A simple test of cardiac function based upon the heart rate changes induced by the valsalva maneuver

The changes in stroke volume (SV) during upright exercise were studied in 20 insulin-dependent diabetics (IDDM) and 20 age- and sex-matched controls. None of the diabetics had any cardiovascular symptoms. In addition, tests of autonomic function were conducted in the diabetics, assessing changes in heart rate (HR) during deep breathing and the Valsalva maneuver. During exercise the SV in the controls gradually increased and then remained essentially unchanged until maximum HR was achieved. Seven of the diabetics failed to sustain an initial increase in SV (fall > 15%), eight showed a "delayed" increase in SV, and the remaining five demonstrated an increasing SV over the range from rest to peak exercise. Abnormal autonomic function results were found during deep breathing (four diabetics) and the Valsalva maneuver (four diabetics). Findings indicate that cardiac function could be abnormal in IDDM without evidence of autonomic dysfunction. This abnormality could be due to a specific cardiomyopathy. Key words: diabetes mellitus, cardiac function, upright exercise, autonomic neuropathy, cardiomyopathy

Download Full-text

Heart rate as a marker of relapse during withdrawal of heart failure therapy in patients with recovered dilated cardiomyopathy: an analysis from TRED-HF

European Heart Journal ◽

10.1093/ehjci/ehaa946.1057 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

B Halliday ◽

A Vazir ◽

R Owen ◽

J Gregson ◽

R Wassall ◽

...

Keyword(s):

Heart Rate ◽

Cardiac Function ◽

Dilated Cardiomyopathy ◽

Funding Source ◽

End Point ◽

Therapy Withdrawal ◽

The Mean ◽

Withdrawal Of Therapy ◽

Continue Therapy

Abstract Introduction In TRED-HF, 40% of patients with recovered dilated cardiomyopathy (DCM) relapsed in the short-term during phased withdrawal of drug therapy. Non-invasive markers of relapse may be used to monitor patients who wish a trial of therapy withdrawal and provide insights into the pathophysiological drivers of relapse. Purpose To investigate the relationship between changes in heart rate (HR) and relapse amongst patients with recovered DCM undergoing therapy withdrawal in TRED-HF. Methods Patients with recovered DCM were randomised to phased withdrawal of therapy or to continue therapy for 6 months. After 6 months of continued therapy, those in the control arm underwent withdrawal of therapy in a single arm crossover phase. HR was measured at each study visit. Mean HR and 95% confidence intervals (CI) were calculated at baseline, 45 days after baseline, 45 days prior to the end of the study or relapse and at the end of the study or relapse. Patients were stratified by treatment arm and the occurrence of the primary relapse end-point. Heart rate at follow-up was compared amongst patients who had therapy withdrawn and relapsed versus those who had therapy withdrawn and did not. ANCOVA was used to adjust for differences in HR at baseline between the two groups. Results Of 51 patients randomised, 26 were assigned to continue therapy and 25 to withdraw therapy. In the randomised and cross-over phases, 20 patients met the primary relapse end-point; one patient withdrew from the study and one patient completed follow-up in the control arm but did not enter the cross-over phase. Mean HR (standard deviation) at baseline and follow-up for (i) patients in the control arm was 69.9 (9.8) & 65.9 (9.1) respectively; (ii) for those who had therapy withdrawn and did not relapse was 64.6 (10.7) & 74.7 (10.4) respectively; and (iii) for those who had therapy withdrawn and relapsed was 68.3 (11.3) & 86.1 (11.8) respectively [all beats per minute]. The mean change in HR between the penultimate visit and the final visit for those who had therapy withdrawn and did not relapse was −2.4 (9.7) compared to 3.1 (15.5) for those who relapsed. After adjusting for differences in HR at baseline, the mean difference in HR measured at follow-up between patients who underwent therapy withdrawal and did, and did not relapse was 10.4bpm (95% CI 4.0–16.8; p=0.002) (Figure 1 & Table 1). Conclusion(s) A larger increase in HR may be a simple and effective marker of relapse for patients with recovered DCM who have insisted on a trial of therapy withdrawal. Whether HR control is crucial to the maintenance of remission amongst patients with improved cardiac function, or is simply a marker of deteriorating cardiac function, warrants further investigation. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): British Heart Foundation

Download Full-text

Heart Rate Response to the Valsalva Maneuver as a Test of Circulatory Integrity

JAMA ◽

10.1001/jama.1963.03710030040006 ◽

1963 ◽

Vol 186 (3) ◽

pp. 200 ◽

Cited By ~ 47

Author(s):

Edward I. Elisberg

Keyword(s):

Heart Rate ◽

Heart Rate Response ◽

Valsalva Maneuver

Download Full-text

Protective effects of garlic extract on cardiac function, heart rate variability, and cardiac mitochondria in obese insulin-resistant rats

European Journal of Nutrition ◽

10.1007/s00394-013-0595-6 ◽

2013 ◽

Vol 53 (3) ◽

pp. 919-928 ◽

Cited By ~ 27

Author(s):

Luerat Supakul ◽

Hiranya Pintana ◽

Nattayaporn Apaijai ◽

Siriporn Chattipakorn ◽

Krekwit Shinlapawittayatorn ◽

...

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Cardiac Function ◽

Garlic Extract ◽

Protective Effects ◽

Cardiac Mitochondria ◽

Insulin Resistant

Download Full-text

Valsalva maneuver effects on heart rate, blood pressure, and intrarectal pressure — Supine vs. sitting

Autonomic Neuroscience ◽

10.1016/j.autneu.2011.08.019 ◽

2011 ◽

Vol 165 (2) ◽

pp. 211-212

Author(s):

Yuko Kuwahara ◽

Mika Imai ◽

Yutaka Yoshida ◽

Yuuki Shimizu ◽

Naoki Nishimura ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Valsalva Maneuver

Download Full-text

Anticipatory, exercise, and recovery heart rates of girls as affected by four running events

Journal of Applied Physiology ◽

10.1152/jappl.1964.19.5.853 ◽

1964 ◽

Vol 19 (5) ◽

pp. 853-856 ◽

Cited By ~ 17

Author(s):

Vera Skubic ◽

Jane Hilgendorf

Keyword(s):

Heart Rate ◽

Cardiac Function ◽

Heart Rate Response ◽

Heart Rates

The heart rate response to running various distances was studied using five highly trained girls as subjects. A telemetering instrument was employed so that the testing could be done under actual sport conditions. The findings indicated that 1) the anticipatory heart rate just prior to exercise represented 59% of the total adjustment to exercise, 2) the heart rates during exercise were 2.5 times the resting values, and 3) heart rates observed at the end of the 220-, 440-, 880-yard, and mile events were simila cardiac function; exercise Submitted on October 22, 1963

Download Full-text

Heat stress alters hemodynamic responses during the Valsalva maneuver

Journal of Applied Physiology ◽

10.1152/japplphysiol.91642.2008 ◽

2010 ◽

Vol 108 (6) ◽

pp. 1591-1594 ◽

Cited By ~ 5

Author(s):

Scott L. Davis ◽

Craig G. Crandall

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Heat Stress ◽

Phase Ii ◽

Valsalva Maneuver ◽

Late Phase ◽

Thermal Conditions ◽

Whole Body ◽

Hemodynamic Responses ◽

Arterial Blood

The Valsalva maneuver can be used as a noninvasive index of autonomic control of blood pressure and heart rate. The purpose of this investigation was to test the hypothesis that sympathetic mediated vasoconstriction, as referenced by hemodynamic responses during late phase II (phase IIb) of the Valsalva maneuver, is inhibited during whole body heating. Seven individuals (5 men, 2 women) performed three Valsalva maneuvers (each at a 30-mmHg expiratory pressure for 15 s) during normothermia and again during whole body heating (increase sublingual temperature ∼0.8°C via water-perfused suit). Each Valsalva maneuver was separated by a minimum of 5 min. Beat-to-beat mean arterial blood pressure (MAP) and heart rate were measured during each Valsalva maneuver, and responses for each phase were averaged across the three Valsalva maneuvers for both thermal conditions. Baseline MAP was not significantly different between normothermic (88 ± 11 mmHg) and heat stress (84 ± 9 mmHg) conditions. The change in MAP (ΔMAP) relative to pre-Valsalva MAP during phases IIa and IIb was significantly lower during heat stress (IIa = −20 ± 8 mmHg; IIb = −13 ± 7 mmHg) compared with normothermia (IIa = −1 ± 15 mmHg; IIb = 3 ± 13 mmHg). ΔMAP from pre-Valsalva baseline during phase IV was significantly higher during heat stress (25 ± 10 mmHg) compared with normothermia (8 ± 9 mmHg). Counter to the proposed hypothesis, the increase in MAP from the end of phase IIa to the end of phase IIb during heat stress was not attenuated. Conversely, this increase in MAP tended to be greater during heat stress relative to normothermia ( P = 0.06), suggesting that sympathetic activation may be elevated during this phase of the Valsalva while heat stressed. These data show that heat stress does not attenuate this index of vasoconstrictor responsiveness during the Valsalva maneuver.

Download Full-text

Abstract 19478: Endothelial and Cardiomyocyte -derived C-type Natriuretic Peptide Coordinate Heart Structure and Function

Circulation ◽

10.1161/circ.132.suppl_3.19478 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Amie J Moyes ◽

Sandy M Chu ◽

Reshma S Baliga ◽

Adrian J Hobbs

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Cardiac Function ◽

Infarct Size ◽

Natriuretic Peptide ◽

Vascular Tone ◽

Ex Vivo ◽

Pressure Overload ◽

Structure And Function ◽

And Function

Background: Endothelium-derived C-type natriuretic peptide (CNP) plays a key vascular homeostatic role governing vascular tone, blood pressure, leukocyte flux, platelet reactivity and the integrity of the vessel wall. However, relatively little is known about physiological role(s) for endogenous CNP in regulating cardiac structure and function. Herein, we have utilised novel mouse strains with endothelium or cardiomyocyte -specific deletion of CNP to determine if the peptide modulates heart function under basal conditions and during cardiac stress. Methods: Blood pressure and ECG were assessed by radiotelemetry. A Langendorff heart model was used to study coronary vascular reactivity and ischemia-reperfusion (I/R) injury ex vivo. Echocardiography was performed to determine cardiac function at baseline and following pressure overload (trans-aortic constriction; 6 weeks) -induced left ventricular hypertrophy/heart failure. Results: Hearts from endothelium-specific CNP knockout (ecCNP KO) mice exhibited smaller reductions in coronary perfusion pressure (CPP) compared to wildtype (WT) littermates in response to the vasodilators bradykinin (ΔCPP: WT=31.7±2.7%, KO=21.1±2.9%, n=8, p<0.05) and acetylcholine (ΔCPP: WT=36.4±4.4%, KO=18.5±3.8%, n=6, p<0.05). Shear-stress induced coronary dilatation (i.e. reactive hyperaemia) was also blunted in ecCNP KO hearts (AUC: WT=2804±280 [a.u.], KO=1493±280 [a.u.], n=8, p<0.05). Under basal conditions the heart rate (BPM: WT=605±5, KO 579±4, n=5, p<0.001) and contractility (QA interval; WT=13.7±0.1ms, KO=14.8±0.1ms, n=5, p<0.001) were significantly reduced in cardiomyocyte-specific CNP (cmCNP) KO mice compared to WT. Myocardial infarct size was larger in cmCNP KO following I/R injury ex vivo (Infarct size: WT=14.1±6.3%, KO=21.8±1.8 %, n=6, p<0.05). Furthermore, cmCNP KO mice exhibited greater cardiac dysfunction following pressure-overload (e.g. fractional shortening: WT=34.4±0.9%, KO=30.5±1.4%, n=8, p<0.05). Conclusion: These data suggest that CNP of endothelial and cardiomyocyte origin preserves cardiac function and morphology via the regulation of coronary vascular tone, heart rate, and myocardial contractility/hypertrophy.

Download Full-text

Abstract 17165: Natural History of Cardiac Function in Patients With Atrial Fibrillation Pre- and Post- Ablation

Circulation ◽

10.1161/circ.142.suppl_3.17165 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Lisa YW Tang ◽

Kendall Ho ◽

Nathaniel Hawkins ◽

Roger Tam ◽

Michael Lim ◽

...

Keyword(s):

Atrial Fibrillation ◽

Heart Rate ◽

Natural History ◽

Cardiac Function ◽

Older Patients ◽

Autonomic Function ◽

Pronounced Increase ◽

Success Group ◽

History Of ◽

Future Work

Intro: The natural history of cardiac function in atrial fibrillation (AF) patients undergoing pulmonary vein isolation (PVI) is incompletely described, as are heart rate patterns pre- and post-ablation. Goals: Examine autonomic status pre- and post-ablation using cardiac data (n=346) captured by implanted recorders Methods: Daily records (90-day pre to 365-day post ablation) were analyzed to extract parameters viz. heart rate variability (HRV), daytime heart rate (DHR) and nighttime heart rate (NHR). Analysis of variance was used to assess relationships between covariates (age, sex, etc.) and pre-post changes in parameters. We define "success" as patients who had no recurrence during post-ablation period per guidelines (“failed” otherwise). Results: Prior to ablation, mean DHR, NHR, and HRV were 69±10bpm, 60±9bpm, 122±32msec, respectively. After PVI, there was an immediate increase of ~5bpm in DHR (P<1e-4) and a more pronounced increase of ~11bpm in NHR (P<1e-4). HRV exhibited an immediate post-ablation peak decreasing by ~60msec (P<1e-4), with rapid recalibration over the first 10 post ablation days (increase of 20-25msec). Antiarrhythmic drug-use was a significant factor only in explaining changes in HRV (P=0.0126), while age was a significant factor only for the changes in DHR (P<1e-4). Comparing between subgroups, DHR and NHR were generally higher in the success than the failed group. At baseline, older patients (92 patients were of age>65years) had a significantly lower DHR and NHR than younger patients (117 were of age<56years). These age-based differences were amplified post ablation in DHR and NHR, but not HRV. Conclusions: PVI results in significant and sustained changes in heart rate parameters related to autonomic function. This relationship was observed globally, with the success group having significantly greater rises in DHR and NHR when compared to the failed group. Future work will explore whether these patterns exist in different cohorts.

Download Full-text