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Lappalainen T, Jurvelin H, Tulppo MP, Pesonen P, Auvinen J, Timonen M. Chronotype and metabolic syndrome in midlife - findings from the Northern Finland Birth Cohort 1966. Am J Physiol Heart Circ Physiol 2024. [PMID: 38758129 DOI: 10.1152/ajpheart.00051.2024] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/10/2024] [Indexed: 05/18/2024]
Abstract
Evening chronotype is known to be associated with various chronic diseases and cardiovascular risk factors. Metabolic syndrome is a group of conditions that together raise the risk of coronary heart disease, diabetes, stroke, and other serious health problems. Only a few studies have been published on the association between chronotype and metabolic syndrome in unselected population data, with conflicting results. The aim of this study was to evaluate the association between chronotype and metabolic syndrome at population level by using unselected Northern Finland Birth cohort 1966 (NFBC1966) database. The study population consists of NFBC66 participants (n=5113, 57% female) at the age of 46 years. Chronotype was determined with shortened Morningness-Eveningness Questionnaires and expressed as morning (44%), intermediate (44%) and evening types (12%). Metabolic syndrome was determined according to the definition of International Diabetes Federation. One-way ANOVA, Kruskal-Walli's test and Chi-squared tests were used to compare the chronotype groups, followed by logistic regression analysis (adjusted with alcohol consumption, smoking, marital status, level of education, and leisure-time physical activity). In women, the prevalence of metabolic syndrome was statistically significantly higher in the evening type group:23%, 24% and 34% for morning, intermediate and evening groups, respectively (p<0,001). In logistic regression analysis, evening chronotype was associated with higher risk of having metabolic syndrome (OR 1.5; CI 95% 1.2 to 2.0). In this population-based birth cohort study, the evening chronotype was independently associated with higher prevalence of metabolic syndrome in women.
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Affiliation(s)
- Taru Lappalainen
- Research Unit of Population Health, University of Oulu, Oulu, Finland
| | - Heidi Jurvelin
- Research Unit of Population Health, University of Oulu, Oulu, Finland, University of Oulu, Finland
| | | | - Paula Pesonen
- Infrastructure for Population Studies, Northern Finland Birth Cohorts, Faculty of Medicine, University of Oulu, Finland, University of Oulu, Finland
| | - Juha Auvinen
- Research Unit of Population Health, University of Oulu, Oulu, Finland, University of Oulu, Finland
| | - Markku Timonen
- Center for Life Course Health Research, University of Oulu
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2
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Rahola JT, Mattila SM, Kiviniemi AM, Ukkola OH, Tulppo MP, Junttila MJ, Huikuri HV, Kenttä TV, Perkiömäki JS. Prognostic significance of beat-to-beat variability of spatial heterogeneity of repolarization analyzed from a 5-minute resting electrocardiogram in coronary artery disease. Heart Rhythm 2024:S1547-5271(24)00224-8. [PMID: 38597856 DOI: 10.1016/j.hrthm.2024.02.052] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 02/22/2024] [Accepted: 02/22/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Data on the prognostic significance of temporal variability of spatial heterogeneity of electrocardiographic repolarization in coronary artery disease (CAD) are limited. OBJECTIVE The purpose of this study was to evaluate the prognostic value of temporal variability of T-wave morphology analyzed from a 5-minute resting electrocardiogram in CAD. METHODS The standard deviation (SD) of T-wave morphology dispersion (TMD-SD) and the SD of total cosine R-to-T were analyzed on a beat-to-beat basis from a 5-minute period of the standard resting 12-lead electrocardiogram obtained before the clinical stress test in 1702 patients with angiographically verified CAD and well-preserved left ventricular function. RESULTS During an average of 8.7 ± 2.2 years of follow-up, 60 patients experienced sudden cardiac death/arrest (SCD/SCA) (3.5%), 69 patients nonsudden cardiac death (NSCD) (4.1%), and 161 patients noncardiac death (9.5%). TMD-SD was significantly higher in patients who experienced SCD/SCA than in other patients (1.72 ± 2.00 vs 1.12 ± 1.75; P = .01) and higher in patients who succumbed to NSCD than in other patients (1.57 ± 1.74 vs 1.12 ± 1.76; P = .04), but it did not differ significantly between patients who experienced noncardiac death and those without such an event (1.16 ± 1.42 vs 1.14 ± 1.79; P = .86). In the Cox multivariable hazards model, TMD-SD retained its significant association with the risk of SCD/SCA (hazard ratio 1.119; 95% confidence interval 1.015-1.233; P = .024) but not with the risk of NSCD (hazard ratio 1.089; 95% confidence interval 0.983-1.206; P = .103). CONCLUSION TMD-SD is independently associated with the long-term risk of SCD/SCA in patients with CAD.
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Affiliation(s)
- Janne T Rahola
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Severi M Mattila
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Antti M Kiviniemi
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Olavi H Ukkola
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Mikko P Tulppo
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - M Juhani Junttila
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Heikki V Huikuri
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Tuomas V Kenttä
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Juha S Perkiömäki
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
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Grönlund T, Kaikkonen K, Junttila MJ, Kiviniemi AM, Ukkola O, Niemelä M, Korpelainen R, Huikuri HV, Jämsä T, Tulppo MP. Lifestyle and Cardiac Structure and Function in Healthy Midlife Population. Am J Cardiol 2024; 211:291-298. [PMID: 37993041 DOI: 10.1016/j.amjcard.2023.11.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/08/2023] [Revised: 10/18/2023] [Accepted: 11/16/2023] [Indexed: 11/24/2023]
Abstract
The association between lifestyle and cardiac structure and function measures, such as global longitudinal strain and diastolic function in a healthy midlife general population, is not well known. A subpopulation of the Northern Finland Birth Cohort 1966 took part in follow-up, including echocardiography (n = 1,155) at the age of 46. All antihypertensive medication users (n = 164), patients with diabetes (n = 70), subjects with any cardiac diseases (n = 24), and subjects with echocardiography abnormalities (n = 21) were excluded. Moderate to vigorous physical activity (MVPA) was recorded with a wrist-worn accelerometer over 14 days and categorized into high, moderate, and low MVPA groups. Similarly, alcohol consumption was categorized as low, moderate, and high-dose users of alcohol and smoking as nonsmokers, former, and current smokers. The total number of healthy subjects included in the study was 715 (44% males). Left ventricular mass index and left atrial end-systolic volume index were significantly higher in the high MVPA group compared with the low MVPA group (adjusted main effect p = 0.002 and p <0.001, respectively). Cardiac function did not differ among the physical activity groups. High alcohol consumption was associated with impaired global longitudinal strain and diastolic function (adjusted main effect p = 0.002 and p = 0.004, respectively) but not with any cardiac structure variables. Smoking was not associated with cardiac structure or function. In healthy middle-aged adults, MVPA was independently associated with structural changes in the heart but not with cardiac function. High alcohol consumption was associated with impaired modern cardiac function measures but not with cardiac structure.
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Affiliation(s)
- Tommi Grönlund
- Research Unit of Biomedicine and Internal Medicine, University of Oulu, Oulu, Finland; Population Health, University of Oulu, Oulu, Finland
| | - Kari Kaikkonen
- Research Unit of Biomedicine and Internal Medicine, University of Oulu, Oulu, Finland; Population Health, University of Oulu, Oulu, Finland
| | - M Juhani Junttila
- Research Unit of Biomedicine and Internal Medicine, University of Oulu, Oulu, Finland; Population Health, University of Oulu, Oulu, Finland
| | - Antti M Kiviniemi
- Research Unit of Biomedicine and Internal Medicine, University of Oulu, Oulu, Finland; Population Health, University of Oulu, Oulu, Finland
| | - Olavi Ukkola
- Research Unit of Biomedicine and Internal Medicine, University of Oulu, Oulu, Finland; Population Health, University of Oulu, Oulu, Finland
| | - Maisa Niemelä
- Population Health, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation sr., Oulu, Finland
| | - Raija Korpelainen
- Population Health, University of Oulu, Oulu, Finland; Medical Imaging, Physics, and Technology, University of Oulu, Oulu, Finland; Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation sr., Oulu, Finland
| | - Heikki V Huikuri
- Research Unit of Biomedicine and Internal Medicine, University of Oulu, Oulu, Finland; Population Health, University of Oulu, Oulu, Finland
| | - Timo Jämsä
- Population Health, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Mikko P Tulppo
- Research Unit of Biomedicine and Internal Medicine, University of Oulu, Oulu, Finland; Population Health, University of Oulu, Oulu, Finland.
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Renlund M, Tulppo MP, Kivelä A, Laivuori H, Heinonen S, Jääskeläinen T, Sarkola T. Preeclampsia-exposed children's heart rate variability 8-12 yr after index pregnancy: FINNCARE study. Am J Physiol Heart Circ Physiol 2024; 326:H74-H81. [PMID: 37921662 DOI: 10.1152/ajpheart.00540.2023] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/01/2023] [Indexed: 11/04/2023]
Abstract
Preeclampsia is related with elevated systolic blood pressure (SBP) in children. We studied if preeclampsia-exposed (PE) children develop alterations in heart rate variability (HRV) and if this is reflected in their blood pressure (BP), as well as overall associations with body size and composition, gestational and perinatal factors. We examined 182 PE (46 early-onset PE) and 85 unexposed (non-PE) children 8-12 yr after preeclampsia exposure. HRV monitoring was performed 5 min in supine followed by 5 min in standing position and compared with office, 24-h ambulatory, and central BPs in relation to body anthropometrics and composition, gestational, and perinatal data. There were no major differences in HRV between PE and non-PE children. HRV in supine position was strongly associated with office and ambulatory heart rates (HRs), and HR was independently associated with office BPs. However, HRV was not related with office or 24-h SBP and PP, nor with elevated SBP in PE compared with non-PE children [adjusted mean differences for office and 24-h SBP 4.8 (P < 0.001) and 2.5 mmHg (P = 0.049), respectively]. In supine position, high-frequency (HF) power [β, -0.04 (95% CI -0.06 to -0.01)], root mean square of successive differences in R-R intervals (rMSSD) [-0.015 (-0.028 to -0.002)], and the ratio of low-frequency (LF) to HF power [0.03 (0.01-0.04)] were independently associated with child fat mass. LF and HF power and rMSSD displayed independent inverse associations with child age. There were no significant associations between child HRV and gestational and perinatal factors. During prepuberty, the HRV in children with PE is similar to that in non-PE children. Elevated SBP following preeclampsia exposure is not related with HRV. Child adiposity could be related to decreased cardiac vagal tone.NEW & NOTEWORTHY Heart rate variability in preadolescent children exposed to preeclampsia in utero is no different from age-matched controls. Preeclampsia-exposed children's elevated SBP is not related to alterations in heart rate variability, which is a noninvasive measure of the modulation of heart rate by autonomic tone. However, childhood adiposity might be coupled with diminished cardiac vagal tone.
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Affiliation(s)
- Michelle Renlund
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
| | - Mikko P Tulppo
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Anni Kivelä
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hannele Laivuori
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Technology, Tampere Center for Child, Adolescent, and Maternal Health Research, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Seppo Heinonen
- Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland
| | - Tiina Jääskeläinen
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Taisto Sarkola
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
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Korpisaari M, Puhakka S, Farrahi V, Niemelä M, Tulppo MP, Ikäheimo T, Korpelainen R, Lankila T. Physical activity, residential greenness, and cardiac autonomic function. Scand J Med Sci Sports 2024; 34:e14505. [PMID: 37767772 DOI: 10.1111/sms.14505] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/14/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE This population-based study examines the associations between physical activity (PA), residential environmental greenness, and cardiac health measured by resting short-term heart rate variability (HRV). METHODS Residential greenness of a birth cohort sample (n = 5433) at 46 years was measured with normalized difference vegetation index (NDVI) by fixing a 1 km buffer around each participant's home. Daily light PA (LPA), moderate PA (MPA), vigorous PA (VPA), and the combination of both (MVPA) were measured using a wrist-worn accelerometer for 14 days. Resting HRV was measured with a heart rate monitor, and generalized additive modeling (GAM) was used to examine the association between PA, NDVI, and resting HRV. RESULTS In nongreen areas, men had less PA at all intensity levels compared to men in green areas. Women had more LPA and total PA and less MPA, MVPA, and VPA in green residential areas compared to nongreen areas. In green residential areas, men had more MPA, MVPA, and VPA than women, whereas women had more LPA than men. GAM showed positive linear associations between LPA, MVPA and HRV in all models. CONCLUSIONS Higher LPA and MVPA were significantly associated with increased HRV, irrespective of residential greenness. Greenness was positively associated with PA at all intensity levels in men, whereas in women, a positive association was found for LPA and total PA. A positive relationship of PA with resting HRV and greenness with PA was found. Residential greenness for promoting PA and heart health in adults should be considered in city planning.
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Affiliation(s)
- Maija Korpisaari
- Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation sr., Oulu, Finland
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
- Geography Research Unit, Faculty of Science, University of Oulu, Oulu, Finland
- Research Unit of Health Sciences and Technology, University of Oulu, Finland
| | - Soile Puhakka
- Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation sr., Oulu, Finland
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
- Geography Research Unit, Faculty of Science, University of Oulu, Oulu, Finland
| | - Vahid Farrahi
- Research Unit of Health Sciences and Technology, University of Oulu, Finland
- Institute for Sport and Sport Sciences, TU Dortmund University, Dortmund, Germany
| | - Maisa Niemelä
- Research Unit of Health Sciences and Technology, University of Oulu, Finland
- Centre for Wireless Communications, University of Oulu, Finland
| | - Mikko P Tulppo
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
- Research Unit of Biomedicine and Internal Medicine, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Tiina Ikäheimo
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
- UiT The Arctic University of Norway, Tromsø, Norway
| | - Raija Korpelainen
- Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation sr., Oulu, Finland
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Tiina Lankila
- Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation sr., Oulu, Finland
- Geography Research Unit, Faculty of Science, University of Oulu, Oulu, Finland
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Bruun E, Pätsi P, Leskinen M, Björkman K, Kulmala P, Tulppo MP, Valkama M, Ojaniemi M. Preterm-Born Young Women Have Weaker Hand Grip Strength Compared to Their Full-Term-Born Peers. Children (Basel) 2023; 10:1898. [PMID: 38136100 PMCID: PMC10741946 DOI: 10.3390/children10121898] [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] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023]
Abstract
Prematurity has been linked to lower muscular fitness and increased morbidity across the human lifespan. Hand grip strength is widely used as a measure of muscle strength. Previous studies have shown inconsistent results regarding the role of vitamin D in hand grip strength. Here, we investigated hand grip strength and the effects of a yearlong vitamin D supplementation in healthy preterm-born young adults. We recruited 38 young adults born preterm at either ≤32 weeks' gestation or <34 weeks' gestation and weighing <1500 g, as well as 39 gender- and age-matched controls, for this study. Anthropometric measurements, hand grip strengths, and vitamin D concentrations were recorded. These investigations were repeated after a yearlong vitamin D supplementation intervention. There was a significant difference in the age- and gender-specific hand grip strength ranks between the preterm- and full-term-born young adults: 57.9% and 30.7%, respectively, were below average (p = 0.009). In the preterm-born group, the females had significantly lower hand grip strengths compared to their full-term-born peers, with a mean difference of -3.46 kg (95% CI: -6.68 to -0.247; p = 0.035). In a linear regression analysis, the preterm-born female adult height was negatively associated with hand grip strength (R2 = 0.24, F (1.43) = 13.61, p < 0.001). The vitamin D concentrations were increased after the supplementation period, with no association with hand grip strength. According to our results, preterm-born young females are at risk for lower muscle strength, independent of their current vitamin D status.
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Affiliation(s)
- Ella Bruun
- Department of Pediatrics, Oulu University Hospital, University of Oulu, Wellbeing Services County of North Ostrobothnia, 90220 Oulu, Finland (M.O.)
- Research Unit of Clinical Medicine, University of Oulu, 90014 Oulu, Finland
- Medical Research Center, Oulu University Hospital, University of Oulu, Wellbeing Services County of North Ostrobothnia, 90014 Oulu, Finland
| | - Pauli Pätsi
- Department of Pediatrics, Oulu University Hospital, University of Oulu, Wellbeing Services County of North Ostrobothnia, 90220 Oulu, Finland (M.O.)
- Research Unit of Clinical Medicine, University of Oulu, 90014 Oulu, Finland
- Medical Research Center, Oulu University Hospital, University of Oulu, Wellbeing Services County of North Ostrobothnia, 90014 Oulu, Finland
| | - Markku Leskinen
- Department of Pediatrics, Oulu University Hospital, University of Oulu, Wellbeing Services County of North Ostrobothnia, 90220 Oulu, Finland (M.O.)
- Research Unit of Clinical Medicine, University of Oulu, 90014 Oulu, Finland
- Medical Research Center, Oulu University Hospital, University of Oulu, Wellbeing Services County of North Ostrobothnia, 90014 Oulu, Finland
| | - Krista Björkman
- Department of Pediatrics, Oulu University Hospital, University of Oulu, Wellbeing Services County of North Ostrobothnia, 90220 Oulu, Finland (M.O.)
- Research Unit of Clinical Medicine, University of Oulu, 90014 Oulu, Finland
- Medical Research Center, Oulu University Hospital, University of Oulu, Wellbeing Services County of North Ostrobothnia, 90014 Oulu, Finland
| | - Petri Kulmala
- Department of Pediatrics, Oulu University Hospital, University of Oulu, Wellbeing Services County of North Ostrobothnia, 90220 Oulu, Finland (M.O.)
- Research Unit of Clinical Medicine, University of Oulu, 90014 Oulu, Finland
- Medical Research Center, Oulu University Hospital, University of Oulu, Wellbeing Services County of North Ostrobothnia, 90014 Oulu, Finland
- Faculty of Medicine, University of Oulu, 90014 Oulu, Finland
| | - Mikko P. Tulppo
- Faculty of Medicine, University of Oulu, 90014 Oulu, Finland
- Research Unit of Biomedicine and Internal Medicine, University of Oulu, 90014 Oulu, Finland
| | - Marita Valkama
- Department of Pediatrics, Oulu University Hospital, University of Oulu, Wellbeing Services County of North Ostrobothnia, 90220 Oulu, Finland (M.O.)
- Research Unit of Clinical Medicine, University of Oulu, 90014 Oulu, Finland
- Medical Research Center, Oulu University Hospital, University of Oulu, Wellbeing Services County of North Ostrobothnia, 90014 Oulu, Finland
| | - Marja Ojaniemi
- Department of Pediatrics, Oulu University Hospital, University of Oulu, Wellbeing Services County of North Ostrobothnia, 90220 Oulu, Finland (M.O.)
- Research Unit of Clinical Medicine, University of Oulu, 90014 Oulu, Finland
- Medical Research Center, Oulu University Hospital, University of Oulu, Wellbeing Services County of North Ostrobothnia, 90014 Oulu, Finland
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Björkman K, Valkama M, Bruun E, Pätsi P, Kulmala P, Tulppo MP, Leskinen M, Ojaniemi M. Heart Rate and Heart Rate Variability in Healthy Preterm-Born Young Adults and Association with Vitamin D: A Wearable Device Assessment. J Clin Med 2023; 12:7504. [PMID: 38137574 PMCID: PMC10743414 DOI: 10.3390/jcm12247504] [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: 10/11/2023] [Revised: 11/26/2023] [Accepted: 12/02/2023] [Indexed: 12/24/2023] Open
Abstract
Prematurity has been associated with impaired parasympathetic cardiac regulation later in life. Changes in heart rate (HR) and heart rate variability (HRV) may indicate a risk for future cardiac dysfunction. The putative role of Vitamin D on cardiac autonomic function in individuals born preterm (PT) remains unknown. This study involves monitoring autonomic cardiac regulation and Vitamin D concentrations in 30 PT and 16 full-term (FT) young adults in a free-living context. The PT subjects were born between 1994 and 1997 at Oulu University Hospital. The inclusion criteria were (1) being born ≤ 32 gestation weeks or (2) being born < 34 gestation weeks with a birth weight under 1500 g. Participants wore an Oura ring sleep tracer, a smart ring device, for 2 weeks to monitor cardiac autonomic function. Parameters related to autonomic cardiac regulation, lowest nighttime resting HR, and the root mean square of successive differences (RMSSD) to describe HRV were collected. PT males exhibited a tendency toward lower RMSSD (71.8 ± 22.6) compared to FT males (95.63 ± 29.0; p = 0.10). Female participants had a similar mean RMSSD in the FT and PT groups at 72.04 ± 33.2 and 74.0 ± 35.0, respectively. Serum 25-hydroxyvitamin D concentration did not correlate with cardiac autonomic function parameters. When assessing the lowest resting nighttime HRs and HRVs in a long-term, real-world context, healthy female PT young adults performed similarly to their FT peers. In contrast, the present study's results suggest that male PT young adults exhibit impaired autonomic cardiac function, potentially putting them at risk for cardiovascular disease later in adulthood.
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Affiliation(s)
- Krista Björkman
- Department of Pediatrics, Oulu University Hospital, Wellbeing Services County of North Ostrobothnia, Pohde, 90220 Oulu, Finland
- Research Unit of Clinical Medicine, University of Oulu, 90014 Oulu, Finland
- Medical Research Center, University of Oulu, Oulu University Hospital, Wellbeing Services County of North Ostrobothnia, 90014 Oulu, Finland;
| | - Marita Valkama
- Department of Pediatrics, Oulu University Hospital, Wellbeing Services County of North Ostrobothnia, Pohde, 90220 Oulu, Finland
- Research Unit of Clinical Medicine, University of Oulu, 90014 Oulu, Finland
- Medical Research Center, University of Oulu, Oulu University Hospital, Wellbeing Services County of North Ostrobothnia, 90014 Oulu, Finland;
| | - Ella Bruun
- Department of Pediatrics, Oulu University Hospital, Wellbeing Services County of North Ostrobothnia, Pohde, 90220 Oulu, Finland
- Research Unit of Clinical Medicine, University of Oulu, 90014 Oulu, Finland
- Medical Research Center, University of Oulu, Oulu University Hospital, Wellbeing Services County of North Ostrobothnia, 90014 Oulu, Finland;
| | - Pauli Pätsi
- Department of Pediatrics, Oulu University Hospital, Wellbeing Services County of North Ostrobothnia, Pohde, 90220 Oulu, Finland
- Research Unit of Clinical Medicine, University of Oulu, 90014 Oulu, Finland
- Medical Research Center, University of Oulu, Oulu University Hospital, Wellbeing Services County of North Ostrobothnia, 90014 Oulu, Finland;
| | - Petri Kulmala
- Department of Pediatrics, Oulu University Hospital, Wellbeing Services County of North Ostrobothnia, Pohde, 90220 Oulu, Finland
- Research Unit of Clinical Medicine, University of Oulu, 90014 Oulu, Finland
- Medical Research Center, University of Oulu, Oulu University Hospital, Wellbeing Services County of North Ostrobothnia, 90014 Oulu, Finland;
- Faculty of Medicine, University of Oulu, 90014 Oulu, Finland
| | - Mikko P. Tulppo
- Medical Research Center, University of Oulu, Oulu University Hospital, Wellbeing Services County of North Ostrobothnia, 90014 Oulu, Finland;
- Research Unit of Biomedicine and Internal Medicine, University of Oulu, 90014 Oulu, Finland
| | - Markku Leskinen
- Department of Pediatrics, Oulu University Hospital, Wellbeing Services County of North Ostrobothnia, Pohde, 90220 Oulu, Finland
- Research Unit of Clinical Medicine, University of Oulu, 90014 Oulu, Finland
- Medical Research Center, University of Oulu, Oulu University Hospital, Wellbeing Services County of North Ostrobothnia, 90014 Oulu, Finland;
| | - Marja Ojaniemi
- Department of Pediatrics, Oulu University Hospital, Wellbeing Services County of North Ostrobothnia, Pohde, 90220 Oulu, Finland
- Research Unit of Clinical Medicine, University of Oulu, 90014 Oulu, Finland
- Medical Research Center, University of Oulu, Oulu University Hospital, Wellbeing Services County of North Ostrobothnia, 90014 Oulu, Finland;
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Pikkarainen K, Valtonen RIP, Hintsala HE, Kiviniemi A, Crandall CG, Perkiömäki J, Hautala AJ, Tulppo MP, Jaakkola JJK, Ikäheimo TM. Baroreflex sensitivity following acute upper-body exercise in the cold among stable coronary artery disease patients. Front Physiol 2023; 14:1184378. [PMID: 37900953 PMCID: PMC10611474 DOI: 10.3389/fphys.2023.1184378] [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: 03/11/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
Background: A cold environment and exercise separately affect the autonomic nervous system (ANS), baroreflex sensitivity (BRS), and blood pressure variability (BPV) but their combined effects on post-exercise recovery are not known. Our cross-over trial examined these responses following upper-body static and dynamic exercise performed in a cold and neutral environment in patients with coronary artery disease (CAD). Methods: 20 patients with stable coronary artery disease performed both graded static (10%-30% of maximal voluntary contraction) and dynamic (light, moderate and high perceived intensity) upper-body exercise at -15°C and +22°C for 30 min. Electrocardiogram and continuous blood pressure were measured to compute post-exercise (10 and 30 min after exercise) spectral powers of heart rate (HR), blood pressure variability and BRS at low (0.04-0.15 Hz) and high (0.15-0.4 Hz) frequencies. Results: Static upper-body exercise performed in a cold environment increased post-exercise high frequency (HF) spectral power of heart rate (HF RR) (p < 0.001) and reduced heart rate (p = 0.001) and low-to-high frequency (LF/HF) ratio (p = 0.006) more than in a neutral environment. In addition, post-exercise mean BRS (p = 0.015) and high frequency BRS (p = 0.041) increased more following static exercise in the cold than in a neutral environment. Dynamic upper-body exercise performed in a cold environment reduced post-exercise HF BRS (p = 0.019) and systolic blood pressure (p = 0.003). Conclusion: Static upper-body exercise in the cold increased post-exercise BRS and overall vagal activity but without reduced systolic blood pressure. Dynamic upper-body exercise in the cold reduced post-exercise vagal BRS but did not affect the other parameters. The influence of cold exposure on post-exercise autonomic and cardiovascular responses following static upper-body exercise require further studies. This information helps understanding why persons with cardiovascular diseases are vulnerable to low environmental temperature. ClinicalTrials.gov: NCT02855905 (04/08/2016).
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Affiliation(s)
- Kalle Pikkarainen
- Center for Environmental and Respiratory Health Research, Research Unit of Population Health, University of Oulu, Oulu, Finland
| | - Rasmus I P Valtonen
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | | | - Antti Kiviniemi
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Craig G Crandall
- Department of Internal Medicine, Texas Health Presbyterian Hospital, Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Juha Perkiömäki
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Arto J Hautala
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Mikko P Tulppo
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Jouni J K Jaakkola
- Center for Environmental and Respiratory Health Research, Research Unit of Population Health, University of Oulu, Oulu, Finland
- Medical Research Center, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Tiina M Ikäheimo
- Center for Environmental and Respiratory Health Research, Research Unit of Population Health, University of Oulu, Oulu, Finland
- Medical Research Center, University of Oulu, Oulu University Hospital, Oulu, Finland
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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Tapio J, Kiviniemi AM, Perkiömäki J, Junttila MJ, Huikuri HV, Ukkola O, Koivunen P, Tulppo MP. Lower hemoglobin levels associate with higher baroreflex sensitivity and heart rate variability. Am J Physiol Heart Circ Physiol 2023; 325:H629-H634. [PMID: 37566112 PMCID: PMC10659262 DOI: 10.1152/ajpheart.00415.2023] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 07/19/2023] [Accepted: 07/31/2023] [Indexed: 08/12/2023]
Abstract
The aim of this study was to cross-sectionally examine whether hemoglobin (Hb) levels within the normal variation associate with heart rate variability (HRV) measures and baroreflex sensitivity (BRS). The study population included 733 Finnish subjects of the OPERA cohort (aged 41-59 yr, 53% males, 51.7% treated for hypertension) of whom HRV was measured from a standardized 45-min period and whose Hb levels were within the Finnish reference intervals. The low Hb tertile (mean Hb, 135 g/L) had an overall healthier metabolic profile compared with the high Hb tertile (mean Hb, 152 g/L). BRS was higher in the low Hb tertile compared with the high Hb tertile (P < 0.05). R-R interval (RRi) and standard deviation (SD) of the RRi (SDNN)index were the longest in the low Hb tertile regardless of posture. Of the spectral components of HRV, HF power was the highest in the low Hb tertile regardless of posture (P < 0.05). In a stepwise logistic regression model, BRS associated negatively with Hb levels after adjusting for covariates (B = -0.160 [-0.285; -0.035]). Similar associations were observed for SDNNindex when lying down (B = -0.105 [-0.207; -0.003]) and walking (B = -0.154 [-0.224; -0.083]). For HF power negative associations with Hb levels were observed when lying down (B = -0.110 [-0.180; -0.040]), sitting (B = -0.150 [-0.221; -0.079]), and in total analysis (B = -0.124 [-0.196; -0.053]). Overall, lower Hb levels associated independently with healthier cardiac autonomic function.NEW & NOTEWORTHY Heart rate variability (HRV) and baroreflex sensitivity (BRS), which can be measured noninvasively, can predict cardiac and metabolic diseases. Our findings show that within normal variation subjects with lower hemoglobin (Hb) levels have an overall healthier HRV profile and increased cardiac parasympathetic activity in middle age, independent of age, sex, smoking status, and key metabolic covariates. These findings support our previous findings that Hb levels can be used in assessing long-term risks for cardiometabolic diseases.
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Affiliation(s)
- Joona Tapio
- Biocenter Oulu and Faculty of Biochemistry and Molecular Medicine, Oulu Center for Cell-Matrix Research, University of Oulu, Oulu, Finland
| | - Antti M Kiviniemi
- Medical Research Center Oulu, Faculty of Medicine, Oulu University Hospital and Research Unit of Internal Medicine, University of Oulu, Oulu, Finland
| | - Juha Perkiömäki
- Medical Research Center Oulu, Faculty of Medicine, Oulu University Hospital and Research Unit of Internal Medicine, University of Oulu, Oulu, Finland
| | - M Juhani Junttila
- Medical Research Center Oulu, Faculty of Medicine, Oulu University Hospital and Research Unit of Internal Medicine, University of Oulu, Oulu, Finland
| | - Heikki V Huikuri
- Medical Research Center Oulu, Faculty of Medicine, Oulu University Hospital and Research Unit of Internal Medicine, University of Oulu, Oulu, Finland
| | - Olavi Ukkola
- Medical Research Center Oulu, Faculty of Medicine, Oulu University Hospital and Research Unit of Internal Medicine, University of Oulu, Oulu, Finland
| | - Peppi Koivunen
- Biocenter Oulu and Faculty of Biochemistry and Molecular Medicine, Oulu Center for Cell-Matrix Research, University of Oulu, Oulu, Finland
| | - Mikko P Tulppo
- Research Unit of Biomedicine and Internal Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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Dragun T, Brown CV, Tulppo MP, Obad A, Dujić Ž. The Influence of Oral Cannabidiol on 24-h Ambulatory Blood Pressure and Arterial Stiffness in Untreated Hypertension: A Double-Blind, Placebo-Controlled, Cross-Over Pilot Study. Adv Ther 2023; 40:3495-3511. [PMID: 37291376 DOI: 10.1007/s12325-023-02560-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 01/29/2023] [Accepted: 05/17/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Studies reveal that cannabidiol may acutely reduce blood pressure and arterial stiffness in normotensive humans; however, it remains unknown if this holds true in patients with untreated hypertension. We aimed to extend these findings to examine the influence of the administration of cannabidiol on 24-h ambulatory blood pressure and arterial stiffness in hypertensive individuals. METHODS Sixteen volunteers (eight females) with untreated hypertension (elevated blood pressure, stage 1, stage 2) were given oral cannabidiol (150 mg every 8 h) or placebo for 24 h in a randomised, placebo-controlled, double-blind, cross-over study. Measures of 24-h ambulatory blood pressure and electrocardiogram (ECG) monitoring and estimates of arterial stiffness and heart rate variability were obtained. Physical activity and sleep were also recorded. RESULTS Although physical activity, sleep patterns and heart rate variability were comparable between groups, arterial stiffness (~ 0.7 m/s), systolic blood pressure (~ 5 mmHg), and mean arterial pressure (~ 3 mmHg) were all significantly (P < 0.05) lower over 24 h on cannabidiol when compared to the placebo. These reductions were generally larger during sleep. Oral cannabidiol was safe and well tolerated with no development of new sustained arrhythmias. CONCLUSIONS Our findings indicate that acute dosing of cannabidiol over 24 h can lower blood pressure and arterial stiffness in individuals with untreated hypertension. The clinical implications and safety of longer-term cannabidiol usage in treated and untreated hypertension remains to be established.
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Affiliation(s)
- Tanja Dragun
- Department of Integrative Physiology, University of Split School of Medicine, Šoltanska 2, 21000, Split, Croatia
| | - Courtney V Brown
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia-Okanagan, Kelowna, BC, Canada
| | - Mikko P Tulppo
- Research Unit of Biomedicine, Medical Research Center Oulu, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland
| | - Ante Obad
- Department of Health Studies, University of Split, Ruđera Boškovića 35, 21000, Split, Croatia
| | - Željko Dujić
- Department of Integrative Physiology, University of Split School of Medicine, Šoltanska 2, 21000, Split, Croatia.
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Hautala AJ, Shavazipour B, Afsar B, Tulppo MP, Miettinen K. Machine learning models in predicting health care costs in patients with a recent acute coronary syndrome: A prospective pilot study. Cardiovasc Digit Health J 2023; 4:137-142. [PMID: 37600445 PMCID: PMC10435951 DOI: 10.1016/j.cvdhj.2023.05.001] [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] [Indexed: 08/22/2023] Open
Abstract
Background Health care budgets are limited, requiring the optimal use of resources. Machine learning (ML) methods may have an enormous potential for effective use of health care resources. Objective We assessed the applicability of selected ML tools to evaluate the contribution of known risk markers for prognosis of coronary artery disease to predict health care costs for all reasons in patients with a recent acute coronary syndrome (n = 65, aged 65 ± 9 years) for 1-year follow-up. Methods Risk markers were assessed at baseline, and health care costs were collected from electronic health registries. The Cross-decomposition algorithms were used to rank the considered risk markers based on their impacts on variances. Then regression analysis was performed to predict costs by entering the first top-ranking risk marker and adding the next-best markers, one by one, to build up altogether 13 predictive models. Results The average annual health care costs were €2601 ± €5378 per patient. The Depression Scale showed the highest predictive value (r = 0.395), accounting for 16% of the costs (P = .001). When the next 2 ranked markers (LDL cholesterol, r = 0.230; and left ventricular ejection fraction, r = -0.227, respectively) were added to the model, the predictive value was 24% for the costs (P = .001). Conclusion Higher depression score is the primary variable forecasting health care costs in 1-year follow-up among acute coronary syndrome patients. The ML tools may help decision-making when planning optimal utilization of treatment strategies.
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Affiliation(s)
- Arto J. Hautala
- Faculty of Sport and Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland
| | | | - Bekir Afsar
- Faculty of Information Technology, University of Jyvaskyla, Jyvaskyla, Finland
| | - Mikko P. Tulppo
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Kaisa Miettinen
- Faculty of Information Technology, University of Jyvaskyla, Jyvaskyla, Finland
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12
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Hekkanen JJ, Kenttä TV, Holmström L, Tulppo MP, Ukkola OH, Pakanen L, Junttila MJ, Huikuri HV, Perkiömäki JS. Association of electrocardiographic spatial heterogeneity of repolarization and spatial heterogeneity of atrial depolarization with left ventricular fibrosis. Europace 2023; 25:820-827. [PMID: 36635858 PMCID: PMC10062366 DOI: 10.1093/europace/euac273] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/14/2022] [Indexed: 01/14/2023] Open
Abstract
AIMS To evaluate the relationship between spatial heterogeneity of electrocardiographic repolarization and spatial heterogeneity of atrial depolarization with arrhythmic substrate represented by left ventricular fibrosis. METHODS AND RESULTS We assessed the associations of T- and P-wave morphology parameters analysed from the standard 12-lead electrocardiograms with left ventricular fibrosis in 378 victims of unexpected sudden cardiac death (SCD) who underwent medico-legal autopsy. Based on autopsy findings, the SCD victims were categorized into four different groups according to different stages of severity of left ventricular fibrosis (substantial fibrosis, moderate patchy fibrosis, scattered mild fibrosis, no fibrosis). T-wave and P-wave area dispersion (TWAd: 0.0841 ± 0.496, 0.170 ± 0.492, 0.302 ± 404, 0.296 ± 0.476, P = 0.008; PWAd: 0.574 ± 0.384, 0.561 ± 0.367, 0.654 ± 0.281, 0.717 ± 0.257, P = 0.011, respectively; low values abnormal), non-dipolar components of T-wave and P-wave morphology (T_NonDipolarABS: 0.0496 ± 0.0377, 0.0571 ± 0.0487, 0.0432 ± 0.0476, 0.0380 ± 0.0377, P = 0.027; P_NonDipolarABS: 0.0132 ± 0.0164, 0.0130 ± 0.0135, 0.0092 ± 0.0117, 0.0069 ± 0.00472, P = 0.005, respectively, high values abnormal), T-wave morphology dispersion (TMD: 45.9 ± 28.3, 40.5 ± 25.8, 35.5 ± 24.9, 33.0 ± 24.6, P = 0.030, respectively, high values abnormal), and P-wave heterogeneity (PWH: 20.0 ± 9.44, 19.7 ± 8.87, 17.9 ± 9.78, 15.4 ± 4.60, P = 0.019, respectively, high values abnormal) differed significantly between the groups with different stages of left ventricular fibrosis. After adjustment with heart weight, T_NonDipolarABS [standardized β (sβ) = 0.131, P = 0.014], PWAd (sβ = -0.161, P = 0.003), P_NonDipolarABS (sβ = 0.174, P = 0.001), and PWH (sβ = 0.128, P = 0.015) retained independent association, and TWAd (sβ = -0.091, P = 0.074) and TMD (sβ = 0.097, P = 0.063) tended to retain their association with the degree of myocardial fibrosis. CONCLUSION Our findings suggest that abnormal values of T- and P-wave morphology are associated with arrhythmic substrate represented by ventricular fibrosis partly explaining the mechanism behind their prognostic significance.
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Affiliation(s)
- Jenni J Hekkanen
- Research Unit of Internal Medicine, Division of Cardiology, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, P.O. Box 5000, Kajaanintie 50, 90014 Oulu, Finland
| | - Tuomas V Kenttä
- Research Unit of Internal Medicine, Division of Cardiology, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, P.O. Box 5000, Kajaanintie 50, 90014 Oulu, Finland
| | - Lauri Holmström
- Research Unit of Internal Medicine, Division of Cardiology, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, P.O. Box 5000, Kajaanintie 50, 90014 Oulu, Finland
| | - Mikko P Tulppo
- Research Unit of Internal Medicine, Division of Cardiology, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, P.O. Box 5000, Kajaanintie 50, 90014 Oulu, Finland
| | - Olavi H Ukkola
- Research Unit of Internal Medicine, Division of Cardiology, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, P.O. Box 5000, Kajaanintie 50, 90014 Oulu, Finland
| | - Lasse Pakanen
- Forensic Medicine Unit, Finnish Institute for Health and Welfare, Hoitajanrinne 1, P.O. Box 310, FI-90101 Oulu, Finland
- Department of Forensic Medicine, Medical Research Center Oulu, Research Unit of Internal Medicine, University of Oulu, Aapistie 5B, P.O. Box 5000, FI-90014 Oulu, Finland
| | - M Juhani Junttila
- Research Unit of Internal Medicine, Division of Cardiology, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, P.O. Box 5000, Kajaanintie 50, 90014 Oulu, Finland
| | - Heikki V Huikuri
- Research Unit of Internal Medicine, Division of Cardiology, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, P.O. Box 5000, Kajaanintie 50, 90014 Oulu, Finland
| | - Juha S Perkiömäki
- Research Unit of Internal Medicine, Division of Cardiology, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, P.O. Box 5000, Kajaanintie 50, 90014 Oulu, Finland
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Hekkanen JJ, Kenttä TV, Tulppo MP, Kiviniemi AM, Ukkola OH, Junttila MJ, Huikuri HV, Perkiömäki JS. Association of atrial depolarization variability and cardiac autonomic regulation with sudden cardiac death in coronary artery disease. Europace 2022; 24:1942-1951. [PMID: 36037009 DOI: 10.1093/europace/euac139] [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: 04/09/2022] [Accepted: 07/16/2022] [Indexed: 12/14/2022] Open
Abstract
AIMS To evaluate the prognostic significance of the temporal variability of P-wave morphology, specifically in relation to cardiac autonomic regulation. METHODS AND RESULTS We analyzed the standard deviation of P-wave residuum (PWRSD) from five consecutive beats of the standard 12-lead ECG in 1236 patients with angiographically verified coronary artery disease (CAD). We evaluated the prognostic value of PWRSD, of PWRSD and PWR in relation to the 24 h standard deviation of normal-to-normal intervals (PWRSD/SDNN and PWR/SDNN). After 8.7 ± 2.2 years of follow-up on average, 43 patients (3.5%) experienced sudden cardiac death (SCD) or were resuscitated from sudden cardiac arrest (SCA), 34 (2.8%) succumbed to non-sudden cardiac death (NSCD) and 113 (9.1%) to non-cardiac death (NCD). In the Cox regression analysis, PWRSD (≥0.002727) had a significant univariate (uv) [hazard ratio (HR): 4.27, 95% confidence interval (CI): 2.26-8.08, P = 0.000008] and multivariate (mv) (HR: 2.58, 95% CI: 1.31-5.08, P = 0.006) association with SCD/SCA but not with NSCD (uv P = 0.76, mv P = 0.33) or NCD (uv P = 0.57, mv P = 0.66). All the studied P-morphology parameters retained a significant association with the risk of SCD/SCA after relevant adjustment (mv P-values from 0.00003 to <0.05) but not with NSCD or NCD. When dichotomized PWRSD, PWR, PWRSD/SDNN, and PWR/SDNN were added to the clinical risk model for SCD/SCD, the C-index increased from 0.799 to 0.834 and integrated discrimination index and net reclassification index improved significantly (P < 0.001). CONCLUSION Variability of P-morphology representing temporo-spatial heterogeneity of atrial depolarization, specifically when combined with cardiac autonomic regulation, independently predicts the risk of SCD in patients with CAD.
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Affiliation(s)
- Jenni J Hekkanen
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Tuomas V Kenttä
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Mikko P Tulppo
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Antti M Kiviniemi
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Olavi H Ukkola
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - M Juhani Junttila
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Heikki V Huikuri
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Juha S Perkiömäki
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
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Vuoti AO, Tulppo MP, Ukkola OH, Junttila MJ, Huikuri HV, Kiviniemi AM, Perkiömäki JS. Prognostic value of heart rate variability in patients with coronary artery disease in the current treatment era. PLoS One 2021; 16:e0254107. [PMID: 34214132 PMCID: PMC8253412 DOI: 10.1371/journal.pone.0254107] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/18/2021] [Indexed: 12/19/2022] Open
Abstract
Coronary artery disease (CAD) mortality has declined substantially over the past decades thanks to advancing medical and interventional/surgical treatments; therefore, the prognostic value of the heart rate variability in CAD in the current treatment era is not well established. We evaluated the prognostic significance of baseline heart rate variability in 1,757 ARTEMIS study patients with angiographically verified CAD. During an average follow-up time of 8.7 ± 2.2 years, a total of 285 (16.2%) patients died. Of the patients, 63 (3.6%) suffered sudden cardiac death or were resuscitated from sudden cardiac arrest (SCD/SCA), 60 (3.4%) experienced non-sudden cardiac death (NSCD), and death attributable to non-cardiac causes (NCD) occurred in 162 (9.2%) patients. For every 10 ms decrease in standard deviation of normal to normal intervals the risk for SCD/SCA, NSCD and NCD increased significantly: HR 1.153 (95% CI 1.075–1.236, p<0.001), HR 1.187 (95% CI 1.102–1.278, p<0.001) and HR 1.080 (95% CI 1.037–1.125, p<0.001), respectively. The natural logarithm of the low-frequency component of the power spectrum and the short-term scaling exponent of the detrended fluctuation analysis also had significant association with all modes of death (p<0.001). After relevant adjustment, standard deviation of normal-to-normal intervals retained its association with NSCD and NCD (p<0.01), the natural logarithm of the low-frequency component of the power spectrum with all modes of death (p from <0.05 to <0.01), and the short-term scaling exponent of the detrended fluctuation analysis with SCD/SCA (p<0.05) and NCD (p<0.001). In conclusion, impairment of many measures of heart rate variability predicts mortality but is not associated with any specific mode of death in patients with stable CAD during the current treatment era, limiting the clinical applicability of heart rate variability to targeting therapy.
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Affiliation(s)
- Antti O Vuoti
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Mikko P Tulppo
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Olavi H Ukkola
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - M Juhani Junttila
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.,Biocenter Oulu, University of Oulu, Oulu, Finland
| | - Heikki V Huikuri
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Antti M Kiviniemi
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Juha S Perkiömäki
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
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Rahola JT, Kiviniemi AM, Ukkola OH, Tulppo MP, Junttila MJ, Huikuri HV, Kenttä TV, Perkiömäki JS. Temporal variability of T-wave morphology and risk of sudden cardiac death in patients with coronary artery disease. Ann Noninvasive Electrocardiol 2021; 26:e12830. [PMID: 33486851 PMCID: PMC8164143 DOI: 10.1111/anec.12830] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 01/04/2021] [Accepted: 01/04/2021] [Indexed: 12/16/2022] Open
Abstract
Background The possible relationship between temporal variability of electrocardiographic spatial heterogeneity of repolarization and the risk of sudden cardiac death (SCD) in patients with coronary artery disease (CAD) is not completely understood. Methods The standard deviation of T‐wave morphology dispersion (TMD‐SD), of QRST angle (QRSTA‐SD), and of T‐wave area dispersion (TW‐Ad‐SD) were analyzed on beat‐to‐beat basis from 10 min period of the baseline electrocardiographic recording in ARTEMIS study patients with angiographically verified CAD. Results After on average of 8.6 ± 2.3 years of follow‐up, a total of 66 of the 1,678 present study subjects (3.9%) had experienced SCD or were resuscitated from sudden cardiac arrest (SCA). TMD‐SD was most closely associated with the risk for SCD and was significantly higher in patients who had experienced SCD/SCA compared with those who remained alive (3.61 ± 2.83 vs. 2.64 ± 2.52, p = .008, respectively), but did not differ significantly between the patients who had experienced non‐SCD (n = 71, 4.2%) and those who remained alive (3.20 ± 2.73 vs. 2.65 ± 2.53, p = .077, respectively) or between the patients who succumbed to non‐cardiac death (n = 164, 9.8%) and those who stayed alive (2.64 ± 2.17 vs. 2.68 ± 2.58, p = .853). After adjustments with relevant clinical risk indicators of SCD/SCA, TMD‐SD still predicted SCD/SCA (HR 1.107, 95% CIs 1.035–1.185, p = .003). Conclusions Temporal variability of electrocardiographic spatial heterogeneity of repolarization represented by TMD‐SD independently predicts long‐term risk of SCD/SCA in patients with CAD.
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Affiliation(s)
- Janne T Rahola
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Antti M Kiviniemi
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Olavi H Ukkola
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Mikko P Tulppo
- Department of Physiology, Research Unit of Biomedicine, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - M Juhani Junttila
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Heikki V Huikuri
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Tuomas V Kenttä
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Juha S Perkiömäki
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
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Hekkanen JJ, Kenttä TV, Haukilahti MAE, Rahola JT, Holmström L, Vähätalo J, Tulppo MP, Kiviniemi AM, Pakanen L, Ukkola OH, Junttila MJ, Huikuri HV, Perkiömäki JS. Increased Beat-to-Beat Variability of T-Wave Heterogeneity Measured From Standard 12-Lead Electrocardiogram Is Associated With Sudden Cardiac Death: A Case-Control Study. Front Physiol 2020; 11:1045. [PMID: 32982784 PMCID: PMC7477294 DOI: 10.3389/fphys.2020.01045] [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: 06/09/2020] [Accepted: 07/29/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction The prognostic significance of beat-to-beat variability of spatial heterogeneity of repolarization measured from standard 12-lead ECG is not well-understood. Methods We measured the short-term variability of repolarization parameters, such as T-wave heterogeneity in leads V4–V6 (TWH) and QT interval (QT), from five consecutive beats of previously recorded standard 12-lead ECG in 200 victims of unexpected sudden cardiac death (SCD) confirmed to be due to complicated atherosclerotic coronary artery disease (CAD) in medico-legal autopsy and 200 age- and sex-matched controls with angiographically confirmed CAD. The short-term variability of repolarization heterogeneity was defined as the standard deviation (SD) of the measured repolarization parameters. All ECGs were in sinus rhythm, and no premature ventricular contractions were included in the measured segment. Results TWH-SD and QT-SD were significantly higher in SCD victims than in subjects with CAD (6.9 ± 5.6 μV vs. 3.8 ± 2.6 μV, p = 1.8E-11; 8.3 ± 13.1 ms vs. 3.8 ± 7.1 ms, p = 0.00003, respectively). After adjusting in the multivariate clinical model with factors, such as diabetes, RR interval, and beta blocker medication, TWH-SD and QT-SD retained their significant power in discriminating between the victims of SCD and the patients with CAD (p = 0.00003, p = 0.006, respectively). TWH-SD outperformed QT-SD in identifying the SCD victims among the study subjects (area under the curve in the receiver operating characteristics curve 0.730 vs. 0.679, respectively). Conclusion Increased short-term variability of repolarization heterogeneity measured from standard 12-lead ECG is associated with SCD.
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Affiliation(s)
- Jenni J Hekkanen
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Tuomas V Kenttä
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Mira Anette E Haukilahti
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Janne T Rahola
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Lauri Holmström
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Juha Vähätalo
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Mikko P Tulppo
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Antti M Kiviniemi
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Lasse Pakanen
- Forensic Medicine Unit, Finnish Institute for Health and Welfare, Oulu, Finland.,Research Unit of Internal Medicine, Department of Forensic Medicine, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Olavi H Ukkola
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - M Juhani Junttila
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Heikki V Huikuri
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Juha S Perkiömäki
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
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17
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Korpela N, Kaikkonen K, Auvinen J, Tulppo MP, Junttila J, Perkiömäki J, Järvelin MR, Huikuri HV, Kiviniemi AM. Early Growth Patterns and Cardiac Structure and Function at Midlife: Northern Finland 1966 Birth Cohort Study. J Pediatr 2020; 221:151-158.e1. [PMID: 32446475 DOI: 10.1016/j.jpeds.2020.03.007] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/29/2020] [Accepted: 03/03/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To evaluate the influence of early growth patterns that have previously been associated with later cardiometabolic risk on cardiac left ventricular (LV) structure and function in midlife. STUDY DESIGN A subpopulation of the Northern Finland Birth Cohort 1966 took part in follow-up, including echocardiography (n = 1155) at the age of 46 years. Body mass index (BMI) growth curves were modeled based on frequent anthropometric measurements in childhood. Age and BMI at adiposity peak (n = 482, mean age 9.0 months) and at adiposity rebound (n = 586, mean age 5.8 years) were determined. Results are reported as unstandardized beta (β) or OR with 95% CIs for 1 SD increase in early growth variable. RESULTS Earlier adiposity rebound was associated with increased LV mass index (β = -4.10 g/m2 (-6.9, -1.3); P = .004) and LV end-diastolic volume index (β = -2.36 mL/m2 (-3.9, -0.84); P = .002) as well as with eccentric LV hypertrophy (OR 0.54 [0.38, 0.77]; P = .001) in adulthood in males. BMI at adiposity rebound was directly associated with LV mass index (β = 2.33 g/m2 [0.80, 3.9]; P = .003). Higher BMI at both adiposity peak and at adiposity rebound were associated with greater LV end-diastolic volume index (β = 1.47 mL/m2; [0.51, 2.4], β = 1.28 mL/m2 [0.41, 2.2], respectively) and also with eccentric LV hypertrophy (OR 1.41 [1.10, 1.82], OR 1.53 [1.23, 1.91], respectively) and LV concentric remodeling (OR 1.38 [1.02, 1.87], OR 1.40 [1.06, 1.83], respectively) in adulthood (P < .05 for all). These relationships were only partly mediated by adult BMI. CONCLUSIONS Early growth patterns in infancy and childhood contribute to cardiac structure at midlife.
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Affiliation(s)
- Nelli Korpela
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Kari Kaikkonen
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Juha Auvinen
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland; Unit of Primary Health Care, Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Mikko P Tulppo
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Juhani Junttila
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Juha Perkiömäki
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Marjo-Riitta Järvelin
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland; Unit of Primary Health Care, Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland; Biocenter Oulu, University of Oulu, Oulu, Finland; Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom; Department of Life Sciences, College of Health and Life Sciences, Brunel University London, United Kingdom
| | - Heikki V Huikuri
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Antti M Kiviniemi
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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18
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Tulppo MP, Kiviniemi AM, Lahtinen M, Ukkola O, Toukola T, Perkiömäki J, Junttila MJ, Huikuri HV. Physical Activity and the Risk for Sudden Cardiac Death in Patients With Coronary Artery Disease. Circ Arrhythm Electrophysiol 2020; 13:e007908. [PMID: 32433894 DOI: 10.1161/circep.119.007908] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 11/16/2022]
Abstract
BACKGROUND The association between leisure-time physical activity (LTPA) and the risk of sudden cardiac death (SCD) in coronary artery disease patients is not well known. We aim to assess whether there is an association between LTPA and the risk of SCD and non-SCD in patients with coronary artery disease. METHODS Patients with angiographically verified coronary artery disease (n=1946) underwent a clinical evaluation, including filling in an LTPA questionnaire and extensive risk profiling at the baseline. The patients were classified into 4 groups according to LTPA: (1) inactive; (2) irregularly active; (3) active, exercise regularly 2× to 3× weekly; (4) highly active, exercise regularly ≥4× weekly. Age, sex, body mass index, left ventricular ejection fraction, type 2 diabetes mellitus, history of myocardial infarction, Canadian Cardiovascular Society grading of angina pectoris class, and exercise capacity were used as covariates in the multivariate Cox regression analysis. RESULTS During follow-up (median 6.3 years), 52 SCDs and 49 non-SCDs occurred. Inactive patients had increased risk for SCD compared with active patients (hazard ratio, 2.45 [95% CI, 1.01-5.98]; P<0.05). A significant LTPA×Canadian Cardiovascular Society grading of angina pectoris class interaction was observed in SCD risk (P=0.019 in highly active patients). LTPA was not associated with SCD in patients with Canadian Cardiovascular Society grading of angina pectoris class 1 (n=1107, 18 events). Among patients with Canadian Cardiovascular Society grading of angina pectoris class 2 or higher (n=839, 34 events), increased risk for SCD was encountered in highly active patients (hazard ratio, 7.46 [95% CI, 2.32-23.9]; P<0.001) and inactive patients (hazard ratio, 3.64 [95% CI, 1.16-11.5]; P<0.05) as compared to active patients. A linear association was observed between LTPA and non-SCD; those with high LTPA had the lowest risk for non-SCD. CONCLUSIONS Inactive coronary artery disease patients had increased risk for SCD. In subgroup analysis among symptomatic patients, the risk of SCD was increased in highly active and inactive patients compared with active patients. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01426685.
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Affiliation(s)
- Mikko P Tulppo
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Finland
| | - Antti M Kiviniemi
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Finland
| | - Minna Lahtinen
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Finland
| | - Olavi Ukkola
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Finland
| | - Tomi Toukola
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Finland
| | - Juha Perkiömäki
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Finland
| | - M Juhani Junttila
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Finland
| | - Heikki V Huikuri
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Finland
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Kiviniemi AM, Tulppo MP, Junttila MJ, Huikuri HV. Response to Comment on Kiviniemi et al. Prediabetes and Risk for Cardiac Death Among Patients With Coronary Artery Disease: The ARTEMIS Study. Diabetes Care 2019;42:1319-1325. Diabetes Care 2019; 42:e195. [PMID: 31748220 DOI: 10.2337/dci19-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Antti M Kiviniemi
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Mikko P Tulppo
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - M Juhani Junttila
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Heikki V Huikuri
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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20
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Karvonen R, Sipola M, Kiviniemi AM, Tikanmäki M, Järvelin MR, Eriksson JG, Tulppo MP, Vääräsmäki M, Kajantie E. Postexercise Heart Rate Recovery in Adults Born Preterm. J Pediatr 2019; 214:89-95.e3. [PMID: 31399247 DOI: 10.1016/j.jpeds.2019.06.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 11/07/2018] [Revised: 05/15/2019] [Accepted: 06/24/2019] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To evaluate postexercise heart rate recovery (HRR) in adults born preterm. STUDY DESIGN We studied the association between preterm birth and postexercise HRR in 545 adults (267 women) at 23.3 years of age (range 19.9-26.3 years). One hundred three participants were born early preterm (<34 completed weeks), 178 late preterm (34-36), and 264 were full term (control group). HRR was calculated as change in heart rate (HR) 30 seconds and 60 seconds after cessation of submaximal step test and maximum HR slope during the first minute after. RESULTS Mean peak HR was 159.5 bpm in the early preterm (P = .16 with controls), 157.8 bpm in the late preterm (P = .56), and 157.0 bpm in the control group. Mean HRR 30 seconds after exercise was 3.2 bpm (95% CI 1.1-5.2) lower in the early preterm group and 2.1 bpm (0.3-3.8) lower in the late preterm group than the full term controls. Mean 60s HRR was 2.5 (-0.1 to 5.1) lower in the early preterm group and 2.8 bpm (0.6-4.9) lower in the late preterm group. Mean maximum slope after exercise was 0.10 beats/s (0.02-0.17) lower in the early preterm group and 0.06 beats/s (0.00-0.12) lower in the late preterm group. CONCLUSIONS Our results suggest reduced HRR after exercise in adults born preterm, including those born late preterm. This suggests altered reactivation of the parasympathetic nervous system, which may contribute to cardiovascular risk among adults born preterm.
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Affiliation(s)
- Risto Karvonen
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Oulu and Helsinki, Finland; PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
| | - Marika Sipola
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Oulu and Helsinki, Finland; PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Antti M Kiviniemi
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Marjaana Tikanmäki
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Oulu and Helsinki, Finland; PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Marjo-Riitta Järvelin
- Department of Children and Families, National Institute for Health and Welfare, Oulu and Helsinki, Finland; Biocenter Oulu, Oulu, Finland; Unit of Primary Care Unit, Oulu, Finland; Department of Epidemiology and Biostatistics, Imperial College London, MRC Health Protection Agency (HPA) Centre for Environment and Health, School of Public Health, London, United Kingdom
| | - Johan G Eriksson
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Oulu and Helsinki, Finland; Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mikko P Tulppo
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Marja Vääräsmäki
- Department of Children and Families, National Institute for Health and Welfare, Oulu and Helsinki, Finland; PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland; Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Eero Kajantie
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Oulu and Helsinki, Finland; PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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21
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Korpela N, Kaikkonen K, Auvinen J, Tulppo MP, Junttila J, Perkiomaki J, Jarvelin MR, Huikuri HV, Kiviniemi AM. P5316Birthweight, childhood growth patterns and left ventricular structure at midlife: Northern Finland 1966 Birth Cohort Study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Higher cardiac left ventricular (LV) mass (LVM) has independently been associated with cardiovascular risk and mortality. Changes in LV structure have been observed in children with obesity. However, information about the long-term influence of early growth on LV structure is limited.
Purpose
To explore the associations between early growth patterns, specifically birth weight, age and body mass index (BMI) at infant BMI peak and at childhood BMI rebound, and LV structure at midlife.
Methods
At the age of 46, a sample of the participants of the Northern Finland Birth Cohort 1966 took part in follow-up examinations. A randomly selected subpopulation was enrolled to echocardiographic examinations (n=1124). BMI at various ages in childhood was calculated from frequent anthropometric measurements collected from child welfare clinical records. Age and BMI at BMI peak (n=541, mean age 9.0 months) and at BMI rebound (n=657, mean age 5.8 years) were derived from random effect models.
Results
Birth weight (n=1124), BMI at BMI peak and at BMI rebound were directly associated with LVM (beta [standardized]: 0.171, 0.186 and 0.223, respectively, p<0.001 for all) and LVM index (LVMI) (beta: 0.146, 0.120 and 0.120, respectively, p<0.01 for all) at midlife. All the associations, except that between BMI at BMI peak and LVMI, remained significant after adjustments for gender, adult blood pressure, heart rate, antihypertensive medications, heart diseases and diabetes (p<0.05 for all). Significant interaction between gender and age at BMI rebound was observed in LVMI. Age at BMI rebound was inversely associated with LVMI in both genders, the association being stronger in males (beta: −0.212, p<0.001) compared to females (beta: −0.117, p=0.025) and independent of potential confounders. There were direct univariate associations of birth weight and BMI at BMI peak and rebound with LV relative wall thickness (p=0.009–0.019), which were largely explained by potential confounders. However, the association of birth weight with LV relative wall thickness retained its significance even after relevant adjustments (beta: 0.097, p=0.001). After additional adjustments for adult BMI, only associations of birth weight and BMI at BMI peak with LVM remained significant, which, however, did not remain significant after additional adjustment for adult height.
Conclusions
This study shows that birth weight and early growth patterns are associated with LV structure at midlife, which is largely explained by adult BMI. Therefore, the relationship between early growth patterns to LV structure in the adulthood may be largely explained by their strong tracking to obesity and related cardiovascular risk factors at midlife and to some extent by normal somatic growth.
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Affiliation(s)
- N Korpela
- Medical Research Center Oulu, Research Unit of Internal Medicine, Oulu, Finland
| | - K Kaikkonen
- Medical Research Center Oulu, Research Unit of Internal Medicine, Oulu, Finland
| | - J Auvinen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - M P Tulppo
- Medical Research Center Oulu, Research Unit of Internal Medicine, Oulu, Finland
| | - J Junttila
- Medical Research Center Oulu, Research Unit of Internal Medicine, Oulu, Finland
| | - J Perkiomaki
- Medical Research Center Oulu, Research Unit of Internal Medicine, Oulu, Finland
| | - M.-R Jarvelin
- Imperial College London, Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment & Health, London, United Kingdom
| | - H V Huikuri
- Medical Research Center Oulu, Research Unit of Internal Medicine, Oulu, Finland
| | - A M Kiviniemi
- Medical Research Center Oulu, Research Unit of Internal Medicine, Oulu, Finland
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22
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Rahola JT, Kiviniemi AM, Ukkola OH, Tulppo MP, Junttila MJ, Huikuri HV, Kentta TV, Perkiomaki JS. P5647Temporal variability of T-wave morphology and risk of sudden cardiac death in patients with coronary artery disease. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The possible relationship between temporal variability of electrocardiographic spatial heterogeneity of repolarisation and the risk of sudden cardiac death (SCD) in patients with coronary artery disease (CAD) is not completely understood.
Purpose
To investigate the prognostic value of temporal variability of T-wave spatial heterogeneity in SCD in patients with CAD.
Methods
The Innovation to reduce Cardiovascular Complications of Diabetes at the Intersection (ARTEMIS) study population consisted of 1,946 patients with angiographically verified CAD. T-wave morphology dispersion (TMD), which estimates the average angle between all reconstruction vector pairs in T-wave loop based on leads I-II and V2-V6, was analysed on beat-to-beat basis from 10 minutes period of the baseline electrocardiographic recording in 1,678 study subjects. The temporal variability of TMD was evaluated by standard deviation of TMD (TMD-SD).
Results
After on average of 7.4±2.0 years of follow-up, a total of 47 of the 1,678 study subjects (2.8%) had experienced SCD or were resuscitated from sudden cardiac arrest (SCA). TMD-SD was significantly higher in patients who had experienced SCD/SCA compared with those who remained alive (3.64±2.57 vs. 2.65±2.54, p<0.01, respectively), but did not differ significantly between the patients who had experienced non-sudden cardiac death (n=40, 2.4%) and those who remained alive (2.98±2.43 vs. 2.67±2.55, p=0.45, respectively) or between the patients who succumbed to non-cardiac death (n=88, 5,2%) and those who stayed alive (2.74±2.44 vs. 2.67±2.55, p=0.81). After adjustments with relevant clinical risk indicators of SCD/SCA, such as left ventricular ejection fraction, diabetes, left bundle branch block and Canadian Cardiac Society class, TMD-SD still predicted SCD/SCA (HR 1.113, 95% CIs 1.028–1.206, p<0.01). The discrimination and reclassification accuracy increased significantly (p=0.02, p=0.033) and the C-index increased from 0.733 to 0.741 when TMD-SD was added to the clinical risk model of SCD/SCA. The Kaplan-Meier survival curves show proportional probabilities of event-free survival for different modes of death for patients classified according to the optimised TMD-SD cut-off point (Figure).
Figure 1
Conclusions
Temporal variability of electrocardiographic spatial heterogeneity of repolarisation represented by TMD-SD independently predicts long-term risk of SCD/SCA in patients with CAD.
Acknowledgement/Funding
Sigrid Juselius Foundation and Finnish Foundation for Cardiovascular Research
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Affiliation(s)
- J T Rahola
- University of Oulu, Medical Research Center, Oulu, Finland
| | - A M Kiviniemi
- University of Oulu, Medical Research Center, Oulu, Finland
| | - O H Ukkola
- University of Oulu, Medical Research Center, Oulu, Finland
| | - M P Tulppo
- University of Oulu, Medical Research Center, Oulu, Finland
| | - M J Junttila
- University of Oulu, Medical Research Center, Oulu, Finland
| | - H V Huikuri
- University of Oulu, Medical Research Center, Oulu, Finland
| | - T V Kentta
- University of Oulu, Medical Research Center, Oulu, Finland
| | - J S Perkiomaki
- University of Oulu, Medical Research Center, Oulu, Finland
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Kiviniemi AM, Lepojärvi ES, Tulppo MP, Piira OP, Kenttä TV, Perkiömäki JS, Ukkola OH, Myerburg RJ, Junttila MJ, Huikuri HV. Prediabetes and Risk for Cardiac Death Among Patients With Coronary Artery Disease: The ARTEMIS Study. Diabetes Care 2019; 42:1319-1325. [PMID: 31076416 DOI: 10.2337/dc18-2549] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/10/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare cardiac mortality in patients with CAD and prediabetes with that in CAD patients with normal glycemic status and type 2 diabetes. RESEARCH DESIGN AND METHODS The Innovation to Reduce Cardiovascular Complications of Diabetes at the Intersection (ARTEMIS) study included patients with CAD after revascularization (79%), optimal medical therapy, or both. Patients had type 2 diabetes (n = 834), impaired glucose tolerance (IGT; n = 314), impaired fasting glucose (IFG; n = 103), or normal glycemic status (n = 697) as defined on the basis of the results of an oral glucose tolerance test. The primary end point was cardiac death. Major adverse cardiac event (MACE: cardiac death, heart failure, or acute coronary syndrome) and all-cause mortality were secondary end points. RESULTS During a mean ± SD follow-up of 6.3 ± 1.6 years, 101 cardiac deaths, 385 MACEs, and 208 deaths occurred. Patients with IGT tended to have 49% lower adjusted risk for cardiac death (P = 0.069), 32% lower adjusted risk for all-cause mortality (P = 0.076), and 36% lower adjusted risk for MACE (P = 0.011) than patients with type 2 diabetes. The patients with IFG had 82% lower adjusted risk for all-cause mortality (P = 0.015) than the patients with type 2 diabetes, whereas risks for cardiac death and MACE did not differ significantly between the two groups. The adjusted risks for cardiac death, MACE, and all-cause mortality among patients with IGT and IFG did not significantly differ from those risks among patients with normal glycemic status. CONCLUSIONS Cardiac mortality or incidence of MACE in patients with CAD with prediabetes (i.e., IGT or IFG after revascularization, optimal medical therapy, or both) does not differ from those values in patients with normal glycemic status.
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Affiliation(s)
- Antti M Kiviniemi
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - E Samuli Lepojärvi
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Mikko P Tulppo
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Olli-Pekka Piira
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Tuomas V Kenttä
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Juha S Perkiömäki
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Olavi H Ukkola
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Robert J Myerburg
- Division of Cardiology, Miller School of Medicine, University of Miami, Miami, FL
| | - M Juhani Junttila
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Heikki V Huikuri
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
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24
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Hintsala HE, Kiviniemi AM, Antikainen R, Mäntysaari M, Jokelainen J, Hassi J, Tulppo MP, Herzig KH, Keinänen-Kiukaanniemi S, Rintamäki H, Jaakkola JJK, Ikäheimo TM. High Home Blood Pressure Variability Associates With Exaggerated Blood Pressure Response to Cold Stress. Am J Hypertens 2019; 32:538-546. [PMID: 30984970 DOI: 10.1093/ajh/hpz011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/08/2018] [Revised: 12/21/2018] [Accepted: 03/28/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Exaggerated sympathetic cardiovascular (CV) reactivity to stress associates with elevated risk for clinical and preclinical end points of CV disease. It would be useful to identify these individuals, preferably from feasible measurements commonly used in health care. Our study examined the association between home blood pressure (BP) variability and cardiac workload response to whole-body cold exposure. METHODS Seventy-five men (55-65 years, 46 hypertensive) measured BP at home twice in the morning and evening for a week. We computed systolic home BP variability as SD of daily means and divided the subjects into groups demonstrating either high or low BP variability. They were exposed to whole-body cold exposure (-10 °C, wind 3 m/second, 15 minutes, winter clothes, standing). BP and heart rate were measured at 3-minute intervals during, and 15 minutes before and after the exposure. Rate-pressure product (RPP) was calculated to represent cardiac workload. RESULTS Subjects with high systolic home BP variability demonstrated a greater RPP increase in cold conditions compared to those with low BP variability [mean change from baseline (95% CI): 1,850 (1,450 to 2,250) bpm × mm Hg vs. 930 (610, 1,250) bpm × mm Hg, P < 0.01]. This was related to the augmented systolic BP change [31(28, 35) mm Hg vs. 23(20, 26) mm Hg, P < 0.01]. Home BP variability correlated with cold-related RPP (rS = 0.34, P = 0.003) and systolic BP (rS = 0.38, P < 0.001) responses. CONCLUSIONS Moderate whole-body cold exposure increased BP and cardiac workload more among those with higher systolic home BP variability, independently of home BP level. Elevated home BP variability may indicate augmented sympathetically mediated vascular reactivity for environmental stressors. PUBLIC TRIALS REGISTRY NUMBER Trial Number NCT02007031.
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Affiliation(s)
- Heidi E Hintsala
- Center for Environmental and Respiratory Health Research (CERH), University of Oulu, Oulu, Finland
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Antti M Kiviniemi
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Riitta Antikainen
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
- Center for Life Course Epidemiology and Systems Medicine, University of Oulu, Oulu, Finland
- Oulu City Hospital, Oulu, Finland
| | - Matti Mäntysaari
- Center for Military Medicine, The Finnish Defence Forces, Helsinki, Finland
| | - Jari Jokelainen
- Center for Life Course Epidemiology and Systems Medicine, University of Oulu, Oulu, Finland
- Unit of General Practice, Oulu University Hospital, Oulu, Finland
| | - Juhani Hassi
- Center for Environmental and Respiratory Health Research (CERH), University of Oulu, Oulu, Finland
| | - Mikko P Tulppo
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Karl-Heinz Herzig
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
- Research Unit of Biomedicine, and Biocenter Oulu, University of Oulu, Oulu, Finland
- Department of Gastroenterology and Metabolism, Poznan University of Medical Sciences, Poznan, Poland
| | - Sirkka Keinänen-Kiukaanniemi
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
- Center for Life Course Health Research, University of Oulu, Finland
- Healthcare and Social Services of Selänne, Pyhäjärvi, Finland
| | | | - Jouni J K Jaakkola
- Center for Environmental and Respiratory Health Research (CERH), University of Oulu, Oulu, Finland
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Tiina M Ikäheimo
- Center for Environmental and Respiratory Health Research (CERH), University of Oulu, Oulu, Finland
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
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25
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Tulppo MP, Kiviniemi AM, Junttila MJ, Huikuri HV. Home Monitoring of Heart Rate as a Predictor of Imminent Cardiovascular Events. Front Physiol 2019; 10:341. [PMID: 30971957 PMCID: PMC6445883 DOI: 10.3389/fphys.2019.00341] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 12/18/2018] [Accepted: 03/13/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction: Previous studies have documented that day-to-day variability of heart rate (HR) has prognostic significance for cardiovascular (CV) events in general population. It is unknown how HR dynamics variate before imminent CV event in patients with coronary artery disease (CAD). Our aim was to study day-to-day variation in HR dynamics before the occurrence of CV event in patients with initially stable CAD. Methods: Forty-four patients with angiographically documented CAD from ARTEMIS study measured R-R intervals on a weekly basis at home for 2 years. Home measurements were performed in controlled conditions (3 min at supine and sitting) 1–2 times per week. Eleven patients had a CV event (7 acute coronary syndromes, 1 cardiac death, 2 new onset of arrhythmia needing hospitalization and 1 stroke), which occurred 11 ± 7 months after enrolment. Mean R-R interval was analyzed prospectively from the home measurements. For the patients with new CV event, average, and standard deviation (SD) of the mean R-R interval over 8 weeks preceding the CV event were calculated. For the patients without new CV event, corresponding period was determined by the median follow-up at the occurrence of new CV event. Results: There were no differences in the mean R-R interval analyzed over 8 weeks between the patients with and without new CV event. The variability of mean R-R interval over 8 weeks was greater in the patients with new CV event compared to the patients without new CV event at the supine (95 ± 34 vs. 59 ± 26 ms, p < 0.001) and sitting positions (92 ± 28 vs. 62 ± 24 ms, p < 0.001). Conclusion: Day-to-day variability of mean R-R interval is greater before the new CV event in CAD patients suggesting to a more unstable cardiac autonomic regulation preceding these events.
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Affiliation(s)
- Mikko P Tulppo
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Antti M Kiviniemi
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - M Juhani Junttila
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Heikki V Huikuri
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
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26
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Kiviniemi AM, Kenttä TV, Lepojärvi S, Perkiömäki JS, Piira OP, Ukkola O, Huikuri HV, Junttila MJ, Tulppo MP. Recovery of rate-pressure product and cardiac mortality in coronary artery disease patients with type 2 diabetes. Diabetes Res Clin Pract 2019; 150:150-157. [PMID: 30872066 DOI: 10.1016/j.diabres.2019.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 08/28/2018] [Accepted: 03/05/2019] [Indexed: 01/09/2023]
Abstract
AIMS To investigate prognostic significance of post-exercise recovery of rate-pressure product (RPP) in patients with stable coronary artery disease (CAD) and type 2 diabetes (T2D). METHODS Patients with angiographically documented CAD and T2D (n = 697) underwent symptom-limited bicycle exercise test. Exercise capacity (EC), heart rate, blood pressure and RPP responses to peak exercise and recovery (2' and 5' after cessation of exercise) were analyzed. Cardiac death was the primary and sudden cardiac death (SCD) secondary endpoint. RESULTS During a median follow-up of 76 months, 49 cardiac deaths (7.0%) and 28 SCDs (4.0%) were observed. The recovery of RPP at 5' was the strongest univariate predictor of cardiac death (hazard ratio [HR]: 2.55 per SD decrease, 95%CI: 1.82-3.58, p < 0.001) and SCD (HR: 2.34, 95%CI: 1.51-3.62, p < 0.001). In multivariate analysis, it remained significantly associated to cardiac death and SCD without (HR: 1.66, 95%CI: 1.14-2.41, p < 0.01 and HR: 1.75, 95%CI: 1.08-2.85, p < 0.05, respectively) and with additional adjustment for EC and peak RPP (HR: 1.45, 95%CI: 1.09-1.92, p < 0.05 and HR: 1.52, 95%CI: 1.01-2.27, p < 0.05, respectively). CONCLUSIONS The recovery of RPP after exercise is a potent predictor of cardiac death in patients with CAD and T2D. It provides significant prognostic information beyond EC and peak RPP.
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Affiliation(s)
- Antti M Kiviniemi
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
| | - Tuomas V Kenttä
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Samuli Lepojärvi
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Juha S Perkiömäki
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Olli-Pekka Piira
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Olavi Ukkola
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Heikki V Huikuri
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - M Juhani Junttila
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Mikko P Tulppo
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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27
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Perkiömäki N, Auvinen J, Tulppo MP, Ollila MM, Junttila J, Perkiömäki J, Karhunen V, Puukka K, Järvelin MR, Huikuri HV, Kiviniemi AM. Childhood growth patterns and cardiovascular autonomic modulation in midlife: Northern Finland 1966 Birth Cohort Study. Int J Obes (Lond) 2019; 43:2264-2272. [PMID: 30718821 DOI: 10.1038/s41366-019-0333-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 01/15/2019] [Accepted: 01/20/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To test the hypothesis that age and body mass index (BMI) at BMI peak during infancy and at BMI rebound in childhood are related to cardiovascular autonomic modulation in adulthood. METHODS At the age of 46 years, a sample (n = 5861) of the participants of the Northern Finland Birth Cohort 1966 took part in follow-up examinations. Heart rate variability (HRV), baroreflex sensitivity (BRS) and low-frequency oscillations of systolic blood pressure (LFSBP) were measured during sympathetic stimulus by standing. BMI at various ages was calculated from frequent anthropometric measurements collected from child welfare clinical records. BRS and LFSBP were available for 1243 participants with BMI peak data and 1524 participants with BMI rebound data, and HRV for 2137 participants with BMI peak data and 2688 participants with BMI rebound data. RESULTS Age at BMI rebound had a significant inverse association with LFSBP (beta = -0.071, p = 0.006) after all adjustments (p < 0.001) and was also directly associated with BRS (beta = 0.082, p = 0.001) independently of birth and maternal factors (p = 0.023). BMI at BMI peak and at BMI rebound was inversely associated with high-frequency component of HRV (HF) (beta = -0.045, p = 0.036 for BMI at peak; beta = -0.043, p = 0.024 for BMI at rebound) and directly associated with the ratio of low- and high-frequency components of HRV (LF/HF ratio) (beta = 0.084, p = < 0.001 for BMI at peak; beta = 0.069, p < 0.001 for BMI at rebound). These associations remained significant after all adjustments (p < 0.05 for all). CONCLUSIONS This novel study shows that younger age at BMI rebound and higher BMI at BMI peak and at BMI rebound are associated with higher levels in markers suggestive of augmented sympathetic and reduced vagal cardiovascular modulation in midlife.
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Affiliation(s)
- Nelli Perkiömäki
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
| | - Juha Auvinen
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.,Unit of Primary Health Care, Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Mikko P Tulppo
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Meri-Maija Ollila
- PEDEGO Research Unit, Medical Research Center Oulu, Department of Obstetrics and Gynecology, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Juhani Junttila
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Juha Perkiömäki
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Ville Karhunen
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Katri Puukka
- NordLab Oulu, Medical Research Center Oulu, Oulu University Hospital and Department of Clinical Chemistry, University of Oulu, Oulu, Finland
| | - Marjo-Riitta Järvelin
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.,Unit of Primary Health Care, Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland.,Biocenter Oulu, University of Oulu, Oulu, Finland.,Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment & Health, School of Public Health, Imperial College London, London, UK.,Department of Life Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, UK
| | - Heikki V Huikuri
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Antti M Kiviniemi
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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28
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Oksanen P, Tulppo MP, Auvinen J, Niemelä M, Jämsä T, Puukka K, Huikuri HV, Korpelainen R, Venojärvi M, Kiviniemi AM. Associations of fitness and physical activity with orthostatic responses of heart rate and blood pressure at midlife. Scand J Med Sci Sports 2019; 29:874-885. [PMID: 30697819 DOI: 10.1111/sms.13398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 09/20/2018] [Accepted: 01/23/2019] [Indexed: 11/30/2022]
Abstract
Cardiorespiratory fitness (CRF) and physical activity (PA) are associated with autonomic function, but their associations to orthostatic autonomic responses are unclear in epidemiological setting. We hypothesized that higher CRF and PA would associate with higher immediate vagal responses and lower incidence of adverse findings during orthostatic test. At age of 46, 787 men and 938 women without cardiorespiratory diseases and diabetes underwent an orthostatic test (3-minutes sitting, 3-minutes standing) with recording of RR intervals (RRi) and blood pressure (BP) by finger plethysmography. Acute responses of RRi (30:15 ratio) and BP were calculated. CRF was measured by a submaximal step test and daily amount of moderate-to-vigorous PA (MVPA) for 2 weeks by wrist-worn accelerometer. Lifelong PA was based on questionnaires at ages of 14, 31, and 46. High CRF was significantly associated with higher RRi 30:15 ratio (adjusted standardized β = 0.17, P < 0.001) and milder acute decrease of systolic BP while standing (β = 0.10, P = 0.001), while MVPA was not (β = 0.04 for RRi 30:15 ratio and β = 0.05 for systolic BP acute response). High lifelong PA was significantly associated with higher RRi 30:15 ratio (β = 0.08, P = 0.002) but not with acute systolic BP response. Those in the lowest tertile of CRF had 9.2-fold risk (P = 0.002) of having postural orthostatic tachycardia syndrome compared to more fit. Cardiorespiratory fitness and lifelong physical activity, but not current physical activity, were independently associated with higher cardiac vagal response to orthostasis. The present results underscore the importance fitness and lifelong physical activity in prevention of abnormal autonomic function and related cardiovascular risk.
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Affiliation(s)
- Päivi Oksanen
- Institute of Biomedicine, Sports and Exercise Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mikko P Tulppo
- Research Unit of Internal Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Juha Auvinen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Unit of Primary Care, Oulu University Hospital, Oulu, Finland
| | - Maisa Niemelä
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Timo Jämsä
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Diagnostic Imaging, Oulu University Hospital, Oulu, Finland
| | - Katri Puukka
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,NordLab Oulu and Department of Clinical Chemistry, University of Oulu, Oulu, Finland
| | - Heikki V Huikuri
- Research Unit of Internal Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Raija Korpelainen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation, Oulu, Finland
| | - Mika Venojärvi
- Institute of Biomedicine, Sports and Exercise Medicine, University of Eastern Finland, Kuopio, Finland
| | - Antti M Kiviniemi
- Research Unit of Internal Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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29
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Lepojärvi ES, Huikuri HV, Piira OP, Kiviniemi AM, Miettinen JA, Kenttä T, Ukkola O, Perkiömäki JS, Tulppo MP, Junttila MJ. Biomarkers as predictors of sudden cardiac death in coronary artery disease patients with preserved left ventricular function (ARTEMIS study). PLoS One 2018; 13:e0203363. [PMID: 30226845 PMCID: PMC6143233 DOI: 10.1371/journal.pone.0203363] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 08/20/2018] [Indexed: 01/19/2023] Open
Abstract
Aims Biomarkers have shown promising results in risk assessment of cardiovascular events. Their role in predicting the risk of sudden cardiac death (SCD) is not well established. We tested the performance of several biomarkers in risk assessment for SCD in patients with coronary artery disease (CAD) and preserved left ventricular function. Methods and results The study population consisted of 1,946 CAD patients (68% male; mean age 66.9±8.6 yrs; type 2 diabetes (T2D) 43%) enrolled in the ARTEMIS study. The study subjects underwent examinations with echocardiography and measurement of several biomarkers. The primary endpoint of the study was SCD. During the mean follow up of 76±20 months 50 patients experienced SCD. Elevated high sensitive CRP (hs-CRP, p = 0.001), soluble ST2 (sST2, p<0.001), B-type natriuretic peptide (BNP, p<0.001), and highly sensitive TroponinT (hs-TnT, p<0.001) predicted the occurrence of SCD in univariate analysis. Using the optimal cutoff points, elevated sST2 (≥27.45ng/mL; hazard ratio [HR] 2.7; 95%CI 1.4–5.1, p = 0.003) and hs-TnT (≥15 ng/mL; HR 2.9; 95% CI 1.5–5.6, p = 0.002) were the strongest predictors of SCD followed by hs-CRP (HR 2.4; 95% CI 1.3–4.4, p = 0.004) and BNP (HR 1.9; 95% CI 1.0–3.7, p = 0.046) in adjusted analysis. Combination of elevated hs-TnT and sST2 resulted in adjusted HR of 6.4 (95% CI 2.6–15.5, p<0.001). Conclusion Elevated sST2 and hs-TnT predict the occurrence of SCD among patients with CAD and preserved left ventricular function. The association between sST2, hs-TnT and SCD may be explained by an ongoing myocardial apoptosis followed by fibrosis leading to vulnerability to malignant arrhythmias.
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Affiliation(s)
- E Samuli Lepojärvi
- Medical Research Center Oulu, Research Unit of Internal Medicine and Clinical Chemistry, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Heikki V Huikuri
- Medical Research Center Oulu, Research Unit of Internal Medicine and Clinical Chemistry, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Olli-Pekka Piira
- Medical Research Center Oulu, Research Unit of Internal Medicine and Clinical Chemistry, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Antti M Kiviniemi
- Medical Research Center Oulu, Research Unit of Internal Medicine and Clinical Chemistry, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Johanna A Miettinen
- Medical Research Center Oulu, Research Unit of Internal Medicine and Clinical Chemistry, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Tuomas Kenttä
- Medical Research Center Oulu, Research Unit of Internal Medicine and Clinical Chemistry, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Olavi Ukkola
- Medical Research Center Oulu, Research Unit of Internal Medicine and Clinical Chemistry, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Juha S Perkiömäki
- Medical Research Center Oulu, Research Unit of Internal Medicine and Clinical Chemistry, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Mikko P Tulppo
- Medical Research Center Oulu, Research Unit of Internal Medicine and Clinical Chemistry, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - M Juhani Junttila
- Medical Research Center Oulu, Research Unit of Internal Medicine and Clinical Chemistry, Oulu University Hospital and University of Oulu, Oulu, Finland
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30
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Lahtinen M, Kiviniemi AM, Junttila MJ, Kääriäinen M, Huikuri HV, Tulppo MP. Depressive Symptoms and Risk for Sudden Cardiac Death in Stable Coronary Artery Disease. Am J Cardiol 2018; 122:749-755. [PMID: 30055759 DOI: 10.1016/j.amjcard.2018.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/03/2018] [Accepted: 05/07/2018] [Indexed: 11/26/2022]
Abstract
The association between the mode of death and depression in patients with stable coronary artery disease (CAD) is far from clear. We investigated the association between depressive symptoms and the mode of death including all-cause mortality, noncardiac death, sudden cardiac death (SCD), and non-SCD in stable CAD patients. Patients with angiographically documented CAD (n = 1,928) underwent a clinical examination including screening for depression symptoms with the Depression Scale (DEPS) and extensive risk profiling at the baseline. The patients were divided into quartiles based on their DEPS score. The patients entered the follow-up (median 6.3 years) during which 49 SCDs (2.5%) and 48 non-SCDs (2.5%) occurred. The incidence of SCD was 1.1% (5 events), 2.0% (9 events), 2.6% (14 events), and 4.4% (21 events) from the lowest to the highest quartile of DEPS. The patients in the highest quartile of DEPS had a fourfold elevated univariate risk (95% confidence interval 1.5 to 10.5; p = 0.006), and after adjustment for traditional risk factors, a 3.2-fold elevated multivariate risk (95% confidence interval 1.2 to 8.9, p = 0.025) for SCD compared with patients in the lowest quartile. DEPS was not associated with non-SCD or noncardiac deaths. Depressive symptoms are associated with an increased risk of SCD independently of clinical risk factors in patients with CAD. The results highlight the importance of screening for depression and emphasize the need for additional interventions to alleviate the depressive symptoms in these patients.
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31
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Lahtinen M, Toukola T, Junttila MJ, Piira OP, Lepojärvi S, Kääriäinen M, Huikuri HV, Tulppo MP, Kiviniemi AM. Effect of Changes in Physical Activity on Risk for Cardiac Death in Patients With Coronary Artery Disease. Am J Cardiol 2018; 121:143-148. [PMID: 29126583 DOI: 10.1016/j.amjcard.2017.10.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/04/2017] [Accepted: 10/06/2017] [Indexed: 11/29/2022]
Abstract
Leisure-time physical activity (LTPA) is associated with longevity in patients with coronary artery disease (CAD). However, less is known about prognostic significance of longitudinally assessed LTPA in patients with stable CAD. The present study assessed the relationship between changes in LTPA and cardiac mortality in patients with CAD. Patients with angiographically documented CAD (n = 1,746) underwent clinical examination and echocardiography at the baseline. Lifestyle factors, including LTPA (inactive, irregularly active, active, highly active), were surveyed at baseline and after 2 years' follow-up. Thereafter, the patients entered the follow-up (median: 4.5 years; first to third quartile: 3.4 to 5.8 years) during which cardiac deaths were registered (n = 68, 3.9%). The patients who remained inactive (n = 114, 18 events, 16%) and became inactive (n = 228, 18 events, 8%) had 7.6- (95% confidence interval [CI] 4.2 to 13.6) and 3.7-fold (95% CI 2.1 to 6.7) univariate risk for cardiac death compared with those who remained at least irregularly active (n = 1,351, 30 events, 2%), respectively. After adjustment for age, gender, body mass index, diabetes, previous myocardial infarction, left ventricular ejection fraction, angina pectoris grading, cardiovascular event during initial 2-year follow-up, smoking and alcohol consumption, the patients who remained inactive and became inactive still had 4.9- (95% CI 2.4 to 9.8, p <0.001) and 2.4-fold (95% CI 1.3 to 4.5, p <0.01) risk for cardiac death, respectively, compared with patients remaining at least irregularly active. In conclusion, LTPA has important prognostic value for cardiac death in patients with stable CAD. Even minor changes in LTPA over 2 years were related to the subsequent risk for cardiac death.
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Affiliation(s)
- Minna Lahtinen
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Tomi Toukola
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - M Juhani Junttila
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Olli-Pekka Piira
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Samuli Lepojärvi
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Maria Kääriäinen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
| | - Heikki V Huikuri
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Mikko P Tulppo
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Antti M Kiviniemi
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
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Kiviniemi AM, Perkiömäki N, Auvinen J, Niemelä M, Tammelin T, Puukka K, Ruokonen A, Keinänen-Kiukaanniemi S, Tulppo MP, Järvelin MR, Jämsä T, Huikuri HV, Korpelainen R. Fitness, Fatness, Physical Activity, and Autonomic Function in Midlife. Med Sci Sports Exerc 2018; 49:2459-2468. [PMID: 29135784 DOI: 10.1249/mss.0000000000001387] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE Although low cardiorespiratory fitness (CRF), physical inactivity, and obesity are associated with impaired autonomic function, they are also extensively interrelated. The present study aimed to assess the extent to which they contribute to autonomic function independently of each other. METHODS At the age of 46 yr, 1383 men and 1761 women without cardiorespiratory diseases and diabetes underwent assessments of vagally mediated heart rate (HR) variability (root mean square of successive differences in R-R interval (rMMSD)), peak HR during a submaximal step test (CRF), and 60-s HR recovery (HRR). Moderate-to-vigorous physical activity (MVPA; ≥3.5 METs, 2 wk) was measured by wrist-worn accelerometer and body fat percentage (Fat%) by bioimpedance. RESULTS In men, CRF and Fat% were significantly associated with higher rMSSD (standardized β = 0.31 and -0.16) and HRR (β = 0.19 and -0.18), whereas higher MVPA was linked with higher HRR (β = 0.13) when including CRF, MVPA, and Fat% in the initial regression. After adjustments for other lifestyle and cardiometabolic factors, CRF remained significantly associated with rMMSD (β = 0.24) and HRR (β = 0.14), as did MVPA with HRR (β = 0.11). In women, CRF was associated with rMSSD (β = 0.23) and HRR (β = 0.15), and MVPA (β = 0.17) and Fat% (β = -0.07) with HRR, when CRF, MVPA, and Fat% were adjusted for each other. After further adjustments, CRF remained a significant determinant of rMSSD (β = 0.20) and HRR (β = 0.13), as did MVPA with HRR (β = 0.15). The final models explained 23% and 21% of variation in rMSSD and HRR in men, and 10% and 12% in women, respectively. CONCLUSIONS CRF was a more important determinant of cardiac autonomic function than MVPA and body fat. Furthermore, MVPA but not body fat was independently associated with cardiac autonomic function in both men and women.
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Affiliation(s)
- Antti M Kiviniemi
- 1Research Unit of Internal Medicine, University of Oulu, Oulu, FINLAND; 2Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, FINLAND; 3Center for Life Course Health Research, University of Oulu, Oulu, FINLAND; 4Unit of Primary Care, University of Oulu, Oulu, FINLAND; 5Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, FINLAND; 6LIKES Research Centre for Physical Activity and Health, Jyväskylä, FINLAND; 7NordLab Oulu, Medical Research Center Oulu, Oulu University Hospital and Department of Clinical Chemistry, University of Oulu, Oulu, FINLAND; 8Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UNITED KINGDOM; 9Biocenter Oulu, University of Oulu, Oulu, FINLAND; 10Diagnostic Imaging, Oulu University Hospital, Oulu, FINLAND; and 11Department of Sports and Exercise Medicine, Oulu Deaconess Institute, Oulu, FINLAND
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Perkiömäki N, Auvinen J, Tulppo MP, Hautala AJ, Perkiömäki J, Karhunen V, Keinänen-Kiukaanniemi S, Puukka K, Ruokonen A, Järvelin MR, Huikuri HV, Kiviniemi AM. Association between Birth Characteristics and Cardiovascular Autonomic Function at Mid-Life. PLoS One 2016; 11:e0161604. [PMID: 27552091 PMCID: PMC4994955 DOI: 10.1371/journal.pone.0161604] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 08/08/2016] [Indexed: 12/19/2022] Open
Abstract
Background Low birth weight is associated with an increased risk of cardiovascular diseases in adulthood. As abnormal cardiac autonomic function is a common feature in cardiovascular diseases, we tested the hypothesis that low birth weight may also be associated with poorer cardiac autonomic function in middle-aged subjects. Methods At the age of 46, the subjects of the Northern Finland Birth Cohort 1966 were invited to examinations including questionnaires about health status and life style and measurement of vagally-mediated heart rate variability (rMSSD) from R-R intervals (RRi) and spontaneous baroreflex sensitivity (BRS) in both seated and standing positions. Maternal parameters had been collected in 1965–1966 since the 16th gestational week and birth variables immediately after delivery. For rMSSD, 1,799 men and 2,279 women without cardiorespiratory diseases and diabetes were included and 902 men and 1,020 women for BRS. The analyses were adjusted for maternal (age, anthropometry, socioeconomics, parity, gestational smoking) and adult variables (life style, anthropometry, blood pressure, glycemic and lipid status) potentially confounding the relationship between birth weight and autonomic function. Results In men, birth weight correlated negatively with seated (r = -0.058, p = 0.014) and standing rMSSD (r = -0.090, p<0.001), as well as with standing BRS (r = -0.092, p = 0.006). These observations were verified using relevant birth weight categories (<2,500 g; 2,500–3,999 g; ≥4,000 g). In women, birth weight was positively correlated with seated BRS (r = 0.081, p = 0.010), but none of the other measures of cardiovascular autonomic function. These correlations remained significant after adjustment for potential confounders (p<0.05 for all). Conclusions In men, higher birth weight was independently associated with poorer cardiac autonomic function at mid-life. Same association was not observed in women. Our findings suggest that higher, not lower, birth weight in males may contribute to less favourable cardiovascular autonomic regulation and potentially to an elevated cardiovascular risk in later life.
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Affiliation(s)
- Nelli Perkiömäki
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Juha Auvinen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Unit of Primary Health Care, Oulu University Hospital, Oulu, Finland
| | - Mikko P. Tulppo
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Arto J. Hautala
- Physiological Signal Analysis Team, Center for Machine Vision and Signal Analysis, University of Oulu, Oulu, Finland
| | - Juha Perkiömäki
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Ville Karhunen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Sirkka Keinänen-Kiukaanniemi
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Unit of Primary Health Care, Oulu University Hospital, Oulu, Finland
| | - Katri Puukka
- NordLab Oulu, Medical Research Center Oulu, Oulu University Hospital and Department of Clinical Chemistry, University of Oulu, Finland
| | - Aimo Ruokonen
- NordLab Oulu, Medical Research Center Oulu, Oulu University Hospital and Department of Clinical Chemistry, University of Oulu, Finland
| | - Marjo-Riitta Järvelin
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Unit of Primary Health Care, Oulu University Hospital, Oulu, Finland
- Department of Epidemiology and Biostatistics, MRC–PHE Centre for Environment & Health, School of Public Health, Imperial College London, London, United Kingdom
- Biocenter Oulu, University of Oulu, Oulu, Finland
| | - Heikki V. Huikuri
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Antti M. Kiviniemi
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- * E-mail:
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Hautala AJ, Kiviniemi AM, Mäkikallio T, Koistinen P, Ryynänen OP, Martikainen JA, Seppänen T, Huikuri HV, Tulppo MP. Economic evaluation of exercise-based cardiac rehabilitation in patients with a recent acute coronary syndrome. Scand J Med Sci Sports 2016; 27:1395-1403. [PMID: 27541076 DOI: 10.1111/sms.12738] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2016] [Indexed: 01/14/2023]
Abstract
Health care decision-making requires evidence of the cost-effectiveness of medical therapies. We evaluated the cost-effectiveness of exercise-based cardiac rehabilitation (ECR) implemented according to guidelines. All the patients (n = 204) had experienced a recent acute coronary syndrome and were randomized to a 1-year ECR (n = 109) or usual care (UC) group (n = 95). The patients' health-related quality of life was followed using the 15D instrument and health care costs were collected from electronic health registries. The cost-effectiveness of ECR was estimated based on intervention and health care costs and quality-adjusted life years (QALYs) gained. The total average cost per patient was lower in ECR than in UC. The incremental cost was divided by the baseline-adjusted incremental QALYs (0.045), yielding an incremental cost-effectiveness ratio of -€24511/QALYs. A combined endpoint of mortality, recurrent coronary event, or hospitalization for a heart failure occurred for five patients in ECR and 16 patients in UC (HR 3.9, 95% CI 1.4-10.6, P = 0.004, relative risk reduction 73%, number needed to treat eight). ECR is a dominant treatment option and decreases the occurrence of adverse cardiac events. These results are useful for decision-making when planning optimal utilization of resources in Finnish health care.
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Affiliation(s)
- A J Hautala
- Center for Machine Vision and Signal Analysis, Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland
| | - A M Kiviniemi
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - T Mäkikallio
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - P Koistinen
- Social and Health Services, City of Oulu, Oulu, Finland
| | - O-P Ryynänen
- Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - J A Martikainen
- Pharmacoeconomics & Outcomes Research Unit, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - T Seppänen
- Center for Machine Vision and Signal Analysis, Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland
| | - H V Huikuri
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - M P Tulppo
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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Hintsala HE, Kiviniemi AM, Tulppo MP, Helakari H, Rintamäki H, Mäntysaari M, Herzig KH, Keinänen-Kiukaanniemi S, Jaakkola JJK, Ikäheimo TM. Hypertension Does Not Alter the Increase in Cardiac Baroreflex Sensitivity Caused by Moderate Cold Exposure. Front Physiol 2016; 7:204. [PMID: 27313543 PMCID: PMC4889607 DOI: 10.3389/fphys.2016.00204] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 01/29/2016] [Accepted: 05/19/2016] [Indexed: 11/13/2022] Open
Abstract
Exposure to cold increases blood pressure and may contribute to higher wintertime cardiovascular morbidity and mortality in hypertensive people, but the mechanisms are not well-established. While hypertension does not alter responses of vagally-mediated heart rate variability to cold, it is not known how hypertension modifies baroreflex sensitivity (BRS) and blood pressure variability during cold exposure. Our study assessed this among untreated hypertensive men during short-term exposure comparable to habitual winter time circumstances in subarctic areas. We conducted a population-based recruitment of 24 untreated hypertensive and 17 men without hypertension (age 55–65 years) who underwent a whole-body cold exposure (−10°C, wind 3 m/s, winter clothes, 15 min, standing). Electrocardiogram and continuous blood pressure were measured to compute spectral powers of systolic blood pressure and heart rate variability at low (0.04–0.15 Hz) and high frequency (0.15–0.4 Hz) and spontaneous BRS at low frequency (LF). Comparable increases in BRS were detected in hypertensive men, from 2.6 (2.0, 4.2) to 3.8 (2.5, 5.1) ms/mmHg [median (interquartile range)], and in control group, from 4.3 (2.7, 5.0) to 4.4 (3.1, 7.1) ms/mmHg. Instead, larger increase (p < 0.05) in LF blood pressure variability was observed in control group; response as median (interquartile range): 8 (2, 14) mmHg2, compared with hypertensive group [0 (−13, 20) mmHg2]. Untreated hypertension does not disturb cardiovascular protective mechanisms during moderate cold exposure commonly occurring in everyday life. Blunted response of the estimate of peripheral sympathetic modulation may indicate higher tonic sympathetic activity and decreased sympathetic responsiveness to cold in hypertension.
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Affiliation(s)
- Heidi E Hintsala
- Center for Environmental and Respiratory Health Research (CERH), University of OuluOulu, Finland; Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of OuluOulu, Finland
| | - Antti M Kiviniemi
- Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of OuluOulu, Finland; Research Unit of Internal Medicine, University of OuluOulu, Finland
| | - Mikko P Tulppo
- Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of OuluOulu, Finland; Research Unit of Internal Medicine, University of OuluOulu, Finland
| | - Heta Helakari
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu Oulu, Finland
| | - Hannu Rintamäki
- Finnish Institute of Occupational HealthOulu, Finland; Research Unit of Biomedicine, University of OuluOulu, Finland
| | - Matti Mäntysaari
- Center for Environmental and Respiratory Health Research (CERH), University of Oulu Oulu, Finland
| | - Karl-Heinz Herzig
- Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of OuluOulu, Finland; Research Unit of Biomedicine, University of OuluOulu, Finland; Biocenter of Oulu, University of OuluOulu, Finland; Department of Gastroenterology and Metabolism, Poznan University of Medical SciencesPoznan, Poland
| | - Sirkka Keinänen-Kiukaanniemi
- Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of OuluOulu, Finland; Center for Life Course Health Research, University of OuluOulu, Finland; Unit of Primary Health Care, Oulu University HospitalOulu, Finland
| | - Jouni J K Jaakkola
- Center for Environmental and Respiratory Health Research (CERH), University of OuluOulu, Finland; Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of OuluOulu, Finland; Internal Medicine, Oulu University HospitalOulu, Finland
| | - Tiina M Ikäheimo
- Center for Environmental and Respiratory Health Research (CERH), University of OuluOulu, Finland; Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of OuluOulu, Finland
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Lepojärvi ES, Piira OP, Kiviniemi AM, Miettinen JA, Kenttä T, Ukkola O, Tulppo MP, Huikuri HV, Junttila MJ. Usefulness of Highly Sensitive Troponin as a Predictor of Short-Term Outcome in Patients With Diabetes Mellitus and Stable Coronary Artery Disease (from the ARTEMIS Study). Am J Cardiol 2016; 117:515-521. [PMID: 26739392 DOI: 10.1016/j.amjcard.2015.11.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 11/18/2015] [Accepted: 11/18/2015] [Indexed: 11/17/2022]
Abstract
The aim of this study was to test the hypothesis that novel biomarkers may predict cardiac events in diabetic patients with stable coronary artery disease (CAD). Serum levels of highly sensitive troponin T (hs-TnT), B-type natriuretic peptide, highly sensitive C-reactive protein (hs-CRP), galectin-3, and soluble suppressor of tumorigenicity-2 (sST2) were analyzed in 1,137 patients with CAD and with type 2 diabetes, impaired glucose tolerance, or fasting glycaemia (diabetic group) and in 649 patients with normal glucose state. Cardiac death or hospitalization for congestive heart failure was the major end point during the follow-up of 2 years. Forty patients in the diabetic group (3.5%) and 9 patients in the nondiabetic group (1.4%) reached the primary end point. High hs-TnT level (≥14 ng/l) was the strongest predictor of the primary end point with hazard ratio of 24.5 (95% confidence interval 8.7 to 69.0; p <0.001) and remained so when adjusted for clinical variables, ejection fraction, renal, lipid, and glycemic status and other biomarkers (hazard ratio 9.9, 95% confidence interval 3.2 to 30.8; p <0.001). In the multivariate model, hs-CRP, B-type natriuretic peptide, and sST2 also predicted the primary end point in the diabetic group (p <0.01 for all). Only sST2 (p <0.001) and hs-CRP (p = 0.02) predicted the primary end point in nondiabetic group. The inclusion of hs-TnT in the model significantly improved discrimination (integrated discrimination improvement 0.050) and reclassification of the patients (net reclassification index 0.21). In conclusion, hs-TnT is a strong predictor of cardiac death or hospitalization for heart failure independently from traditional risk markers or other biomarkers in diabetic patients with stable CAD.
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Affiliation(s)
- E Samuli Lepojärvi
- Department of Internal Medicine and Clinical Chemistry, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland.
| | - Olli-Pekka Piira
- Department of Internal Medicine and Clinical Chemistry, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Antti M Kiviniemi
- Department of Internal Medicine and Clinical Chemistry, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Johanna A Miettinen
- Department of Internal Medicine and Clinical Chemistry, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Tuomas Kenttä
- Department of Internal Medicine and Clinical Chemistry, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Olavi Ukkola
- Department of Internal Medicine and Clinical Chemistry, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Mikko P Tulppo
- Department of Internal Medicine and Clinical Chemistry, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Heikki V Huikuri
- Department of Internal Medicine and Clinical Chemistry, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - M Juhani Junttila
- Department of Internal Medicine and Clinical Chemistry, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
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Kiviniemi AM, Lepojärvi S, Kenttä TV, Junttila MJ, Perkiömäki JS, Piira OP, Ukkola O, Hautala AJ, Tulppo MP, Huikuri HV. Exercise capacity and heart rate responses to exercise as predictors of short-term outcome among patients with stable coronary artery disease. Am J Cardiol 2015; 116:1495-501. [PMID: 26381535 DOI: 10.1016/j.amjcard.2015.08.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/18/2015] [Accepted: 08/18/2015] [Indexed: 02/05/2023]
Abstract
Although exercise capacity (EC) and autonomic responses to exercise predict clinical outcomes in various populations, they are not routinely applied in patients with coronary artery disease (CAD). We hypothesized that the composite index of EC and exercise heart rate responses would be a powerful determinant of short-term risk in CAD. Patients with angiographically documented stable CAD and treated with β blockers (n = 1,531) underwent exercise testing to allow the calculation of age- and gender-adjusted EC, maximal chronotropic response index (CRI), and 2-minute postexercise heart rate recovery (HRR, percentage of maximal heart rate). Cardiovascular deaths and hospitalization due to heart failure, registered during a 2-year follow-up (n = 39, 2.5%), were defined as the composite primary end point. An exercise test risk score was calculated as the sum of hazard ratios related to abnormal (lowest tertile) EC, CRI, and HRR. Abnormal EC, CRI, and HRR predicted the primary end point, involving 4.5-, 2.2-, and 6.2-fold risk, respectively, independently of each other. The patients with intermediate and high exercise test risk score had 11.1-fold (95% confidence interval 2.4 to 51.1, p = 0.002) and 25.4-fold (95% confidence interval 5.5 to 116.8, p <0.001) adjusted risk for the primary end point in comparison with the low-risk group, respectively. The addition of this risk score to the established risk model enhanced discrimination by integrated discrimination index and reclassification by categorical and continuous net reclassification index (p <0.001 for all). In conclusion, the composite index of EC and heart rate responses to exercise and recovery is a powerful predictor of short-term outcome in patients with stable CAD.
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Affiliation(s)
- Antti M Kiviniemi
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland.
| | - Samuli Lepojärvi
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Tuomas V Kenttä
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - M Juhani Junttila
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Juha S Perkiömäki
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Olli-Pekka Piira
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Olavi Ukkola
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Arto J Hautala
- Biomedical Engineering Research Group, Department of Computer Science and Engineering, University of Oulu, Oulu, Finland
| | - Mikko P Tulppo
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland; Department of Applied Sciences, London South Bank University, London, United Kingdom
| | - Heikki V Huikuri
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
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Pekkanen MP, Ukkola O, Hedberg P, Piira OP, Lepojärvi S, Lumme J, Tulppo MP, Huikuri HV. Serum 25-hydroxyvitamin D is associated with major cardiovascular risk factors and cardiac structure and function in patients with coronary artery disease. Nutr Metab Cardiovasc Dis 2015; 25:471-478. [PMID: 25816731 DOI: 10.1016/j.numecd.2015.02.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [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: 10/06/2014] [Revised: 02/03/2015] [Accepted: 02/17/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS Vitamin D deficiency has been associated with increased risk for cardiovascular (CV) disease, but the possible effects of Vitamin D on cardiac structure and function are not well characterized. METHODS AND RESULTS The correlation between 25-hydroxyvitamin D levels and metabolic and cardiac echocardiographic parameters was studied in ARTEMIS study population including 831diabetic and 659 non-diabetic patients with stable coronary artery disease (CAD). Low levels of Vitamin D were associated with high BMI (p < 0.001), high total and LDL cholesterol and triglyceride levels (p < 0.001 for all) in both diabetics and non-diabetics. Among non-diabetic patients, low Vitamin D was also associated independently with elevated systolic and diastolic blood pressure (p < 0.005). Low Vitamin D levels were independently associated with reduced left ventricular (LV) ejection fraction (p < 0.005) and increased left atrial diameter (p < 0.03) measured by cardiac ultrasound by 2-dimensional echo. In the non-diabetic group, low Vitamin D levels were associated with impaired LV filling (high E/E') (p < 0.03) and low E/A mitral flow pattern measured by Doppler echocardiography (p < 0.05). Among diabetics, low Vitamin D levels were also related to increased LV end-systolic diameter (p < 0.05) and right ventricular diameter (p < 0.005). The association between LV diastolic filling (E/E') and Vitamin D levels was significant (p < 0.01) after adjustment for the commonly recognized risk factors of diastolic dysfunction in linear regression analysis. CONCLUSIONS Low Vitamin D is associated with several major cardiovascular risk factors and cardiac structural changes including impaired systolic and diastolic function, which together may explain the association of low Vitamin D to worse cardiovascular outcome.
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Affiliation(s)
- M P Pekkanen
- Institute of Clinical Medicine, Medical Research Center, Oulu University Hospital and University of Oulu, Finland
| | - O Ukkola
- Institute of Clinical Medicine, Medical Research Center, Oulu University Hospital and University of Oulu, Finland.
| | - P Hedberg
- NordLab Oulu, Oulu University Hospital and Department of Clinical Chemistry University of Oulu, Oulu, Finland
| | - O P Piira
- Institute of Clinical Medicine, Medical Research Center, Oulu University Hospital and University of Oulu, Finland
| | - S Lepojärvi
- Institute of Clinical Medicine, Medical Research Center, Oulu University Hospital and University of Oulu, Finland
| | - J Lumme
- Institute of Clinical Medicine, Medical Research Center, Oulu University Hospital and University of Oulu, Finland
| | - M P Tulppo
- Department of Exercise and Medical Physiology, Verve Research, Oulu, Finland; Department of Applied Sciences, London South Bank University, London, UK
| | - H V Huikuri
- Institute of Clinical Medicine, Medical Research Center, Oulu University Hospital and University of Oulu, Finland
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Karjalainen JJ, Kiviniemi AM, Hautala AJ, Piira OP, Lepojärvi ES, Perkiömäki JS, Junttila MJ, Huikuri HV, Tulppo MP. Effects of physical activity and exercise training on cardiovascular risk in coronary artery disease patients with and without type 2 diabetes. Diabetes Care 2015; 38:706-15. [PMID: 25592198 DOI: 10.2337/dc14-2216] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Leisure-time physical activity (LTPA) and exercise training are essential parts of current guidelines for patients with coronary artery disease (CAD). However, the contributions of LTPA and exercise training to cardiovascular (CV) risk in CAD patients with type 2 diabetes (T2D) are not well established. RESEARCH DESIGN AND METHODS We examined the effects of LTPA (n = 539 and n = 507; with and without T2D, respectively) and 2-year controlled, home-based exercise training (n = 63 plus 64 control subjects with T2D and n = 72 plus 68 control subjects without T2D) on the CV risk profile and composite end point among CAD patients. RESULTS During the 2-year follow-up, patients with reduced LTPA at baseline had an increased risk of CV events (adjusted hazard ratio 2.3 [95% CI 1.1-5.1; P = 0.033], 2.1 [1.1-4.2; P = 0.027], and 2.0 [1.0-3.9; P = 0.044] for no LTPA, LTPA irregularly, and LTPA two to three times weekly, respectively) compared with those with LTPA more than three times weekly. Among patients who completed the 2-year exercise intervention, exercise training resulted in favorable changes in exercise capacity both in CAD patients with T2D (+0.2 ± 0.8 vs. -0.1 ± 0.8 MET, P = 0.030) and without T2D (+0.3 ± 0.7 vs. -0.1 ± 0.5 MET, P = 0.002) as compared with the control group but did not have any significant effects on major metabolic or autonomic nervous system risk factors in CAD patients with or without T2D. CONCLUSIONS There is an inverse association between habitual LTPA and short-term CV outcome, but controlled, home-based exercise training has only minor effects on the CV risk profile in CAD patients with T2D.
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Affiliation(s)
- Jaana J Karjalainen
- Department of Exercise and Medical Physiology, Verve Research, Oulu, Finland Medical Research Center, University of Oulu and University Central Hospital, Oulu, Finland
| | - Antti M Kiviniemi
- Department of Exercise and Medical Physiology, Verve Research, Oulu, Finland
| | - Arto J Hautala
- Department of Exercise and Medical Physiology, Verve Research, Oulu, Finland
| | - Olli-Pekka Piira
- Medical Research Center, University of Oulu and University Central Hospital, Oulu, Finland
| | - E Samuli Lepojärvi
- Medical Research Center, University of Oulu and University Central Hospital, Oulu, Finland
| | - Juha S Perkiömäki
- Medical Research Center, University of Oulu and University Central Hospital, Oulu, Finland
| | - M Juhani Junttila
- Medical Research Center, University of Oulu and University Central Hospital, Oulu, Finland
| | - Heikki V Huikuri
- Medical Research Center, University of Oulu and University Central Hospital, Oulu, Finland
| | - Mikko P Tulppo
- Department of Exercise and Medical Physiology, Verve Research, Oulu, Finland Medical Research Center, University of Oulu and University Central Hospital, Oulu, Finland Department of Applied Sciences, London South Bank University, London, U.K.
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Kiviniemi AM, Hautala AJ, Karjalainen JJ, Piira OP, Lepojärvi S, Ukkola O, Huikuri HV, Tulppo MP. Acute post-exercise change in blood pressure and exercise training response in patients with coronary artery disease. Front Physiol 2015; 5:526. [PMID: 25628572 PMCID: PMC4290526 DOI: 10.3389/fphys.2014.00526] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 11/19/2014] [Accepted: 12/22/2014] [Indexed: 11/13/2022] Open
Abstract
We tested the hypothesis that acute post-exercise change in blood pressure (BP) may predict exercise training responses in BP in patients with coronary artery disease (CAD). Patients with CAD (n = 116, age 62 ± 5 years, 85 men) underwent BP assessments at rest and during 10-min recovery following a symptom-limited exercise test before and after the 6-month training intervention (one strength and 3-4 aerobic moderate-intensity exercises weekly). Post-exercise change in systolic BP (SBP) was calculated by subtracting resting SBP from lowest post-exercise SBP. The training-induced change in resting SBP was -2 ± 13 mmHg (p = 0.064), ranging from -42 to 35 mmHg. Larger post-exercise decrease in SBP and baseline resting SBP predicted a larger training-induced decrement in SBP (β = 0.46 and β = -0.44, respectively, p < 0.001 for both). Acute post-exercise decrease in SBP provided additive value to baseline resting SBP in the prediction of training-induced change in resting SBP (R(2) from 0.20 to 0.26, p = 0.002). After further adjustments for other potential confounders (sex, age, baseline body mass index, realized training load), post-exercise decrease in SBP still predicted the training response in resting SBP (β = 0.26, p = 0.015). Acute post-exercise change in SBP was associated with training-induced change in resting SBP in patients with CAD, providing significant predictive information beyond baseline resting SBP.
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Affiliation(s)
- Antti M Kiviniemi
- Department of Exercise and Medical Physiology, Verve Research Oulu, Finland ; Medical Research Center, University of Oulu, Oulu University Hospital Oulu, Finland
| | - Arto J Hautala
- Department of Exercise and Medical Physiology, Verve Research Oulu, Finland
| | - Jaana J Karjalainen
- Medical Research Center, University of Oulu, Oulu University Hospital Oulu, Finland
| | - Olli-Pekka Piira
- Medical Research Center, University of Oulu, Oulu University Hospital Oulu, Finland
| | - Samuli Lepojärvi
- Medical Research Center, University of Oulu, Oulu University Hospital Oulu, Finland
| | - Olavi Ukkola
- Medical Research Center, University of Oulu, Oulu University Hospital Oulu, Finland
| | - Heikki V Huikuri
- Medical Research Center, University of Oulu, Oulu University Hospital Oulu, Finland
| | - Mikko P Tulppo
- Department of Exercise and Medical Physiology, Verve Research Oulu, Finland ; Department of Applied Sciences, London South Bank University London, UK
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Kiviniemi AM, Hintsala H, Hautala AJ, Ikäheimo TM, Jaakkola JJ, Tiinanen S, Seppänen T, Tulppo MP. Impact and management of physiological calibration in spectral analysis of blood pressure variability. Front Physiol 2014; 5:473. [PMID: 25520670 PMCID: PMC4253737 DOI: 10.3389/fphys.2014.00473] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 08/22/2014] [Accepted: 11/17/2014] [Indexed: 11/17/2022] Open
Abstract
Physiological calibration (Physiocal) improves the quality of continuous blood pressure (BP) signal from finger. However, the effects of Physiocal on spectral characteristics of systolic BP (SBP) variability are not well-known. We tested the hypothesis that the use of Physiocal may alter the results on SBP variability when compared with BP recording without Physiocal. Continuous BP was recorded simultaneously from fingers of both arms during 10-min standing by two Nexfin devices, one with (ON) and the other without (OFF) Physiocal (n = 19). Missing SBP values in ON signal were linearly interpolated over Physiocal sequences (ONinter). The OFF signal was analyzed without any corrections (OFFreference) and after linear interpolation of corresponding sequences when Physiocal appeared in the ON signal (OFFinter). Mean low frequency power of SBP oscillations (LFSBP, 0.04–0.15 Hz) did not differ between the OFFreference, OFFinter, and ONinter. However, LFSBP deviated more from OFFreference when analyzed from ONinter compared with the analysis from OFFinter [median (interquartile range): 14.7 (4.6–38.6) vs. 0.9 (0.5–1.8) %, p < 0.05]. In conclusion, the use of Physiocal had a significant effect on the spectral SBP variability that overwhelms the impact of linear interpolation of short data sequences. Therefore, caution is needed when comparing SBP variability between BP datasets acquired with and without Physiocal.
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Affiliation(s)
- Antti M Kiviniemi
- Department of Exercise and Medical Physiology, Verve Research Oulu, Finland
| | - Heidi Hintsala
- Center for Environmental and Respiratory Health Research, University of Oulu Oulu, Finland ; Medical Research Center, University of Oulu Oulu, Finland
| | - Arto J Hautala
- Department of Exercise and Medical Physiology, Verve Research Oulu, Finland
| | - Tiina M Ikäheimo
- Center for Environmental and Respiratory Health Research, University of Oulu Oulu, Finland ; Medical Research Center, University of Oulu Oulu, Finland ; Institute of Health Sciences, University of Oulu Oulu, Finland
| | - Jouni J Jaakkola
- Center for Environmental and Respiratory Health Research, University of Oulu Oulu, Finland ; Medical Research Center, University of Oulu Oulu, Finland ; Institute of Health Sciences, University of Oulu Oulu, Finland
| | - Suvi Tiinanen
- Department of Computer Science and Engineering, University of Oulu Oulu, Finland
| | - Tapio Seppänen
- Department of Computer Science and Engineering, University of Oulu Oulu, Finland
| | - Mikko P Tulppo
- Department of Exercise and Medical Physiology, Verve Research Oulu, Finland ; Department of Applied Sciences, London South Bank University London, UK
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Stuckey MI, Tulppo MP, Kiviniemi AM, Petrella RJ. Heart rate variability and the metabolic syndrome: a systematic review of the literature. Diabetes Metab Res Rev 2014; 30:784-93. [PMID: 24816921 DOI: 10.1002/dmrr.2555] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 04/02/2014] [Accepted: 04/18/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND A number of cross-sectional studies have examined associations between heart rate variability and metabolic syndrome, but differences in study populations, data collection and analysis methodologies make synthesis difficult. The purpose of this study was to systematically review published primary research examining associations between heart rate variability and metabolic syndrome or its individual risk factors. METHODS A systematic literature search of PubMed and EMBASE was conducted to identify relevant articles published from January 1999 to December 2012. Studies were included if they examined associations between heart rate variability analysed by standard protocols and metabolic syndrome risk factors according to published definitions. All papers were scored with a modified Downs and Black instrument, and data were extracted. RESULTS Fourteen studies were included. Heart rate variability generally was reduced in women with metabolic syndrome compared to those without, while results in men were inconsistent. Time and frequency domain heart rate variability parameters were associated with individual metabolic syndrome risk factors, though sex differences exist. Only two studies considered nonlinear and Poincaré plot heart rate variability parameters, which were reduced in metabolic syndrome. CONCLUSIONS Heart rate variability is altered differently in men and women with metabolic syndrome. Future studies should follow consistent heart rate variability analysis protocols and metabolic syndrome definitions and include more comprehensive analyses to investigate potential mechanisms.
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Affiliation(s)
- Melanie I Stuckey
- School of Kinesiology, The University of Western Ontario, London, ON, Canada; Aging, Rehabilitation and Geriatric Care Research Centre, Lawson Health Research Institute, London, ON, Canada
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Kenttä T, Tulppo MP, Nearing BD, Karjalainen JJ, Hautala AJ, Kiviniemi AM, Huikuri HV, Verrier RL. Effects of exercise rehabilitation on cardiac electrical instability assessed by T-wave alternans during ambulatory electrocardiogram monitoring in coronary artery disease patients without and with diabetes mellitus. Am J Cardiol 2014; 114:832-7. [PMID: 25107578 DOI: 10.1016/j.amjcard.2014.06.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 06/25/2014] [Accepted: 06/25/2014] [Indexed: 10/25/2022]
Abstract
Effects of exercise rehabilitation on electrocardiographic markers of risk for sudden cardiac death have not been adequately studied. We examined effects of controlled exercise training on T-wave alternans (TWA) in 24-hour ambulatory electrocardiogram recordings in patients with stable coronary artery disease (CAD) without and with type 2 diabetes mellitus (DM). Consecutive patients with angiographically confirmed CAD were recruited to join the ARTEMIS (Innovation to Reduce Cardiovascular Complications of Diabetes at the Intersection) study. Exercise (n = 65) and control groups (n = 65) were matched on age, sex, DM, and previous myocardial infarction. Ambulatory electrocardiograms were recorded before and after a 2-year training period. TWA was assessed using time domain-modified moving average method by an investigator blinded to patients' clinical status. Average TWA values decreased in the rehabilitation group but not in control patients (rehabilitation [mean ± SEM]: 52.8 ± 1.7 μV vs 48.7 ± 1.5 μV, p <0.001; control: 53.7 ± 1.7 μV vs 54.3 ± 1.6 μV, p = 0.746). Changes in TWA differed between the groups (rehabilitation: -4.1 ± 1.2 μV vs controls: +0.6 ± 1.1 μV, p = 0.005). In CAD + DM patients, 50% (n = 9) of the 18 positive TWA cases were converted with exercise versus 10% (n = 2 of 20) of controls (p = 0.020). In CAD patients, 30% (n = 8 of 27) of positive TWA cases were converted with exercise versus 4% (n = 1 of 28) of controls (p = 0.012). In conclusion, this is the first report of the effectiveness of exercise rehabilitation to reduce TWA, a marker of sudden cardiac death risk, in patients with stable CAD.
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Kiviniemi AM, Tulppo MP, Hautala AJ, Perkiömäki JS, Ylitalo A, Kesäniemi YA, Ukkola O, Huikuri HV. Prognostic significance of impaired baroreflex sensitivity assessed from Phase IV of the Valsalva maneuver in a population-based sample of middle-aged subjects. Am J Cardiol 2014; 114:571-6. [PMID: 25015692 DOI: 10.1016/j.amjcard.2014.05.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 05/27/2014] [Accepted: 05/27/2014] [Indexed: 11/18/2022]
Abstract
Depressed baroreflex sensitivity (BRS) is associated with an increased risk of mortality in patients with a known cardiac disease. The prognostic significance of BRS in subjects without history of major cardiovascular (CV) events is unknown. The present study tested the hypothesis that impaired BRS predicts the CV mortality in a population-based sample of middle-aged subjects. The present study is a part of the Oulu Project Elucidating Risk of Atherosclerosis study, where middle-aged hypertensive and age- and gender-matched control subjects were randomly selected. Along with clinical and laboratory assessments, BRS was measured from the blood pressure overshoot of Valsalva maneuver in 559 subjects (age 51 ± 6 years; 300 men). The causes of death (n = 72) were registered during a follow-up of up to 19 years. CV death (n = 23) was defined as the primary end point. CV death was predicted by smoking status, alcohol consumption, high-sensitivity C-reactive protein, use of diuretics, waist circumference, and fasting glucose. Among all measured risk factors, impaired Valsalva BRS (<3 ms/mm Hg) was the most potent predictor of CV death (hazard ratio 9.1, 95% confidence interval 3.8 to 21.7, p <0.001) and remained so after adjustments for the other significant predictors (hazard ratio 5.3, 95% confidence interval 2.1 to 13.3, p <0.001). In conclusion, impaired Valsalva BRS is a potent and independent predictor of CV death in a population-based sample of middle-aged subjects without history of major CV complications and may have important clinical implications in early risk stratification.
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Affiliation(s)
- Antti M Kiviniemi
- Department of Exercise and Medical Physiology, Verve Research, Oulu, Finland.
| | - Mikko P Tulppo
- Department of Exercise and Medical Physiology, Verve Research, Oulu, Finland; Department of Applied Sciences, London South Bank University, London, United Kingdom
| | - Arto J Hautala
- Department of Exercise and Medical Physiology, Verve Research, Oulu, Finland
| | - Juha S Perkiömäki
- Institute of Clinical Medicine, Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Antti Ylitalo
- Institute of Clinical Medicine, Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Y Antero Kesäniemi
- Institute of Clinical Medicine, Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Olavi Ukkola
- Institute of Clinical Medicine, Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Heikki V Huikuri
- Institute of Clinical Medicine, Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
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Tulppo MP, Piira OP, Hautala AJ, Kiviniemi AM, Miettinen JA, Huikuri HV. Exercise capacity is associated with endothelin-1 release during emotional excitement in coronary artery disease patients. Am J Physiol Heart Circ Physiol 2014; 307:H391-6. [PMID: 24878772 DOI: 10.1152/ajpheart.00902.2013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 01/18/2023]
Abstract
Endothelin-1 (ET-1), a potent vasoconstrictor, IL-6, and catecholamines are increased and heart rate variability [SD of normal to normal R-R intervals (SDNN)] decreased during emotional excitement, but individual responses vary. We tested the hypothesis that exercise capacity is associated with physiological responses caused by real-life emotional excitement. We measured the plasma levels of ET-1, IL-6, catecholamines, heart rate, and SDNN in enthusiastic male ice hockey spectators (n = 51; age, 59 ± 9 years) with stable coronary artery disease (CAD) at baseline and during the Finnish National Ice Hockey League's final play-off matches. Maximal exercise capacity (METs) by bicycle exercise test and left ventricular ejection fraction (LVEF) were measured on a separate day. ET-1 response from baseline to emotional excitement correlated with maximal METs (r = -0.30; P = 0.040). In a linear stepwise regression analysis age, body mass index (BMI), METs, LVEF, basal ET-1, and subjective experience of excitement were entered the model as independent variables to explain ET-1 response. This model explained 27% of ET-1 response (P = 0.003). Maximal METs were most strongly correlated with ET-1 response (β = -0.45; partial correlation r = -0.43; P = 0.002), followed by BMI (β = -0.31; partial correlation r = -0.31; P = 0.033) and LVEF (β = -0.30; partial correlation r = -0.33; P = 0.023). Exercise capacity may protect against further cardiovascular events in CAD patients, because it is associated with reduced ET-1 release during emotional excitement.
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Affiliation(s)
- Mikko P Tulppo
- Institute of Clinical Medicine, Department of Internal Medicine, University of Oulu, Finland; Department of Exercise and Medical Physiology, Verve Research, Verve, Oulu, Finland; and Department of Applied Sciences, London South Bank University, London, UK
| | - Olli-Pekka Piira
- Institute of Clinical Medicine, Department of Internal Medicine, University of Oulu, Finland
| | - Arto J Hautala
- Department of Exercise and Medical Physiology, Verve Research, Verve, Oulu, Finland; and
| | - Antti M Kiviniemi
- Institute of Clinical Medicine, Department of Internal Medicine, University of Oulu, Finland; Department of Exercise and Medical Physiology, Verve Research, Verve, Oulu, Finland; and
| | - Johanna A Miettinen
- Institute of Clinical Medicine, Department of Internal Medicine, University of Oulu, Finland
| | - Heikki V Huikuri
- Institute of Clinical Medicine, Department of Internal Medicine, University of Oulu, Finland
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Tulppo MP, Jurvelin H, Roivainen E, Nissilä J, Hautala AJ, Kiviniemi AM, Kiviniemi VJ, Takala T. Effects of bright light treatment on psychomotor speed in athletes. Front Physiol 2014; 5:184. [PMID: 24860513 PMCID: PMC4026757 DOI: 10.3389/fphys.2014.00184] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 02/18/2014] [Accepted: 04/23/2014] [Indexed: 11/13/2022] Open
Abstract
Purpose: A recent study suggests that transcranial brain targeted light treatment via ear canals may have physiological effects on brain function studied by functional magnetic resonance imaging (fMRI) techniques in humans. We tested the hypothesis that bright light treatment could improve psychomotor speed in professional ice hockey players. Methods: Psychomotor speed tests with audio and visual warning signals were administered to a Finnish National Ice Hockey League team before and after 24 days of transcranial bright light or sham treatment. The treatments were given during seasonal darkness in the Oulu region (latitude 65 degrees north) when the strain on the players was also very high (10 matches during 24 days). A daily 12-min dose of bright light or sham (n = 11 for both) treatment was given every morning between 8 and 12 am at home with a transcranial bright light device. Mean reaction time and motor time were analyzed separately for both psychomotor tests. Analysis of variance for repeated measures adjusted for age was performed. Results: Time × group interaction for motor time with a visual warning signal was p = 0.024 after adjustment for age. In Bonferroni post-hoc analysis, motor time with a visual warning signal decreased in the bright light treatment group from 127 ± 43 to 94 ± 26 ms (p = 0.024) but did not change significantly in the sham group 121 ± 23 vs. 110 ± 32 ms (p = 0.308). Reaction time with a visual signal did not change in either group. Reaction or motor time with an audio warning signal did not change in either the treatment or sham group. Conclusion: Psychomotor speed, particularly motor time with a visual warning signal, improves after transcranial bright light treatment in professional ice-hockey players during the competition season in the dark time of the year.
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Affiliation(s)
- Mikko P Tulppo
- Department of Exercise and Medical Physiology Verve, Oulu, Finland
| | - Heidi Jurvelin
- Department of General Practice, Institute of Health Sciences, University of Oulu Oulu, Finland
| | - Eka Roivainen
- Department of Exercise and Medical Physiology Verve, Oulu, Finland
| | - Juuso Nissilä
- Department of Biology, University of Oulu Oulu, Finland
| | - Arto J Hautala
- Department of Exercise and Medical Physiology Verve, Oulu, Finland
| | | | - Vesa J Kiviniemi
- Department of Diagnostic Radiology, University of Oulu Oulu, Finland
| | - Timo Takala
- Department of Sports and Exercise Medicine, Oulu Deaconess Institute Oulu, Finland
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Kiviniemi AM, Hautala AJ, Karjalainen JJ, Piira OP, Lepojärvi S, Tiinanen S, Seppänen T, Ukkola O, Huikuri HV, Tulppo MP. Impact of type 2 diabetes on cardiac autonomic responses to sympathetic stimuli in patients with coronary artery disease. Auton Neurosci 2013; 179:142-7. [DOI: 10.1016/j.autneu.2013.08.068] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 06/22/2013] [Accepted: 08/22/2013] [Indexed: 01/02/2023]
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48
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Piira OP, Miettinen JA, Hautala AJ, Huikuri HV, Tulppo MP. Physiological responses to emotional excitement in healthy subjects and patients with coronary artery disease. Auton Neurosci 2013; 177:280-5. [DOI: 10.1016/j.autneu.2013.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 05/30/2013] [Accepted: 06/05/2013] [Indexed: 01/20/2023]
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Kiviniemi AM, Tulppo MP, Hautala AJ, Vanninen E, Uusitalo ALT. Altered relationship between R-R interval and R-R interval variability in endurance athletes with overtraining syndrome. Scand J Med Sci Sports 2013; 24:e77-85. [PMID: 24024550 DOI: 10.1111/sms.12114] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2013] [Indexed: 12/29/2022]
Abstract
Autonomic dysfunction decreases within-subject correlation between R-R interval length (RRi) and vagally mediated RRi variability in cardiac disease. We tested the hypothesis that overtraining syndrome (OTS) may also weaken this relationship. Nine OTS and 10 control endurance athletes underwent 24-h electrocardiogram monitoring, which was repeated in eight OTS and nine control athletes after 6 months, when two OTS athletes still had symptoms of OTS. The power of high-frequency (HF) oscillations of RRi was analyzed in 5-min epochs over the whole recording. Quadratic regression was performed between 5-min values of RRi and log-transformed (ln) HF to obtain R(2) for each recording. The relationship between RRi and HFln was higher in the OTS athletes than controls [R(2): 0.87 (90% confidence interval, CI: 0.84-0.89) vs 0.78 (90% CI: 0.72-0.84); P = 0.034; effect size = 1.22]. Large decrease in R(2) was observed in six recovered OTS athletes after 6 months follow-up [ΔR(2): -0.12 (90% CI: -0.25-0.01); P = 0.11; effect size = 1.44] with no changes in the controls. Mean values of RRi and its variability did not differ between the groups. The within-subject correlation between RRi and vagally mediated RRi variability was stronger in endurance athletes with OTS compared with controls. The present findings may improve the detection of OTS and recovery from OTS in endurance athletes.
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Affiliation(s)
- A M Kiviniemi
- Department of Exercise and Medical Physiology, Verve Research, Oulu, Finland
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Hautala AJ, Kiviniemi AM, Karjalainen JJ, Piira OP, Lepojärvi S, Mäkikallio T, Huikuri HV, Tulppo MP. Peak exercise capacity prediction from a submaximal exercise test in coronary artery disease patients. Front Physiol 2013; 4:243. [PMID: 24027537 PMCID: PMC3761155 DOI: 10.3389/fphys.2013.00243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 06/20/2013] [Accepted: 08/15/2013] [Indexed: 12/21/2022] Open
Abstract
The purpose of this study was to determine whether a rating of perceived exertion scale (RPE) obtained during submaximal exercise could be used to predict peak exercise capacity (METpeak) in coronary artery disease (CAD) patients. Angiographically documented CAD patients (n = 124, 87% on β blockade) completed a symptom-limited peak exercise test on a bicycle ergometer, reporting RPE values at every second load on a scale of 6–20. Regression analysis was used to develop equations for predicting METpeak. We found that submaximal METs at a workload of 60/75 W (for women and men, respectively) and the corresponding RPE (METs/RPE ratio) was the most powerful predictor of METpeak (r = 0.67, p < 0.0001). The final model included the submaximal METs/RPE ratio, body mass index (BMI), sex, resting heart rate, smoking history, age, and use of a β blockade (r = 0.86, p < 0.0001, SEE 0.98 METs). These data suggest that RPE at submaximal exercise intensity is related to METpeak in CAD patients. The model based on easily measured variables at rest and during “warm-up” exercise can reasonably predict absolute METpeak in patients with CAD.
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Affiliation(s)
- Arto J Hautala
- Department of Exercise and Medical Physiology, Verve Research Oulu, Finland
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