Circadian rhythm of heart rate variability in survivors of cardiac arrest

doi:10.1016/0002-9149(92)90200-I

The American Journal of Cardiology

Volume 70, Issue 6, 1 September 1992, Pages 610-615

https://doi.org/10.1016/0002-9149(92)90200-I Get rights and content

Abstract

Reduced heart rate (HR) variability is associated with increased risk of cardiac arrest in patients with coronary artery disease. In this study, the power spectral components of HR variability and their circadian pattern in 22 survivors of out-of-hospital cardiac arrest not associated with acute myocardial infarction were compared with those of 22 control patients matched with respect to age, sex, previous myocardial infarction, ejection fraction and number of diseased coronary arteries. Survivors of cardiac arrest had significantly lower 24-hour average standard deviation of RR intervals than control patients (29 ± 10 vs 51 ±15 ms, p < 0.001), and the 24-hour mean high frequency spectral area was also lower in survivors of cardiac arrest than in control patients (13 ± 7 ms² × 10 vs 28 ± 14 ms² × 10, p < 0.01). In a single cosinor analysis, a significant circadian rhythm of HR variability was observed in both groups with the acrophase of standard deviation of RR intervals and high-frequency spectral area occurring between 3 and 6 A.M. which was followed by an abrupt decrease in HR variability after arousal. The amplitude of the circadian rhythm of HR variability did not differ between the groups.

Thus, HR variability is reduced in survivors of cardiac arrest but its circadian rhythm is maintained so that a very low HR variability is observed in the morning after awakening, corresponding to the time period at which the incidence of sudden cardiac death is highest.

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Heart failure (HF) is a multi-faceted and life-threatening syndrome that affects more than 64.3 million people worldwide. Current gold-standard screening technique, echocardiography, neglects cardiovascular information regulated by the circadian rhythm and does not incorporate knowledge from patient profiles. In this study, we propose a novel multi-parameter approach to assess heart failure using heart rate variability (HRV) and patient clinical information.
In this approach, features from 24-hour HRV and clinical information were combined as a single polar image and fed to a 2D deep learning model to infer the HF condition. The edges of the polar image correspond to the timely variation of different features, each of which carries information on the function of the heart, and internal illustrates color-coded patient clinical information.
Under a leave-one-subject-out cross-validation scheme and using 7,575 polar images from a multi-center cohort (American and Greek) of 303 coronary artery disease patients (median age: 58 years [50–65], median body mass index (BMI): 27.28 kg/m² [24.91–29.41]), the model yielded mean values for the area under the receiver operating characteristics curve (AUC), sensitivity, specificity, normalized Matthews correlation coefficient (NMCC), and accuracy of 0.883, 90.68%, 95.19%, 0.93, and 92.62%, respectively. Moreover, interpretation of the model showed proper attention to key hourly intervals and clinical information for each HF stage.
The proposed approach could be a powerful early HF screening tool and a supplemental circadian enhancement to echocardiography which sets the basis for next-generation personalized healthcare.
Low spontaneous variability in cerebral blood flow velocity in non-survivors after cardiac arrest
2017, Resuscitation
To investigate spontaneous variability in the time and frequency domain in mean flow velocity (MFV) and mean arterial pressure (MAP) in comatose patients after cardiac arrest, and determine possible differences between survivors and non-survivors.
A prospective observational study was performed at the ICU of a tertiary care university hospital in the Netherlands. We studied 11 comatose patients and 10 controls. MFV in the middle cerebral artery was measured with simultaneously recording of MAP. Coefficient of variation (CV) was used as a standardized measure of dispersion in the time domain. In the frequency domain, the average spectral power of MAP and MFV were calculated in the very low, low and high frequency bands.
In survivors CV of MFV increased from 4.66 [3.92–6.28] to 7.52 [5.52–15.23] % at T = 72 h. In non-survivors CV of MFV decreased from 9.02 [1.70–9.36] to 1.97 [1.97–1.97] %. CV of MAP was low immediately after admission (1.46 [1.09–2.25] %) and remained low at 72 h (3.05 [1.87–3.63] %) (p = 0.13). There were no differences in CV of MAP between survivors and non-survivors (p = 0.30). We noticed significant differences between survivors and non-survivors in the VLF band for average spectral power of MAP (p = 0.03) and MFV (p = 0.003), whereby the power of both MAP and MFV increased in survivors during admission, while remaining low in non-survivors.
Cerebral blood flow is altered after cardiac arrest, with decreased spontaneous fluctuations in non-survivors. Most likely, these changes are the consequence of impaired intrinsic myogenic vascular function and autonomic dysregulation.
Elevated nighttime heart rate due to insufficient circadian adaptation detects heart failure patients prone for malignant ventricular arrhythmias
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Exercise training improves hemodynamic recovery to isometric exercise in obese men with type 2 diabetes but not in obese women
2012, Metabolism: Clinical and Experimental
Citation Excerpt :
During this test, subjects were instructed to breathe at a regular pace, closely watched for breathholding and to avoid the Valsalva maneuver. After visual filtering and automatic editing of the ECG signal according to procedures described by Huikuri et al. [26], HR variability data were analyzed in 2 min epochs (Heart Signal software, Oulu, Finland) [27]. The high frequency power of the HR variability spectrum (HFRRI) was used as an index of cardiovagal modulation and was expressed in normalized units (nu, normalized to total power of the HR spectrum), while the low frequency (LFRRI)/HFRRI ratio was used as an indirect measure of cardiac sympathovagal dominance [28].
Women with type 2 diabetes (T2D) show greater rates of mortality due to ischemic heart disease than men with T2D. We aimed to examine cardiovascular and autonomic function responses to isometric handgrip (IHG) exercise between men and women with T2D, before and after an exercise training program.
Hemodynamic responses were measured in 22 men and women with T2D during and following a 3-min IHG test, and before and after 16 wks of aerobic exercise training.
Women had a smaller decrease in mean arterial pressure (MAP) and systolic blood pressure (BP) during recovery from IHG (ΔMAP_REC) than men pre- and post-training (P < 0.05). Men showed a greater reduction in diastolic BP during recovery from IHG (P < 0.05), and exercise training improved this response in men but not in women (men, pre-training: − 13.9 ± 1.8, post-training: − 20.5 ± 5.3 mmHg vs. women, pre-training: − 10.7 ± 1.7, post-training: − 4.1 ± 4.9 mmHg; P < 0.05). Men had a greater reduction in sympathetic modulation of vasomotor tone (P < 0.05), as estimated by blood pressure variability, following IHG. This response was accentuated after training, while this training effect was not seen in women. Post-training ΔMAP_REC was correlated with recovery of low frequency component of the BP spectrum (ΔLF_SBPrec, r = 0.52, P < 0.05).
Differences in BP recovery immediately following IHG may be attributed to gender differences in cardiovascular autonomic modulation. An improvement in these responses occurs following aerobic exercise training in obese men, but not in obese women with T2D which reflects a better adaptive autonomic response to exercise training.
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Postresuscitation autonomic nervous modulation after cardiac arrest resembles that of severe sepsis
2012, American Journal of Emergency Medicine
Citation Excerpt :
By using power spectral analysis of HRV, studies have demonstrated that patients with severe sepsis have depressed sympathetic modulation, which is indicative of poor outcome [17,18]. In addition, studies have reported that HRV measures are reduced in the survivors of cardiac arrest [19,20]. Although it is conceivable that post-resuscitation status and severe sepsis may share similar mechanisms of impaired HPA axis and impaired autonomic nervous modulation, their similarities have not been well established.
This study explored whether post-resuscitation status resembles severe sepsis in terms of autonomic nervous modulation by using heart rate variability (HRV) analysis.
Successfully resuscitated nontraumatic out-of-hospital cardiac arrest (OHCA) adult patients in an emergency department were prospectively enrolled as the study group. Age- and sex-matched patients with severe sepsis with and without mechanical ventilation were included as positive controls, while sepsis patients and healthy volunteers were included as negative controls. The HRV measures obtained from 10-minute electrocardiogram were compared among 5 groups of subjects.
Sixty-four successfully resuscitated OHCA patients were studied. There were no significant differences in all HRV measures (standard deviation of R-R intervals [SD_RR], coefficient of variation of R-R intervals [CV_RR], total power [TP], very-low-frequency component [VLF], low-frequency component [LF], high-frequency component [HF], normalized LF [LF%], normalized HF [HF%], and LF/HF) among the successfully resuscitated OHCA patients and severe sepsis patients with and without mechanical ventilation. Also, no significant differences in all HRV measures were found between nonsurvivors of OHCA group and nonsurvivors of severe sepsis group. In the nonsurvivors of OHCA group and severe sepsis group, the LF% and LF/HF were significantly lower, whereas the HF and HF% were significantly higher, as compared with the survivors of these 2 groups.
The autonomic nervous modulation in the initial phase of OHCA patients resembles that of severe sepsis in that both groups of patients have decreased global HRV (TP, SD_RR, and CV_RR), sympathovagal balance (LF% and LF/HF), and renin-angiotensin-aldosterone modulation (VLF), as compared to healthy subjects.

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^☆: This study was supported by a grant from the Finnish Foundation for Cardiovascular Research, Helsinki, Finland; Grant HL28130 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland; and Grant IF05W04022-01 from the Fogarty International Foundation, Washington, D.C.

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Circadian rhythm of heart rate variability in survivors of cardiac arrest☆

Abstract

Am J Cardiol

Am J Cardiol

Am J Cardiol

Am J Cardiol

Am J Cardiol

Clin Chim Acta

Continuous 24-hour assessment of the neural regulation of systemic arterial pressure and RR variabilities in ambulant subjects

Circulation

Circadian variation in the frequency of sudden cardiac death

Circulation

Spectral characteristics of heart rate variability before and during postural tilt. Relations to aging and risk of syncope

Circulation

Impaired vagal heart rate control in coronary artery disease

Br Heart J

Assessment of autonomic regulation in chronic congestive heart failure by heart rate spectral analysis

Am J Cardiol