- Center of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xuecheng Wang
- Center of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Dian Cheng
- Center of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jian Zhou
- Center of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zijun Chen
- Center of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fenghua Fan
- Center of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiujuan Zhou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Aibin Tao
- Department of Cardiology, The Affiliated People’s Hospital of Jiangsu University, Zhenjiang, China
| | - Bing Yang
- Center of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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Kozorosky EM, Lee CH, Lee JG, Nunez Martinez V, Padayachee LE, Stauss HM. Transcutaneous auricular vagus nerve stimulation augments postprandial inhibition of ghrelin. Physiol Rep 2022; 10:e15253. [PMID: 35441808 PMCID: PMC9020171 DOI: 10.14814/phy2.15253] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 05/15/2023] Open
Abstract
Vagus nerve stimulation (VNS) facilitates weight loss in animals and patients treated with VNS for depression or epilepsy. Likewise, chronic transcutaneous auricular VNS (taVNS) reduces weight gain and improves glucose tolerance in Zucker diabetic fatty rats. If these metabolic effects of taVNS observed in rats translate to humans is unknown. Therefore, the hypothesis of this study was that acute application of taVNS affects glucotropic and orexigenic hormones which could potentially facilitate weight loss and improve glucose tolerance if taVNS were applied chronically. In two single-blinded randomized cross-over protocols, blood glucose levels, plasma concentrations of insulin, C-peptide, glucagon, leptin, and ghrelin, together with heart rate variability and baroreceptor-heart rate reflex sensitivity were determined before and after taVNS (left ear, 10 Hz, 300 µs, 2.0-2.5 mA, 30 min) or sham-taVNS (electrode attached to ear with the stimulator turned off). In a first protocol, subjects (n = 16) were fasted throughout the protocol and in a second protocol, subjects (n = 10) received a high-calorie beverage (220 kCal) after the first blood sample, just before initiation of taVNS or sham-taVNS. No significant effects of taVNS on heart rate variability and baroreceptor-heart rate reflex sensitivity and only minor effects on glucotropic hormones were observed. However, in the second protocol taVNS significantly lowered postprandial plasma ghrelin levels (taVNS: -115.5 ± 28.3 pg/ml vs. sham-taVNS: -51.2 ± 30.6 pg/ml, p < 0.05). This finding provides a rationale for follow-up studies testing the hypothesis that chronic application of taVNS may reduce food intake through inhibition of ghrelin and, therefore, may indirectly improve glucose tolerance through weight loss.
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Affiliation(s)
| | - Cristina H. Lee
- Burrell College of Osteopathic MedicineLas CrucesNew MexicoUSA
| | - Jessica G. Lee
- Burrell College of Osteopathic MedicineLas CrucesNew MexicoUSA
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Wang J, Xu Z, Lv K, Ye Y, Luo D, Wan L, Zhou F, Yu A, Wang S, Liu J, Gao L. The Predictive Value of Serum Calcium on Heart Rate Variability and Cardiac Function in Type 2 Diabetes Patients. Front Endocrinol (Lausanne) 2022; 13:864008. [PMID: 35498438 PMCID: PMC9047897 DOI: 10.3389/fendo.2022.864008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/03/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cardiovascular autonomic neuropathy (CAN) is common in patients with type 2 diabetes mellitus (T2DM), mainly presented as decreased heart rate variability (HRV) which often leads to cardiac death. However, HRV measurement is not convenient in most clinics. Therefore, identifying high-risk patients for CAN in diabetes with easier measurements is crucial for the early intervention and prevention of catastrophic consequences. METHODS In this cross-sectional study, 675 T2DM patients with normocalcemia were selected. Of these, they were divided into two groups: normal HRV group (n = 425, 100 ms≤ SDNN ≤180 ms) vs. declined HRV group (n = 250, SDNN <100 ms). All patients' clinical data were collected and the correlation of clinical variables with HRV were analyzed by correlation and logistic regression analysis. The area below the ROC curve was used to evaluate the predictive performance of serum calcium on HRV. RESULTS In this study, declines in HRV were present in 37.0% of T2DM patients. Significant differences in albumin-adjusted serum calcium levels (CaA) (8.86 ± 0.27 vs. 9.13 ± 0.39 mg/dl, p <0.001) and E/A (0.78 ± 0.22 vs. 0.83 ± 0.26, p = 0.029) were observed between declined HRV and normal HRV groups. Bivariate linear correlation analysis showed that CaA and E/A were positively correlated with HRV parameters including SDNN (p < 0.001), SDNN index (p < 0.001), and Triangle index (p < 0.05). The AUC in the ROC curve for the prediction of CaA on HRV was 0.730 (95% CI (0.750-0.815), p < 0.001). The cutoff value of CaA was 8.87 mg/dl (sensitivity 0.644, specificity 0.814). The T2DM patients with CaA <8.87 mg/dl had significantly lower HRV parameters (SDNN, SDNN index, rMSSD, and triangle index) than those with CaA ≥8.87 mg/dl (p < 0.01, respectively). Multivariate logistic regression analysis showed a significantly increased risk of declined HRV in subjects with CaA level <8.87 mg/dl [OR (95% CI), 0.049 (0.024-0.099), p < 0.001]. CONCLUSIONS Declined HRV is associated with a lower CaA level and worse cardiac function. The serum calcium level can be used for risk evaluation of declined HRV in T2DM patients even within the normocalcemic range.
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Affiliation(s)
- Junyi Wang
- Department of Endocrinology & Metabolism, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zihui Xu
- Department of Endocrinology & Metabolism, Renmin Hospital of Wuhan University, Wuhan, China
| | - Kang Lv
- Shenzhen University, College of Big Data and Internet, Shenzhen, China
| | - Yingchun Ye
- Department of Endocrinology & Metabolism, Renmin Hospital of Wuhan University, Wuhan, China
| | - Deng Luo
- Department of Endocrinology & Metabolism, Renmin Hospital of Wuhan University, Wuhan, China
| | - Li Wan
- Department of Endocrinology & Metabolism, Renmin Hospital of Wuhan University, Wuhan, China
| | - Fen Zhou
- Department of Endocrinology & Metabolism, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ailin Yu
- Department of Endocrinology & Metabolism, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shuo Wang
- Department of Endocrinology & Metabolism, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jingcheng Liu
- Department of Endocrinology & Metabolism, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ling Gao
- Department of Endocrinology & Metabolism, Renmin Hospital of Wuhan University, Wuhan, China
- *Correspondence: Ling Gao,
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Morelli D, Rossi A, Bartoloni L, Cairo M, Clifton DA. SDNN24 Estimation from Semi-Continuous HR Measures. Sensors (Basel) 2021; 21:1463. [PMID: 33672456 PMCID: PMC7923410 DOI: 10.3390/s21041463] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 12/31/2022]
Abstract
The standard deviation of the interval between QRS complexes recorded over 24 h (SDNN24) is an important metric of cardiovascular health. Wrist-worn fitness wearable devices record heart beats 24/7 having a complete overview of users' heart status. Due to motion artefacts affecting QRS complexes recording, and the different nature of the heart rate sensor used on wearable devices compared to ECG, traditionally used to compute SDNN24, the estimation of this important Heart Rate Variability (HRV) metric has never been performed from wearable data. We propose an innovative approach to estimate SDNN24 only exploiting the Heart Rate (HR) that is normally available on wearable fitness trackers and less affected by data noise. The standard deviation of inter-beats intervals (SDNN24) and the standard deviation of the Average inter-beats intervals (ANN) derived from the HR (obtained in a time window with defined duration, i.e., 1, 5, 10, 30 and 60 min), i.e., ANN=60HR (SDANNHR24), were calculated over 24 h. Power spectrum analysis using the Lomb-Scargle Peridogram was performed to assess frequency domain HRV parameters (Ultra Low Frequency, Very Low Frequency, Low Frequency, and High Frequency). Due to the fact that SDNN24 reflects the total power of the power of the HRV spectrum, the values estimated from HR measures (SDANNHR24) underestimate the real values because of the high frequencies that are missing. Subjects with low and high cardiovascular risk show different power spectra. In particular, differences are detected in Ultra Low and Very Low frequencies, while similar results are shown in Low and High frequencies. For this reason, we found that HR measures contain enough information to discriminate cardiovascular risk. Semi-continuous measures of HR throughout 24 h, as measured by most wrist-worn fitness wearable devices, should be sufficient to estimate SDNN24 and cardiovascular risk.
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Affiliation(s)
- Davide Morelli
- Huma Therapeutics Limited, London SW1P 4QP, UK; (L.B.); (M.C.)
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford OX1 2JD, UK;
| | - Alessio Rossi
- Department of Computer Science, University of Pisa, 56126 Pisa, Italy;
| | | | - Massimo Cairo
- Huma Therapeutics Limited, London SW1P 4QP, UK; (L.B.); (M.C.)
| | - David A. Clifton
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford OX1 2JD, UK;
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10
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Rossi A, Pedreschi D, Clifton DA, Morelli D. Error Estimation of Ultra-Short Heart Rate Variability Parameters: Effect of Missing Data Caused by Motion Artifacts. Sensors (Basel) 2020; 20:E7122. [PMID: 33322560 DOI: 10.3390/s20247122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 02/05/2023]
Abstract
Application of ultra–short Heart Rate Variability (HRV) is desirable in order to increase the applicability of HRV features to wrist-worn wearable devices equipped with heart rate sensors that are nowadays becoming more and more popular in people’s daily life. This study is focused in particular on the the two most used HRV parameters, i.e., the standard deviation of inter-beat intervals (SDNN) and the root Mean Squared error of successive inter-beat intervals differences (rMSSD). The huge problem of extracting these HRV parameters from wrist-worn devices is that their data are affected by the motion artifacts. For this reason, estimating the error caused by this huge quantity of missing values is fundamental to obtain reliable HRV parameters from these devices. To this aim, we simulate missing values induced by motion artifacts (from 0 to 70%) in an ultra-short time window (i.e., from 4 min to 30 s) by the random walk Gilbert burst model in 22 young healthy subjects. In addition, 30 s and 2 min ultra-short time windows are required to estimate rMSSD and SDNN, respectively. Moreover, due to the fact that ultra-short time window does not permit assessing very low frequencies, and the SDNN is highly affected by these frequencies, the bias for estimating SDNN continues to increase as the time window length decreases. On the contrary, a small error is detected in rMSSD up to 30 s due to the fact that it is highly affected by high frequencies which are possible to be evaluated even if the time window length decreases. Finally, the missing values have a small effect on rMSSD and SDNN estimation. As a matter of fact, the HRV parameter errors increase slightly as the percentage of missing values increase.
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11
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Martino PF, Miller DP, Miller JR, Allen MT, Cook-Snyder DR, Handy JD, Servatius RJ. Cardiorespiratory Response to Moderate Hypercapnia in Female College Students Expressing Behaviorally Inhibited Temperament. Front Neurosci 2020; 14:588813. [PMID: 33281546 PMCID: PMC7691270 DOI: 10.3389/fnins.2020.588813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/26/2020] [Indexed: 11/19/2022] Open
Abstract
Behaviorally inhibited (BI) temperament is marked by heightened behavioral sensitivity to environmental threats. The degree to which threat sensitivity is reflected in cardiorespiratory responses has been relatively unexplored. Female college students were exposed to modest hypercapnia (7.0% CO2) or ambient air (AA) while engaging in a computerized task with cued reinforcement features. All physiological variables except for blood pressure were processed in 4 min epochs corresponding to pre-exposure, exposure, and post-exposure. Primary respiratory measures were respiratory frequency (fb), tidal volume (VT), and minute ventilation (VE). Electrocardiograms (ECGs) were processed using ARTiiFACT software with resultant heart rate variability (HRV) measures in the frequency domain and time domain. Consistent with the literature, modest hypercapnia increased VT, Fb, and VE. No differences in respiratory parameters were detected between BI and non-behaviorally inhibited individuals (NI). For HRV in the time domain, RMSSD and NN50 values increased during CO2 inhalation which then returned to pre-exposure levels after CO2 cessation. Hypercapnia increased high frequency (HF) power which then recovered. BI exhibited reduced low frequency (LF) power during the pre-exposure period. For NI, LF power reduced over the subsequent phases ameliorating differences between BI and NI. Hypercapnia improved the task performance of BI. This is the largest study of female reactivity to hypercapnia and associated HRV to date. In general, hypercapnia increased time domain HRV and HF power, suggesting a strong vagal influence. Those expressing BI exhibited similar respiratory and HRV reactivity to NI despite inherently reduced LF power. Although 7% CO2 represents a mild challenge to the respiratory and cardiovascular systems, it is nonetheless sufficient to explore inherent difference in stress reactivity in those vulnerable to develop anxiety disorders.
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Affiliation(s)
- Paul F Martino
- Biology Department, Carthage College, Kenosha, WI, United States.,Department of Physiology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Daniel P Miller
- Neuroscience Department, Carthage College, Kenosha, WI, United States
| | - Justin R Miller
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Michael T Allen
- School of Psychological Sciences, College of Education and Behavioral Sciences, University of Northern Colorado, Greeley, CO, United States
| | - Denise R Cook-Snyder
- Biology Department, Carthage College, Kenosha, WI, United States.,Department of Physiology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Justin D Handy
- Naval Submarine Medical Research Laboratory, Groton, CT, United States
| | - Richard J Servatius
- United States Department of Veterans Affairs, Syracuse VA Medical Center, Syracuse, NY, United States.,Department of Psychiatry, State University of New York Upstate Medical University, Syracuse, NY, United States
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12
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Dutt R, Shankar N, Srivastava S, Yadav A, Ahmed RS. Cardiac autonomic tone, plasma BDNF levels and paroxetine response in newly diagnosed patients of generalised anxiety disorder. Int J Psychiatry Clin Pract 2020; 24:135-142. [PMID: 32022607 DOI: 10.1080/13651501.2020.1723642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective: The study examined the effect on cardiac autonomic tone via heart rate variability (HRV), brain derived neurotrophic factor (BDNF) in newly diagnosed generalised anxiety disorder (GAD) cases with paroxetine-controlled release (PX) CR intervention.Methods: Fifty GAD cases using DSM-5 criteria, matched with healthy controls (HC) were assessed with clinical measures (Hamilton Anxiety Scale (HAM-A), Clinical Global Impression- Severity Scale (CGI-Severity), General Health Questionnaire -12 (GHQ-12), HRV, plasma BDNF levels initially and 6 weeks postintervention with paroxetine CR.Results: HRV parameters were significantly lower in GAD vs HC at baseline for standard deviation of normal to normal intervals (SDNN) and proportion of differences in consecutive NN intervals that are longer than 50 ms (pNN50). Significantly higher plasma BDNF levels were noted between HC versus GAD at baseline. Postintervention HAM-A, CGI scores, GHQ-12 item scores showed significant reduction. Significant differences also noted in square root of mean squared difference of successive NN intervals (RMSSD), (SDNN), pNN50 and in plasma BDNF levels after intervention within GAD group. Significant negative correlation observed between HAM-A scores and SDNN parameter after taking PX CR in GAD.Conclusion: GAD showed cardiac autonomic dysfunction, lowered plasma BDNF levels and their improvement with paroxetine CR.Key messageGAD is associated with significantly lower HRV, suggestive of cardiac autonomic dysfunction and lowered plasma BDNF levels, an indicator of stress.Therapeutic intervention with Paroxetine in GAD patients showed clinically significant improvement reflecting restoration of the cardiac autonomic tone and BDNF levels, thus implying their role as potential biomarkers.
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Affiliation(s)
- Ravi Dutt
- Department of Physiology, University College of Medical sciences and GTB Hospital, Delhi, India
| | - Nilima Shankar
- Department of Physiology, University College of Medical sciences and GTB Hospital, Delhi, India
| | - Shruti Srivastava
- Department of Psychiatry, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Asha Yadav
- Department of Physiology, University College of Medical sciences and GTB Hospital, Delhi, India
| | - Rafat S Ahmed
- Department of Biochemistry, University College of Medical Sciences and GTB Hospital, Delhi, India
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Alassiri M, Alanazi A, Aldera H, Alqahtani SA, Alraddadi AS, Alberreet MS, Alhussaini AI, Alotaibi Y, Alkhateeb MA, Shatoor AS. Exposure to cell phones reduces heart rate variability in both normal-weight and obese normotensive medical students. Explore (NY) 2020; 16:264-270. [PMID: 32249199 DOI: 10.1016/j.explore.2020.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 01/26/2020] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND We investigated and compared the effect of the radiofrequency electromagnetic field (RF-EM) emitted by a cell phone on the electrocardiogram and heart rate variability (HRV) of normotensive normal-weight and obese medical students. METHOD Twenty medical student volunteers, normal weight (age = 23 ± 2, BMI = 23.05 ± 1.72) or obese (age = 24 ± 2, BMI = 32.39 ± 4.78), were exposed to a cell phone (1) close to the heart in silent mode, no ringing or vibrating; (2) close to the heart in ring and vibration mode; (3) next to the ear (brain) while listening; and (4) next to the ear while listening and speaking. RESULTS The average basal HR of obese students significantly increased, while the PR interval; time domains, including standard deviation (SD) of all normal R-R intervals (SDNN), mean of the SD of all normal R-R intervals (SDNNi), SD of the average of normal R-R intervals (SDANN), and percentage of R-R intervals at least 50 ms different from the previous interval (pNN50); and high-power frequency (HF) decreased. The LF/HF ratio also significantly increased. The SDNN, SDNNi, SDANN, pNN50, and HF levels significantly decreased and the LF/HF significantly increased in normal-weight and obese individuals only when the phone was near the apex of the heart in ring and vibration mode. All changes were more profound in obese students. CONCLUSION Keeping the phone in a chest pocket reduced the HRV of normal-weight and obese medical students and exaggerated the effect of obesity on sympathetic activation.
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Affiliation(s)
- Mohammed Alassiri
- Department of Basic Sciences, College of Science and Health Professions, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia.; King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia.
| | - Asma Alanazi
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia; King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - Hussain Aldera
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia; King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - Sultan A Alqahtani
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia; King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - Abdulrahman S Alraddadi
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia; King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - Meshal S Alberreet
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
| | - Abdullah I Alhussaini
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
| | - Yousef Alotaibi
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
| | - Mahmoud A Alkhateeb
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
| | - Abdullah S Shatoor
- College Medicine, Department of Internal Medicine, Cardiology Section, King Khalid University, Abha, Saudi Arabia
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14
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Karey E, Pan S, Morris AN, Bruun DA, Lein PJ, Chen CY. The Use of Percent Change in RR Interval for Data Exclusion in Analyzing 24-h Time Domain Heart Rate Variability in Rodents. Front Physiol 2019; 10:693. [PMID: 31244671 PMCID: PMC6562196 DOI: 10.3389/fphys.2019.00693] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 05/16/2019] [Indexed: 11/13/2022] Open
Abstract
While epidemiological data support the link between reduced heart rate variability (HRV) and a multitude of pathologies, the mechanisms underlying changes in HRV and disease progression are poorly understood. Even though we have numerous rodent models of disease for mechanistic studies, not being able to reliably measure HRV in conscious, freely moving rodents has hindered our ability to extrapolate the role of HRV in the progression from normal physiology to pathology. The sheer number of heart beats per day (>800,000 in mice) makes data exclusion both time consuming and daunting. We sought to evaluate an RR interval exclusion method based on percent (%) change of adjacent RR intervals. Two approaches were evaluated: % change from “either” and “both” adjacent RR intervals. The data exclusion method based on standard deviation (SD) was also evaluated for comparison. Receiver operating characteristic (ROC) curves were generated to determine the performance of each method. Results showed that exclusion based on % change from “either” adjacent RR intervals was the most accurate method in identifying normal and abnormal RR intervals, with an overall accuracy of 0.92–0.99. As the exclusion value increased (% change or SD), the sensitivity (correctly including normal RR intervals) increased exponentially while the specificity (correctly rejecting abnormal RR intervals) decreased linearly. Compared to the SD method, the “either” approach had a steeper rise in sensitivity and a more gradual decrease in specificity. The intersection of sensitivity and specificity where the exclusion criterion had the same accuracy in identifying normal and abnormal RR intervals was 10–20% change for the “either” approach and ∼ 1 SD for the SD-based exclusion method. Graphically (tachogram and Lorenz plot), 20% change from either adjacent RR interval resembled the data after manual exclusion. Finally, overall (SDNN) and short-term (rMSSD) indices of HRV generated using 20% change from “either” adjacent RR intervals as the exclusion criterion were closer to the manual exclusion method with lower subject-to-subject variability than those generated using the 2 SD exclusion criterion. Thus, 20% change from “either” adjacent RR intervals is a good criterion for data exclusion for reliable 24-h time domain HRV analysis in rodents.
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Affiliation(s)
- Emma Karey
- Department of Pharmacology, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Shiyue Pan
- Department of Pharmacology, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Amber N Morris
- Department of Pharmacology, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Donald A Bruun
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Pamela J Lein
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Chao-Yin Chen
- Department of Pharmacology, School of Medicine, University of California, Davis, Davis, CA, United States
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15
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Kim JY, Park JH, Jang SY, Yang JR. Peak Detection Algorithm for Vital Sign Detection Using Doppler Radar Sensors. Sensors (Basel) 2019; 19:s19071575. [PMID: 30939799 PMCID: PMC6480531 DOI: 10.3390/s19071575] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/15/2019] [Accepted: 03/28/2019] [Indexed: 11/16/2022]
Abstract
An accurate method for detecting vital signs obtained from a Doppler radar sensor is proposed. A Doppler radar sensor can remotely obtain vital signs such as heartbeat and respiration rate, but the vital signs obtained by using the sensor do not show clear peaks like in electrocardiography (ECG) because of the operating characteristics of the radar. The proposed peak detection algorithm extracts the vital signs from the raw data. The algorithm shows the mean accuracy of 96.78% compared to the peak count from the reference ECG sensor and a processing time approximately two times faster than the gradient-based algorithm. To verify whether heart rate variability (HRV) analysis similar to that with an ECG sensor is possible for a radar sensor when applying the proposed method, the continuous parameter variations of the HRV in the time domain are analyzed using data processed with the proposed peak detection algorithm. Experimental results with six subjects show that the proposed method can obtain the heart rate with high accuracy but cannot obtain the information for an HRV analysis because the proposed method cannot overcome the characteristics of the radar sensor itself.
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Affiliation(s)
- Ju-Yeon Kim
- Department of Electronic Engineering, Yeungnam University, Gyeongsan, Gyeongbuk-do 38541, Korea.
| | - Jae-Hyun Park
- Department of Electronic Engineering, Yeungnam University, Gyeongsan, Gyeongbuk-do 38541, Korea.
| | - Se-Young Jang
- Department of Life Science, Yeungnam University, Gyeongsan, Gyeongbuk-do 38541, Korea.
| | - Jong-Ryul Yang
- Department of Electronic Engineering, Yeungnam University, Gyeongsan, Gyeongbuk-do 38541, Korea.
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16
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Ciccone AB, Siedlik JA, Wecht JM, Deckert JA, Nguyen ND, Weir JP. Reminder: RMSSD and SD1 are identical heart rate variability metrics. Muscle Nerve 2017; 56:674-678. [PMID: 28073153 DOI: 10.1002/mus.25573] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2017] [Indexed: 11/10/2022]
Abstract
Assessment of heart rate variability (HRV) is a common approach to examine cardiac autonomic nervous system modulation that has been employed in a variety of settings. Frequently, both the root mean square of successive differences (RMSSD) and SD1, which is a Poincaré plot component, have been used to quantify short-term heart rate variability. It is not typically appreciated, however, that RMSSD and SD1 are identical metrics of HRV. As a reminder to clinicians and researchers who use and study HRV, we show both empirically and mathematically that RMSSD and SD1 are identical metrics. Because the homology between RMSSD and SD1 is not commonly known, the inclusion of both measures has been reported in many recent publications. The inappropriate use of such redundant data may affect the interpretation of HRV studies. Muscle Nerve 56: 674-678, 2017.
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Affiliation(s)
- Anthony B Ciccone
- Osness Human Performance Laboratories, Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, Kansas, 66045, USA
| | - Jacob A Siedlik
- Department of Exercise Science and Pre-Health Professions, Creighton University, Omaha Nebraska, USA
| | - Jill M Wecht
- Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA.,Department of Medicine and Rehabilitation Medicine, the Icahn School of Medicine, Mount Sinai, New York, New York, USA
| | - Jake A Deckert
- Osness Human Performance Laboratories, Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, Kansas, 66045, USA
| | - Nhuquynh D Nguyen
- Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Joseph P Weir
- Osness Human Performance Laboratories, Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, Kansas, 66045, USA
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Abstract
OBJECTIVES Sertindole is a nonsedating atypical antipsychotic drug with low propensity to cause extrapyramidal side effects but it has been associated with a 20 ms QTc prolongation and increased risk of cardiac events. It is uncertain whether this drug-induced increase in cardiac risk might also be revealed by dynamic measures of the QT interval such as the ratio of QT variability to heart rate variability (variability ratio [VR]). The aim of this study was to investigate the effect of sertindole on QT dynamics. METHODS QTc and the VR were assessed in an observational study using 24-hour Holter monitoring at baseline and after 3 weeks of treatment with sertindole 16 mg. The VR was calculated by dividing the standard deviation of QT intervals with the standard deviation of heart rates. Outcome measures were compared using paired t-test. RESULTS A total of 18 patients participated in the study, two were excluded from further analysis due to low amplitude of the T-wave. When patients were shifted to sertindole, the VR increased from 0.192 (SD 0.045) to 0.223 (SD 0.061), p = 0.02. The QTcF interval increased from 388 (SD 16) to 403 ms (SD 14), p = 0.002. There was no difference in heart rate 78 bpm (SD 8) versus 80 bpm (SD 10), p = 0.3 or heart rate variability (SDNN) 127 (SD 40) versus 115 ms (SD 45), p = 0.4. CONCLUSION Sertindole was associated with 19 ms QTc prolongation and an increased ratio of QT variability to heart rate variability. Both measures may contribute to the increased cardiovascular mortality found with sertindole.
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Affiliation(s)
- Jimmi Nielsen
- Clinical Department of medicine, Centre for Schizophrenia, Aalborg Psychiatric Hospital, Brandevej 5, 9220 Aalborg Ø, Denmark, UK
| | - Fan Wang
- Laboratory of Experimental Cardiology, Danish National Foundation Centre of Arrhythmias, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark, UK
| | - Claus Graff
- Medical Informatics Group (MI), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark, UK
| | - Jørgen K Kanters
- Laboratory of Experimental Cardiology, Danish National Foundation Centre of Arrhythmias, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark, UK
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18
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Wu JS, Yang YC, Lu FH, Lin TS, Chen JJ, Huang YH, Yeh TL, Chang CJ. Cardiac autonomic function and insulin resistance for the development of hypertension: a six-year epidemiological follow-up study. Nutr Metab Cardiovasc Dis 2013; 23:1216-1222. [PMID: 23419733 DOI: 10.1016/j.numecd.2013.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 12/27/2012] [Accepted: 01/04/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS To explore the impact of cardiac autonomic function (CAF) and insulin resistance (IR) on incident hypertension. METHODS AND RESULTS In 1996, 1638 subjects finished baseline examination, which included anthropometry, blood pressures, CAF, blood biochemistry, plasma insulin, urine examination and electrocardiogram. CAF included standard deviation of normal-to-normal intervals or RR intervals (SDNN), low- and high-frequency power spectrum (LF and HF), and LF/HF ratio at supine for 5 min, the RR interval changes during lying-to-standing maneuver, and the ratio between the longest RR interval during expiration and the shortest RR interval during inspiration (E/I ratio). We used homeostasis model assessment to define beta cell function (HOMA-B) and insulin resistance (HOMA-IR). In total, 992 non-hypertensive participants completed the follow-up assessment in 2003 and 959 participants were included for the final analysis. Incident hypertension was determined by blood pressure status at follow-up. In unadjusted model, both square root of HOMA-IR (OR:3.37, 95%CI: 2.10-6.64) and HOMA-B (OR:0.996, 95%CI: 0.992-0.999) were related to incident hypertension. In multivariate model, square root of HOMA-IR (OR:1.97, 95%CI: 1.05-3.70), but not HOMA-B, was associated with incident hypertension. After further adjustment for baseline CAF, the positive relationship between the square root of HOMA-IR and incident hypertension disappeared. In contrast, LF/HF ratio (OR:1.18, 95%CI: 1.01-1.37), HF power (OR:0.98, 95%CI: 0.96-0.999), and E/I ratio (OR:0.71, 95%CI: 0.54-0.95) were each independently associated with incident hypertension after further adjustment for HOMA measures. CONCLUSION Sympathovagal imbalance with an apparently decreased parasympathetic tone is an important predictor of incident hypertension independent of IR.
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Affiliation(s)
- J S Wu
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Taiwan, ROC; Department of Family Medicine, National Cheng Kung University Hospital, Taiwan, ROC
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Chiu SN, Lin LY, Wang JK, Lu CW, Chang CW, Lin MT, Hua YC, Lue HC, Wu MH. Long-term outcomes of pediatric sinus bradycardia. J Pediatr 2013; 163:885-9.e1. [PMID: 23623512 DOI: 10.1016/j.jpeds.2013.03.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 03/04/2013] [Accepted: 03/19/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To delineate the long-term outcomes and mechanisms of pediatric sinus bradycardia. STUDY DESIGN Participants with sinus bradycardia who were identified from a survey of 432,166 elementary and high school students, were enrolled 10 years after the survey. The clinical course, heart rate variability, and hyperpolarization-activated cyclic nucleotide-gated potassium channel 4 (HCN4) gene were assessed. RESULTS A total of 104 (male:female was 60:44; prevalence, 0.025%) participants were observed to have sinus bradycardia at age 15.5 ± 0.2 years with a mean heart rate of 48.4 ± 0.4 beats per minute; 86 study participants (83%) responded to clinical assessment and 37 (36%) underwent laboratory assessment. Athletes composed 37.8% of the study participants. During the extended 10-year follow-up, 15 (17%) of the participants had self-limited syncopal episodes, but none had experienced life-threatening events. According to Holter recordings, none of the participants had heart rate <30 beats per minute or a pause longer than 3 seconds. Compared with 67 age- and sex-matched controls, the variables of heart rate based on the spectral and time domain analysis of the participants with sinus bradycardia were all significantly higher, indicating higher parasympathetic activity. The results of mutation analysis were negative in the HCN4 gene in all of our participants. CONCLUSIONS The long-term outcomes of the children and adolescents with sinus bradycardia identified using school electrocardiographic survey are favorable. Parasympathetic hyperactivity, instead of HCN4 gene mutation, is responsible for the occurrence of sinus bradycardia.
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Affiliation(s)
- Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
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20
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Abstract
Heart rate turbulence (HRT) is a baroreflex-mediated biphasic reaction of heart rate in response to premature ventricular beats. Heart rate turbulence is quantified by: turbulence onset (TO) reflecting the initial acceleration of heart rate following premature beat and turbulence slope (TS) describing subsequent deceleration of heart rate. Abnormal HRT identifies patients with autonomic dysfunction or impaired baroreflex sensitivity due to variety of disorders, but also may reflect changes in autonomic nervous system induced by different therapeutic modalities such as drugs, revascularization, or cardiac resynchronization therapy. More importantly, impaired HRT has been shown to identify patients at high risk of all-cause mortality and sudden death, particularly in postinfarction and congestive heart failure patients. It should be emphasized that abnormal HRT has a well-established role in stratification of postinfarction and heart failure patients with relatively preserved left ventricular ejection fraction. The ongoing clinical trials will document whether HRT can be used to guide implantation of cardioverter-defibrillators in this subset of patients, not covered yet by ICD guidelines. This review focuses on the current state-of-the-art knowledge regarding clinical significance of HRT in detection of autonomic dysfunction and regarding the prognostic significance of this parameter in predicting all-cause mortality and sudden death.
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Affiliation(s)
- Iwona Cygankiewicz
- Department of Electrocardiology, Medical University of Lodz, Sterling Regional Center for Heart Diseases, 91-425 Lodz, Poland.
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21
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Abstract
Heart rate (HR) variability has been extensively studied in cardiac patients, especially in patients surviving an acute myocardial infarction (AMI) and also in patients with congestive heart failure (CHF) or left ventricular (LV) dysfunction. The majority of studies have shown that patients with reduced or abnormal HR variability have an increased risk of mortality within a few years after an AMI or after a diagnosis of CHF/LV dysfunction. Various measures of HR dynamics, such as time-domain, spectral, and non-linear measures of HR variability have been used in risk stratification. The prognostic power of various measures, except of those reflecting rapid R-R interval oscillations, has been almost identical, albeit some non-linear HR variability measures, such as short-term fractal scaling exponent have provided somewhat better prognostic information than the others. Abnormal HR variability predicts both sudden and non-sudden cardiac death. Because of remodeling of the arrhythmia substrate after AMI, early measurement of HR variability to identify those at high risk should likely be repeated later in order to assess the risk of fatal arrhythmia events. Future randomized trials using HR variability/turbulence as one of the pre-defined inclusion criteria will show whether routine measurement of HR variability/turbulence will become a routine clinical tool for risk stratification of cardiac patients.
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Affiliation(s)
- Heikki V Huikuri
- Institute of Clinical Medicine, Department of Internal Medicine, University of Oulu, and University Hospital of Oulu, Oulu, Finland.
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