scholarly journals Impaired autonomic function after incomplete revascularisation

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001835
Author(s):  
Richard Armstrong ◽  
Peter Wheen ◽  
Lisa Brandon ◽  
Ciarán Finucane ◽  
Rose Anne Kenny ◽  
...  
Keyword(s):  
Heart Rate ◽  
Autonomic Function ◽  
Heart Rate Recovery ◽  
Beta Blockers ◽  
Demographic Data ◽  
Syntax Score ◽  
Channel Blockers ◽  
Tertiary Referral Centre ◽  
Ethical Approval ◽  
Residual Syntax Score

IntroductionIncomplete cardiac revascularisation (ICR) assessed by residual SYNTAX score (rSs) is associated with increased 5-year mortality. Furthermore, in the general population, our group has demonstrated that impaired autonomic function determined by heart rate recovery time between 10 and 20 s (HRR10–20) following an active stand is associated with increased all-cause mortality.PurposeWe hypothesised that ICR would be associated with impaired autonomic function determined by HRR10–20.MethodsAfter ethical approval and informed consent, consecutive patients attending cardiac rehabilitation in a tertiary referral centre were enrolled. All patients had percutaneous coronary revascularisation. During an active stand, real-time heart rate, blood pressure and ECG recordings were taken using non-invasive digital photoplethysmography and HRR10–20 determined. Assessment of autonomic function was performed by determining speed of HRR10–20 post-orthostatic challenge.Patients with an rSs >0 were considered incompletely revascularised and those with an rSs of 0 fully revascularised. Demographic data were recorded and statistical analysis performed.ResultsPatients (n=53) comprised those with complete revascularisation (CR) (n=37) and ICR (n=16). In the ICR group, mean rSs was 9.4.HRR10–20 was impaired in the ICR group (−3±0.60) compared with the CR cohort (−6.56±0.52) (p<0.0001). Completeness of revascularisation was strongly associated with HRR10–20 (Pearson’s correlation coefficient 0.529; p<0.0001). Baseline demographics did not differ significantly. Use of rate-limiting medication was similar between cohorts (beta blockers, calcium channel blockers, ivabradine).ConclusionsOur data confirm significant correlation between ICR and impaired autonomic function determined by speed of heart rate recovery. Thus, determining autonomic dysfunction post-ICR may identify those at increased mortality risk.

scholarly journals 345 Blood pressure and autonomic function in essential hypertension: comparative evaluation of 24-hour heart rate variability and blood pressure

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Vanessa Pivetti ◽  
Davide Lazzeroni ◽  
Luca Moderato ◽  
Claudio Stefano Centorbi ◽  
Matteo Bini ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Autonomic Function ◽  
Linear Complexity ◽  
Complexity Analysis ◽  
Beta Blockers ◽  
Sympathetic Tone ◽  
Night Time ◽  
Non Linear

Abstract Aims Arterial hypertension (AHT) represents the leading cause of cardiovascular disease (CVD) and premature death worldwide. Essential AHT accounts for 95% of all cases of hypertension; although the aetiology of essential AHT is still largely unknown, a pivotal role of autonomic nervous system has been proposed and demonstrated. Both excessive sympathetic tone and vagal withdrawal, that define autonomic dysfunction, has been associated with essential AHT. The aim of our study was to investigate the relationship between blood pressure and autonomic function in essential hypertension; this was done comparing 24 h heart rate variability and 24 h blood pressure data, simultaneously collected, in a population of essential AHT subjects. Methods A prospective registry of 179 consecutive not selected essential AHT patients were considered in the present study. All patients underwent cardiac evaluation at the Primary and Secondary Cardiovascular Prevention Unit of the Don Gnocchi Foundation of Parma. All subjects underwent 24 h ECG monitoring, and 24 h Ambulatory Blood Pressure Monitoring, during the same day. Twenty-four hours Heart Rate variability analysis included: Time-domain, frequency-domain and non-linear domain. Results Mean age was 60 0a11.7 years, male gender was prevalent (68.4%). Among the population 26 (14.7%) subjects had diabetes; the prevalence of family history of CVD was 61.7% and 66.5% had dyslipidaemia; body mass index mean values were 27.6 7.4.3. In the whole population, the prevalence of uncontrolled AHT was 80.5%, divided into: 53.1% systo-diastolic, 17.9% isolated systolic, and 9.5% isolated diastolic. The prevalence of untreated AHT (recent diagnosis) was 40.2%, while treated AHT was 59.8% and only 19.6% had controlled blood pressure values (AHT at target). 12.3% of patients were treated with Beta Blockers. A significant correlations between diastolic blood pressure (DBP) values (24 h and day-time), LF/HF ratio (24 h) (r = 0.200; P = 007) and DFA alfa1 (24 h) (r = 0.325; P = 0.000), two know markers of sympathetic tone, were found. A higher sympathetic tone, expressed as high LF/HF, was found in isolated diastolic AHT compared to other types of AHT and the lowest sympathetic tone was found in isolated systolic AHT. Considering non-linear (complexity) analysis, DFA alfa1 (24 h) showed a significant correlation with DBP values that remained independent even after multiple adjustment for BMI, age, gender and Beta Blockers (β = 0.218; P = 0.011). Moreover, the lack of DBP control was associated with high sympathetic tone (LF/HF 3.8 112.3 vs 5.5 .33.3; P &lt; 0.0001). On the other hand, no significant correlations between all DBP data and vagal markers, such as SDNN index, RMSSD and HF, were found. Again, no significant correlations between 24 h, daytime, night-time SBP and time or frequency HRV data as well as with non-linear (complexity) analysis were found. Finally, considering ‘autonomic dipping’, expressed as changes in HRV data between day and night, a strong inverse correlation between vagal markers and Heart Rate Dipping (r = −0.297; P &lt; 0.0001) was found; correlation that remain independent even adjusted for age, gender, BMI, and BB. On the other hand, no association between blood pressure dipping and autonomic dipping was found. Conclusion Diastolic blood pressure and uncontrolled diastolic AHT, rather than systolic AHT, are associated with a hyper-sympathetic tone rather than with blunted vagal tone. The lack of heart rate dipping during night-time in AHT is associated with blunted vagal activation rather than a persistent night-time hyper-adrenergic tone.

scholarly journals Decreased heart rate recovery may predict a high SYNTAX score in patients with stable coronary artery disease

2019 ◽  
Vol 19 (1) ◽  
pp. 109-115
Author(s):  
Sadık Volkan Emren ◽  
Rahman Bilal Gediz ◽  
Oktay Şenöz ◽  
Uğur Karagöz ◽  
Ersin Çağrı Şimşek ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Heart Rate ◽  
Coronary Artery ◽  
Heart Rate Recovery ◽  
Stable Coronary Artery Disease ◽  
Recovery Period ◽  
Multivariate Logistic Regression Analysis ◽  
Syntax Score ◽  
Increased Risk ◽  
Artery Disease

An impaired heart rate recovery (HRR) has been associated with increased risk of cardiovascular events, cardiovascular, and all‐cause mortality. However, the diagnostic ability of HRR for the presence and severity of coronary artery disease (CAD) has not been clearly elucidated. Our aim was to investigate the relationship between HRR and the SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) score in patients with stable CAD (SCAD). A total of 406 patients with an abnormal treadmill exercise test and ≥50% coronary stenosis on coronary angiography were included. The HRR was calculated by subtracting the HR in the first minute of the recovery period from the maximum HR during exercise. The SYNTAX score ≥23 was accepted as high. Correlation of HRR with SYNTAX score and independent predictors of high SYNTAX score were determined. A high SYNTAX score was present in 172 (42%) patients. Mean HRR was lower in patients with a high SYNTAX score (9.8 ± 4.5 vs. 21.3 ± 9, p < 0.001). The SYNTAX score was negatively correlated with HRR (r: -0.580, p < 0.001). In multivariate logistic regression analysis, peripheral arterial disease (OR: 13.3; 95% CI: 3.120–34.520; p < 0.001), decreased HRR (OR: 0.780; 95% CI: 0.674–0.902; p = 0.001), peak systolic blood pressure (OR: 1.054; 95% CI: 1.023–1.087; p = 0.001), and peak HR (OR: 0.950; 95% CI: 0.923–0.977; p < 0.001) were found to be independent predictors of a high SYNTAX score. Our results showed that HRR is significantly correlated with the SYNTAX score, and a decreased HRR is an independent predictor of a high SYNTAX score in patients with SCAD.

Anti-anginal agents in critical illness

2016 ◽  
Author(s):  
Ajay Suri ◽  
Jean R. McEwan
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Sodium Current ◽  
Beta Blockers ◽  
Reduce Blood Pressure ◽  
Critically Ill Patient ◽  
Haemodynamic Monitoring ◽  
Coronary Perfusion ◽  
Channel Blockers ◽  
Treatment Unit

Angina is chest pain resulting from the lack of blood supply to heart muscle most commonly due to obstructive atherosclerotic. Intensive care unit patients are subject to various stresses that will increase the demand on the heart and are in a pro-thrombotic state. Patients in an intensive treatment unit may be sedated and so cardiac ischaemia may be detected by electrocardiogram, haemodynamic monitoring, and echocardiographic imaging of function. These signs may indicate critical coronary perfusion heralding a myocardial infarction and are alleviated by anti-anginal drugs. Beta-blockers and calcium channel blockers are the usual first-line treatments for angina, but may not be ideal in the critically-ill patient. Nitrates reduce blood pressure without typically affecting heart rate. Nicorandil is a similar mechanism of action and tends to be given orally, while ivabridine, an If channel blocker, is a newer anti-anginal, which acts by reducing heart rate, while not affecting blood pressure. Ranolazine is the one of the newest anti-anginal agents and is believed to alter the transcellular late sodium current thereby decreasing sodium entry into ischaemic myocardial cells.

Rate control: medical therapy

ESC CardioMed ◽  
2018 ◽  
pp. 2155-2159
Author(s):  
Isabelle C. Van Gelder ◽  
Michiel Rienstra ◽  
Laurent Pison ◽  
Harry J. G. M. Crijns
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rate ◽  
Rate Control ◽  
Beta Blockers ◽  
Systolic Heart Failure ◽  
Atrioventricular Node ◽  
Channel Blockers ◽  
Control Approach ◽  
Important Message ◽  
Reasonable Choice

Control of the heart rate (rate control) is central to atrial fibrillation management, even for patients who ultimately require control of the rhythm. The choice of rate control depends on symptoms and clinical characteristics of the patient, but for all patients with atrial fibrillation, rate control is part of the management. Choice of drugs is patient dependent and driven by the patient-specific rate–symptom relationship as well as associated conditions. Beta blockers, alone or in combination with digoxin, or non-dihydropyridine calcium channel blockers effectively lower the heart rate. Digoxin is least effective, but a reasonable choice for older, physically inactive patients, in whom other therapies are ineffective or contraindicated, and as an additional drug, especially in systolic heart failure. Institution of all rate control drugs should be performed cautiously. Atrioventricular node ablation with pacemaker insertion for rate control should be the approach of last resort. Catheter ablation of atrial fibrillation, however, should be considered before atrioventricular node ablation. No one formula can integrate the best approach to a specific drug or the effects of therapeutic combinations, but one important message is that a lenient approach to rate control is easy, safe, and effective in many patients and should be considered as the initial approach. A stricter rate control approach is adopted when symptoms persist or deterioration of the left ventricular function occurs. Although rate control is the top priority and one of the first management issues for all patients with atrial fibrillation, and has been studied extensively, many issues remain.

Correlation Between Cardiac Autonomic Function At Rest And Heart Rate Recovery After Submaximal Exercise Test

2016 ◽  
Vol 48 ◽  
pp. 203-204
Author(s):  
Giliard L. Garcia ◽  
Carlos J. Gomes ◽  
Keila E. Fontana ◽  
Luiz Guilherme G. Porto ◽  
Luiz F. Junqueira ◽  
...  
Keyword(s):  
Heart Rate ◽  
Exercise Test ◽  
Autonomic Function ◽  
Heart Rate Recovery ◽  
Submaximal Exercise ◽  
Cardiac Autonomic Function ◽  
Submaximal Exercise Test

scholarly journals A Systematic Review on Heart-Rate Recovery to Monitor Changes in Training Status in Athletes

2012 ◽  
Vol 7 (3) ◽  
pp. 251-260 ◽  
Author(s):  
Hein A.M. Daanen ◽  
Robert P. Lamberts ◽  
Victor L. Kallen ◽  
Anmin Jin ◽  
Nico L.U. Van Meeteren
Keyword(s):  
Systematic Review ◽  
Heart Rate ◽  
Autonomic Function ◽  
Heart Rate Recovery ◽  
Training Status ◽  
Cross Sectional ◽  
Trained Subjects ◽  
Exercise Period ◽  
Changes Over Time ◽  
And Training

Heart-rate recovery (HRR) has been proposed as a marker of autonomic function and training status in athletes. The authors performed a systematic review of studies that examined HRR after training. Five cross-sectional studies and 8 studies investigating changes over time (longitudinal) met our criteria. Three out of 5 crosssectional studies observed a faster HRR in trained compared with untrained subjects, while 2 articles showed no change as a result of training. Most longitudinal studies observed a corresponding increase in HRR and power output (training status). Although confounding factors such as age, ambient temperature, and the intensity and duration of the exercise period preceding HRR make it difficult to compare these studies, the available studies indicated that HRR was related to training status. Therefore, the authors conclude that HRR has the potential to become a valuable tool to monitor changes in training status in athletes and less well-trained subjects, but more studies and better standardization are required to match this potential.

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