A Non-Invasive Tool to Quantify Autonomic Dysfunctuion: A Prognostic Indicator in Covid-19

2021 ◽  
Vol 6 (02) ◽  
pp. 103-108
Author(s):  
Avinash H Rajanna ◽  
Jayanthi C R ◽  
Swetha R ◽  
Subramani ◽  
Deepak Padmanabhan ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Health Risk ◽  
Autonomic Dysfunction ◽  
Predictive Ability ◽  
Heart Rhythm ◽  
Prognostic Indicator ◽  
P Value ◽  
Reactive Protein ◽  
Non Invasive

Background: The Outbreak of SARS-CoV-2 has caused a major pandemic posing a threat to the millions of lives all over the world. The evidence shows that there is a relation between the autonomic nervous system and coronaviruses and likewise, levels of inflammatory markers - C-reactive protein (CRP) and autonomic dysfunction. Autonomic dysfunction is elicited using heart rate variability which in turn quantified using autonomous regulatory index (ARI). Hence this study was conducted to determine if ARI measured using patented NEUROCOR Precision HRV® Solution instrument could be used as a non-invasive measure of autonomic dysfunction among COVID-19 subjects. Materials & Methods: An exploratory study was conducted among randomly selected 22 COVID-19 male patients aged more than 18 years, admitted to COVID ward, Victoria Hospital, Bengaluru for 5 days, using ANS Recorder, a non-invasive heart rate variability recorder heart rhythm data were collected, one test per day continuously for 5 days and a patented NEUROCOR Precision HRV® Solution, an ANS Analysis Software instrument was used to record, analyze and interpret the heart rate variability in terms of ARI and CRP levels were measured. Data was analyzed using SPSS version 18.0. A P value of < 0.05 was considered statistically significant. Results: The occurrence of autonomic dysfunction in COVID-19 patients using the Patented NEUROCOR Precision HRV® Solution was found to be among 50.0%. The median scores of average ARI indices were significantly lesser among those with higher health risk (28.39) compared to those with lower health risk (65.95) (P<0.05). The Median ARI index showed a weak negative correlation (r = -0.13, P>0.05) with CRP (P>0.05). ARI index showed a significantly excellent predictive ability in detecting the higher health risk with the areas under the curves (AUC) being 0.93 with an optimal cut-off of 40.85 with maximum sensitivity and specificity of 100.0% and 93.0%. Conclusion: Autonomous Regulatory Index (ARI) index with significantly excellent predictive ability in detecting the higher health risk can be used as a non-invasive measure of autonomic dysfunction among COVID-19 subjects.

scholarly journals ESTIMATION AND PROGNOSTIC VALUE OF THE PATIENTS SIMPATOVAGAL STATUS IN THE ACUTE PERIOD OF MYOCARDIAL INFARCT WITH ST SEGMENT ELEVATION

2019 ◽  
Vol 33 (4) ◽  
pp. 90-97
Author(s):  
V. E. Oleynikov ◽  
E. V. Dushina ◽  
M. V. Lukyanova ◽  
Yu. A. Barmenkova ◽  
I. Y. Moiseeva
Keyword(s):  
Myocardial Infarction ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Heart Rhythm ◽  
Heart Rhythm Variability ◽  
St Segment Elevation ◽  
Reactive Protein ◽  
Segment Elevation Myocardial Infarction ◽  
Normal Heart Rate ◽  
St Segment

The aimof the study was to analyze the impact of the status of cardiac autonomic nervous regulation on the fragmentation activity, development and progression of heart failure, and the long-term prognosis in patients with early ST segment elevation myocardial infarction.Material and Methods. The study included 143 subjects; 54 healthy volunteers were examined to identify normal values of heart rhythm variability parameters. The observation group comprised 89 patients with ST segment elevation myocardial infarction who underwent 24-hour ECG monitoring at day 7 to 9 as well as at 24 and 48 weeks with follow up assessment of heart rate variability and late ventricular potentials. At the time points, the levels of brain natriuretic peptide and highly sensitive C-reactive protein were determined. Patients underwent a 6-min walk test every 12 weeks. The development of repeated cardiovascular events has been monitored as an end-point. Patients were assigned to two groups according to results of heart rhythm variability analysis at day 7–9 after onset of ST segment elevation myocardial infarction: group 1 had normal heart rate variability; group 2 had increased sympathetic impact on rhythm.Results. In group 1, a pronounced regression of the brain natriuretic peptide level was registered 24 week after onset of ST segment elevation myocardial infarction. The value of C-reactive protein decreased in all groups. A favorable transformation of the indices reflecting the fragmentation activity — high-frequency low-amplitude and root mean square — of the myocardium was recorded only in the group with normal heart rate variability parameters. The risk of repeated cardiovascular events during 48 weeks after ST segment elevation myocardial infarction was significantly higher in the group with dominant sympathetic activity than in the group with normal status of the autonomic nervous system.Conclusion. Hypersympathicotonia in the acute period of ST segment elevation myocardial infarction was associated with an increased relative risk of repeated cardiac events and negatively affected the dynamics of laboratory parameters indicative of heart failure development and progression.

scholarly journals Arrhythmias in Patients after Surgical Myocardial Revascularization

2020 ◽  
Vol 16 (1) ◽  
pp. 133-138
Author(s):  
N. U. Zakirov ◽  
A. G. Kevorkov ◽  
A. S. Rasulov ◽  
E. Y. Tursunov
Keyword(s):  
Myocardial Infarction ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Cardiac Death ◽  
Ventricular Arrhythmias ◽  
Myocardial Revascularization ◽  
Heart Rhythm ◽  
Non Invasive ◽  
Life Threatening ◽  
Vegetative Regulation

This work represents literature review data regarding the study of the effect of surgical myocardial revascularization on the processes of electrical myocardial instability underlying the onset of life-threatening ventricular arrhythmias, as well as the possibilities for its non-invasive assessment by studying the heart rhythm variability and turbulence. Analyzed data demonstrated that, relying only on the presence of a viable myocardium, it is often impossible to predict the positive effect of revascularization on the prognosis in patients, especially those with reduced myocardial contractility. Considering the well-studied relationship between myocardial remodeling and neurohormonal activation, such non-invasive methods for assessing vegetative regulation of cardiac activity, as heart rate variability and turbulence may provide additional diagnostic information. The literature data indicate that heart failure, ventricular arrhythmias and recurrences of angina and myocardial infarction are the main problems that determine an unfavorable outcome in the postoperative period. There is important evidence that violations of the vegetative regulation of the heart, the heterogeneity of repolarization processes in the myocardium are integral indicators of the morphofunctional changes occurring in the process of coronary heart disease (CHD) progression. The role of indicators of heart rate variability and turbulence as predictors of sudden cardiac death was proved, mainly due to fatal ventricular heart rhythm disorders and cardiovascular mortality. Along with this, changes in these indicators, and their prognostic role in patients with CHD in revascularization are the subject of discussion, which determines the relevance of further studies on the effect of various methods of revascularization on the electrical instability of the myocardium, as one of the most important factors in the development of life-threatening ventricular arrhythmias that are predictors of sudden cardiac death, especially in patients who previously had acute myocardial infarction. Besides it is important to study the effect of myocardial revascularization on the indicators of cardiac autonomic regulation and the possibility of their use as prognostic criteria before and after surgery.

scholarly journals Differential effects of the blood pressure state on pulse rate variability and heart rate variability in critically ill patients

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Elisa Mejía-Mejía ◽  
James M. May ◽  
Mohamed Elgendi ◽  
Panayiotis A. Kyriacou
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Pulse Rate ◽  
Pulse Transit Time ◽  
Pulse Rate Variability ◽  
Physiological Factors ◽  
Ecg Signals ◽  
Non Invasive ◽  
Electrocardiogram Ecg

AbstractHeart rate variability (HRV) utilizes the electrocardiogram (ECG) and has been widely studied as a non-invasive indicator of cardiac autonomic activity. Pulse rate variability (PRV) utilizes photoplethysmography (PPG) and recently has been used as a surrogate for HRV. Several studies have found that PRV is not entirely valid as an estimation of HRV and that several physiological factors, including the pulse transit time (PTT) and blood pressure (BP) changes, may affect PRV differently than HRV. This study aimed to assess the relationship between PRV and HRV under different BP states: hypotension, normotension, and hypertension. Using the MIMIC III database, 5 min segments of PPG and ECG signals were used to extract PRV and HRV, respectively. Several time-domain, frequency-domain, and nonlinear indices were obtained from these signals. Bland–Altman analysis, correlation analysis, and Friedman rank sum tests were used to compare HRV and PRV in each state, and PRV and HRV indices were compared among BP states using Kruskal–Wallis tests. The findings indicated that there were differences between PRV and HRV, especially in short-term and nonlinear indices, and although PRV and HRV were altered in a similar manner when there was a change in BP, PRV seemed to be more sensitive to these changes.

Characteristics of heart rate variability in patients with acute coronary syndrome without ST segment elevation in comparison with clinical and biochemical parameters

2021 ◽  
Vol 29 (3) ◽  
pp. 369-378
Author(s):  
Aleksej A. Nizov ◽  
Aleksej I. Girivenko ◽  
Mihail M. Lapkin ◽  
Aleksej V. Borozdin ◽  
Yana A. Belenikina ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Acute Coronary Syndrome ◽  
Creatine Phosphokinase ◽  
Spectral Power ◽  
Low Frequency ◽  
Heart Rhythm ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment

BACKGROUND: The search for rational methods of primary, secondary, and tertiary prevention of coronary heart disease. To date, there are several publications on heart rate variability in ischemic heart disease. AIM: To study the state of the regulatory systems in the organism of patients with acute coronary syndrome without ST segment elevation based on the heart rhythm, and their relationship with the clinical, biochemical and instrumental parameters of the disease. MATERIALS AND METHODS: The open comparative study included 76 patients (62 men, 14 women) of mean age, 61.0 0.9 years, who were admitted to the Emergency Cardiology Department diagnosed of acute coronary syndrome without ST segment elevation. On admission, cardiointervalometry was performed using Varicard 2.51 apparatus, and a number of clinical and biochemical parameters were evaluated RESULTS: Multiple correlations of parameters of heart rate variability and clinical, biochemical and instrumental parameters were observed. From this, a cluster analysis of cardiointervalometry was performed, thereby stratifying patients into five clusters. Two extreme variants of dysregulation of the heart rhythm correlated with instrumental and laboratory parameters. A marked increase in the activity of the subcortical nerve centers (maximal increase of the spectral power in the very low frequency range with the underlying reduction of SDNN) in cluster 1 was associated with reduction of the left ventricular ejection fraction: cluster 147.0 [40.0; 49.0], cluster 260.0 [58.0; 64.0], cluster 360.0 [52.5; 64.5] % (the data are presented in the form of median and interquartile range; Me [Q25; Q75], p 0,05). Cluster 5 showed significant reduction in SDNN (monotonous rhythm), combined with increased level of creatine phosphokinase (CPC): cluster 5446,0 [186.0; 782.0], cluster 4141.0 [98.0; 204.0] IU/l; Me [Q25; Q75], p 0.05) and MВ-fraction of creatine phosphokinase; cluster 532.0 [15.0; 45.0], 4 cluster 412.0 [9.0; 18.0] IU/l; Me [Q25; Q75], p 0.05). CONCLUSIONS: In patients with acute coronary syndrome without ST segment elevation, cluster analysis of parameters of heart rate variability identified different peculiarities of regulation of the heart rhythm. Pronounced strain of the regulatory systems of the body was found to be associated with signs of severe pathology: the predominance of VLF (spectral power of the curve enveloping a dynamic range of cardiointervals in the very low frequency range) in spectral analysis with an underlying reduced SDNN is characteristic of patients with a reduced ejection fraction, and a monotonous rhythm is characteristic of patients with an increased level of creatine phosphokinase and MB-fraction of creatine phosphokinase.

Trends in Heart Rate and Heart Rate Variability during Pregnancy and Three Months Postpartum: Continuous Monitoring in a Free-Living Context (Preprint)

2021 ◽  
Author(s):  
Fatemeh Sarhaddi ◽  
Iman Azimi ◽  
Anna Axelin ◽  
Hannakaisa Niela-Vilen ◽  
Pasi Liljeberg ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Pregnant Women ◽  
Time Domain ◽  
Second Trimester ◽  
Third Trimester ◽  
Non Invasive ◽  
The Third ◽  
Invasive Method ◽  
Frequency Power

BACKGROUND Heart rate variability (HRV) is a non-invasive method reflecting autonomic nervous system (ANS) regulations. Altered HRV is associated with adverse mental or physical health complications. ANS also has a central role in physiological adaption during pregnancy causing normal changes in HRV. OBJECTIVE Assessing trends in heart rate (HR) and HRV parameters as a non-invasive method for remote maternal health monitoring during pregnancy and three months postpartum. METHODS Fifty-eight pregnant women were monitored using an Internet-of-Things (IoT)-based remote monitoring system during pregnancy and 3-months postpartum. Pregnant women were asked to continuously wear Gear sport smartwatch to monitor their HR and HRV. In addition, a cross-platform mobile application was utilized for collecting pregnancy-related information. The trends of HR and HRV parameters were extracted using reliable data. We also analyzed the trends of normalized HRV parameters based on HR to remove the effect of HR changes on HRV trends. Finally, we exploited hierarchical linear mixed models to analyze the trends of HR, HRV, and normalized HRV parameters. RESULTS HR increased significantly during the second trimester (P<.001) and decreased significantly during the third trimester (P<.01). Time-domain HRV parameters, average normal interbeat intervals (AVNN), standard deviation of normal interbeat intervals (SDNN), root mean square of the successive difference of normal interbeat intervals (RMSSD), normalized SDNN (nSDNN), and normalized RMSSD (nRMSSD) decreased significantly during the second trimester (P<.001) then increased significantly during the third trimester (P<.01). Some of the frequency domain parameters, low-frequency power (LF), high-frequency power (HF), and normalized HF (nHF) decreased significantly during the second trimester (P<.01), and HF increased significantly during the third trimester (P<.01). In the postpartum period, nRMSSD decreased (P<.05), and the LF to HF ratio (LF/HF) increased significantly (P<.01). CONCLUSIONS Our study showed that HR increased and HRV parameters decreased as the pregnancy proceeded, and the values returned to normal after the delivery. Moreover, our results show that HR started to decrease while time-domain HRV parameters and HF started to increase during the third trimester. Our results also demonstrate the possibility of continuous HRV monitoring in everyday life settings.

HEART RATE VARIABILITY RELATED TO N95 RESPIRATOR USE IN INTERNS DURING COVID-19 PANDEMIC

2021 ◽  
pp. 69-70
Author(s):  
Pakanati Sujana ◽  
Venkata Mahesh Gandhavalla ◽  
K. Prabhakara Rao
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Low Frequency ◽  
Protective Equipment ◽  
Short Term ◽  
Non Invasive ◽  
Critical Components ◽  
The Individual ◽  
N95 Respirators ◽  
Respiratory Droplets

Introduction: COVID19 is caused by SARS-CoV-2 which is primarily transmitted through respiratory droplets and contact routes. WHO recommended the use of personal protective equipment (PPE) for prevention and N95 respirators are critical components of PPE. Breathing through N95 respirator will impart stress in the individual and that can be assessed by heart rate variability (HRV). HRV measures the variation in time between each heartbeat controlled by autonomic nervous system (ANS), which is a non invasive reliable index to identify the ANS imbalances. Aims And Objectives: This study is aimed at assessing the HRV of Interns working in COVID19 wards using N95 respirators. Methodology: This study included 100 interns in whom short term HRV was recorded using the standard protocol. Lead II of ECG was recorded using AD instruments (ADI) 8channel polygraph and HRV was analysed using Labchart 8pro software. The recordings were taken before and 1hour after wearing N95 respirator. Results: Overall HRV (SDRR) was found to decrease signicantly after wearing N95 respirator for 1hr (p=0.000). Similarly, indices representing the parasympathetic component ( RMSSD and HF ) were also found to decrease signicantly with the use of N95 respirator. Low frequency (LF) power and LF/HF ratio increased signicantly with N95 respirator use (p=0.000). Conclusion: We conclude that using N95 respirator increased sympathetic activity reecting decreased HRV in our subjects Hence we recommend that it is better to change the duty pattern for interns.

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