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Arriola-Montenegro J, Mutirangura P, Akram H, Tsangaris A, Koukousaki D, Tschida M, Money J, Kosmopoulos M, Harata M, Hughes A, Toth A, Alexy T. Noninvasive biometric monitoring technologies for patients with heart failure. Heart Fail Rev 2024:10.1007/s10741-024-10441-7. [PMID: 39436486 DOI: 10.1007/s10741-024-10441-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2024] [Indexed: 10/23/2024]
Abstract
Heart failure remains one of the leading causes of mortality and hospitalizations in the US that not only impacts quality of life but also poses a significant public health burden. The majority of affected patients are admitted with signs and symptoms of congestion. Despite the initial enthusiasm, traditional remote monitoring strategies focusing primarily on weight gain failed to improve clinical outcomes. Implantable pulmonary artery pressure sensors provide earlier and actionable data, but most patients would favor forgoing an invasive procedure in favor of an alternative, non-invasive monitoring platform. Several devices utilizing different combinations of multiparameter monitoring to reliably detect congestion have recently been developed and are undergoing testing in the clinical setting. Combining these sensors with the power of artificial intelligence and machine learning has the potential to revolutionize remote patient monitoring and early congestion detection and to facilitate timely interventions by the care team to prevent hospitalization. This manuscript provides an objective review of novel, noninvasive, multiparameter remote monitoring platforms that may be tailored to individual heart failure phenotypes, aiming to improve quality of life and survival.
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Affiliation(s)
| | | | - Hassan Akram
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Adamantios Tsangaris
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN, 55127, USA
| | - Despoina Koukousaki
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN, 55127, USA
| | | | - Joel Money
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN, 55127, USA
| | | | - Mikako Harata
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Andrew Hughes
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN, 55127, USA
| | - Andras Toth
- Department of Medical Imaging, University of Pecs, Pecs, Hungary
| | - Tamas Alexy
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN, 55127, USA.
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Gomes BFDO, Benchimol-Barbosa PR, Nadal J. Predictive Model of All-Cause Death in Patients with Heart Failure using Heart Rate Variability. Arq Bras Cardiol 2023; 120:e20220379. [PMID: 38126484 PMCID: PMC10763696 DOI: 10.36660/abc.20220379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/31/2023] [Accepted: 09/13/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Central Illustration : Predictive Model of All-Cause Death in Patients with Heart Failure using Heart Rate Variability. BACKGROUND Short and long-duration heart rate variability (HRV) data from Holter monitoring could identify predictors of all-cause death in heart failure (HF) patients. OBJECTIVES To build a predictive model of all-cause death in patients with HF using HRV. METHODS Retrospective study including patients with suspected or confirmed HF who were admitted for decompensated HF or syncope that underwent Holter monitoring. In analysis of augmented sympathetic tonus, we evaluated the lowest HRV in nonoverlapping 10-minutes periods throughout 24h continuous electrocardiographic signal recording (short HRV variables). Variables with p<0.01 were included in a multivariate Cox regression model to determine the occurrence of the all-cause death. Variables with statistical significance in Cox regression were chosen to build the predictive model. P<0.05 was considered significant. RESULTS A total of 116 patients were included, mean age of 71.9±16.3 years, 45.7% men, mean follow-up of 2.83±1.27 years. Thirty-nine deaths occurred (33.6%). By comparing survivors vs. non-survivors, the variables that showed statistical significance were lowest SDNN, lowest rMSSD, age and left ventricular ejection fraction (LVEF). In Cox regression, independent predictors of all-cause death were: age>69 years (HR 3.95, 95%CI 1.64-9.52); LVEF≤57% (HR 4.70, 95%CI 2.38-9.28) and lowest rMSSD≤12ms (HR 5.54, 95%CI 2.04-15.08). An integer value was assigned to each variable. Score<3 showed AUC=0.802 (95%CI 0.72-0.87). CONCLUSION In HF patients hospitalized for decompensated HF or syncope, independent long-term predictors of all-cause death were age, LVEF, and 10-minutes rMSSD. These findings indicate that even brief moments of high sympathetic tone can impact survival, specifically in the elderly and patients with HF with reduced ejection fraction.
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Affiliation(s)
- Bruno Ferraz de Oliveira Gomes
- Hospital Barra D’OrRio de JaneiroRJBrasil Hospital Barra D’Or , Rio de Janeiro , RJ – Brasil
- Universidade Federal do Rio de JaneiroRio de JaneiroRJBrasil Universidade Federal do Rio de Janeiro , Rio de Janeiro , RJ – Brasil
| | - Paulo Roberto Benchimol-Barbosa
- Universidade do Estado do Rio de JaneiroHospital Universitário Pedro ErnestoCoordenação de Medicina ClínicaRio de JaneiroRJBrasil Universidade do Estado do Rio de Janeiro , Hospital Universitário Pedro Ernesto – Coordenação de Medicina Clínica , Rio de Janeiro , RJ – Brasil
- Universidade Federal do Rio de JaneiroInstituto Alberto Luiz Coimbra de Pós-graduação e Pesquisa de EngenhariaPrograma de Engenharia BiomédicaRio de JaneiroRJBrasil Universidade Federal do Rio de Janeiro Instituto Alberto Luiz Coimbra de Pós-graduação e Pesquisa de Engenharia – Programa de Engenharia Biomédica , Rio de Janeiro , RJ – Brasil
| | - Jurandir Nadal
- Universidade Federal do Rio de JaneiroInstituto Alberto Luiz Coimbra de Pós-graduação e Pesquisa de EngenhariaPrograma de Engenharia BiomédicaRio de JaneiroRJBrasil Universidade Federal do Rio de Janeiro Instituto Alberto Luiz Coimbra de Pós-graduação e Pesquisa de Engenharia – Programa de Engenharia Biomédica , Rio de Janeiro , RJ – Brasil
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Costa T, Bagnall A, Murray S, Bailey K, MacGowan G, Ng WF, McKinnon I, Watson S, McAllister-Williams RH. Role of autonomic dysregulation in quality of life and functional impairment in implantable cardioverter defibrillator patients. J Psychosom Res 2023; 171:111390. [PMID: 37270908 DOI: 10.1016/j.jpsychores.2023.111390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/26/2023] [Accepted: 05/27/2023] [Indexed: 06/06/2023]
Affiliation(s)
- Tiago Costa
- Translational and Clinical Research Institute, Faculty of Medical Sciences, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, United Kingdom; Northern Centre for Mood Disorders, Wolfson Research Centre, Newcastle University, Newcastle upon Tyne NE4 5PL, United Kingdom; Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, St. Nicholas Hospital, Jubilee Road, Gosforth, Newcastle upon Tyne NE3 3XT, United Kingdom.
| | - Alan Bagnall
- Newcastle Cardiovascular Trials and Research, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cardiovascular Research, Room 122F, Education Centre, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom; Department of Cardiology, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom; Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Catherine Cookson Building, Newcastle upon Tyne NE2 4HH, United Kingdom
| | - Stephen Murray
- Newcastle Cardiovascular Trials and Research, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cardiovascular Research, Room 122F, Education Centre, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom; Department of Cardiology, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom
| | - Kristian Bailey
- Newcastle Cardiovascular Trials and Research, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cardiovascular Research, Room 122F, Education Centre, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom; Department of Cardiology, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom
| | - Guy MacGowan
- Newcastle Cardiovascular Trials and Research, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cardiovascular Research, Room 122F, Education Centre, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom; Department of Cardiology, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom; Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Catherine Cookson Building, Newcastle upon Tyne NE2 4HH, United Kingdom
| | - Wan-Fai Ng
- Translational and Clinical Research Institute, Faculty of Medical Sciences, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, United Kingdom; Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Catherine Cookson Building, Newcastle upon Tyne NE2 4HH, United Kingdom; NIHR Newcastle Biomedical Research Centre and NIHR Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne NE4 5PL, United Kingdom
| | - Iain McKinnon
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, St. Nicholas Hospital, Jubilee Road, Gosforth, Newcastle upon Tyne NE3 3XT, United Kingdom; Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne NE2 4AX, United Kingdom
| | - Stuart Watson
- Translational and Clinical Research Institute, Faculty of Medical Sciences, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, United Kingdom; Northern Centre for Mood Disorders, Wolfson Research Centre, Newcastle University, Newcastle upon Tyne NE4 5PL, United Kingdom; Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, St. Nicholas Hospital, Jubilee Road, Gosforth, Newcastle upon Tyne NE3 3XT, United Kingdom
| | - R Hamish McAllister-Williams
- Translational and Clinical Research Institute, Faculty of Medical Sciences, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, United Kingdom; Northern Centre for Mood Disorders, Wolfson Research Centre, Newcastle University, Newcastle upon Tyne NE4 5PL, United Kingdom; Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, St. Nicholas Hospital, Jubilee Road, Gosforth, Newcastle upon Tyne NE3 3XT, United Kingdom
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Berg SK, Herning M, Schjødt I, Thorup CB, Juul C, Svendsen JH, Jorgensen MB, Risom SS, Christensen SW, Thygesen L, Rasmussen TB. The heart & mind trial: intervention with cognitive-behavioural therapy in patients with cardiac disease and anxiety: randomised controlled trial protocol. BMJ Open 2021; 11:e057085. [PMID: 34862302 PMCID: PMC8647551 DOI: 10.1136/bmjopen-2021-057085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Patients with cardiac disease often experience anxiety (prevalence about 20%-25%) and have a doubled mortality risk when suffering from anxiety compared with patients without anxiety. This calls for interventions aiming to reduce anxiety. METHODS AND ANALYSIS The Heart & Mind Trial consists of three parts: (1) screening of all hospitalised and outpatient cardiac patients with arrhythmia, heart failure or ischaemic heart disease at four university hospitals in Denmark using the Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A); Patients scoring ≥8 is invited to participate; (2) Assessment of the type of anxiety by Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders and (3) Randomised clinical superiority trial with blinded outcome assessment, with 1:1 randomisation to cognitive-behavioural therapy (CBT) performed by a CBT-trained cardiac nurse plus usual care or, usual care alone. The primary outcome is anxiety measured with HADS-A at 5 months. Secondary outcomes include anxiety symptoms measured with Becks Anxiety Inventory and heart rate variability. Exploratory outcomes measured at 12 months include blood cortisol (stress response), blood C reactive protein (stress response), health-related quality of life, readmission, mortality and attributable direct costs. A total of 336 patients will be included. The primary analyses are based on the intention-to-treat principle. For the primary outcome, we will use a linear regression model. For the long-term outcomes, mixed regression models will be used including repeated measurements. ETHICS AND DISSEMINATION The trial is performed in accordance with the Declaration of Helsinki. All patients must give informed consent prior to participation and the trial is initiated after approval by the Danish Data Protection Agency (P-2020-894) and the National Committee on Health Research Ethics (H-20066739). Positive, neutral and negative results of the trial will be published. TRIAL REGISTRATION NUMBER NCT04582734.
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Affiliation(s)
- Selina Kikkenborg Berg
- The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen O, 2100, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, 2200, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen K, 1455, Denmark
| | - Margrethe Herning
- Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, 2900, Denmark
| | - Inge Schjødt
- Department of Cardiology, Aarhus University Hospital, Aarhus, 8200, Denmark
| | - Charlotte Brun Thorup
- Clinical Nursing Research Unit and Department of Cardiology, Aalborg University Hospital, Aalborg, 9000, Denmark
| | - Carsten Juul
- Psychological consulting, Heypeople, Copenhagen K, 1260, Denmark
| | - Jesper Hastrup Svendsen
- The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen O, 2100, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, 2200, Denmark
| | - Martin Balslev Jorgensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, 2200, Denmark
- Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen O, 2100, Denmark
| | - Signe Stelling Risom
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, 2200, Denmark
- Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, 2900, Denmark
- University College Copenhagen, Institute of Nursing and Nutrition, Copenhagen N, 2200, Denmark
| | - Signe Westh Christensen
- The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen O, 2100, Denmark
| | - Lau Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen K, 1455, Denmark
| | - Trine Bernholdt Rasmussen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, 2200, Denmark
- Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, 2900, Denmark
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Sharpe E, Lacombe A, Sadowski A, Phipps J, Heer R, Rajurkar S, Hanes D, Jindal RD, Bradley R. Investigating components of pranayama for effects on heart rate variability. J Psychosom Res 2021; 148:110569. [PMID: 34271528 PMCID: PMC8568305 DOI: 10.1016/j.jpsychores.2021.110569] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/02/2021] [Accepted: 07/04/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Traditional Indian breath control practices of Pranayama have been shown to increase indices of heart rate variability (HRV) that are generally held to reflect parasympathetic nervous system (PNS) tone. To our knowledge, individual components of pranayama have not been separately evaluated for impact on HRV. The objective of this study was to isolate five components of a pranayama practice and evaluate their impact on HRV. METHODS In a crossover clinical trial, 46 healthy adults were allocated to complete five activities in random order, over five separate visits: 1) sitting quietly; 2) self-paced deep breathing; 3) externally-paced deep breathing; 4) self-paced Sheetali/Sheetkari pranayama; and 5) externally paced Sheetali/Sheetkari pranayama RESULTS: Our final sample included 25 participants. There was a significant increase in a time-domain index of HRV, the root mean square successive differences between RR intervals (RMSSD), during the five interventions. The change in logRMSSD ranged from 0.2 to 0.5 (p < .01 in all conditions by paired t-test). Greater increases were evident during externally-paced breathing than during self-paced breathing (mean pre-during logRMSSD change of 0.50 vs. 0.36, p = .02) or sitting quietly (mean, 0.17 ms; p = .005 and 0.02 when comparing Activities 3 and 5 to Activity 1 by random intercept model with Tukey correction for multiple comparisons). Lastly, pre-during increase in RMSSD was greater for Sheetali/Sheetkari vs. deep breathing, when controlling for respiration rate, though not significantly different (p = .07 in random intercept model) CONCLUSIONS: RMSSD increased with paced breathing, deep breathing, and Sheetali/Sheetkari pranayama, reinforcing evidence of a physiologic mechanism of pranayama. TRIAL REGISTRATION NCT03280589 https://www.clinicaltrials.gov/ct2/show/NCT03280589?term=sheetali&draw=2&rank=1.
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Affiliation(s)
- Erica Sharpe
- National University of Natural Medicine, Portland, OR, United States of America; State University of New York at Canton, Canton, NY, United States of America.
| | - Alison Lacombe
- National University of Natural Medicine, Portland, OR,United States Department of Agriculture, Produce Safety Microbiology Research Unit, Albany, CA
| | - Adam Sadowski
- National University of Natural Medicine, Portland, OR, United States of America.
| | - John Phipps
- National University of Natural Medicine, Portland, OR, United States of America.
| | - Ryan Heer
- National University of Natural Medicine, Portland, OR
| | - Savita Rajurkar
- National University of Natural Medicine, Portland, OR, United States of America.
| | - Douglas Hanes
- National University of Natural Medicine, Portland, OR, United States of America.
| | - Ripu D Jindal
- Birmingham VA Medical Center, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Ryan Bradley
- National University of Natural Medicine, Portland, OR, United States of America; University of California, San Diego, La Jolla, CA, United States of America; Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.
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Faragli A, Abawi D, Quinn C, Cvetkovic M, Schlabs T, Tahirovic E, Düngen HD, Pieske B, Kelle S, Edelmann F, Alogna A. The role of non-invasive devices for the telemonitoring of heart failure patients. Heart Fail Rev 2021; 26:1063-1080. [PMID: 32338334 PMCID: PMC8310471 DOI: 10.1007/s10741-020-09963-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Heart failure (HF) patients represent one of the most prevalent as well as one of the most fragile population encountered in the cardiology and internal medicine departments nowadays. Estimated to account for around 26 million people worldwide, diagnosed patients present a poor prognosis and quality of life with a clinical history accompanied by repeated hospital admissions caused by an exacerbation of their chronic condition. The frequent hospitalizations and the extended hospital stays mean an extremely high economic burden for healthcare institutions. Meanwhile, the number of chronically diseased and elderly patients is continuously rising, and a lack of specialized physicians is evident. To cope with this health emergency, more efficient strategies for patient management, more accurate diagnostic tools, and more efficient preventive plans are needed. In recent years, telemonitoring has been introduced as the potential answer to solve such needs. Different methodologies and devices have been progressively investigated for effective home monitoring of cardiologic patients. Invasive hemodynamic devices, such as CardioMEMS™, have been demonstrated to be reducing hospitalizations and mortality, but their use is however restricted to limited cases. The role of external non-invasive devices for remote patient monitoring, instead, is yet to be clarified. In this review, we summarized the most relevant studies and devices that, by utilizing non-invasive telemonitoring, demonstrated whether beneficial effects in the management of HF patients were effective.
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Affiliation(s)
- A Faragli
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - D Abawi
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - C Quinn
- Department of Biological Sciences, Rensselaer Polytechnic Institute, 110 Eighth Street, Troy, NY, USA
| | - M Cvetkovic
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - T Schlabs
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - E Tahirovic
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - H-D Düngen
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - B Pieske
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - S Kelle
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - F Edelmann
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Alessio Alogna
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany.
- Berlin Institute of Health (BIH), Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
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Borovac JA, D'Amario D, Bozic J, Glavas D. Sympathetic nervous system activation and heart failure: Current state of evidence and the pathophysiology in the light of novel biomarkers. World J Cardiol 2020; 12:373-408. [PMID: 32879702 PMCID: PMC7439452 DOI: 10.4330/wjc.v12.i8.373] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/19/2020] [Accepted: 07/19/2020] [Indexed: 02/06/2023] Open
Abstract
Heart failure (HF) is a complex clinical syndrome characterized by the activation of at least several neurohumoral pathways that have a common role in maintaining cardiac output and adequate perfusion pressure of target organs and tissues. The sympathetic nervous system (SNS) is upregulated in HF as evident in dysfunctional baroreceptor and chemoreceptor reflexes, circulating and neuronal catecholamine spillover, attenuated parasympathetic response, and augmented sympathetic outflow to the heart, kidneys and skeletal muscles. When these sympathoexcitatory effects on the cardiovascular system are sustained chronically they initiate the vicious circle of HF progression and become associated with cardiomyocyte apoptosis, maladaptive ventricular and vascular remodeling, arrhythmogenesis, and poor prognosis in patients with HF. These detrimental effects of SNS activity on outcomes in HF warrant adequate diagnostic and treatment modalities. Therefore, this review summarizes basic physiological concepts about the interaction of SNS with the cardiovascular system and highlights key pathophysiological mechanisms of SNS derangement in HF. Finally, special emphasis in this review is placed on the integrative and up-to-date overview of diagnostic modalities such as SNS imaging methods and novel laboratory biomarkers that could aid in the assessment of the degree of SNS activation and provide reliable prognostic information among patients with HF.
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Affiliation(s)
- Josip Anđelo Borovac
- Department of Pathophysiology, University of Split School of Medicine, Split 21000, Croatia
- Working Group on Heart Failure of Croatian Cardiac Society, Zagreb 10000, Croatia
| | - Domenico D'Amario
- Department of Cardiovascular and Thoracic Sciences, IRCCS Fondazione Policlinico A. Gemelli, Universita Cattolica Sacro Cuore, Rome 00168, Italy
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, Split 21000, Croatia
| | - Duska Glavas
- Working Group on Heart Failure of Croatian Cardiac Society, Zagreb 10000, Croatia
- Clinic for Cardiovascular Diseases, University Hospital of Split, Split 21000, Croatia
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Fang SC, Wu YL, Tsai PS. Heart Rate Variability and Risk of All-Cause Death and Cardiovascular Events in Patients With Cardiovascular Disease: A Meta-Analysis of Cohort Studies. Biol Res Nurs 2019; 22:45-56. [PMID: 31558032 DOI: 10.1177/1099800419877442] [Citation(s) in RCA: 145] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Lower heart rate variability (HRV) is associated with a higher risk of cardiovascular events and mortality, although the extent of the association is uncertain. We performed a meta-analysis of cohort studies to elucidate the association between HRV and the risk of all-cause death or cardiovascular events in patients with cardiovascular disease (CVD) during a follow-up of at least 1 year. We searched four databases (PubMed, MEDLINE, Embase, and Cochrane Central Register of Controlled Trials) and extracted the adjusted hazard ratio (HR) from eligible studies. We included 28 cohort studies involving 3,094 participants in the meta-analysis. Results revealed that lower HRV was associated with a higher risk of all-cause death and cardiovascular events; the pooled HR was 2.27 (95% confidence interval [CI]: 1.72, 3.00) and 1.41 (95% CI: 1.16, 1.72), respectively. In subgroup analyses, the pooled HR of all-cause death was significant for patients with acute myocardial infarction (AMI) but not for those with heart failure. The pooled HR for cardiovascular events was significant for the subgroup of patients with AMI and acute coronary syndrome but not for those with coronary artery disease and heart failure. Additionally, both time and frequency domains of HRV were significantly associated with risk of all-cause death and cardiovascular events in patients with CVD.
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Affiliation(s)
- Su-Chen Fang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei
| | - Yu-Lin Wu
- Department of Nursing, St. Mary's Junior College of Medicine, Nursing and Management, Yilan
| | - Pei-Shan Tsai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei.,Department of Nursing and Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei.,Sleep Research Center, Taipei Medical University Hospital, Taipei
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Grilletti JVF, Scapini KB, Bernardes N, Spadari J, Bigongiari A, de Andrade e Souza Mazuchi F, Caperuto EC, Sanches IC, Rodrigues B, De Angelis K. Impaired baroreflex sensitivity and increased systolic blood pressure variability in chronic post-ischemic stroke. Clinics (Sao Paulo) 2018; 73:e253. [PMID: 30304297 PMCID: PMC6152139 DOI: 10.6061/clinics/2018/e253] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 03/21/2018] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES Acute post-stroke patients present cardiovascular autonomic dysfunction, which manifests as lower heart rate variability and impaired baroreflex sensitivity. However, few studies performed to date have evaluated cardiovascular autonomic function in chronic post-stroke patients. The aim of this study was to evaluate cardiovascular autonomic modulation in chronic post-ischemic stroke patients. METHODS The seventeen enrolled subjects were divided into a stroke group (SG, n=10, 5±1 years after stroke) and a control group (CG, n=7). Non-invasive curves for blood pressure were continuously recorded (Finometer®) for 15 minutes while the subject was in a supine position. Heart rate variability and blood pressure variability were analyzed in the time and frequency domains. RESULTS No differences were observed in systolic and diastolic pressure and heart rate between post-stroke patients and healthy individuals. The SG group had lower indexes for heart rate variability in the time domain (standard deviation of normal to normal R-R intervals, SDNN; variance of normal to normal R-R intervals, VarNN; and root mean square differences of successive R-R intervals, RMSSD) and a lower high-frequency band for heart rate variability than was observed in the CG. Systolic blood pressure variability and the low-frequency band for systolic pressure were higher in post-stroke patients, while the alpha index was lower in the SG than in the CG. CONCLUSION After ischemic stroke, affected patients present chronically reduced heart rate variability, impaired cardiac vagal modulation, increased systolic blood pressure variability and higher sympathetic vascular modulation along with impaired baroreflex sensitivity, which can increase the risk of cardiovascular events, despite adequate blood pressure control.
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Affiliation(s)
| | - Katia Bilhar Scapini
- Laboratorio do Movimento Humano, Universidade Sao Judas Tadeu (USJT), Sao Paulo, SP, BR
| | - Nathalia Bernardes
- Laboratorio de Fisiologia Translacional, Universidade Nove de Julho (UNINOVE), Sao Paulo, SP, BR
| | | | | | | | - Erico Chagas Caperuto
- Laboratorio do Movimento Humano, Universidade Sao Judas Tadeu (USJT), Sao Paulo, SP, BR
| | - Iris Callado Sanches
- Laboratorio do Movimento Humano, Universidade Sao Judas Tadeu (USJT), Sao Paulo, SP, BR
| | - Bruno Rodrigues
- Departamento de Educacao Fisica Adaptada, Faculdade de Educacao Fisica, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, BR
| | - Kátia De Angelis
- Departamento de Fisiologia, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, BR
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10
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Rapalis A, Petrėnas A, Šimaitytė M, Bailón R, Marozas V. Towards pulse rate parametrization during free-living activities using smart wristband. Physiol Meas 2018; 39:055007. [DOI: 10.1088/1361-6579/aac24a] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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11
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Martirosyan M, Caliskan K, Theuns DA, Szili-Torok T. Remote monitoring of heart failure: benefits for therapeutic decision making. Expert Rev Cardiovasc Ther 2017; 15:503-515. [DOI: 10.1080/14779072.2017.1348229] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Mihran Martirosyan
- Department of Electrophysiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Kadir Caliskan
- Department of Heart Failure/Heart Transplantation, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Dominic A.M.J. Theuns
- Department of Electrophysiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Tamas Szili-Torok
- Department of Electrophysiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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12
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Sherwood A, Blumenthal JA, Koch GG, Hoffman BM, Watkins LL, Smith PJ, O'Connor CM, Adams KF, Rogers JG, Sueta C, Chang PP, Johnson KS, Schwartz J, Hinderliter AL. Effects of Coping Skills Training on Quality of Life, Disease Biomarkers, and Clinical Outcomes in Patients With Heart Failure: A Randomized Clinical Trial. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.116.003410. [PMID: 28062537 DOI: 10.1161/circheartfailure.116.003410] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 12/09/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Heart failure (HF) is a chronic disease that compromises patients' quality of life (QoL). Interventions designed to reduce distress and improve disease self-management are needed. We evaluated the efficacy of a telephone-based coping skills training (CST) intervention. METHODS AND RESULTS This randomized clinical trial involved 180 HF outpatients with reduced ejection fraction. Participants ranged in age from 29 to 87 years (mean=58 years); 27% were women, and 47% were nonwhite. Participants were randomized to either a CST intervention or heart failure education, both delivered over 16 weeks. The primary outcomes were (1) postintervention effects on QoL and HF disease biomarkers (both with α=0.01), and (2) a composite measure of time to death or first hospitalization (with α=0.03) over a median follow-up period of 3 years. CST resulted in greater improvements in QoL compared with heart failure education (P<0.01), including the Kansas City Cardiomyopathy Questionnaire (P=0.009), depressive symptoms (P=0.027), and the 6-minute walk test (P=0.012). However, it did not differentially improve HF disease biomarkers or reduce risk of all-cause hospitalizations or death (hazard ratio=0.84 [95% confidence interval, 0.59-1.12]). Interestingly, exploratory analyses showed that participants randomized to CST experienced a reduction in the composite end point of worsening HF hospitalization or death during the 3-year follow-up period (hazard ratio=0.65 [95% confidence interval, 0.44-0.98]; P=0.040). CONCLUSIONS CST improved QoL in patients with HF. Monitoring and improving QoL is emerging as an important aspect of the clinical management of HF that can reduce disease burden and may help improve clinical outcomes in this vulnerable patient population. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT00873418.
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Affiliation(s)
- Andrew Sherwood
- From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.).
| | - James A Blumenthal
- From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.)
| | - Gary G Koch
- From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.)
| | - Benson M Hoffman
- From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.)
| | - Lana L Watkins
- From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.)
| | - Patrick J Smith
- From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.)
| | - Christopher M O'Connor
- From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.)
| | - Kirkwood F Adams
- From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.)
| | - Joseph G Rogers
- From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.)
| | - Carla Sueta
- From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.)
| | - Patricia P Chang
- From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.)
| | - Kristy S Johnson
- From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.)
| | - Jeanne Schwartz
- From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.)
| | - Alan L Hinderliter
- From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.)
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13
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Heart rate variability regression and risk of sudden unexpected death in epilepsy. Med Hypotheses 2017; 99:49-52. [DOI: 10.1016/j.mehy.2016.11.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 11/23/2016] [Indexed: 01/16/2023]
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14
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Berg SK, Herning M, Svendsen JH, Christensen AV, Thygesen LC. The Screen-ICD trial. Screening for anxiety and cognitive therapy intervention for patients with implanted cardioverter defibrillator (ICD): a randomised controlled trial protocol. BMJ Open 2016; 6:e013186. [PMID: 27798030 PMCID: PMC5093681 DOI: 10.1136/bmjopen-2016-013186] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Previous research shows that patients with an implanted cardioverter defibrillator (ICD) have a fourfold increased mortality risk when suffering from anxiety compared with ICD patients without anxiety. This research supports the screening of ICD patients for anxiety with the purpose of starting relevant intervention. METHODS AND ANALYSIS Screen-ICD consists of 3 parts: (1) screening of all hospitalised and outpatient patients at two university hospitals using the Hospital Anxiety and Depression Scale (HADS), scores ≥8 are invited to participate. (2) Assessment of type of anxiety by Structured Clinical Interview for DSM Disorders (SCID). (3) Investigator-initiated randomised clinical superiority trial with blinded outcome assessment, with 1:1 randomisation to cognitive-behavioural therapy (CBT) performed by a cardiac nurse with CBT training, plus usual care or usual care alone. The primary outcome is HADS-A measured at 16 weeks. Secondary outcomes include Becks Anxiety Inventory, HeartQoL, Hamilton Anxiety Scale, heart rate variability, ICD shock, time to first shock and antitachycardia pacing. A total of 88 participants will be included. The primary analyses are based on the intention-to-treat principle and we use a mixed model with repeated measurements for continuous outcomes. For binary outcomes (HADS-A score <8), we use a generalised mixed model with repeated measurements. ETHICS AND DISSEMINATION The trial is performed in accordance with the Declaration of Helsinki. All patients must give informed consent prior to participation and the trial is initiated after approval by the Danish Data Protection Agency (RH-2015-282) and the regional ethics committee (H-16018868). Positive, neutral and negative results of the trial will be published. TRIAL REGISTRATION NUMBER NCT02713360.
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Affiliation(s)
- Selina Kikkenborg Berg
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Margrethe Herning
- Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark
| | - Jesper Hastrup Svendsen
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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15
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Alvarez SM, Katsamanis Karavidas M, Coyle SM, Lu SE, Macor M, Oikawa LO, Lehrer PM, Calvano SE, Lowry SF. Low-dose steroid alters in vivo endotoxin-induced systemic inflammation but does not influence autonomic dysfunction. ACTA ACUST UNITED AC 2016; 13:358-68. [DOI: 10.1177/0968051907086465] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Severe injury and infection are associated with autonomic dysfunction. Diminished heart rate variability (HRV) is also observed as a component of autonomic dysfunction and is induced by endotoxin administration to healthy subjects. It is established that low-dose glucocorticoid administration diminishes the systemic inflammatory manifestations of endotoxinemia but the influence of this anti-inflammatory intervention on overall autonomic dysfunction and HRV responses to endotoxin is unknown. This study was designed to assess the influence of a low-dose hydrocortisone infusion upon endotoxin-elicited systemic inflammatory responses including phenotypic features, cytokine production, and parameters of HRV. Of 19 subjects studied, nine received a continuous infusion of hydrocortisone (3 µg/kg/min continuously over 6 h) prior to intravenous administration of Escherichia coli endotoxin (2 ng/kg, CC-RE, Lot #2) while 10 healthy subjects received only the endotoxin after a 6-h period of saline control infusion. Serial determinations of vital signs, heart rate variability assessments, and cytokine levels were obtained over the subsequent 24 h. Prior cortisol infusion diminished the peak TNF-α ( P < 0.01) and IL-6 ( P < 0.0001) responses after endotoxin challenge, as compared to saline infusion controls and diminished the peak core temperature response to endotoxin ( P < 0.01). In contrast to the influence of cortisol on the above parameters of systemic inflammation, the significant endotoxin-induced decreases in HRV time and frequency domains were not influenced by prior hydrocortisone treatment. Hence, alterations in autonomic dysfunction occur despite hydrocortisone attenuation of other traditional systemic manifestations of endotoxinemia. The maintenance or restoration of autonomic balance is not influenced by glucocorticoid administration.
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Affiliation(s)
- Sonia M. Alvarez
- Division of Surgical Sciences, UMDNJ-Robert Wood Johnson Medical School, Now Brunswick, New Jersey, USA
| | | | - Susette M. Coyle
- Division of Surgical Sciences, UMDNJ-Robert Wood Johnson Medical School, Now Brunswick, New Jersey, USA
| | - Shou-En Lu
- Department of Biostatistics, UMDNJ-School of Public Health, New Brunswick, New Jersey, USA
| | - Marie Macor
- Division of Surgical Sciences, UMDNJ-Robert Wood Johnson Medical School, Now Brunswick, New Jersey, USA
| | - Leo O. Oikawa
- Department of Psychiatry, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Paul M. Lehrer
- Department of Psychiatry, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Steve E. Calvano
- Division of Surgical Sciences, UMDNJ-Robert Wood Johnson Medical School, Now Brunswick, New Jersey, USA
| | - Stephen F. Lowry
- Division of Surgical Sciences, UMDNJ-Robert Wood Johnson Medical School, Now Brunswick, New Jersey, USA,
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16
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Abstract
This review aims to discuss and summarize the evidence base for devices that have a role in monitoring patients with heart failure for the purpose of attempting to prevent heart failure-related admissions. Despite contemporary heart failure service provision, many patients continue to need acute admission for decompensation. There is a clinical need for a better strategy for predicting decompensation earlier so that appropriate therapeutic interventions can be commenced sooner in order to prevent the need for acute hospital admission. Between clinical assessment visits, the contemporary approach to management is based primarily on daily home monitoring of weight by patients; while this has proved useful, it falls short. For example, substantial weight gain was seen in only 20% of ADHF admission patients according to data collected in the TEN-HMS home telemonitoring study. Monitoring devices offer the possibility of tracking additional physiological or haemodynamic parameters that may allow for earlier detection and more accurate identification of patients at risk of acute decompensation.
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17
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Shahbazi F, Asl BM. Generalized discriminant analysis for congestive heart failure risk assessment based on long-term heart rate variability. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2015; 122:191-198. [PMID: 26344584 DOI: 10.1016/j.cmpb.2015.08.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 07/08/2015] [Accepted: 08/13/2015] [Indexed: 06/05/2023]
Abstract
The aims of this study are summarized in the following items: first, to investigate the class discrimination power of long-term heart rate variability (HRV) features for risk assessment in patients suffering from congestive heart failure (CHF); second, to introduce the most discriminative features of HRV to discriminate low risk patients (LRPs) and high risk patients (HRPs), and third, to examine the influence of feature dimension reduction in order to achieve desired accuracy of the classification. We analyzed two public Holter databases: 12 data of patients suffering from mild CHF (NYHA class I and II), labeled as LRPs and 32 data of patients suffering from severe CHF (NYHA class III and IV), labeled as HRPs. A K-nearest neighbor classifier was used to evaluate the performance of feature set in the classification. Moreover, to reduce the number of features as well as the overlap of the samples of two classes in feature space, we used generalized discriminant analysis (GDA) as a feature extraction method. By applying GDA to the discriminative nonlinear features, we achieved sensitivity and specificity of 100% having the least number of features. Finally, the results were compared with other similar conducted studies regarding the performance of feature selection procedure and classifier besides the number of features used in training.
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Affiliation(s)
- Fatemeh Shahbazi
- Department of Biomedical Engineering, Tarbiat Modares University, Tehran, Iran
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18
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Cloud-Based Smart Health Monitoring System for Automatic Cardiovascular and Fall Risk Assessment in Hypertensive Patients. J Med Syst 2015; 39:109. [PMID: 26276015 DOI: 10.1007/s10916-015-0294-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 07/20/2015] [Indexed: 02/01/2023]
Abstract
The aim of this paper is to describe the design and the preliminary validation of a platform developed to collect and automatically analyze biomedical signals for risk assessment of vascular events and falls in hypertensive patients. This m-health platform, based on cloud computing, was designed to be flexible, extensible, and transparent, and to provide proactive remote monitoring via data-mining functionalities. A retrospective study was conducted to train and test the platform. The developed system was able to predict a future vascular event within the next 12 months with an accuracy rate of 84 % and to identify fallers with an accuracy rate of 72 %. In an ongoing prospective trial, almost all the recruited patients accepted favorably the system with a limited rate of inadherences causing data losses (<20 %). The developed platform supported clinical decision by processing tele-monitored data and providing quick and accurate risk assessment of vascular events and falls.
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19
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Melillo P, De Luca N, Bracale M, Pecchia L. Classification tree for risk assessment in patients suffering from congestive heart failure via long-term heart rate variability. IEEE J Biomed Health Inform 2014; 17:727-33. [PMID: 24592473 DOI: 10.1109/jbhi.2013.2244902] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
This study aims to develop an automatic classifier for risk assessment in patients suffering from congestive heart failure (CHF). The proposed classifier separates lower risk patients from higher risk ones, using standard long-term heart rate variability (HRV) measures. Patients are labeled as lower or higher risk according to the New York Heart Association classification (NYHA). A retrospective analysis on two public Holter databases was performed, analyzing the data of 12 patients suffering from mild CHF (NYHA I and II), labeled as lower risk, and 32 suffering from severe CHF (NYHA III and IV), labeled as higher risk. Only patients with a fraction of total heartbeats intervals (RR) classified as normal-to-normal (NN) intervals (NN/RR) higher than 80% were selected as eligible in order to have a satisfactory signal quality. Classification and regression tree (CART) was employed to develop the classifiers. A total of 30 higher risk and 11 lower risk patients were included in the analysis. The proposed classification trees achieved a sensitivity and a specificity rate of 93.3% and 63.6%, respectively, in identifying higher risk patients. Finally, the rules obtained by CART are comprehensible and consistent with the consensus showed by previous studies that depressed HRV is a useful tool for risk assessment in patients suffering from CHF.
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20
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Kang EK, Choi JS. Two Cases of Increased Parasympathetic Nerve System in Irritable Bowel Syndrome with Diarrhea as a Predominant Symptom. KOSIN MEDICAL JOURNAL 2013. [DOI: 10.7180/kmj.2013.28.1.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The irritable bowel syndrome(IBS) is a chronic functional gastrointestinal disorder, characterized by abdominal pain, bloating and bowel disturbance. The pathophysiology of IBS is very complicated. Recent studies indicate that the most important mechanisms include visceral hypersensitivity, abnormal gut motility, autonomic nervous system(ANS) dysfunction and disorder of regulation of the brain-gut axis. Patients with IBS frequently present impaired autonomic regulation. Heart rate variability(HRV) is an acknowledged tool for estimating autonomic function. We experienced two cases of increased parasympathetic nervous system by HRV in irritable bowel syndrome with diarrhea as a predominant symptom
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Özcan F, Turak O, Avci S, Tok D, İşLeyen A, aras D, Aydoğdu S. Heart rate variability and red cell distribution width in patients with systolic left heart failure. SCAND CARDIOVASC J 2013. [DOI: 10.3109/14017431.2012.755561] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Peltola MA. Role of editing of R-R intervals in the analysis of heart rate variability. Front Physiol 2012; 3:148. [PMID: 22654764 PMCID: PMC3358711 DOI: 10.3389/fphys.2012.00148] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 05/02/2012] [Indexed: 01/08/2023] Open
Abstract
This paper reviews the methods used for editing of the R–R interval time series and how this editing can influence the results of heart rate (HR) variability analyses. Measurement of HR variability from short and long-term electrocardiographic (ECG) recordings is a non-invasive method for evaluating cardiac autonomic regulation. HR variability provides information about the sympathetic-parasympathetic autonomic balance. One important clinical application is the measurement of HR variability in patients suffering from acute myocardial infarction. However, HR variability signals extracted from R–R interval time series from ambulatory ECG recordings often contain different amounts of artifact. These false beats can be either of physiological or technical origin. For instance, technical artifact may result from poorly fastened electrodes or be due to motion of the subject. Ectopic beats and atrial fibrillation are examples of physiological artifact. Since ectopic and other false beats are common in the R–R interval time series, they complicate the reliable analysis of HR variability sometimes making it impossible. In conjunction with the increased usage of HR variability analyses, several studies have confirmed the need for different approaches for handling false beats present in the R–R interval time series. The editing process for the R–R interval time series has become an integral part of these analyses. However, the published literature does not contain detailed reviews of editing methods and their impact on HR variability analyses. Several different editing and HR variability signal pre-processing methods have been introduced and tested for the artifact correction. There are several approaches available, i.e., use of methods involving deletion, interpolation or filtering systems. However, these editing methods can have different effects on HR variability measures. The effects of editing are dependent on the study setting, editing method, parameters used to assess HR variability, type of study population, and the length of R–R interval time series. The purpose of this paper is to summarize these pre-processing methods for HR variability signal, focusing especially on the editing of the R–R interval time series.
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Affiliation(s)
- Mirja A Peltola
- Department of Internal Medicine, Institute of Clinical Medicine, University of Oulu Oulu, Finland
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Hollander SA, Bernstein D, Yeh J, Dao D, Sun HY, Rosenthal D. Outcomes of children following a first hospitalization for dilated cardiomyopathy. Circ Heart Fail 2012; 5:437-43. [PMID: 22570362 DOI: 10.1161/circheartfailure.111.964510] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We hypothesized that children with dilated cardiomyopathy who require hospital admission are at increased risk for death or transplantation during their first hospitalization and in the first year that follows. We also assessed the value of routine data collected during that time to predict death or the need for transplantation prior to discharge and within 1 year of admission. METHODS AND RESULTS We conducted a retrospective review of 83 pediatric patients with dilated cardiomyopathy whose initial hospitalization fell between 2004 and 2009. The mean age at hospitalization was 7 years. The majority of patients demonstrated moderate or severe left ventricular dysfunction on initial echocardiogram (80%) and/or the need for intravenous inotropes within 7 days of hospital admission (69%). Five patients (6%) died, and 15 (18%) were transplanted in the initial hospitalization. At 1 year, 11/71 (15%) had died, and 27/71 (38%) were transplanted. The overall freedom from death, transplantation, or rehospitalization at 1 year following admission was 21%. Fractional shortening, left ventricular ejection fraction, serum cholesterol, uric acid, mixed venous saturation, and atrial filling pressures were all predictive of death or transplantation during the initial hospitalization. Left ventricular ejection fraction was predictive of death or transplantation at 1 year. CONCLUSIONS The first hospitalization for dilated cardiomyopathy marks a period of high risk for clinical decline, end stage heart failure, and the need for cardiac transplantation. Echocardiographic function and hemodynamic and serum measurements may aid in predicting outcomes. Despite medical management, most patients will be rehospitalized and/or require cardiac transplantation within 1 year of admission.
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Affiliation(s)
- Seth A Hollander
- Department of Pediatrics, Stanford University Medical Center, 750 Welch Road, , Palo Alto, CA 94304, USA.
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Tanindi A, Olgun H, Celik B, Boyaci B. Heart rate variability in patients hospitalized for decompensated diastolic heart failure at admission and after clinical stabilization. Future Cardiol 2012; 8:473-82. [DOI: 10.2217/fca.12.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Aims: We investigated heart rate variability (HRV) in patients hospitalized for decompensated diastolic heart failure and the effect of compensation course on HRV parameters. We also examined the association between the degree of diastolic dysfunction and HRV indices. Patients & methods: A total of 42 patients hospitalized for decompensated heart failure, who had a measured ejection fraction ≥50%, and ten age- and sex-matched healthy volunteers were enrolled. Results: All HRV indices were lower compared with the control group both at admission (p < 0.001) and after compensation, although a significant increase was observed in each index measured after clinical stabilization (p < 0.001). Improvement in HRV indices was lowest in patients with a restrictive pattern among groups of different degrees of diastolic dysfunction. Conclusion: Impairment in HRV in decompensated diastolic heart failure is more pronounced with increasing grade of diastolic dysfunction. It remains to be investigated whether decompensation may be predicted by marked depression in these indexes or if severely impaired HRV is a consequence of decompensation.
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Murad K, Brubaker PH, Fitzgerald DM, Morgan TM, Goff DC, Soliman EZ, Eggebeen JD, Kitzman DW. Exercise training improves heart rate variability in older patients with heart failure: a randomized, controlled, single-blinded trial. ACTA ACUST UNITED AC 2012; 18:192-7. [PMID: 22536936 DOI: 10.1111/j.1751-7133.2011.00282.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Reduced heart rate variability (HRV) in older patients with heart failure (HF) is common and indicates poor prognosis. Exercise training (ET) has been shown to improve HRV in younger patients with HF. However, the effect of ET on HRV in older patients with HF is not known. Sixty-six participants (36% men), aged 69±5 years, with HF and both preserved ejection fraction (HFPEF) and reduced ejection fraction (HFREF), were randomly assigned to 16 weeks of supervised ET (ET group) vs attention-control (AC group). Two HRV parameters (the standard deviation of all normal RR intervals [SDNN] and the root mean square of successive differences in normal RR intervals [RMSSD]) were measured at baseline and after completion of the study. When compared with the AC group, the ET group had a significantly greater increase in both SDNN (15.46±5.02 ms in ET vs 2.37±2.13 ms in AC, P=.016) and RMSSD (17.53±7.83 ms in ET vs 1.69±2.63 ms in AC, P=.003). This increase was seen in both sexes and HF categories. ET improved HRV in older patients with both HFREF and HFPEF.
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Affiliation(s)
- Khalil Murad
- Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
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De Jong MJ, Chung ML, Wu JR, Riegel B, Rayens MK, Moser DK. Linkages between anxiety and outcomes in heart failure. Heart Lung 2011; 40:393-404. [PMID: 21453974 PMCID: PMC3149715 DOI: 10.1016/j.hrtlng.2011.02.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 01/29/2011] [Accepted: 02/06/2011] [Indexed: 01/08/2023]
Abstract
OBJECTIVE We investigated the relationship between anxiety and event-free survival (ie, composite endpoint of death, emergency department visits, or hospitalizations) for patients with heart failure (HF), and examined whether behavioral and physiologic mechanisms mediate any association between anxiety and outcomes. METHODS In this longitudinal study, patients with HF completed the anxiety subscale of the Brief Symptom Inventory, and heart-rate variability and plasma norepinephrine levels were measured. Dietary adherence and medication adherence were measured according to 24-hour urine sodium level and the Medication Event Monitoring System, respectively. Patients were followed at least 1 year for event-free survival. RESULTS In total, 147 patients were enrolled. Patients with high anxiety had a shorter (hazard ratio, 2.2; 95% confidence interval, 1.1-4.3; P = .03) period of event-free survival than patients with lower anxiety. Anxiety independently predicted adherence to medication (P = .008), which in turn predicted event-free survival (hazard ratio, 2.0; 95% confidence interval, 1.2-3.3; P = .008). The effect of anxiety (P = .17) on event-free survival was less significant when the regression model included both anxiety and adherence to medication than when the model only included anxiety (P = .03), indicating that adherence to medication mediated the relationship between anxiety and event-free survival. CONCLUSION This is the first study to show that nonadherence to medication links anxiety and event-free survival for patients with HF. Interventions that reduce anxiety and improve adherence may benefit outcomes.
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Affiliation(s)
- Marla J De Jong
- TriService Nursing Research Program, Uniformed Services University of the Health Sciences, Frederick, Maryland 21702, USA.
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Martins CDD, Chianca DA, Fernandes LG. Cardiac autonomic balance in rats submitted to protein restriction after weaning. Clin Exp Pharmacol Physiol 2011; 38:89-93. [PMID: 21143492 DOI: 10.1111/j.1440-1681.2010.05468.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
1. In the present study, we evaluated the autonomic balance of the heart in protein/energy-undernourished rats. 2. Rats were divided into two groups according to the diet they received after weaning: (i) the control group (n=16), given a 15% protein diet, and (ii) the malnourished group (n=14), fed a 6% protein diet. Cardiovascular recordings were made and, through selective autonomic blockade, the tonic autonomic balance, cardiac autonomic index and the power spectrum of heart rate (HR) variability were determined. 3. Muscarinic receptor blockade with methylatropine (5.0 mg/kg, i.v.) increased HR in the control group (371 ± 6 vs 427 ± 15 b.p.m. before and after drug administration, respectively), but not the malnourished group (438 ± 24 vs 472 ± 38 b.p.m. before and after drug administration, respectively). Inhibition of β(1)-adrenoceptors with metoprolol (2.0 mg/kg, i.v.) reduced HR in malnourished rats (428 ± 24 vs 355 ± 16 b.p.m. before and after drug administration, respectively), but had no effect on the HR of the control group (363 ± 8 vs 362 ± 7 b.p.m. before and after drug administration, respectively). Double autonomic blockade by inhibiting both muscarinic cholinoceptors and β(1)-adrenoceptors reduced HR in the malnourished group (428 ± 24 vs 342 ± 14 b.p.m.) but had no effect on HR in the control group (371 ± 6 vs 382 ± 6 b.p.m.). 4. Sympathetic tone was augmented in malnourished compared with control rats (131 ± 17 vs 41 ± 11 b.p.m., respectively), whereas parasympathetic tone was reduced in malnourished compared with control rats (-4 ± 4 vs 22 ± 9 b.p.m., respectively). 5. The ratio of oscillations in HR induced by sympathetic and parasympathetic activity was higher in malnourished compared with control rats (0.43 ± 0.03 vs 0.34 ± 0.02, respectively). 6. The results of the present study indicate that protein malnutrition after weaning increases sympathetic activity and reduces vagal activity to the heart in rats. These data provide a new perspective on the pathophysiology of metabolic and cardiovascular diseases associated with protein malnutrition, especially with regard to autonomic modulation.
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Affiliation(s)
- Carlito D D Martins
- Department of Biological Sciences, Institute of Exact and Biological Sciences, Federal University of Ouro Preto, Ouro Preto, Brazil
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Abstract
PURPOSE The purpose of this article is to provide an overview of relevant clinical issues including pathophysiology, clinical presentation, assessment/diagnosis, and treatment strategies regarding depression in the heart failure (HF) patient. This information was synthesized to create a clinical protocol to guide the practitioner in identifying, diagnosing, and treating depression in adult HF patients. This protocol was designed for use in the primary care or HF clinic setting. DATA SOURCES PubMed and CINAHL were utilized to search for articles pertaining to HF and depression. CONCLUSIONS The presence of depression in HF is associated with a worsening prognosis, increased risk of death, rehospitalization, and functional decline. The practitioner must identify predisposing factors for depression and evaluate symptoms. Self-rated screening instruments can assist the practitioner in identifying those with depression. Evidence is lacking regarding the treatment of depression in HF but selective serotonin reuptake inhibitors are likely the best option. IMPLICATIONS FOR PRACTICE Understanding depression as it occurs in patients with HF is critical. If depression is identified and properly managed it may lead to better patient outcomes.
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Affiliation(s)
- Louise Smith
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.
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Melillo P, Fusco R, Sansone M, Bracale M, Pecchia L. Discrimination power of long-term heart rate variability measures for chronic heart failure detection. Med Biol Eng Comput 2011; 49:67-74. [PMID: 21203855 DOI: 10.1007/s11517-010-0728-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2010] [Accepted: 12/21/2010] [Indexed: 01/08/2023]
Abstract
The aim of this study was to investigate the discrimination power of standard long-term heart rate variability (HRV) measures for the diagnosis of chronic heart failure (CHF). The authors performed a retrospective analysis on four public Holter databases, analyzing the data of 72 normal subjects and 44 patients suffering from CHF. To assess the discrimination power of HRV measures, an exhaustive search of all possible combinations of HRV measures was adopted and classifiers based on Classification and Regression Tree (CART) method was developed, which is a non-parametric statistical technique. It was found that the best combination of features is: Total spectral power of all NN intervals up to 0.4 Hz (TOTPWR), square root of the mean of the sum of the squares of differences between adjacent NN intervals (RMSSD) and standard deviation of the averages of NN intervals in all 5-min segments of a 24-h recording (SDANN). The classifiers based on this combination achieved a specificity rate and a sensitivity rate of 100.00 and 89.74%, respectively. The results are comparable with other similar studies, but the method used is particularly valuable because it provides an easy to understand description of classification procedures, in terms of intelligible "if … then …" rules. Finally, the rules obtained by CART are consistent with previous clinical studies.
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Affiliation(s)
- Paolo Melillo
- Department of Biomedical, Telecommunication and Electronic Engineering (DIBET), University of Naples Federico II, Naples, Italy
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30
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Changes in autonomic balance in patients with decompensated chronic heart failure. Clin Auton Res 2010; 21:47-54. [PMID: 21080025 DOI: 10.1007/s10286-010-0089-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 09/16/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE In chronic heart failure (CHF) episodes of decompensation may be linked to derangements within cardiovascular reflex control. We investigated changes in autonomic tone in patients with decompensated CHF. METHODS We examined 17 patients with decompensated CHF (14 men, age 62 ± 2 years, LVEF 32 ± 3%) on admission and after clinical stabilization. Control group consisted of 9 patients (8 men, age 64 ± 7 years, LVEF 30 ± 7%) with stable CHF. Assessment of autonomic tone was based on 5-min ECG and blood pressure recordings using time and frequency domains of heart rate variability (HRV) and a sequence method to derive baroreflex sensitivity (BRS). RESULTS On admission, decompensated CHF patients had reduced HRV indices (p < 0.05) and depressed BRS (p < 0.01) as compared to those with stable CHF. After clinical stabilization (4 ± 2 days of treatment) time domain HRV indices and BRS increased (SDNN, 34.4 ± 5.4 vs. 55.8 ± 9.8 ms; RMSSD, 38.4 ± 12.0 vs. 51.1 ± 10.4 ms; BRS, 4.3 ± 0.7 vs. 7.6 ± 1.3 ms/mmHg; all p < 0.01) and became similar to those seen in stable CHF patients. Breathing with oxygen affected autonomic indices neither in decompensated nor in stable CHF patients. Eight patients developed an episode of additional CHF worsening during hospitalization, in whom the third assessment was performed on discharge. Worsening in clinical status was followed by a decrease in HRV and BRS that became similar to those noted on admission. INTERPRETATION HRV measures and BRS are severely deranged in the acute phase of CHF decompensation. Clinical stabilization results in an improvement of autonomic indices. However, subsequent clinical worsening adversely affects HRV and BRS.
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31
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Rossi Caruso FC, Arena R, Mendes RG, Reis MS, Papa V, Borghi-Silva A. Heart rate autonomic responses during deep breathing and walking in hospitalised patients with chronic heart failure. Disabil Rehabil 2010; 33:751-7. [PMID: 20731562 DOI: 10.3109/09638288.2010.511420] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To evaluate the acute effect of physiotherapy (deep breathing exercises and walking) on heart rate variability in patients hospitalised with chronic heart failure (CHF). DESIGN Ten males with CHF (57 ± 7 years) and 10 healthy controls (59 ± 9 years) were included. Heart rate and RR intervals were recorded in the following conditions: supine, seated, during deep breathing exercises and during and after walking. Heart rate variability was analysed by linear and non-linear methods (α2, Mean HR, rMSSD, SDNN and ApEn). RESULTS Patients presented significantly lower SDNN (12.4 ± 4 versus 26 ± 8 ms), rMSSD (18.2 ± 16.2 versus 25 ± 19.5 ms) and ApEn (9.9 ± 10 versus 16.68 ± 22.6) during the walking compared to controls (p < 0.05). In addition, mean HR was significantly higher during and after walking for patients with CHF compared to controls (103 ± 8 versus 80 ± 2 bpm and 90 ± 9 versus 68 ± 2 bpm, respectively). Patients with CHF demonstrated a significant reduction of α2 during deep breathing (0.78 ± 0.1) when compared to the seated position (1.08 ± 0.1) and walking (1.15 ± 0.2, p < 0.05). Additionally, rMSSD index increased during deep breathing when compared to walking in both groups. CONCLUSION Deep breathing exercises and walking are safe and promote beneficial effects on heart rate variability in patients hospitalised for CHF.
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Affiliation(s)
- Flávia C Rossi Caruso
- Cardiopulmonary Physiotherapy Laboratory, Nucleus of Research in Physical Exercise, Federal University of Sao Carlos, Sao Paulo, Brazil
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Routledge FS, Campbell TS, McFetridge-Durdle JA, Bacon SL. Improvements in heart rate variability with exercise therapy. Can J Cardiol 2010; 26:303-12. [PMID: 20548976 DOI: 10.1016/s0828-282x(10)70395-0] [Citation(s) in RCA: 229] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Heart rate variability (HRV) is a noninvasive, practical and reproducible measure of autonomic nervous system function. A heart rate that is variable and responsive to demands is believed to bestow a survival advantage, whereas reduced HRV may be associated with poorer cardiovascular health and outcomes. In recent years, many researchers have investigated the prognostic implications of HRV in a variety of clinical populations. Evidence suggests that reduced HRV has prognostic significance for individuals with myocardial infarction, chronic heart failure, unstable angina and diabetes mellitus. Interventions to increase HRV, such as exercise therapy, have also been examined. The findings of the present review suggest that exercise therapy may improve HRV in myocardial infarction, chronic heart failure and revascularization patients by increasing vagal tone and decreasing sympathetic activity. One hypothesis is that a shift toward greater vagal modulation may positively affect the prognosis of these individuals. While the underlying mechanisms by which exercise training improves vagal modulation are speculative at present, angiotensin II and nitric oxide may be potential mediators.
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Affiliation(s)
- Faye S Routledge
- Dalhousie University, School of Nursing, Halifax, Nova Scotia, Canada.
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Thuraisingham RA. A Classification System to Detect Congestive Heart Failure Using Second-Order Difference Plot of RR Intervals. Cardiol Res Pract 2010; 2009:807379. [PMID: 20339561 PMCID: PMC2842886 DOI: 10.4061/2009/807379] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 09/30/2009] [Accepted: 11/26/2009] [Indexed: 11/20/2022] Open
Abstract
A classification system to detect congestive heart failure (CHF) patients from normal (N) patients is described. The classification procedure uses the k-nearest neighbor algorithm and uses features from the second-order difference plot (SODP) obtained from Holter monitor cardiac RR intervals. The classification system which employs a statistical procedure to obtain the final result gave a success rate of 100% to distinguish CHF patients from normal patients. For this study the Holter monitor data of 36 normal and 36 CHF patients were used. The classification system using standard deviation of RR intervals also performed well, although it did not match the 100% success rate using the features from SODP. However, the success rate for classification using this procedure for SDRR was many fold higher compared to using a threshold. The classification system in this paper will be a valuable asset to the clinician, in the detection congestive heart failure.
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Nakane T, Nakamae H, Koh H, Nakamae M, Aimoto R, Terada Y, Koh KR, Yamane T, Hino M. Heart rate variability during and after peripheral blood stem cell leukapheresis in autologous transplant patients and allogeneic transplant donors. Int J Hematol 2010; 91:478-84. [PMID: 20224872 DOI: 10.1007/s12185-010-0543-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2009] [Revised: 01/22/2010] [Accepted: 02/14/2010] [Indexed: 01/08/2023]
Abstract
Side effects of varying severity are frequent in peripheral blood stem cell harvest (PBSCH). Life-threatening complications associated with PBSCH have also been reported. Heart rate variability (HRV), which reflects sympathovagal balance and autonomic cardiovascular control, has been a subject of intense interest in various diseases precipitating sudden death. Here, we prospectively assessed the impact of leukapheresis on HRV among autologous hematopoietic cell transplant patients and healthy donors. We found that HRV indicators, the standard deviation of normal-to-normal intervals (SDNN) value, the square root of the mean of the sum of squared differences between the adjacent normal-to-normal interval (r-MSSD) value, total frequency (TF), high frequency (HF) and low frequency (LF) powers decreased significantly to morbid levels during leukapheresis (all P < 0.01). Morbid changes in SDNN value, TF and LF powers were significantly sustained for 6-9 h after leukapheresis (all P < 0.05). Furthermore, TF and LF powers prior to leukapheresis were significantly lower in subjects with symptomatic hypotension than in the other subjects [3282 (3121-4427) vs. 6018 (4983-9816) ms(2), P = 0.03; 93 (42-144) vs. 237 (142-360) ms(2), P = 0.03, respectively]. Our results suggest that HRV analysis might be of use in evaluating and predicting the adverse effects of cardiovascular complications in PBSCH.
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Affiliation(s)
- Takahiko Nakane
- Hematology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
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Almoznino-Sarafian D, Sarafian G, Berman S, Shteinshnaider M, Tzur I, Cohen N, Gorelik O. Magnesium administration may improve heart rate variability in patients with heart failure. Nutr Metab Cardiovasc Dis 2009; 19:641-645. [PMID: 19201586 DOI: 10.1016/j.numecd.2008.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Revised: 12/01/2008] [Accepted: 12/04/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIM Intracellular magnesium (icMg) depletion may coexist with normomagnesemia. Mg deficiency (serum and/or intracellular) and decreased heart rate variability (HRV) are common in heart failure (HF). Since both are predictors of poor prognosis, it was of interest to evaluate the effect of Mg supplementation on HRV in patients with HF. METHODS AND RESULTS We investigated the effect of Mg administration on HRV in normomagnesemic patients with systolic HF. HRV, serum Mg and icMg were determined before and after 5-week 300 mg/day Mg citrate treatment in 16 patients (group 1). The control group included 16 Mg-non-treated HF patients (group 2). HRV was determined by a non-linear dynamics analysis, derived from the chaos theory, which calculates HRV-correlation dimension (HRV-CD). After 5 weeks, serum Mg (mmol/l) increased more significantly in group 1 (from 0.78+/-0.04 to 0.89+/-0.06, p<0.001), than in group 2 (from 0.79+/-0.07 to 0.84+/-0.06, p=0.042). IcMg and HRV-CD increased significantly only in group 1 (from 59+/-7 to 66+/-9 mmol/g cell protein, p=0.025, and from 3.47+/-0.42 to 3.94+/-0.36, p<0.001, respectively). In group 2, the differences in the respective parameters were 63+/-12 to 66+/-9 mmol/g cell protein (p=0.7) and 3.59+/-0.42 to 3.55+/-0.4 (p=0.8). CONCLUSION Mg administration to normomagnesemic patients with systolic HF increases serum Mg, icMg and HRV-CD. Increasing of HRV by Mg supplementation may prove beneficial to HF patients.
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Affiliation(s)
- D Almoznino-Sarafian
- Department of Internal Medicine F, Assaf Harofeh Medical Center (Affiliated to the Sackler School of Medicine, Tel Aviv University), Zerifin 70300, Israel.
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Karemaker JM, Wesseling KH. Variability in cardiovascular control: the baroreflex reconsidered. ACTA ACUST UNITED AC 2009; 8:23-9. [PMID: 18041583 DOI: 10.1007/s10558-007-9046-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Although blood pressure control is often viewed as a paradigmatic example of a "homeostatic" biological control system, blood pressure levels can fluctuate considerably over shorter and longer time scales. In modern signal analysis, coherence between heart rate and blood pressure variability is used to estimate baroreflex gain. However, the shorter the measurement period, the more variability this gain factor reveals. We review evidence that this variability is not due to the technique used for the estimation, but may be an intrinsic property of the circulatory control mechanisms. The baroreflex is reviewed from its evolutionary origin, starting in fishes as a reflex mechanism to protect the gills from excessively high pressures by slowing the heart via the (parasympathetic) vagus nerve. Baroreflex inhibition of cardiovascular sympathetic nervous outflow is a later development; the maximally possible extent of sympathetic activity probably being set in the central nervous system by mechanisms other than blood pressure per se. In the sympathetic outflow tract not only baroreflex inhibition but also as yet unidentified, stochastic mechanisms decide to pass or not pass on the sympathetic activity to the periphery. In this short essay, the "noisiness" of the baroreflex as nervous control system is stressed. This property is observed in all elements of the reflex, even at the--supposedly--most basic relation between afferent receptor nerve input and efferent--vagus--nerve output signal.
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Affiliation(s)
- John M Karemaker
- Department of Physiology, Systems Physiology, Academic Medical Center, University of Amsterdam, Rm M01-216, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
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Cardiac and autonomic nerve function after reduced-intensity stem cell transplantation for hematologic malignancy in patients with pre-transplant cardiac dysfunction. Ann Hematol 2009; 88:871-9. [PMID: 19153734 DOI: 10.1007/s00277-009-0695-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2008] [Accepted: 01/06/2009] [Indexed: 01/08/2023]
Abstract
Recent reports have shown that cardiomyopathy caused by hemochromatosis in severe aplastic anemia is reversible after reduced-intensity allogeneic stem-cell transplantation (RIST). We comprehensively evaluated cardiac and autonomic nerve function to determine whether cardiac dysfunction due to causes other than hemochromatosis is attenuated after RIST. In five patients with cardiac dysfunction before transplant, we analyzed the changes in cardiac and autonomic nerve function after transplant, using electrocardiography (ECG), echocardiography, radionuclide angiography (RNA), serum markers, and heart rate variability (HRV), before and up to 100 days after transplant. There was no significant improvement in cardiac function in any patient and no significant alteration in ECG, echocardiogram, RNA, or serum markers. However, on time-domain analysis of HRV, the SD of normal-to-normal RR intervals (SDNN) and the coefficient of variation of the RR interval (CVRR) decreased significantly 30 and 60 days after transplant (P = 0.04 and 0.01, respectively). Similarly, on frequency-domain analysis of HRV, low and high frequency power (LF and HF) significantly and temporarily decreased (P = 0.003 and 0.03, respectively). Notably, in one patient who had acute heart failure after transplantation, the values of SDNN, CVRR, r-MSSD, LF, and HF at 30 and 60 days after transplantation were the lowest of all the patients. In conclusion, this study suggests that (a) RIST is well-tolerated in patients with cardiac dysfunction, but we cannot expect improvement in cardiac dysfunction due to causes other than hemochromatosis; and (b) monitoring HRV may be useful in predicting cardiac events after RIST.
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de Sousa MR, Barbosa MPT, Lombardi F, Ribeiro ALP. Standard Deviation of normal interbeat intervals as a risk marker in patients with left ventricular systolic dysfunction: a meta-analysis. Int J Cardiol 2009; 141:313-6. [PMID: 19157593 DOI: 10.1016/j.ijcard.2008.11.128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2008] [Accepted: 11/22/2008] [Indexed: 11/19/2022]
Abstract
Our aim was to evaluate the Standard Deviation of Normal-Normal (SDNN) interbeat interval as a risk marker in left ventricular systolic dysfunction (LVSD) patients through a meta-analysis. We searched PubMed for studies that evaluated SDNN as a predictor of all-cause-death, cardiac death, transplantation, and progressive clinical deterioration using a search strategy validated for MEDLINE. Mean values and SD for SDNN in sixteen studies included were 115+/-48 ms in survivors versus 87+/-40 ms in non-survivors, resulting in a statistically significant standardized mean difference (0.594, 95%CI 0.385 to 0.803). In conclusion, SDNN may be a useful prognostic marker in LVSD. Additional studies must evaluate if SDNN may be used to subsidize therapeutic decisions.
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Nonlinear short-term heart rate variability prediction of spontaneous ventricular tachyarrhythmia. Sci Bull (Beijing) 2008. [DOI: 10.1007/s11434-008-0345-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chattipakorn N, Incharoen T, Kanlop N, Chattipakorn S. Heart rate variability in myocardial infarction and heart failure. Int J Cardiol 2007; 120:289-96. [PMID: 17349699 DOI: 10.1016/j.ijcard.2006.11.221] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2006] [Revised: 11/20/2006] [Accepted: 11/21/2006] [Indexed: 12/11/2022]
Abstract
The need to refine the identification of patients who might benefit from implantation of an implantable cardioverter defibrillator has been risen by the results of many clinical trials on ICD therapy. Traditional parameters such as left ventricular ejection fraction and the presence of non-sustained ventricular tachycardia were not strong enough to achieve this goal with reasonable cost-effectiveness. Heart rate variability (HRV) is one of the most popular parameters used to assess the autonomic tone. HRV has been reported as a strong predictor of cardiovascular mortality. Currently, three different categories of methods in HRV analysis are being used; the time domain, frequency domain, and non-linear dynamic analysis. Both time domain and frequency domain analyses of HRV have been investigated extensively regarding their use as a prognostic marker for cardiovascular mortality. The non-linear dynamic analysis is the latest tool that has shown to have an even higher predictive value than any of the traditional parameters. However, standardized and supporting evidence on this new technique is still lacking. In this article, the current role of HRV in the prediction of cardiovascular mortality in myocardial infarction and heart failure patients has been reviewed.
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Affiliation(s)
- Nipon Chattipakorn
- Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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Sandercock GRH, Brodie DA. The role of heart rate variability in prognosis for different modes of death in chronic heart failure. Pacing Clin Electrophysiol 2006; 29:892-904. [PMID: 16923007 DOI: 10.1111/j.1540-8159.2006.00457.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Classic risk factors for mortality due to chronic heart failure (CHF), such as low left ventricular ejection fraction, NYHA functional stage, and increased heart rate perform well in the prediction of death from pump failure. The prediction of sudden cardiac death (SCD) remains somewhat problematic. Numerous studies have analyzed the potential contribution heart rate variability (HRV) can make to risk assessment in CHF. The aim of this review was to summarize the literature and identify the role HRV might play in identifying mode of death, as well as overall mortality risk. In studies where all-cause mortality or cardiac events were the clinical end point(s), global and slow oscillatory measures of HRV were the strongest risk predictors. In the fewer studies that used SCD as an end point, the strongest risk factors were HRV measures of short-term oscillations and sympathovagal interaction. We concluded from these findings that different HRV measurements predict different modes of death in CHF.Additionally, further studies using short-term analysis of HRV and non-linear analyses are warranted. Furthermore, studies with multiple end points, which clearly delineate pump failure from SCD, may be useful to identify more clearly the role HRV measures can play in the prediction of SCD.
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Abstract
BACKGROUND Autonomic dysfunction is common in patients with chronic liver disease, but it is still unclear whether acute hepatitis coincides with alterations in autonomic functions. METHODS We evaluated the heart rate variability (HRV) of 10 patients with acute hepatitis (6 males, 4 females; mean age, 44.0 y; range, 20-69 y). Frequency-domain analysis of short-term and stationary R-R intervals was performed on the first day of admission to detect low-frequency power (LF; 0.04-0.15 Hz), high-frequency power (HF, 0.15-0.40 Hz), the ratio of LF to HF (LF/HF), and LF in normalized units (LF%). The same measurement was repeated on the 7th day of admission. RESULTS We found that there was a significant increase of HF as well as variance of the R-R interval on the 7th day after admission (P < 0.05). There was a significant negative correlation between HF and the change of total bilirubin (P < 0.05). CONCLUSIONS The study demonstrates a change in cardiac vagal tone associated with acute hepatitis by analysis of HRV, and such alteration is less pronounced later during the clinical course of acute hepatitis.
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Affiliation(s)
- Kuan-Yang Chen
- Department of Medicine, Taipei Municipal Jen Ai Hospital, Taipei, Taiwan
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43
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Abstract
Structural heart disease, electrical instability, and increased sympathetic activity can generate a number of specific and nonspecific ECG changes and arrhythmias in patients with congestive heart failure (CHF). This review describes direct alterations of the P-QRS-T complex and ECG-derived parameters in CHF, together with the significance of cardiac arrhythmias, markers of atrial and ventricular electrical instability, and the parameters of sympathetic nervous system activity.
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Affiliation(s)
- Vinzenz Hombach
- Department of Internal Medicine II, University Hospital of Ulm, Robet-Koch Strasse 8, Ulm D-89081, Germany.
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Alter P, Grimm W, Vollrath A, Czerny F, Maisch B. Heart rate variability in patients with cardiac hypertrophy--relation to left ventricular mass and etiology. Am Heart J 2006; 151:829-36. [PMID: 16569542 DOI: 10.1016/j.ahj.2005.06.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2005] [Accepted: 06/08/2005] [Indexed: 12/19/2022]
Abstract
BACKGROUND Decreased heart rate variability (HRV) has been shown to reflect disturbances of the autonomic nervous system that is related to increased cardiovascular mortality. Most studies investigated HRV in patients with systolic left ventricular dysfunction due to remote myocardial infarction or dilated cardiomyopathy. To date, only few data are available on HRV in patients with predominant diastolic dysfunction in the presence of cardiac hypertrophy of different etiologies. METHODS Time domain analysis of HRV was performed from digital 24-hour Holter electrocardiogram recordings in 86 patients with sinus rhythm and cardiac hypertrophy, which was due to aortic valve stenosis in 33 patients, hypertrophic cardiomyopathy in 29 patients, and hypertensive heart disease in 24 patients. Heart rate variability analysis was compared with 91 healthy controls. RESULTS The SD of all normal-to-normal R-R intervals (SDNN) was reduced in patients with aortic valve stenosis, hypertrophic cardiomyopathy, and hypertensive heart disease when compared with controls (SDNN 119 +/- 42 vs 154 +/- 36 milliseconds, P < .001). The extent of cardiac hypertrophy indexed by echocardiography based left ventricular mass calculation and increased patient age were independent predictors for depression of SDNN. CONCLUSIONS Cardiac hypertrophy of various etiologies is related to decreased HRV on 24-hour Holter electrocardiogram. Both the patient age and the extent of left ventricular hypertrophy are independently associated with depression of HRV. These findings are independent of the cause of cardiac hypertrophy. The significance of these findings remains to be determined by future studies.
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Affiliation(s)
- Peter Alter
- Department of Internal Medicine-Cardiology, Philipps University of Marburg, D-35033 Marburg, Germany.
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45
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Woo MA, Macey PM, Keens PT, Kumar R, Fonarow GC, Hamilton MA, Harper RM. Functional Abnormalities in Brain Areas That Mediate Autonomic Nervous System Control in Advanced Heart Failure. J Card Fail 2005; 11:437-46. [PMID: 16105635 DOI: 10.1016/j.cardfail.2005.02.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2004] [Revised: 02/04/2005] [Accepted: 02/07/2005] [Indexed: 12/30/2022]
Abstract
BACKGROUND Heart failure patients show substantial gray matter loss in brain areas that mediate autonomic control. Those injuries may lead to the aberrant autonomic patterns found in the syndrome. The purpose of this study was to determine if functional responses in the brain to an autonomic challenge would differ from normal patterns and would appear in areas of previously-demonstrated gray matter loss. METHODS AND RESULTS We subjected 6 heart failure patients (left ventricular ejection fraction 0.15 +/- 0.08; age 49 +/- 12 years) and 16 controls (age 48 +/- 11 years) to a forehead cold pressor challenge that would enhance sympathetic outflow and assessed functional magnetic resonance image signals over the entire brain during a 54-second baseline and 90-second challenge. Application of the cold stimulus elicited aberrant responses in the anterior and posterior hypothalamus, bilateral amygdala, hippocampus, cerebellar cortex, insular cortex, mid/posterior cingulate cortex, right ventral frontal cortex, and temporal and frontal cortices. Many of the areas neighbored or overlaid regions of previously demonstrated gray matter damage. Both classical autonomic control regions, as well as brain areas modulating these sites showed deficient responses, some of which appeared to be of an overdampened or underdampened nature. CONCLUSION The findings suggest that the earlier demonstrated changes in brain structure in heart failure result in aberrant functional neural responses; these dysfunctions may contribute to progression of the pathology in heart failure.
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Affiliation(s)
- Mary A Woo
- School of Nursing, David Geffen School of Medicine at UCLA, University of California at Los Angeles, 90095, USA
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46
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De Jong MJ, Randall DC. Heart rate variability analysis in the assessment of autonomic function in heart failure. J Cardiovasc Nurs 2005; 20:186-95; quiz 196-7. [PMID: 15870589 DOI: 10.1097/00005082-200505000-00010] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Heart rate is not static, but rather changes continuously in response to physical and mental demands. In fact, an invariant heart rate is associated with disease processes such as heart failure. Heart rate variability analysis is a noninvasive technique used to quantify fluctuations in heart rate. In this article, the authors review neural control of heart rate, briefly describe heart rate variability, and summarize research data demonstrating that heart failure is associated with altered heart rate variability. In addition, the authors present evidence that heart failure patients with decreased heart rate variability are at risk for future cardiac events, heart transplantations, and death.
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Affiliation(s)
- Marla J De Jong
- College of Nursing, University of Kentucky, Lexington, KY 40536, USA.
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Gehi A, Ix J, Shlipak M, Pipkin SS, Whooley MA. Relation of anemia to low heart rate variability in patients with coronary heart disease (from the Heart and Soul study). Am J Cardiol 2005; 95:1474-7. [PMID: 15950576 PMCID: PMC2776675 DOI: 10.1016/j.amjcard.2005.02.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2004] [Revised: 02/14/2005] [Accepted: 02/11/2005] [Indexed: 12/22/2022]
Abstract
We examined the association between anemia (hemoglobin < or =12 g/dl) and 6 indexes of heart rate variability (HRV) as measured by 24-hour ambulatory electrocardiography in a cross-sectional study of 874 outpatients who had stable coronary heart disease. Of 90 participants who had anemia, 29% to 41% had low HRV, defined as the lowest quartile of each HRV index, compared with 23% to 25% of the 784 participants who did not have anemia (comparison p values <0.05 for all HRV indexes except high-frequency power). With the exception of high-frequency power, each 1 g/dl decrease in hemoglobin was associated with increased odds of having low HRV. This association remained strong after adjustment for potential confounding variables, including ischemia, left ventricular mass, left ventricular ejection fraction, and diastolic dysfunction. Thus, anemia is associated with low HRV in ambulatory patients who have stable coronary heart disease. Low HRV could potentially mediate the association of anemia with increased cardiac risk.
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Affiliation(s)
- Anil Gehi
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York, USA
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Motte S, Mathieu M, Brimioulle S, Pensis A, Ray L, Ketelslegers JM, Montano N, Naeije R, van de Borne P, Entee KM. Respiratory-related heart rate variability in progressive experimental heart failure. Am J Physiol Heart Circ Physiol 2005; 289:H1729-35. [PMID: 15923309 DOI: 10.1152/ajpheart.01129.2004] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Heart failure is associated with autonomic imbalance, and this can be evaluated by a spectral analysis of heart rate variability. However, the time course of low-frequency (LF) and high-frequency (HF) heart rate variability changes, and their functional correlates during progression of the disease are not exactly known. Progressive heart failure was induced in 16 beagle dogs over a 7-wk period by rapid ventricular pacing. Spectral analysis of heart rate variability and respiration, echocardiography, hemodynamic measurements, plasma atrial natriuretic factor, and norepinephrine was obtained at baseline and every week, 30 min after pacing interruption. Progressive heart failure increased heart rate (from 91 +/- 4 to 136 +/- 5 beats/min; P < 0.001) and decreased absolute and normalized (percentage of total power) HF variability from week 1 and 2, respectively (P < 0.01). Absolute LF variability did not change during the study until it disappeared in two dogs at week 7 (P < 0.05). Normalized LF variability increased in moderate heart failure (P < 0.01), leading to an increased LF-to-HF ratio (P < 0.05), but decreased in severe heart failure (P < 0.044; week 7 vs. week 5). Stepwise regression analysis revealed that among heart rate variables, absolute HF variability was closely associated with wedge pressure, right atrial and pulmonary arterial pressure, left ventricular ejection fraction and volume, ratio of maximal velocity of early (E) and atrial (A) mitral flow waves, left atrial diameter, plasma norepinephrine, and atrial natriuretic peptide (0.45 < r < 0.65, all P < 0.001). In tachycardia-induced heart failure, absolute HF heart rate variability is a more reliable indicator of cardiac dysfunction and neurohumoral activation than LF heart rate variability.
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Affiliation(s)
- Sophie Motte
- Free University of Brussels, Laboratory of Physiology, B-1070 Brussels, Belgium
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Klein L, O'Connor CM, Leimberger JD, Gattis-Stough W, Piña IL, Felker GM, Adams KF, Califf RM, Gheorghiade M. Lower serum sodium is associated with increased short-term mortality in hospitalized patients with worsening heart failure: results from the Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF) study. Circulation 2005; 111:2454-60. [PMID: 15867182 DOI: 10.1161/01.cir.0000165065.82609.3d] [Citation(s) in RCA: 413] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The prognostic value of serum sodium in patients hospitalized for worsening heart failure has not been well defined. METHODS AND RESULTS The Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF) study randomized 949 patients with systolic dysfunction hospitalized for worsening heart failure to receive 48 to 72 hours of intravenous milrinone or placebo in addition to standard therapy. In a retrospective analysis, we investigated the relationship between admission serum sodium and the primary end point of days hospitalized for cardiovascular causes within 60 days of randomization, as well as the secondary end points of in-hospital mortality, 60-day mortality, and 60-day mortality/rehospitalization. The number of days hospitalized for cardiovascular causes was higher in the lowest sodium quartile: 8.0 (4.5, 18.5) versus 6 (4, 13) versus 6 (4, 11.5) versus 6 (4, 12) days (P<0.015 for comparison with the lowest quartile). Lower serum sodium was associated with higher in-hospital and 60-day mortality: 5.9% versus 1% versus 2.3% versus 2.3% (P<0.015) and 15.9% versus 6.4% versus 7.8% versus 7% (P=0.002), respectively. There was a trend toward higher mortality/rehospitalization for patients who were in the lowest sodium quartile. Multivariable-adjusted Cox proportional hazards analysis showed that serum sodium on admission, when modeled linearly, predicted increased 60-day mortality: sodium (per 3-mEq/L decrease) had a hazard ratio of 1.18 with a 95% CI of 1.03 to 1.36 (P=0.018). CONCLUSIONS In patients hospitalized for worsening heart failure, admission serum sodium is an independent predictor of increased number of days hospitalized for cardiovascular causes and increased mortality within 60 days of discharge.
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Affiliation(s)
- Liviu Klein
- Northwestern University Feinberg School of Medicine, Chicago, Ill 60611, USA
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Aronson D, Burger AJ. Effect of nesiritide (human b-type natriuretic peptide) and dobutamine on heart rate variability in decompensated heart failure. Am Heart J 2004; 148:e16. [PMID: 15523294 DOI: 10.1016/j.ahj.2004.05.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous studies have suggested that natriuretic peptides may have direct sympathoinhibitory effects. Nesiritide (recombinant human B-type natriuretic peptide) has been recently approved for treatment of decompensated congestive heart failure (CHF). We sought to assess the effects of nesiritide compared with dobutamine on time-domain indices of heart rate variability (HRV) in patients with decompensated CHF. METHODS The study population consisted of 185 patients, who were randomized to intravenous nesiritide at a low (0.015 microg/kg/min, n = 56) or high (0.03 microg/kg/min, n = 58) dose, or to dobutamine (> or = 5 microg/kg/min, n = 58). Time-domain HRV indices were obtained from 24-hour Holter recordings immediately before and during study drug therapy. RESULTS Dobutamine therapy resulted in a decrease in standard deviation of the R-R intervals over a 24-hour period (SDNN), standard deviation of all 5-minute mean R-R intervals (SDANN), and the percentage of R-R intervals with >50 ms variation (pNN50) (all P < .05). Low-dose nesiritide induced an increase in SDNN (P < .05), and high-dose nesiritide resulted in a nonsignificant decrease in all measures of HRV. A significant interaction was noted between baseline HRV and the effect of vasoactive therapy on HRV (P = .028). Therefore, the effect of nesiritide and dobutamine was analyzed in relation to baseline HRV. In the dobutamine group, patients with moderately depressed HRV at baseline displayed a reduction in SDNN (P = .01), SDANN (P = .01), pNN50 (P = .04), and the square root of mean squared differences of successive R-R intervals (RMSSD) (P = .05), whereas no significant changes occurred in patients with severely depressed HRV. In the low-dose nesiritide group, patients with severely depressed HRV displayed an increase in SDNN (P = .001), SDANN (P = .02), and RMSSD (P = .01), with no significant changes in patients with moderately depressed HRV. HRV response to high-dose nesiritide was similar to that of dobutamine. CONCLUSIONS Low-dose nesiritide therapy in patients with decompensated CHF improves indices of overall HRV and parasympathetic modulation, particularly if HRV is severely depressed at baseline. Dobutamine and possibly high-dose nesiritide can potentially lead to further deterioration of autonomic dysregulation.
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Affiliation(s)
- Doron Aronson
- Division of Cardiology, Rambam Medical Center, Haifa, Israel
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