Clinical Neurophysiology: Motor/Sensory Physiology

Low heart rate variability in patients with clinical burnout

To test associations between heart rate variability (HRV), depressed mood, and positive affect in patients with suspected coronary artery disease (CAD). Depression is associated with impaired HRV post acute cardiac events, but evidence in patients with stable coronary artery disease (CAD) is inconsistent. Seventy-six patients (52 men, 24 women; mean age = 61.1 years) being investigated for suspected CAD on the basis of symptomatology and positive noninvasive tests, completed 24-hour electrocardiograms. The Beck Depression Inventory (BDI) was administered, and positive and depressed affect was measured over the study period with the Day Reconstruction Method (DRM). A total of 46 (60.5%) patients were later found to have definite CAD. HRV was analyzed, using spectral analysis. Typical diurnal profiles of HRV were observed, with greater normalized high frequency (HF) and lower normalized low frequency (LF) power in the night compared with the day. BDI depression scores were not consistently associated with HRV. But positive affect was associated with greater normalized HF power (p = .039) and reduced normalized LF power (p = .007) independently of age, gender, medication with beta blockers, CAD status, body mass index, smoking, and habitual physical activity level. In patients with definite CAD, depressed affect assessed using the DRM was associated with reduced normalized HF power and heightened normalized LF power (p = .007) independently of covariates. Relationships between depression and HRV in patients with CAD may depend on affective experience over the monitoring period. Enhanced parasympathetic cardiac control may be a process through which positive affect protects against cardiovascular disease.

Left atrial enlargement in mitral stenosis predisposes to atrial fibrillation (AF). Analysis of heart rate variability (HRV) prior to the onset of an arrhythmia may show alterations in autonomic balance that are known to predispose to the development of AF. The aim of this study was to determine whether HRV in patients with rheumatic mitral stenosis (MS) is abnormal in comparison to normal controls, and to find the relationship between left atrial size and HRV in patients with MS in sinus rhythm and in AF. A series of 24-hour ambulatory Holter electrocardiogram recordings were obtained for 10 consecutive, newly diagnosed untreated subjects with pure mitral stenosis in sinus rhythm, 10 with mitral stenosis complicated by atrial fibrillation and 10 age-matched normal controls. Digitized records were processed using time domain and power spectral analysis. In patients with mitral stenosis in sinus rhythm, we observed significant decrease of the standard deviation of the RR intervals (SDRR), as well as of the root mean square of successive RR interval differences (RMSSD) and Edinburgh index (sNN50), while in patients with AF, the RMSSD and sNN50 were much larger than those in normal. The areas under all spectral bands were markedly increased in patients with AF compared with normal. Furthermore, the high low frequency/high frequency (HLF/HF ratio) ratio was very small compared to normal. HRV measures were independent of atrial size in both groups. Decreased HRV in mitral stenosis patients with sinus rhythm suggests increased sympathetic activity in patients prone to atrial fibrillation, while marked increased of HRV in patients with AF may indicate that parasympathetic activity modulates the intrinsic behavior of the atrioventricular node during atrial fibrillation. The evaluation of HRV may be a useful tool for the identification of patients predisposed to AF.

Aim. To study heart rate variability (HRV) in patients with chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) in relation to: blood oxygen saturation level, parameters of respiratory function (RPF), Nt – proBNP concentration in blood plasma.Materials and methods. We examined 128 outpatients of both sexes. The patients’ age ranged from 45 to 70 years. Group 1 – main (60 patients) with CHF of ischemic genesis of NYHA functional class II – III and GOLD COPD of I – III degree of airflow restriction (GOLD 2019 classification) in the stage of stable remission, group 2 – control group (63 patients), with isolated CHF. All patients with CHF, who were included in the study, had myocardial infarction (AMI) from 1 to 5 years ago. There were no statistically significant differences in the severity of CHF between groups 1 and 2.Results. In patients with CHF and COPD, in contrast to patients with isolated CHF, a significant prevalence of the frequency of occurrence of the hypersympathicotonic type of autonomic regulation was revealed. Significantly lower indicators of heart rate variability were in the group of patients with concomitant COPD in comparison with patients with isolated CHF. Statistically significant correlations were revealed between HRV parameters and RPF, parameters of blood oxygen saturation level, NT-proBNP concentration in blood. Multivariate regression analysis showed a significant dependence of HRV parameters on the parameters of HRV and the concentration of NT-proBNP in the blood in the group of patients with CHF and COPD.

Chronic obstructive pulmonary disease (COPD) patients present functional and structural changes of the respiratory system that have a profound influence on cardiac autonomic dysfunction. To analyse heart rate variability in COPD patients under stable condition and during acute exacerbation episodes (AECOPD). Twenty three severe COPD male patients, 69.6 ± 7.3 years, in stable condition were followed up for two years. Home visits were carried out by a nurse every month, and home or hospital visits were arranged on demand. Every three months an ECG, oxygen saturation and spirometric recording was obtained for each patient. If the patient presented AECOPD compatible clinical data the same measurements were performed before any change of treatment. Spectral parameters of heart rate variability in time and frequency domains were obtained from ECG. The time evolution of power in low frequency (LF) and high frequency (HF) bands were obtained from the spectrogram. In addition, we calculated the LF/HF ratio and total heart rate variability power (POW). We analysed 154 patient-visit records during the follow up, pertaining to 23 patients and 8 controls; 19 of the patients had experienced at least one AECOPD. Stable COPD patients had higher HF values than control subjects. No significant differences were found in LF, LF/HF ratio or POW variables. AECOPD patients had higher LF, HF and POW than the stable COPD and control groups. AECOPD patients exhibited signs of increased autonomic activity compared with stable COPD.

Relation of Anemia to Low Heart Rate Variability in Patients With Coronary Heart Disease (from the Heart and Soul Study)

We aimed to assess the effect of exercise training on heart rate variability (HRV) in hypertensive patients and to provide practical recommendations. We systematically searched seven databases for randomized controlled trials (RCTs) comparing the efficacy of exercise interventions vs. non-exercise control for HRV in adults with hypertension. HRV parameters, blood pressure (BP), and heart rate (HR) from the experimental and control groups were extracted to carry out meta-analysis. To explore the heterogeneity, we performed sensitivity analysis, sub-analysis, and meta-regression. Twelve RCTs were included, and the main results demonstrated exercise produced improvement in root mean square of successive RR-intervals differences (RMSSD) and high frequency (HF), and reductions in LF/HF, resting systolic blood pressure (SBP), and HR. The sub-analysis and meta-regression showed that AE improved more HRV indices and was effective in reducing BP compared with RE. Follow-up duration was also an important factor. Data suggests exercise training has ameliorating effects on HRV parameters, resting SBP, and HR in hypertensive patients, showing enhanced autonomic nervous system function and vagal activity. This effect may be better realized with exercise interventions of 4 weeks or more. Considering our results and the hypertension practice guidelines, we tend to recommend patients choose supervised AE.

Comparison of the prognostic value of cardiac iodine-123 metaiodobenzylguanidine imaging and heart rate variability in patients with chronic heart failure: A prospective study

BackgroundMany family caregivers of patients with cancer feel guilty about self-care. A meaningful relationship with patients reduces such negative feelings and functions as self-care for family caregivers. Moreover, handholding improves autonomic functions in non-cancer patients. However, the effects of handholding on both patients with cancer and family caregivers remain unknown.MethodsWe evaluated the effects of handholding on heart rate variability (HRV) in patients with cancer and their family caregivers. This randomized crossover study divided patients with cancer and their family caregivers into two trial groups: Handholding trial (the family caregiver holds the patient’s hand for five minutes) and Beside trial (the family caregiver stays beside the patient without holding their hand). The study included 37 pairs of patients with cancer who received treatment in the cancer department of a university hospital in Japan and their family caregivers (n = 74). The primary end-point was the change in HRV before and during the intervention.ResultsThe median performance status of the patients was 3. An interaction was observed between trials in the standard deviation of the normal-to-normal interval (SDNN) of HRV for family caregivers (F = 7.669; p = 0.006), and a significant difference in time course was observed between the trials (before p = 0.351; during p = 0.003). No interaction was observed between trials in the SDNN for patients (F = 0.331; p = 0.566). Only a main effect in time course (F = 6.254; p = 0.014) was observed. SDNN increased significantly during the intervention in both trials (Handholding trial: p = 0.002, Beside trial: p = 0.049).ConclusionsHandholding improves autonomic functions of family caregivers and may function as self-care for family caregivers.Trial registrationUMIN000020557. Registered on January 15, 2016.

Aim . To identify the presence and the correction method of decreased heart rate variability (HRV) in patients with chronic coronary artery disease (CAD) and comorbid depressive disorders (DD). Materials and methods . 79 patients with CAD (with class II–III angina pectoris and myocardial infarction that occurred more than 6 months ago) were divided into two groups. The first group included 50 CAD patients with depression, and the second – 29 CAD patients without depression. 17 patients received agomelatine (1st subgroup), 12 patients received fluvoxamine and fluoxetine (2nd subgroup), and 21 patients refused to take antidepressants (3rd subgroup). Initially and after 6 months, the HRV parameters were evaluated using the SCHILLER MT-200 Holter-ECG apparatus (Switzerland). Results . A significant decrease in HRV was revealed in the patients with depression compared to the patients without it: SDNN (96 [83; 117] ms vs. 110 [98; 127] ms; p = 0.02), SDANN (80.5 [67; 94] ms vs. 91 [79; 102] ms; p = 0.03), SDNNindex (46.5 [38; 56] ms vs. 55 [48; 66] ms; p = 0.006), rMSSD (29 [23; 38] ms vs. 33 [29; 45] ms; p = 0.04), pNN50% (3.9 [2.4; 5,7] vs. 5.7 [2.9; 12.6]; p = 0.03). Initially, the 1st, 2nd, and 3rd subgroups did not differ in all HRV parameters. Against the background of antidepressant therapy, there were significant differences between the 2nd and 3rd subgroups in SDNN (110 [96; 140] ms vs. 85.5 [75; 103] ms; p = 0.008), SDANN (93.7 ± 22.9 ms vs. 72.7 ± 21.4 ms; p = 0.02), SDNNindex (55.8 ± 16.4 ms vs. 42.4 ± 10.8 ms; p = 0.01) and pNN50% (7.8 ± 6.7 vs. 3.6 ± 1.8; p = 0.02), as well as between the 1st and 3rd subgroups (SDANN (93.6 ± 28.5 ms vs. 72.7 ± 21.4 ms; p = 0.03), rMSSD (36.5 [28.5; 51] ms vs. 26.5 [25; 32] ms; p = 0.02)). Conclusion . In patients with CAD with comorbid DD, significant impairment of heart rhythm regulation occurs due to a pronounced decrease in HRV, which can seriously affect the course and prognosis of CAD. Prescribing modern antidepressants can be used as a method of correcting autonomic dysfunction in patients with CAD with comorbid depression.

Objectives Decreased vagal modulation, which has consistently been observed in schizophrenic patients, might contribute to increased cardiac mortality in schizophrenia. Previously, associations between CHRM2 (Cholinergic Receptor Muscarinic 2) and cardiac autonomic features have been reported. Here, we tested for possible associations between these polymorphisms and heart rate variability in patients with schizophrenia. Methods A total of three single nucleotide polymorphisms (SNPs) in CHRM2 (rs73158705 A>G, rs8191992 T>A and rs2350782 T>C) that achieved significance (p < 5 * 10−8) in genome-wide association studies for cardiac autonomic features were genotyped in 88 drug-naïve patients, 61 patients receiving antipsychotic medication and 144 healthy controls. Genotypes were analysed for associations with parameters of heart rate variability and complexity, in each diagnostic group. Results We observed a significantly altered heart rate variability in unmedicated patients with identified genetic risk status in rs73158705 A>G, rs8191992 T>A and rs2350782 T>C as compared to genotype non-risk status. In patients receiving antipsychotic medication and healthy controls, these associations were not observed. Discussion We report novel candidate genetic associations with cardiac autonomic dysfunction in schizophrenia, but larger cohorts are required for replication.

To determine the effects on heart rate variability of home-based daily activity in patients with mild hypertension and/or stable angina pectoris and to clarify the relationship between daily activity and sympathovagal balance. Several prior studies have assessed the ability of exercise training to improve functional capacity and produce beneficial effects on mortality and physical capacity in patients with cardiovascular disease. A non-randomised six-month prospective longitudinal study. This study consisted of 41 patients (59-83 years old) with mild hypertension and/or stable angina pectoris. The home-based daily activity and heart rate variability were measured at the start of the study (BASE) and six months after the start of the study (6MoA). At 6MoA, the active mass increased in 23 patients (the IC group), while it decreased in the remaining 18 patients (the DC group). There were significant increases in the high-frequency component in the IC group between the data at BASE and 6MoA. There were significant decreases in the low frequency to high-frequency ratio (low frequency/high-frequency) during sleep in the IC group between the data at BASE and 6MoA. The active mass was classified into life activities and walk activities in terms of intensity of activity. In a multivariate model, increased life activitiesrevealed a trend towards an association with increased high-frequency. In patients with mild hypertension and/or stable angina pectoris, an increase in active mass improved heart rate variability outcomes with increased high-frequency and decreased low frequency/high-frequency during sleep. To increase life activitiesmight improve heart rate variability and prognosis in patients. This study demonstrated that the potential importance of low-intensity daily activities in patients with mild hypertension and/or stable angina pectoris.

To investigate the effect of combining acupuncture and auricular point sticking on heart rate variability (HRV) in patients with post-stroke depression (PSD). A total of 80 cases with PSD were randomized into a treatment group and a control group. The control group was intervened by oral administration of paroxetine hydrochloride, whereas the treatment group received acupuncture plus auricular point sticking base on the same oral administration. The Hamilton depression rating scale (HAMD) and HRV were measured before and after treatment in both groups. The individual and global scores of HAMD significantly dropped after 8 weeks of treatment in both groups (all P 50 ms (PNN50) and high frequency (HF) were increased while low frequency (LF) and LF/HF decreased significantly after 8 weeks of treatment in both groups (P<0.05). All items in the treatment group were significantly different from those in the control group (all P<0.05). Combining acupuncture and auricular point sticking can enhance the conventional medical treatment for HRV in patients with PSD.

Heart rate variability in patients with essential tremor: A cross sectional study

Effects of cardiac resynchronization therapy on heart rate variability in patients with chronic systolic heart failure and intraventricular conduction delay