Reference Citation Analysis: Find an Article, Find a Category, Find a Journal, Find a Scholar

For: Bauer A, Malik M, Schmidt G, Barthel P, Bonnemeier H, Cygankiewicz I, Guzik P, Lombardi F, Müller A, Oto A, Schneider R, Watanabe M, Wichterle D, Zareba W. Heart rate turbulence: standards of measurement, physiological interpretation, and clinical use: International Society for Holter and Noninvasive Electrophysiology Consensus. J Am Coll Cardiol 2008;52:1353-65. [PMID: 18940523 DOI: 10.1016/j.jacc.2008.07.041] [Citation(s) in RCA: 260] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Revised: 06/18/2008] [Accepted: 07/10/2008] [Indexed: 01/09/2023]

For:	Bauer A, Malik M, Schmidt G, Barthel P, Bonnemeier H, Cygankiewicz I, Guzik P, Lombardi F, Müller A, Oto A, Schneider R, Watanabe M, Wichterle D, Zareba W. Heart rate turbulence: standards of measurement, physiological interpretation, and clinical use: International Society for Holter and Noninvasive Electrophysiology Consensus. J Am Coll Cardiol 2008;52:1353-65. [PMID: 18940523 DOI: 10.1016/j.jacc.2008.07.041] [Citation(s) in RCA: 260] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Revised: 06/18/2008] [Accepted: 07/10/2008] [Indexed: 01/09/2023]

Number

Cited by Other Article(s)

Candia-Rivera D, Chavez M. A method for dyadic cardiac rhythmicity analysis: Preliminary evidence on bilateral interactions in fetal-maternal cardiac dynamics. Exp Physiol 2025. [PMID: 39985150 DOI: 10.1113/ep092532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2024] [Accepted: 02/05/2025] [Indexed: 02/24/2025]

Milovanovic B, Markovic N, Petrovic M, Zugic V, Ostojic M, Rankovic-Nicic L, Bojic M. Assessment of Autonomic Nervous System Function in Patients with Chronic Fatigue Syndrome and Post-COVID-19 Syndrome Presenting with Recurrent Syncope. J Clin Med 2025;14:811. [PMID: 39941481 PMCID: PMC11818862 DOI: 10.3390/jcm14030811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Revised: 01/18/2025] [Accepted: 01/23/2025] [Indexed: 02/16/2025] Open

Abstract

Background/Objectives: Chronic fatigue syndrome and post-COVID-19 syndrome are associated with dysfunction of the autonomic nervous system, which may manifest as syncope and orthostatic intolerance. This study aimed to compare autonomic nervous system function in patients with chronic fatigue syndrome of unknown etiology and those with chronic fatigue syndrome secondary to post-COVID-19 syndrome using multiple diagnostic modalities, and to assess the prevalence and characteristics of syncope in these populations. Methods: This cross-sectional study included 440 patients examined at the Neurocardiological Laboratory of the Institute for Cardiovascular Diseases "Dedinje". Patients were divided into three groups: chronic fatigue syndrome of unknown etiology (Group 1, n = 210), chronic fatigue syndrome secondary to post-COVID-19 syndrome (Group 2, n = 137), and healthy controls (Group 3, n = 91). Diagnostic modalities included cardiovascular reflex tests, the head-up tilt test, beat-to-beat analysis, 24 h Holter electrocardiogram monitoring, and 24 h ambulatory blood pressure monitoring. Statistical analyses were performed using analysis of variance, Tukey's honestly significant difference test, and the Mann-Whitney U test. Results: Both chronic fatigue syndrome groups demonstrated significant autonomic nervous system dysfunction compared to healthy controls (p < 0.05), including reduced baroreceptor sensitivity and impaired heart rate variability parameters. Syncope prevalence was high in both chronic fatigue syndrome groups, with extreme blood pressure variability observed in 45-47% of patients during the head-up tilt test. Patients with post-COVID-19 chronic fatigue syndrome exhibited greater blood pressure increases during the head-up tilt test than those with chronic fatigue syndrome of unknown etiology (p < 0.05). Conclusions: Patients with chronic fatigue syndrome, irrespective of etiology, exhibit significant autonomic nervous system dysfunction and a high prevalence of syncope. Post-COVID-19 chronic fatigue syndrome demonstrates distinct hemodynamic patterns, suggesting unique pathophysiological mechanisms that warrant further investigation.

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Dirschinger RJ, Müller A, Barthel P, Steger A, Dommasch M, Bauer A, Laugwitz KL, Schmidt G, Sinnecker D. Post-extrasystolic variation of ST segment and T wave as a mortality risk predictor after myocardial infarction. Front Physiol 2025;15:1505242. [PMID: 39896195 PMCID: PMC11782248 DOI: 10.3389/fphys.2024.1505242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2024] [Accepted: 12/27/2024] [Indexed: 02/04/2025] Open

Abstract

Aims

Efficient use of preventive cardiac therapies is often limited by inefficient risk prediction, calling for new prediction tools. Ventricular premature complexes (VPCs) elicit electrocardiographic changes in the repolarization of the first post-extrasystolic normal beat. The aim of this study was to assess whether this post-extrasystolic ST segment and T wave variation (PEST) conveys prognostic information regarding the mortality risk of cardiac patients.

Methods

PEST was calculated from 30-min ECGs obtained from 941 survivors of acute myocardial infarction (AMI) as mean difference between the sum of squared voltages from three orthogonal leads (XYZ) of the first (post-extrasystolic) and second (reference) beat after each VPC, in a time window between the limits ϕ1 and ϕ2. Optimal limits yielding a maximum area under the receiver-operating characteristics (ROC) curve were determined by systematic testing, covering the time window from the J point to the end of the T wave. A strong association was found with ϕ1/ϕ2 encompassing 40-230 ms after the J point, which was used to calculate PEST in the analysis. Kaplan-Meier curves and univariable/multivariable Cox proportional hazards models were used to study mortality prediction by PEST. The findings were validated in an independent cohort of 1.788 general population subjects aged 60 years or older.

Results

The area under the ROC curve for PEST was 0.72, with an optimum cutoff at ≤ -6.69 mV2. The 88 patients with PEST values below this cutoff had a considerably higher mortality than the remainder of the patients (25% vs. 5.8%, p < 0.0001; univariable hazard ratio 4.7, 95% CI 2.4-12.0, p < 0.001). In a multivariable Cox regression analysis considering left-ventricular ejection fraction, presence of diabetes mellitus, and Global Registry of Acute Coronary Events (GRACE) score, PEST remained significantly associated with mortality (hazard ratio 3.6, 95% CI 1.9-6.9, p < 0.0001). In the validation cohort, abnormal PEST was also associated with significantly increased 4-year mortality (11.9% vs. 4.3%, p = 0.00095).

Conclusion

PEST is a strong independent predictor of all-cause mortality in AMI survivors and elderly subjects from the general population. While the pathophysiology of this association remains to be investigated, PEST may complement current risk prediction tools in various clinical settings.

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Hsu KT, Nguyen TN, Krishnan AN, Govindan R, Shekhar R. Maternal ECG-Guided Neural Network for Improved Fetal Electrocardiogram Extraction. Biomed Signal Process Control 2025;99:106793. [PMID: 39492951 PMCID: PMC11525986 DOI: 10.1016/j.bspc.2024.106793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2024]

Dong K, Krishnamoorthy V, Vavilala MS, Miller J, Minic Z, Ohnuma T, Laskowitz D, Goldstein BA, Ulloa L, Sheng H, Korley FK, Meurer W, Hu X. Data analysis protocol for early autonomic dysfunction characterization after severe traumatic brain injury. Front Neurol 2024;15:1484986. [PMID: 39777307 PMCID: PMC11704490 DOI: 10.3389/fneur.2024.1484986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Accepted: 12/11/2024] [Indexed: 01/11/2025] Open

Abstract

Background

Traumatic brain injury (TBI) disrupts normal brain tissue and functions, leading to high mortality and disability. Severe TBI (sTBI) causes prolonged cognitive, functional, and multi-organ dysfunction. Dysfunction of the autonomic nervous system (ANS) after sTBI can induce abnormalities in multiple organ systems, contributing to cardiovascular dysregulation and increased mortality. Currently, detailed characterization of early autonomic dysfunction in the acute phase after sTBI is lacking. This study aims to use physiological waveform data collected from patients with sTBI to characterize early autonomic dysfunction and its association with clinical outcomes to prevent multi-organ dysfunction and improving patient outcomes.

Objective

This data analysis protocol describes our pre-planned protocol using cardiac waveforms to evaluate early autonomic dysfunction and to inform multi-dimensional characterization of the autonomic nervous system (ANS) after sTBI.

Methods

We will collect continuous cardiac waveform data from patients managed in an intensive care unit within a clinical trial. We will first assess the signal quality of the electrocardiogram (ECG) using a combination of the structural image similarity metric and signal quality index. Then, we will detect premature ventricular contractions (PVC) on good-quality ECG beats using a deep-learning model. For arterial blood pressure (ABP) data, we will employ a singular value decomposition (SVD)-based approach to assess the signal quality. Finally, we will compute multiple indices of ANS functions through heart rate turbulence (HRT) analysis, time/frequency-domain analysis of heart rate variability (HRV) and pulse rate variability, and quantification of baroreflex sensitivity (BRS) from high-quality continuous ECG and ABP signals. The early autonomic dysfunction will be characterized by comparing the values of calculated indices with their normal ranges.

Conclusion

This study will provide a detailed characterization of acute changes in ANS function after sTBI through quantified indices from cardiac waveform data, thereby enhancing our understanding of the development and course of eAD post-sTBI.

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Dimitriadis K, Iliakis P, Pyrpyris N, Tatakis F, Fragkoulis C, Mantziaris V, Plaitis A, Beneki E, Tsioufis P, Hering D, Kollias A, Konstantinidis D, Tsioufis K. Renal Denervation in Heart Failure Treatment: Data for a Self-Fulfilling Prophecy. J Clin Med 2024;13:6656. [PMID: 39597800 PMCID: PMC11594571 DOI: 10.3390/jcm13226656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2024] [Revised: 11/02/2024] [Accepted: 11/04/2024] [Indexed: 11/29/2024] Open

Affiliation(s)

Kyriakos Dimitriadis First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (P.I.); (N.P.); (F.T.); (C.F.); (V.M.); (A.P.); (E.B.); (P.T.); (D.K.); (K.T.)
Panagiotis Iliakis First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (P.I.); (N.P.); (F.T.); (C.F.); (V.M.); (A.P.); (E.B.); (P.T.); (D.K.); (K.T.)
Nikolaos Pyrpyris First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (P.I.); (N.P.); (F.T.); (C.F.); (V.M.); (A.P.); (E.B.); (P.T.); (D.K.); (K.T.)
Fotis Tatakis First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (P.I.); (N.P.); (F.T.); (C.F.); (V.M.); (A.P.); (E.B.); (P.T.); (D.K.); (K.T.)
Christos Fragkoulis First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (P.I.); (N.P.); (F.T.); (C.F.); (V.M.); (A.P.); (E.B.); (P.T.); (D.K.); (K.T.)
Vasileios Mantziaris First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (P.I.); (N.P.); (F.T.); (C.F.); (V.M.); (A.P.); (E.B.); (P.T.); (D.K.); (K.T.)
Aristides Plaitis First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (P.I.); (N.P.); (F.T.); (C.F.); (V.M.); (A.P.); (E.B.); (P.T.); (D.K.); (K.T.)
Eirini Beneki First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (P.I.); (N.P.); (F.T.); (C.F.); (V.M.); (A.P.); (E.B.); (P.T.); (D.K.); (K.T.)
Panagiotis Tsioufis First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (P.I.); (N.P.); (F.T.); (C.F.); (V.M.); (A.P.); (E.B.); (P.T.); (D.K.); (K.T.)
Dagmara Hering Department of Hypertension and Diabetology, Medical University of Gdansk, 80-214 Gdansk, Poland;
Anastasios Kollias Hypertension Center STRIDE-7, School of Medicine, Third Department of Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, 115 27 Athens, Greece;
Dimitrios Konstantinidis First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (P.I.); (N.P.); (F.T.); (C.F.); (V.M.); (A.P.); (E.B.); (P.T.); (D.K.); (K.T.)
Konstantinos Tsioufis First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (P.I.); (N.P.); (F.T.); (C.F.); (V.M.); (A.P.); (E.B.); (P.T.); (D.K.); (K.T.)

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Kim JY, Park YJ, Park SJ, Kim J, Park KM, On YK, Kim JS, Nam GB, Lee YS, Kim DH, Ahn M, Shin DG, Kim NH, Namgung J, Park YM, Park HS. Noninvasive risk assessment and prediction of cardiac outcomes in patients with congestive heart failure or myocardial infarction. Heart Rhythm 2024:S1547-5271(24)03427-1. [PMID: 39395571 DOI: 10.1016/j.hrthm.2024.10.012] [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] [Received: 08/04/2024] [Revised: 10/02/2024] [Accepted: 10/04/2024] [Indexed: 10/14/2024]

Abstract

BACKGROUND

Heart rate turbulence (HRT) and T-wave alternans (TWA), recognized as promising noninvasive markers for ventricular tachyarrhythmias and cardiac death, have been studied predominantly in Western populations, specifically in patients with myocardial infarction (MI) or heart failure (HF) with reduced ejection fraction (EF).

OBJECTIVE

The purpose of this study was to investigate the clinical implications of HRT and TWA in predicting adverse cardiac events, including cardiac death, ventricular tachyarrhythmia, and heart failure-related hospitalization (HFH).

METHODS

The K-REDEFINE study, a prospective, observational, multicenter analysis of 26 tertiary hospitals in South Korea, investigated the prognostic implications of Holter-based variables including HRT and TWA in 1116 patients with acute MI or HF (age 60.8 ± 2.9 years; 76.3% male). All participants underwent 24-hour Holter recording within 6.8 ± 16.5 days after hospitalization. The primary composite outcome included cardiac death, ventricular tachyarrhythmias, and HFH.

RESULTS

During 4.3 ± 1.2 years of follow-up, impaired HRT demonstrated the most powerful predictive value for the composite (adjusted hazard ratio [aHR] 3.41, 95% confidence interval [CI] 2.27-5.13) or individual events: cardiac death (aHR 4.08, 95% CI 2.17-7.70), ventricular tachyarrhythmia (aHR 3.72, 95% CI 1.29-10.77), and HFH (aHR 4.32, 95% CI 2.25-8.28). The predictive power of abnormal HRT remained consistently significant across subgroups of MI and HF, or across varying degrees of EF. When combined with reduced EF (<50%), the predictive power was further enhanced. However, abnormal TWA was significantly associated only with the composite outcome (aHR 1.51, 95% CI 1.06-2.16).

CONCLUSION

The K-REDEFINE study identified abnormal HRT, mostly assessed within 1 month after hospitalization, as a significant predictor not only for cardiac death and ventricular tachyarrhythmia but also for HFH.

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Affiliation(s)

Ju Youn Kim Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Young Jun Park Wonju Severance Christian Hospital, Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea
Seung-Jung Park Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Juwon Kim Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Kyoung-Min Park Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Young Keun On Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
June Soo Kim Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Gi-Byoung Nam Asan Medical Center, Seoul, Republic of Korea
Young Soo Lee Daegu Catholic University Medical Center, Daegu, Republic of Korea
Dae Hyeok Kim Inha University Hospital, Incheon, Republic of Korea
Minsoo Ahn Wonju Severance Christian Hospital, Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea
Dong-Gu Shin Yeungnam University Hospital, Daegu, Republic of Korea
Nam-Ho Kim Wonkwang University Hospital, Iksan, Republic of Korea
June Namgung Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
Yae Min Park Gachon University Gil Medical Center, Incheon, Republic of Korea
Hyoung-Seob Park Keimyung University Dongsan Medical Center, Daegu, Republic of Korea

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Dougherty CM, Cordoza M, Wang D, Alsoyan AH, Stein PK, Burr RL. Aerobic Exercise Improves Heart Rate Variability After an Implantable Cardioverter Defibrillator (ICD). Biol Res Nurs 2024;26:584-596. [PMID: 38881252 DOI: 10.1177/10998004241261273] [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] [Indexed: 06/18/2024]

Galazka MA, Thorsson M, Lundin Kleberg J, Hadjikhani N, Åsberg Johnels J. Pupil contagion variation with gaze, arousal, and autistic traits. Sci Rep 2024;14:18282. [PMID: 39112540 PMCID: PMC11306570 DOI: 10.1038/s41598-024-68670-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 07/26/2024] [Indexed: 08/10/2024] Open

Oyelade T, Moore KP, Mani AR. Physiological network approach to prognosis in cirrhosis: A shifting paradigm. Physiol Rep 2024;12:e16133. [PMID: 38961593 PMCID: PMC11222171 DOI: 10.14814/phy2.16133] [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: 04/30/2024] [Revised: 06/12/2024] [Accepted: 06/24/2024] [Indexed: 07/05/2024] Open

Kimata M, Hashimoto K, Harada N, Kawamura Y, Kimizuka Y, Fujikura Y, Kaneko M, Kiriu N, Sekine Y, Iwabuchi N, Kiyozumi T, Kawana A, Matsukuma S, Tanaka Y. Noninvasive Ambulatory Electrocardiographic Markers from Patients with COVID-19 Pneumonia: A Report of Three Cases. MEDICINA (KAUNAS, LITHUANIA) 2024;60:655. [PMID: 38674301 PMCID: PMC11052239 DOI: 10.3390/medicina60040655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/05/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024]

Affiliation(s)

Motohiro Kimata Department of General Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (M.K.); (N.H.); (Y.T.)
Kenichi Hashimoto Department of General Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (M.K.); (N.H.); (Y.T.)
Naomi Harada Department of General Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (M.K.); (N.H.); (Y.T.)
Yusuke Kawamura Department of General Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (M.K.); (N.H.); (Y.T.) Department of Integrative Physiology and Bio-Nano Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan
Yoshifumi Kimizuka Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (Y.K.); (Y.F.); (A.K.)
Yuji Fujikura Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (Y.K.); (Y.F.); (A.K.)
Mayuko Kaneko Department of Traumatology and Critical Care Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (M.K.); (N.K.); (Y.S.); (T.K.)
Nobuaki Kiriu Department of Traumatology and Critical Care Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (M.K.); (N.K.); (Y.S.); (T.K.)
Yasumasa Sekine Department of Traumatology and Critical Care Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (M.K.); (N.K.); (Y.S.); (T.K.)
Natsumi Iwabuchi Department of Laboratory Medicine, National Defense Medical College Hospital, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (N.I.); (S.M.)
Tetsuro Kiyozumi Department of Traumatology and Critical Care Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (M.K.); (N.K.); (Y.S.); (T.K.) Department of Defense Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan
Akihiko Kawana Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (Y.K.); (Y.F.); (A.K.)
Susumu Matsukuma Department of Laboratory Medicine, National Defense Medical College Hospital, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (N.I.); (S.M.) Department of Pathology and Laboratory Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan
Yuji Tanaka Department of General Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (M.K.); (N.H.); (Y.T.)

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Stengl H, Ganeshan R, von Rennenberg R, Hellwig S, Herm J, Krause T, Bauer A, Endres M, Georg Haeusler K, Scheitz JF, Nolte CH. Heart rate turbulence in acute ischemic stroke. Eur Stroke J 2024;9:226-234. [PMID: 37932964 PMCID: PMC10916809 DOI: 10.1177/23969873231211166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/13/2023] [Indexed: 11/08/2023] Open

Affiliation(s)

Helena Stengl Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany Center for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, Berlin, Germany Berlin Institute of Health (BIH) at Charité – Universitätsmedizin Berlin, Berlin, Germany
Ramanan Ganeshan Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany Center for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, Berlin, Germany
Regina von Rennenberg Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany Center for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, Berlin, Germany German Center for Cardiovascular Research (DZHK), Partner Site, Berlin, Germany
Simon Hellwig Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany Center for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, Berlin, Germany Berlin Institute of Health (BIH) at Charité – Universitätsmedizin Berlin, Berlin, Germany
Juliane Herm Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany Center for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, Berlin, Germany
Thomas Krause Department of Neurology, Jüdisches Krankenhaus Berlin, Berlin, Germany
Axel Bauer Working Group on Biosignal Analysis, Department of Cardiology, Medical University of Innsbruck, Innsbruck, Austria
Matthias Endres Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany Center for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, Berlin, Germany Berlin Institute of Health (BIH) at Charité – Universitätsmedizin Berlin, Berlin, Germany German Center for Cardiovascular Research (DZHK), Partner Site, Berlin, Germany German Center for Neurodegenerative Diseases (DZNE), Partner Site, Berlin, Germany German Center for Mental Health (DZPG), Partner Site, Berlin, Germany
Karl Georg Haeusler Department of Neurology, Universitätsklinikum Würzburg (UKW), Würzburg, Germany
Jan F Scheitz Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany Center for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, Berlin, Germany Berlin Institute of Health (BIH) at Charité – Universitätsmedizin Berlin, Berlin, Germany German Center for Cardiovascular Research (DZHK), Partner Site, Berlin, Germany
Christian H Nolte Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany Center for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, Berlin, Germany Berlin Institute of Health (BIH) at Charité – Universitätsmedizin Berlin, Berlin, Germany German Center for Cardiovascular Research (DZHK), Partner Site, Berlin, Germany

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Lambiase PD. Determining risk of sudden death: is it all in the T wave? Heart 2024;110:151-153. [PMID: 37788892 DOI: 10.1136/heartjnl-2023-323232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open

Vandenberk B, Haemers P, Morillo C. The autonomic nervous system in atrial fibrillation-pathophysiology and non-invasive assessment. Front Cardiovasc Med 2024;10:1327387. [PMID: 38239878 PMCID: PMC10794613 DOI: 10.3389/fcvm.2023.1327387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/13/2023] [Indexed: 01/22/2024] Open

Roche F, Pichot V, Mouhli-Gasmi L, Monier M, Barthélémy JC, Berger M, Celle S, Chouchou F. Anatomy and physiology of the autonomic nervous system: Implication on the choice of diagnostic/monitoring tools in 2023. Rev Neurol (Paris) 2024;180:42-52. [PMID: 38176987 DOI: 10.1016/j.neurol.2023.12.003] [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: 11/11/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024]

Triantafyllou K, Fragakis N, Gatzoulis KA, Antoniadis A, Giannopoulos G, Arsenos P, Tsiachris D, Antoniou C, Trachanas K, Tsimos K, Vassilikos V. Risk assessment of post-myocardial infarction patients with preserved ejection fraction using 45-min short resting Holter electrocardiographic recordings. Ann Noninvasive Electrocardiol 2023;28:e13087. [PMID: 37700553 PMCID: PMC10646375 DOI: 10.1111/anec.13087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/04/2023] [Accepted: 08/17/2023] [Indexed: 09/14/2023] Open

Abstract

BACKGROUND

Risk stratification for sudden cardiac death in post-myocardial infarction (post-MI) patients remains a challenging task. Several electrocardiographic noninvasive risk factors (NIRFs) have been associated with adverse outcomes and were used to refine risk assessment. This study aimed to evaluate the performance of NIRFs extracted from 45-min short resting Holter ECG recordings (SHR), in predicting ventricular tachycardia inducibility with programmed ventricular stimulation (PVS) in post-MI patients with preserved left ventricular ejection fraction (LVEF).

METHODS

We studied 99 post-MI ischemia-free patients (mean age: 60.5 ± 9.5 years, 86.9% men) with LVEF ≥40%, at least 40 days after revascularization. All the patients underwent PVS and a high-resolution SHR. The following parameters were evaluated: mean heart rate, ventricular arrhythmias (premature ventricular complexes, couplets, tachycardias), QTc duration, heart rate variability (HRV), deceleration capacity, heart rate turbulence, late potentials, and T-wave alternans.

RESULTS

PVS was positive in 24 patients (24.2%). HRV, assessed by the standard deviation of normal-to-normal R-R intervals (SDNN), was significantly decreased in the positive PVS group (42 ms vs. 51 ms, p = .039). SDNN values <50 ms were also associated with PVS inducibility (OR 3.081, p = .032 in univariate analysis, and 4.588, p = .013 in multivariate analysis). No significant differences were identified for the other NIRFs. The presence of diabetes, history of ST-elevation MI (STEMI) and LVEF <50% were also important predictors of positive PVS.

CONCLUSIONS

HRV assessed from SHR, combined with other noninvasive clinical and echocardiographic variables (diabetes, STEMI history, LVEF), can provide an initial, practical, and rapid screening tool for arrhythmic risk assessment in post-MI patients with preserved LVEF.

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Kim JY, Park YJ, Park KM, On YK, Kim JS, Park SJ, Lee YT. Non-Invasive Risk Assessment and Prediction of Mortality in Patients Undergoing Coronary Artery Bypass Graft Surgery. J Cardiovasc Dev Dis 2023;10:365. [PMID: 37754794 PMCID: PMC10531738 DOI: 10.3390/jcdd10090365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/13/2023] [Accepted: 08/24/2023] [Indexed: 09/28/2023] Open

Abstract

Objectives: Heart rate turbulence (HRT) and T-wave alternans (TWA), non-invasive markers of cardiac autonomic dysfunction, and ventricular repolarization abnormality, reportedly, predict the risk of cardiovascular death after myocardial infarction. We investigated whether pre-operative assessment of HRT and/or TWA could predict long-term mortality following coronary artery bypass graft (CABG) surgery. Methods: From May 2010 to December 2017, patients undergoing elective CABG and receiving 24 h ambulatory electrocardiogram monitoring 1 to 5 days prior to CABG surgery were prospectively enrolled. Pre-operative HRT and TWA were measured using a 24 h ambulatory electrocardiogram. The relative risk of cardiac or overall death was assessed according to abnormalities of HRT, TWA, or left ventricular ejection fraction (LV EF). Results: During the mean follow-up period of 4.6 ± 3.9 years, 40 adjudicated overall (5.9%/yr) and 5 cardiac deaths (0.9%/yr) occurred in 146 enrolled patients (64.9 ± 9.3 years; 108 males). Patients with abnormal HRT exhibited significantly higher relative risks of cardiac death (adjusted hazard ratio [HR] 24.9, 95% confidence interval [CI] 1.46-427) and all-cause death (adjusted HR 5.77, 95% CI 2.34-14.2) compared to those with normal HRT. Moreover, abnormal HRT plus abnormal TWA and LV EF < 50% was associated with a greater elevation in cardiac and overall mortality risk. The predictive role of abnormal HRT with/without abnormal TWA for all-cause death was likely more prominent in patients with mildly reduced (35 to 50%) or preserved (≥50%) LV EF. Abnormal HRT plus abnormal TWA and LV EF < 50% showed high negative predictive value in cardiac and overall mortality risk. Conclusions: Assessment of pre-operative HRT and/or TWA predicted mortality risk in patients undergoing elective CABG. Combined analysis of HRT, TWA, and LVEF enhanced the prognostic power. In particular, the predictive value of HRT was enhanced in patients with preserved or mid-range LV EF.

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Taş S, Taş Ü. Effects of COVID-19 on the Autonomic Cardiovascular System: Heart Rate Variability and Turbulence in Recovered Patients. Tex Heart Inst J 2023;50:e227952. [PMID: 37605870 PMCID: PMC10660136 DOI: 10.14503/thij-22-7952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]

Abstract

BACKGROUND

COVID-19 may be a risk factor for developing cardiovascular autonomic dysfunction. Data are limited, however, on the association between heart rate variability, heart rate turbulence, and COVID-19. The aims of this study were to evaluate the effect of COVID-19 on the cardiovascular autonomic system in patients with persistent symptoms after recovering from COVID-19 and to determine whether these patients showed changes in ambulatory electrocardiography monitoring.

METHODS

Fifty-one adults who had confirmed SARS-CoV-2 infection and presented with persistent symptoms to the cardiology outpatient clinic after clinical recovery between April and June 2021 were included. Patients were prospectively followed for 6 months. The patients were evaluated at the time of first application to the cardiology outpatient clinic and at 6 months after presentation. Ambulatory electrocardiography monitoring and echocardiographic findings were compared with a control group of 95 patients.

RESULTS

Patients in the post-COVID-19 group had significantly higher mean (SD) turbulence onset (0.39% [1.82%] vs -1.37% [2.93%]; P < .001) and lower heart rate variability than those in the control group at both initial and 6-month evaluations. The post-COVID-19 group had no significant differences in echocardiographic findings compared with the control group at 6 months, except for right ventricle late diastolic mitral annular velocity (P = .034). Furthermore, turbulence onset was significantly correlated with turbulence slope (r = -0.232; P = .004), heart rate variability, and the parameters of left (r = -0.194; P=.049) and right (r = 0.225; P = .02) ventricular diastolic function.

CONCLUSIONS

COVID-19 may cause cardiovascular autonomic dysfunction. Heart rate variability and turbulence parameters can be used to recognize cardiovascular autonomic dysfunction in patients who have recovered from COVID-19 but have persistent symptoms.

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Wu Z, Liao J, Liu Q, Zhou S, Chen M. Chronic vagus nerve stimulation in patients with heart failure: challenge or failed translation? Front Cardiovasc Med 2023;10:1052471. [PMID: 37534273 PMCID: PMC10390725 DOI: 10.3389/fcvm.2023.1052471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 05/31/2023] [Indexed: 08/04/2023] Open

Milaras N, Dourvas P, Doundoulakis I, Sotiriou Z, Nevras V, Xintarakou A, Laina A, Soulaidopoulos S, Zachos P, Kordalis A, Arsenos P, Archontakis S, Antoniou CK, Tsiachris D, Dilaveris P, Tsioufis K, Sideris S, Gatzoulis K. Noninvasive electrocardiographic risk factors for sudden cardiac death in dilated ca rdiomyopathy: is ambulatory electrocardiography still relevant? Heart Fail Rev 2023;28:865-878. [PMID: 36872393 PMCID: PMC10289982 DOI: 10.1007/s10741-023-10300-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 03/07/2023]

Affiliation(s)

Nikias Milaras National and Kapodistrian University of Athens, Athens, Greece. State Department of Cardiology, "Hippokration" Hospital, Vasilisis Sofias 14, 11256, Athens, Greece.
Panagiotis Dourvas State Department of Cardiology, "Hippokration" Hospital, Vasilisis Sofias 14, 11256, Athens, Greece
Ioannis Doundoulakis First Department of Cardiology, National and Kapodistrian University, Hippokration" Hospital, Athens, Greece
Zoi Sotiriou Department of Cardiology, General Hospital of Karditsa, Karditsa, Greece
Vasileios Nevras Department of Cardiology, General Hospital of Thessaloniki Gennimatas, Thessaloniki, Greece
Anastasia Xintarakou First Department of Cardiology, National and Kapodistrian University, Hippokration" Hospital, Athens, Greece
Aggeliki Laina First Department of Cardiology, National and Kapodistrian University, Hippokration" Hospital, Athens, Greece
Stergios Soulaidopoulos First Department of Cardiology, National and Kapodistrian University, Hippokration" Hospital, Athens, Greece
Panagiotis Zachos Department of Cardiology, General Hospital of Karditsa, Karditsa, Greece
Athanasios Kordalis First Department of Cardiology, National and Kapodistrian University, Hippokration" Hospital, Athens, Greece
Petros Arsenos First Department of Cardiology, National and Kapodistrian University, Hippokration" Hospital, Athens, Greece
Stefanos Archontakis State Department of Cardiology, "Hippokration" Hospital, Vasilisis Sofias 14, 11256, Athens, Greece
Christos-Konstantinos Antoniou Athens Heart Center, Athens Medical Center, Athens, Greece
Dimitrios Tsiachris Athens Heart Center, Athens Medical Center, Athens, Greece
Polychronis Dilaveris First Department of Cardiology, National and Kapodistrian University, Hippokration" Hospital, Athens, Greece
Konstantinos Tsioufis First Department of Cardiology, National and Kapodistrian University, Hippokration" Hospital, Athens, Greece
Skevos Sideris State Department of Cardiology, "Hippokration" Hospital, Vasilisis Sofias 14, 11256, Athens, Greece
Konstantinos Gatzoulis First Department of Cardiology, National and Kapodistrian University, Hippokration" Hospital, Athens, Greece

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Michou V, Nikodimopoulou M, Liakopoulos V, Anifanti M, Papagianni A, Zembekakis P, Deligiannis A, Kouidi E. Home-Based Exercise Training and Cardiac Autonomic Neuropathy in Kidney Transplant Recipients with Type-II Diabetes Mellitus. Life (Basel) 2023;13:1394. [PMID: 37374177 PMCID: PMC10302776 DOI: 10.3390/life13061394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open

Abstract

This randomized clinical trial aimed to examine the effects of a 6-month home-based, combined exercise training program on Cardiac Autonomic Neuropathy (CAN) in kidney transplant recipients (KTRs) with diabetes. Twenty-five KTRs (19 men (76.0%), with a mean age of 54.4 ± 11.3 years old, CAN and type II Diabetes Mellitus (DM-II)), were randomly assigned into two groups: A (n1 = 13 KTRs), who underwent a home-based exercise training program for 6 months, and B (n2 = 12 KTRs), who were assessed at the end of the study. A cardiopulmonary exercise testing (CPET), sit-to-stand test in 30 s (30-s STS), isokinetic muscle strength dynamometry, and 24-h electrocardiographic monitoring were applied to all participants, both at the baseline and at the end of the clinical trial. At first, there were no statistically significant differences between groups. After 6 months, group A showed higher values in exercise time by 8.7% (p = 0.02), VO2peak by 7.3% (p < 0.05), 30-s STS by 12.0% (p < 0.05), upper limb strength by 46.1% (p < 0.05), and lower limb strength by 24.6% (p = 0.02), respectively, compared to the B group. Furthermore, inter-group changes at the end of the 6-month study indicated that group A statistically increased the standard deviation of R-R intervals (SDNN) by 30.3% (p = 0.01), root mean square of successive differences between normal heartbeats (rMSSD) by 32.0% (p = 0.03), number of pairs of successive NN (R-R) intervals that differ by more than 50 ms (pNN50) by 29.0% (p = 0.04), high frequency (HF (ms2)) by 21.6% (p < 0.05), HF (n.u.) by 48.5% (p = 0.01), and turbulence slope (TS) by 22.5% (p = 0.02), and decreased the low frequency (LF (ms2)) by 13.2% (p = 0.01), LF (n.u.) by 24.9% (p = 0.04), and LF/HF ratio by 24% (p = 0.01), compared to group B. Linear regression analysis after the 6-month study showed that there was a strong positive correlation between VO2peak and SDNN (r = 0.701, p < 0.05) in group A. Moreover, multiple regression analysis showed that KTRs' participation in the exercise program showed favorable modifications to sympathovagal balance and aerobic capacity, as measured with SDNN and VO2peak, respectively. To summarize, diabetic KTRs' cardiac autonomic function and functional capacity can be improved after a home-based long-term exercise training program.

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Clasen L, Angendohr S, Becher S, Bartsch B, Enkel S, Meyer C, Kelm M, Makimoto H, Klöcker N. Cardiac ischemia and reperfusion in mice: a comprehensive hemodynamic, electrocardiographic and electrophysiological characterization. Sci Rep 2023;13:5693. [PMID: 37029160 PMCID: PMC10082073 DOI: 10.1038/s41598-023-32346-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/26/2023] [Indexed: 04/09/2023] Open

Affiliation(s)

Lukas Clasen Department of Cardiology, Pulmonary and Vascular Diseases, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany Department of Cardiology, Rhythmology and Angiology, Josephs-Hospital Warendorf, Academic Teaching Hospital, University of Münster, Warendorf, Germany
Stephan Angendohr Department of Cardiology, Pulmonary and Vascular Diseases, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany Cardiovascular Research Institute Düsseldorf (CARID), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
Stefanie Becher Department of Cardiology, Pulmonary and Vascular Diseases, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
Benedikt Bartsch Department of Cardiology, Pulmonary and Vascular Diseases, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
Stephan Enkel Department of Cardiology, Pulmonary and Vascular Diseases, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
Christian Meyer Division of Cardiology, Angiology, Intensive Care Medicine, EVK Düsseldorf, cNEP, Cardiac Neuro- and Electrophysiology Research Consortium, Düsseldorf, Germany
Malte Kelm Department of Cardiology, Pulmonary and Vascular Diseases, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany Cardiovascular Research Institute Düsseldorf (CARID), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
Hisaki Makimoto Department of Cardiology, Pulmonary and Vascular Diseases, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
Nikolaj Klöcker Institute of Neural and Sensory Physiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany. Cardiovascular Research Institute Düsseldorf (CARID), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany.

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Kumar HU, Nearing BD, Mittal S, Premchand RK, Libbus I, DiCarlo LA, Amurthur B, KenKnight BH, Anand IS, Verrier RL. Autonomic regulation therapy in chronic heart failure with preserved/mildly reduced ejection fraction: ANTHEM-HFpEF study results. Int J Cardiol 2023;381:37-44. [PMID: 36934987 DOI: 10.1016/j.ijcard.2023.03.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/08/2023] [Accepted: 03/13/2023] [Indexed: 03/21/2023]

Abstract

BACKGROUND

Autonomic regulation therapy (ART) utilizing cervical vagus nerve stimulation (VNS) appeared to be safe and to improve autonomic tone, symptoms, and cardiac mechanical function in patients with symptomatic heart failure and reduced ejection fraction in the ANTHEM-HF Study. The ANTHEM-HFpEF Study is the first investigation to evaluate the safety and feasibility of ART in patients with symptomatic heart failure and preserved or mildly reduced ejection fraction (HFpEF, HFmrEF).

METHODS

This open-label interventional study enrolled 52 patients with HFpEF or HFmrEF, NYHA Class II-III, and LVEF ≥40%, who received stable guideline-directed medical therapy. All patients were successfully implanted with LivaNova VNS Therapy® system with an electrical lead surrounding the right cervical vagus nerve.

RESULTS

Adverse event incidence was low. At 12 months, NYHA class (p < 0.0001), 6-min walk distance (p < 0.05), and quality of life (p < 0.0001) were improved. Cardiac mechanical function measures were normal at baseline, except for left ventricular mass index in women and E/e' ratio in all patients, which were elevated at baseline, and were unchanged by ART. Autonomic tone and reflexes improved, indicated by 29% decrease in low-frequency/high-frequency heart rate variability to normal levels (p = 0.028) and by increased heart rate turbulence slope (p = 0.047). T-wave alternans (p = 0.001) and T-wave heterogeneity (p = 0.001) were reduced from abnormal to normal ranges. Nonsustained ventricular tachycardia incidence decreased (p = 0.027).

CONCLUSIONS

ART appeared well-tolerated and safe in patients with HFpEF or HFmrEF. Chronic ART did not alter mechanical function measures but was associated with improved heart failure symptoms, exercise tolerance, autonomic tone, and cardiac electrical stability.

CLINICAL TRIAL REGISTRY

Autonomic Neural Regulation Therapy to Enhance Myocardial Function in Heart Failure with Preserved Ejection Fraction [ClinicalTrials.gov #NCT03163030, registered 05/22/2017].

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Grégoire JM, Gilon C, Carlier S, Bersini H. Autonomic nervous system assessment using heart rate variability. Acta Cardiol 2023:1-15. [PMID: 36803313 DOI: 10.1080/00015385.2023.2177371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]

Abstract

The role of the autonomic nervous system in the onset of supraventricular and ventricular arrhythmias is well established. It can be analysed by the spontaneous behaviour of the heart rate with ambulatory ECG recordings, through heart rate variability measurements. Input of heart rate variability parameters into artificial intelligence models to make predictions regarding the detection or forecast of rhythm disorders is becoming routine and neuromodulation techniques are now increasingly used for their treatment. All this warrants a reappraisal of the use of heart rate variability for autonomic nervous system assessment.Measurements performed over long periods such as 24H-variance, total power, deceleration capacity, and turbulence are suitable for estimating the individual basal autonomic status. Spectral measurements performed over short periods provide information on the dynamics of systems that disrupt this basal balance and may be part of the triggers of arrhythmias, as well as premature atrial or ventricular beats. All heart rate variability measurements essentially reflect the modulations of the parasympathetic nervous system which are superimposed on the impulses of the adrenergic system. Although heart rate variability parameters have been shown to be useful for risk stratification in patients with myocardial infarction and patients with heart failure, they are not part of the criteria for prophylactic implantation of an intracardiac defibrillator, because of their high variability and the improved treatment of myocardial infarction. Graphical methods such as Poincaré plots allow quick screening of atrial fibrillation and are set to play an important role in the e-cardiology networks. Although mathematical and computational techniques allow manipulation of the ECG signal to extract information and permit their use in predictive models for individual cardiac risk stratification, their explicability remains difficult and making inferences about the activity of the ANS from these models must remain cautious.

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Zalas D, Bobkowski W, Piskorski J, Guzik P. Heart Rate Asymmetry in Healthy Children. J Clin Med 2023;12:jcm12031194. [PMID: 36769841 PMCID: PMC9918166 DOI: 10.3390/jcm12031194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/25/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open

Călburean PA, Pannone L, Sorgente A, Gauthey A, Monaco C, Strazdas A, Almorad A, Bisignani A, Bala G, Ramak R, Overeinder I, Ströker E, Pappaert G, Van Dooren S, de Ravel T, La Meir M, Brugada P, Sieira J, Chierchia GB, de Asmundis C. Heart rate variability and microvolt T wave alternans changes during ajmaline test may predict prognosis in Brugada syndrome. Clin Auton Res 2023;33:51-62. [PMID: 36645559 DOI: 10.1007/s10286-023-00922-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 01/03/2023] [Indexed: 01/17/2023]

Affiliation(s)

Paul-Adrian Călburean Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium.,George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, Romania
Luigi Pannone Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
Antonio Sorgente Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
Anaïs Gauthey Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
Cinzia Monaco Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
Antanas Strazdas Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
Alexandre Almorad Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
Antonio Bisignani Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
Gezim Bala Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
Robbert Ramak Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
Ingrid Overeinder Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
Erwin Ströker Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
Gudrun Pappaert Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
Sonia Van Dooren Genetics Department, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
Thomy de Ravel Genetics Department, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
Mark La Meir Cardiac Surgery Department, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
Pedro Brugada Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
Juan Sieira Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
Gian-Battista Chierchia Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
Carlo de Asmundis Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium.

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Gomes RAF, Sobral-Filho DC. Heart rate turbulence assessed through ergometry after myocardial infarction: a feasibility study. SAO PAULO MED J 2022;140:762-766. [PMID: 36043674 PMCID: PMC9671564 DOI: 10.1590/1516-3180.2021.0884.r1.27012022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/27/2022] [Indexed: 11/06/2022] Open

Piskorski J, Kośmider M, Mieszkowski D, Żurek S, Biczuk B, Jurga S, Krauze T, Wykrętowicz A, Guzik P. Associations between heart rate asymmetry expression and asymmetric detrended fluctuation analysis results. Med Biol Eng Comput 2022;60:2969-2979. [PMID: 36001222 PMCID: PMC9463330 DOI: 10.1007/s11517-022-02645-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/09/2022] [Indexed: 11/30/2022]

Barthelemy JC, Pichot V, Hupin D, Berger M, Celle S, Mouhli L, Bäck M, Lacour JR, Roche F. Targeting autonomic nervous system as a biomarker of well-ageing in the prevention of stroke. Front Aging Neurosci 2022;14:969352. [PMID: 36185479 PMCID: PMC9521604 DOI: 10.3389/fnagi.2022.969352] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open

Abstract Stroke prediction is a key health issue for preventive medicine. Atrial fibrillation (AF) detection is well established and the importance of obstructive sleep apneas (OSA) has emerged in recent years. Although autonomic nervous system (ANS) appears strongly implicated in stroke occurrence, this factor is more rarely considered. However, the consequences of decreased parasympathetic activity explored in large cohort studies through measurement of ANS activity indicate that an ability to improve its activity level and equilibrium may prevent stroke. In support of these observations, a compensatory neurostimulation has already proved beneficial on endothelium function. The available data on stroke predictions from ANS is based on many long-term stroke cohorts. These data underline the need of repeated ANS evaluation for the general population, in a medical environment, and remotely by emerging telemedicine digital tools. This would help uncovering the reasons behind the ANS imbalance that would need to be medically adjusted to decrease the risk of stroke. This ANS unbalance help to draw attention on clinical or non-clinical evidence, disclosing the vascular risk, as ANS activity integrates the cumulated risk from many factors of which most are modifiable, such as metabolic inadaptation in diabetes and obesity, sleep ventilatory disorders, hypertension, inflammation, and lack of physical activity. Treating these factors may determine ANS recovery through the appropriate management of these conditions. Natural aging also decreases ANS activity. ANS recovery will decrease global circulating inflammation, which will reinforce endothelial function and thus protect the vessels and the associated organs. ANS is the whistle-blower of vascular risk and the actor of vascular health. Such as, ANS should be regularly checked to help draw attention on vascular risk and help follow the improvements in response to our interventions. While today prediction of stroke relies on classical cardiovascular risk factors, adding autonomic biomarkers as HRV parameters may significantly increase the prediction of stroke. Collapse

Affiliation(s)

Jean-Claude Barthelemy Physical Exercise and Clinical Physiology Department, CHU Nord, Saint-Étienne, France INSERM U1059 Santé Ingénierie Biologie, Université Jean Monnet, Saint-Étienne, France *Correspondence: Jean-Claude Barthelemy,
Vincent Pichot Physical Exercise and Clinical Physiology Department, CHU Nord, Saint-Étienne, France INSERM U1059 Santé Ingénierie Biologie, Université Jean Monnet, Saint-Étienne, France
David Hupin Physical Exercise and Clinical Physiology Department, CHU Nord, Saint-Étienne, France INSERM U1059 Santé Ingénierie Biologie, Université Jean Monnet, Saint-Étienne, France Section of Translational Cardiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
Mathieu Berger Physical Exercise and Clinical Physiology Department, CHU Nord, Saint-Étienne, France INSERM U1059 Santé Ingénierie Biologie, Université Jean Monnet, Saint-Étienne, France Centre d’Investigation et de Recherche sur le Sommeil, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
Sébastien Celle Physical Exercise and Clinical Physiology Department, CHU Nord, Saint-Étienne, France INSERM U1059 Santé Ingénierie Biologie, Université Jean Monnet, Saint-Étienne, France
Lytissia Mouhli Physical Exercise and Clinical Physiology Department, CHU Nord, Saint-Étienne, France Département de Neurologie, Hôpital Universitaire Nord, Saint-Étienne, France
Magnus Bäck Section of Translational Cardiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
Jean-René Lacour Laboratoire de Physiologie, Faculté de Médecine Lyon-Sud, Oullins, France
Frederic Roche Physical Exercise and Clinical Physiology Department, CHU Nord, Saint-Étienne, France INSERM U1059 Santé Ingénierie Biologie, Université Jean Monnet, Saint-Étienne, France

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Buś S, Jędrzejewski K, Guzik P. Using Minimum Redundancy Maximum Relevance Algorithm to Select Minimal Sets of Heart Rate Variability Parameters for Atrial Fibrillation Detection. J Clin Med 2022;11:4004. [PMID: 35887768 PMCID: PMC9318370 DOI: 10.3390/jcm11144004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/08/2022] [Accepted: 07/09/2022] [Indexed: 02/06/2023] Open

Abstract

Heart rate is quite regular during sinus (normal) rhythm (SR) originating from the sinus node. In contrast, heart rate is usually irregular during atrial fibrillation (AF). Complete atrioventricular block with an escape rhythm, ventricular pacing, or ventricular tachycardia are the most common exceptions when heart rate may be regular in AF. Heart rate variability (HRV) is the variation in the duration of consecutive cardiac cycles (RR intervals). We investigated the utility of HRV parameters for automated detection of AF with machine learning (ML) classifiers. The minimum redundancy maximum relevance (MRMR) algorithm, one of the most effective algorithms for feature selection, helped select the HRV parameters (including five original), best suited for distinguishing AF from SR in a database of over 53,000 60 s separate electrocardiogram (ECG) segments cut from longer (up to 24 h) ECG recordings. HRV parameters entered the ML-based classifiers as features. Seven different, commonly used classifiers were trained with one to six HRV-based features with the highest scores resulting from the MRMR algorithm and tested using the 5-fold cross-validation and blindfold validation. The best ML classifier in the blindfold validation achieved an accuracy of 97.2% and diagnostic odds ratio of 1566. From all studied HRV features, the top three HRV parameters distinguishing AF from SR were: the percentage of successive RR intervals differing by at least 50 ms (pRR50), the ratio of standard deviations of points along and across the identity line of the Poincare plots, respectively (SD2/SD1), and coefficient of variation-standard deviation of RR intervals divided by their mean duration (CV). The proposed methodology and the presented results of the selection of HRV parameters have the potential to develop practical solutions and devices for automatic AF detection with minimal sets of simple HRV parameters. Using straightforward ML classifiers and the extremely small sets of simple HRV features, always with pRR50 included, the differentiation of AF from sinus rhythms in the 60 s ECGs is very effective.

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Balcıoğlu AS, Aksu E, Aykan AÇ. Triglyceride glucose index is related with cardiac autonomic dysfunction in patients with metabolic syndrome. KARDIOLOGIIA 2022;62:45-50. [PMID: 35834341 DOI: 10.18087/cardio.2022.6.n2049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/28/2022] [Indexed: 06/15/2023]

Heart rate variability in hypothyroid patients: A systematic review and meta-analysis. PLoS One 2022;17:e0269277. [PMID: 35657799 PMCID: PMC9165841 DOI: 10.1371/journal.pone.0269277] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 05/17/2022] [Indexed: 11/19/2022] Open

Pereira ABN, Santana LL, Rocha LDB, Cunha KDC, Rocha LSDO, Santos MCDS, Normando VMF, Torres DDC, Rocha RSB. Physical Exercise Affects Quality of Life and Cardiac Autonomic Modulation in Patients With Chronic Kidney Failure Submitted to Hemodialysis: A Randomized Clinical Trial. Percept Mot Skills 2022;129:696-713. [DOI: 10.1177/00315125221085811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]

The Polyscore of autonomic parameters predicts mortality and identifies low-risk individuals among diabetic survivors of acute myocardial infarction. Sci Rep 2022;12:6069. [PMID: 35414085 PMCID: PMC9005709 DOI: 10.1038/s41598-022-09899-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 03/28/2022] [Indexed: 11/09/2022] Open

Abstract

Survivors of an acute myocardial infarction with diabetes mellitus retain an increased mortality risk. Reliable assessment of individual risk is required for effective and cost-efficient medical care in these patients. The Polyscore is a previously established risk predictor consisting of seven autonomic tests derived from electrocardiogram, blood pressure, and respiration. The Polyscore allows classification of survivors of myocardial infarction in groups at low, intermediate and high mortality risk. The aim of this study was to investigate the prognostic value of the Polyscore in diabetic survivors of acute myocardial infarction, which may be impaired by the presence of diabetic autonomic neuropathy. Survivors of an acute myocardial infarction were included in a prospective cohort study during hospitalisation due to the index event at two university hospitals in Munich, Germany. The Polyscore was determined from simultaneous non-invasive 30-min recordings of electrocardiogram, continuous arterial blood pressure, and respiration which were performed in all participants. Patients were followed for 5 years. The primary and secondary outcomes were all-cause mortality and cardiac mortality. 184 of 941 enrolled patients (19.6%) suffered from diabetes mellitus. 5-year-mortality was higher in diabetic patients (15.2%) compared to non-diabetic patients (5.8%). A multivariable Cox regression model confirmed the Polyscore as a strong predictor of mortality in diabetic post-MI patients (intermediate risk: HR 6.56, 95% CI 1.61–26.78, p = 0.004, mortality 22.8%; high risk: HR 18.76, 95% CI 4.35–80.98, p < 0.001, mortality 68.8%). There was no interaction between diabetes mellitus and the Polyscore regarding mortality prediction (p = 0.775). Interestingly, in contrast to the groups at intermediate and high risk (73 patients, 39.7%), the Polyscore identified a majority of diabetic patients (111, 60.3%) with a low mortality risk, comparable to that of low-risk non-diabetic patients (3.6% and 2.1%, respectively, p = 0.339). Consistent results were observed for cardiac mortality. This analysis shows that the Polyscore predicts all-cause and cardiac mortality in diabetic survivors of acute myocardial infarction. Within these patients it identifies a large population not affected by the excess mortality associated with diabetes in this setting. Thus, the Polyscore may facilitate risk-adapted follow-up strategies in diabetic survivors of myocardial infarction.

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Blesius V, Schölzel C, Ernst G, Dominik A. Comparability of Heart Rate Turbulence Methodology: 15 Intervals Suffice to Calculate Turbulence Slope – A Methodological Analysis Using PhysioNet Data of 1074 Patients. Front Cardiovasc Med 2022;9:793535. [PMID: 35463773 PMCID: PMC9019151 DOI: 10.3389/fcvm.2022.793535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/07/2022] [Indexed: 11/24/2022] Open

Abstract

Heart rate turbulence (HRT) is a characteristic heart rate pattern triggered by a ventricular premature contraction (VPC). It can be used to assess autonomic function and health risk for various conditions, e.g., coronary artery disease or cardiomyopathy. While comparability is essential for scientific analysis, especially for research focusing on clinical application, the methodology of HRT still varies widely in the literature. Particularly, the ECG measurement and parameter calculation of HRT differs, including the calculation of turbulence slope (TS). In this article, we focus on common variations in the number of intervals after the VPC that are used to calculate TS (#TSRR) posing two questions: 1) Does a change in #TSRR introduce noticeable changes in HRT parameter values and classification? and 2) Do larger values of turbulence timing (TT) enabled by a larger #TSRR still represent distinct HRT? We compiled a free-access data set of 1,080 annotated long-term ECGs provided by Physionet. HRT parameter values and risk classes were determined both with #TSRR 15 and 20. A standard local tachogram was created by averaging the tachograms of only the files with the best heart rate variability values. The shape of this standard VPC sequence was compared to all VPC sequences grouped by their TT value using dynamic time warping (DTW) in order to identify HRT shapes. When calculated with different #TSRR, our results show only a little difference between the number of files with enough valid VPC sequences to calculate HRT (<1%) and files with different risk classes (5 and 6% for HRT0-2 and HRTA-C, respectively). In the DTW analysis, the difference between averaged sequences with a specific TT and the standard sequence increased with increasing TT. Our analysis suggests that HRT occurs in the early intervals after the VPC and TS calculated from late intervals reflects common heart rate variability rather than a distinct response to the VPC. Even though the differences in classification are marginal, this can lead to problems in clinical application and scientific research. Therefore, we recommend uniformly using #TSRR 15 in HRT analysis.

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Verrier RL, Libbus I, Nearing BD, KenKnight BH. Multifactorial Benefits of Chronic Vagus Nerve Stimulation on Autonomic Function and Cardiac Electrical Stability in Heart Failure Patients With Reduced Ejection Fraction. Front Physiol 2022;13:855756. [PMID: 35431984 PMCID: PMC9005779 DOI: 10.3389/fphys.2022.855756] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 02/21/2022] [Indexed: 12/20/2022] Open

Zhang J, Du L, Li J, Li R, Jin X, Ren J, Gao Y, Wang X. Association between circadian variation of heart rate and mortality among critically ill patients: a retrospective cohort study. BMC Anesthesiol 2022;22:45. [PMID: 35151270 PMCID: PMC8840314 DOI: 10.1186/s12871-022-01586-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/08/2022] [Indexed: 11/24/2022] Open

Abstract

Background

Heart rate (HR) related parameters, such as HR variability, HR turbulence, resting HR, and nighttime mean HR have been recognized as independent predictors of mortality. However, the influence of circadian changes in HR on mortality remains unclear in intensive care units (ICU). The study is designed to evaluate the relationship between the circadian variation in HR and mortality risk among critically ill patients.

Methods

The present study included 4,760 patients extracted from the Multiparameter Intelligent Monitoring in Intensive Care II database. The nighttime mean HR/daytime mean HR ratio was adopted as the circadian variation in HR. According to the median value of the circadian variation in HR, participants were divided into two groups: group A (≤ 1) and group B (> 1). The outcomes included ICU, hospital, 30-day, and 1-year mortalities. The prognostic value of HR circadian variation was investigated by multivariable logistic regression models and Cox proportional hazards models.

Results

Patients in group B (n = 2,471) had higher mortality than those in group A (n = 2,289). Multivariable models revealed that the higher circadian variation in HR was associated with ICU mortality (odds ratio [OR], 1.393; 95% confidence interval [CI], 1.112–1.745; P = 0.004), hospital mortality (OR, 1.393; 95% CI, 1.112–1.745; P = 0.004), 30-day mortality (hazard ratio, 1.260; 95% CI, 1.064–1.491; P = 0.007), and 1-year mortality (hazard ratio, 1.207; 95% CI, 1.057–1.378; P = 0.005), especially in patients with higher SOFA scores.

Conclusions

The circadian variation in HR might aid in the early identification of critically ill patients at high risk of associated with ICU, hospital, 30-day, and 1-year mortalities.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12871-022-01586-9.

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Yalim Z, Alan Yalim S, Eroğul Ö, Doğan M. The role of heart rate variability and heart rate turbulence in diabetic retinopathy. Minerva Endocrinol (Torino) 2022;47:172-180. [PMID: 35142481 DOI: 10.23736/s2724-6507.20.03346-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]

Hashimoto K, Kinoshita T, Miwa Y, Amino M, Yoshioka K, Yodogawa K, Nakagawa M, Nakamura K, Watanabe E, Nakamura K, Watanabe T, Kasamaki Y, Ikeda T. Ambulatory electrocardiographic markers predict serious cardiac events in patients with chronic kidney disease: The Japanese Noninvasive Electrocardiographic Risk Stratification of Sudden Cardiac Death in Chronic Kidney Disease (JANIES-CKD) study. Ann Noninvasive Electrocardiol 2021;27:e12923. [PMID: 34873791 PMCID: PMC8916573 DOI: 10.1111/anec.12923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/18/2021] [Indexed: 11/25/2022] Open

Trachanas K, Sideris S, Arsenos P, Tsiachris D, Antoniou CK, Dilaveris P, Triantafyllou K, Xenogiannis I, Tsimos K, Efremidis M, Kanoupakis E, Flevari P, Vassilikos V, Sideris A, Korantzopoulos P, Tousoulis D, Tsioufis K, Gatzoulis K. Noninvasive risk factors for the prediction of inducibility on programmed ventricular stimulation in post-myocardial infarction patients with an ejection fraction ≥40% at risk for sudden cardiac arrest: Insights from the PRESERVE-EF study. Ann Noninvasive Electrocardiol 2021;27:e12908. [PMID: 34873786 PMCID: PMC8916556 DOI: 10.1111/anec.12908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/05/2021] [Accepted: 10/11/2021] [Indexed: 11/29/2022] Open

Affiliation(s)

Konstantinos Trachanas State Department of Cardiology, Hippokrateion General Hospital, Athens, Greece
Skevos Sideris State Department of Cardiology, Hippokrateion General Hospital, Athens, Greece
Petros Arsenos First Department of Cardiology, Hippokrateion General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
Dimitrios Tsiachris First Department of Cardiology, Hippokrateion General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
Christos-Konstantinos Antoniou First Department of Cardiology, Hippokrateion General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
Polychronis Dilaveris First Department of Cardiology, Hippokrateion General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
Konstantinos Triantafyllou Third Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
Iosif Xenogiannis Second Department of Cardiology, Attikon General Hospital, National and Kapodistrian University of Athens School of Medicine, Chaidari, Greece
Konstantinos Tsimos Department of Cardiology, Faculty of Medicine, University of Ioannina, Ioannina, Greece
Michalis Efremidis Second State Department of Cardiology, Evangelismos Athens General Hospital, Athens, Greece
Emmanuel Kanoupakis Department of Cardiology, Heraklion University Hospital, University of Crete, School of Medicine, Heraklion, Greece
Panagiota Flevari Second Department of Cardiology, Attikon General Hospital, National and Kapodistrian University of Athens School of Medicine, Chaidari, Greece
Vassilios Vassilikos Third Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
Antonios Sideris Second State Department of Cardiology, Evangelismos Athens General Hospital, Athens, Greece
Panagiotis Korantzopoulos Department of Cardiology, Faculty of Medicine, University of Ioannina, Ioannina, Greece
Dimitrios Tousoulis First Department of Cardiology, Hippokrateion General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
Konstantinos Tsioufis First Department of Cardiology, Hippokrateion General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
Konstantinos Gatzoulis First Department of Cardiology, Hippokrateion General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece

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Berger M, Pichot V, Solelhac G, Marques-Vidal P, Haba-Rubio J, Vollenweider P, Waeber G, Preisig M, Barthélémy JC, Roche F, Heinzer R. Association between nocturnal heart rate variability and incident cardiovascular disease events: The HypnoLaus population-based study. Heart Rhythm 2021;19:632-639. [PMID: 34864166 DOI: 10.1016/j.hrthm.2021.11.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 11/10/2021] [Accepted: 11/29/2021] [Indexed: 11/04/2022]

Hayano J, Yuda E. Assessment of autonomic function by long-term heart rate variability: beyond the classical framework of LF and HF measurements. J Physiol Anthropol 2021;40:21. [PMID: 34847967 PMCID: PMC8630879 DOI: 10.1186/s40101-021-00272-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/12/2021] [Indexed: 12/16/2022] Open

Vorobiev AP, Vaykhanskaya TG, Melnikova OP, Krupenin VP, Polyakov VB, Frolov AV. A Digital Electrocardiographic System for Assessing Myocardial Electrical Instability: Principles and Applications. Sovrem Tekhnologii Med 2021;12:15-19. [PMID: 34796014 PMCID: PMC8596236 DOI: 10.17691/stm2020.12.6.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Indexed: 11/14/2022] Open

Călburean PA, Osorio TG, Sorgente A, Almorad A, Pannone L, Monaco C, Miraglia V, Al Housari M, Mojica J, Bala G, Bisignani A, Lipartiti F, Strazdas A, Ramak R, Overeinder I, La Meir M, Ströker E, Brugada P, Boveda S, Paparella G, Iacopino S, Sieira J, Chierchia GB, de Asmundis C. High vagal tone predicts pulmonary vein reconnection after cryoballoon ablation for paroxysmal atrial fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021;44:2075-2083. [PMID: 34773413 DOI: 10.1111/pace.14408] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/19/2021] [Accepted: 11/07/2021] [Indexed: 12/01/2022]

Abstract

BACKGROUND

Pulmonary vein (PV) isolation is an established treatment for paroxysmal drug-refractory atrial fibrillation (AF). High parasympathetic tone and reconnection of PVs have demonstrated to be possible culprits of AF recurrence after ablation. Our aim was to investigate the association between parasympathetic tone and reconnected PVs in patients with paroxysmal AF.

METHODS

Consecutive patients who underwent a redo catheter ablation procedure for atrial tachyarrhythmia recurrence by means of 3D electroanatomic mapping with documentation of presence or absence of PVs reconnection following an initial procedure of cryoballoon (CB) ablation for symptomatic drug-refractory paroxysmal AF were screened for the study.

RESULTS

A total of 92 patients were included, of whom 50 (54.35%) were males. Reconnected PVs were found in 64 (69%) patients. PVs reconnection could be predicted by DC (C-statistic = .770), by SDNNI (C-statistic = .714) and by absolute VLF power (C-statistic = .722), while right-sided PVs reconnection could be better predicted by DC (C-statistic = .848) and by SDNNI (C-statistic = .761). In multivariate binary logistic regression analysis, a DC value ≥6.45 ms and an absolute VLF power value ≥160 ms² were associated with three times and five times higher odds of PVs reconnection, respectively. On a vein-per-vein analysis, absolute VLF power ≥160 ms² was associated with three times higher odds, while reaching of -40°C within 60 s was associated with three times lower odds of PVs reconnection.

CONCLUSION

High parasympathetic tonus accurately predicts PVs reconnection. On a vein-per-vein analysis, parasympathetic markers along with biophysical parameters predicted PVs reconnection. On a case-by-case analysis, parasympathetic markers were the only predictors of PVs reconnection, thus being a robust PVs reconnection prediction tool.

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Affiliation(s)

Paul-Adrian Călburean Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium.,Department of Medical Informatics and Biostatistics, University of Medicine, Pharmacy, Science and Technology "George Emil Palade" of Târgu Mureş, Târgu Mureş, Romania
Thiago Guimaraes Osorio Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
Antonio Sorgente Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
Alexandre Almorad Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
Luigi Pannone Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
Cinzia Monaco Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
Vincenzo Miraglia Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
Maysam Al Housari Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
Joerelle Mojica Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
Gezim Bala Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
Antonio Bisignani Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
Felicia Lipartiti Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
Antanas Strazdas Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
Robbert Ramak Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
Ingrid Overeinder Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
Mark La Meir Cardiac Surgery Department, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
Erwin Ströker Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
Pedro Brugada Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
Serge Boveda Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
Gaetano Paparella Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
Saverio Iacopino Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
Juan Sieira Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
Gian Battista Chierchia Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
Carlo de Asmundis Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium

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Taggart P, Pueyo E, van Duijvenboden S, Porter B, Bishop M, Sampedro-Puente DA, Orini M, Hanson B, Rinaldi CA, Gill JS, Lambiase P. Emerging evidence for a mechanistic link between low-frequency oscillation of ventricular repolarization measured from the electrocardiogram T-wave vector and arrhythmia. Europace 2021;23:1350-1358. [PMID: 33880542 PMCID: PMC8427352 DOI: 10.1093/europace/euab009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Indexed: 11/17/2022] Open

Akıncı S, Çoner A, Balcıoğlu AS, Akbay E, Müderrisoğlu İH. Heart rate variability and heart rate turbulence in patients with vasovagal syncope. ACTA ACUST UNITED AC 2021;61:54-59. [PMID: 34549694 DOI: 10.18087/cardio.2021.8.n1523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 06/14/2021] [Accepted: 06/16/2021] [Indexed: 11/18/2022]

Huikuri H. The autonomic cardiac nervous system and arrhythmogenesis: risk stratification in the foreseeable future. Herzschrittmacherther Elektrophysiol 2021;32:320-322. [PMID: 34255143 PMCID: PMC8413184 DOI: 10.1007/s00399-021-00777-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022]

Autonomic dysfunction and heart rate variability with Holter monitoring: a diagnostic look at autonomic regulation. Herzschrittmacherther Elektrophysiol 2021;32:315-319. [PMID: 34236476 DOI: 10.1007/s00399-021-00780-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/06/2021] [Indexed: 10/20/2022]

Holter-Derived Autonomic Function, Arrhythmias and Carbohydrate Metabolism in Patients with Class III Obesity Treated with Laparoscopic Sleeve Gastrectomy. J Clin Med 2021;10:jcm10102140. [PMID: 34063446 PMCID: PMC8156268 DOI: 10.3390/jcm10102140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 12/05/2022] Open

Maru Y, Yodogawa K, Tanaka T, Kashiwada T, Iwasaki Y, Azuma A, Shimizu W. Detection of cardiac involvement in pulmonary sarcoidosis using high-resolution Holter electrocardiogram. J Arrhythm 2021;37:438-444. [PMID: 33850586 PMCID: PMC8022007 DOI: 10.1002/joa3.12501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/03/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022] Open