Functional capacity of the cardiovascular system of elderly people as estimated by heart rate variability

With the aid of mathematical and spectral analysis of the heart rate (HR) wave structure in a dynamic interval tachogram (TG) in elderly subjects, it has been shown that a stable sinus rhythm is typical of the majority of the indigenous population of the rural areas of the North aged 78–97 years and migrants living in the city of Vorkuta aged 60–88 years. The total RR-interval spectrum power (800 ± 98 ms²) in the TGs of the native population is shifted to the very low frequency band (VLF, 52%), which indicates predomination of the humoral-metabolic HR regulation level. The reaction to orthostatic load in elderly subjects is characterized by a significant increase in the total spectrum power, which indicates changes in the autonomic balance of regulation of the wave structure of the HR variability. A low total spectrum power (609 ± 104 ms²) with a predominance of low frequency (LF) waves in the TGs of the migrants at rest reflects the activity of the sympathetic component of HR regulation. The reduction of the parasympathetic regulation and the growth of the sympathetic activity during an active orthostatic test in the migrants is a predictor of cardiovascular diseases. In individual TGs of recipients with HR disorders, the orthostatic test (the redistribution of blood flow in the main vessels) results in a decrease in the number of extrasystoles due to the specific features of the baroreflex regulation mechanisms of the cardiovascular system. The HR variability has been shown to be an indicator of the functional capacity of the cardiovascular system in elderly subjects.     

Non-linear heart rate variability and risk stratification in cardiovascular disease

Traditional time and frequency domain heart rate variability (HRV) have cardiac patients at risk of mortality post-myocardial infarction. More recently, non linear HRV has been applied to risk stratification of cardiac patients. In this review we describe studies of non linear HRV and outcome in cardiac patients. We have included studies that used the three most common non-linear indices: power law slope, the short term fractal scaling exponent and measures based on Poincare plots. We suggest that a combination of traditional and non-linear HRV may be optimal for risk stratification. Considerations in using non linear HRV in a clinical setting are described.     

Osteopathic manipulative treatment and its relationship to autonomic nervous system activity as demonstrated by heart rate variability: a repeated measures study

Background

Osteopathic manipulative treatment (OMT) and ultrasound physical therapy (UPT) are commonly used for chronic low back pain. Although there is evidence from a systematic review and meta-analysis that OMT generally reduces low back pain, there are no large clinical trials that specifically assess OMT efficacy in chronic low back pain. Similarly, there is a lack of evidence involving UPT for chronic low back pain.

Methods

The OSTEOPAThic Health outcomes In Chronic low back pain (OSTEOPATHIC) Trial is a Phase III randomized controlled trial that seeks to study 488 subjects between August 2006 and June 2010. It uses a 2 × 2 factorial design to independently assess the efficacy of OMT and UPT for chronic low back pain. The primary outcome is a visual analogue scale score for pain. Secondary outcomes include back-specific functioning, generic health, work disability, and satisfaction with back care.

Conclusion

This randomized controlled trial will potentially be the largest involving OMT. It will provide long awaited data on the efficacy of OMT and UPT for chronic low back pain.

Trial registration

http://www.clinicaltrials.gov, NCT00315120     

Autonomic control of heart rate during exercise studied by heart rate variability spectral analysis.

Spectral analysis of heart rate variability (HRV) might provide an index of relative sympathetic (SNS) and parasympathetic nervous system (PNS) activity during exercise. Eight subjects completed six 17-min submaximal exercise tests and one resting measurement in the upright sitting position. During submaximal tests, work rate (WR) was increased for the initial 3 min in a ramp fashion until it reached constant WRs of 20 W, or 30, 60, 90, 100, and 110% of the predetermined ventilatory threshold (Tvent). Ventilatory profile and alveolar gas exchange were monitored breath by breath, and beat-to-beat HRV was measured as R-R intervals of an electrocardiogram. Spectral analysis was applied to the HRV from 7 to 17 min. Low-frequency (0-0.15 Hz) and high-frequency (0.15-1.0 Hz) areas under power spectra (LO and HI, respectively) were calculated. The indicator of PNS activity (HI) decreased dramatically (P less than 0.05) when the subjects exercised compared with rest and continued to decrease until the intensity reached 60% Tvent. The indicator of SNS activity (LO/HI) remained unchanged up to 100% Tvent, whereas it increased abruptly (P less than 0.05) at 110% Tvent. The results suggested that (cardiac) PNS activity decreased progressively from rest to a WR equivalent to 60% Tvent, and SNS activity increased only when exercise intensity exceeded Tvent.     

糖尿病植物神经病变病人心率变异的非线性定量分析

目的：研究糖尿病人植物神经病变与心率变异的关系。对象：正常对照组和根据临床有无糖尿病神经病变（ＤＡＮ）分组的糖尿病病人,方法：应用２４小时动态心电图对正常和糖尿病人进行心率变异的线性,非线性散点图和非线性定量参数分析,结果：单纯糖尿病组ＳＤＮＮ,ＳＤＡＮＮ和ＰＮＮ５０低于正常组（Ｐ〈０．０５）;糖尿病＋ＤＡＮ组各项线性时域分析指标均低于正常和单纯糖尿病组（Ｐ〈０．０１－０．００１）,散点图分析结果     

An estimate of fetal autonomic state by time-frequency analysis of fetal heart rate variability.

In this study we present a noninvasive method that enables the investigation of the fetal heart rate (FHR) fluctuations. The objective was to design a quantitative measurement to assess the fetal autonomic nervous system and to investigate its development as a function of the gestational age. Our Medical Physics group has developed a complex algorithm for online beat-to-beat detection of the fetal ECG (FECG), extracted from the maternal abdominal ECG signal. We used our previously acquired FECG data, which includes noninvasive recordings of 200 maternal abdominal ECG signals. From these, we chose 35 cases of healthy pregnancies that we divided into three groups according to gestational age: Group 1, 23 +/- 2 wk; Group 2, 32 +/- 1 wk; and Group 3, 39 +/- 1 wk. The FHR variability was analyzed by a time-frequency decomposition based on a continuous wavelet transform. We showed that, independent of the gestational age, most of the FHR power is concentrated in the very-low-frequency range (0.02-0.08 Hz) and in the low-frequency range (0.08-0.2 Hz). In addition, there is power in the high-frequency range that correlates with the frequency range of fetal respiratory motion (0.4-1.7 Hz). In the intermediate-frequency range (0.2-0.4 Hz), the power is significantly smaller. The changes in the average power spectrum in relation to gestation time were carefully and quantitatively examined. The results imply that there is a neural organization during the last trimester of the pregnancy, and the sympathovagal balance is reduced with the gestational age.     

Alteration of cardiovascular autonomic functions by vegetarian diets in postmenopausal women is related to LDL cholesterol levels

This study was designed to test the hypothesis that alteration of cardiovascular autonomic functions by vegetarian diets in healthy postmenopausal women is related to lipid metabolism. A total of 70 healthy postmenopausal women not on hormone therapy participated in this study: 35 were vegetarians (mean age 55.0 years) and 35 were omnivores (mean age 55.1 years). Cardiovascular autonomic functions and baroreflex sensitivity were evaluated by specific frequency-domain measures of heart rate variability (HRV) and arterial blood pressure fluctuation. The vegetarians had statistically significant lowered blood pressure, total cholesterol, low-density lipoprotein (LDL) cholesterol, triglyceride, and fasting glucose levels compared with the omnivores. The vegetarians exhibited a significant higher total power, low-frequency (LF; 0.04-0.15 Hz) and high-frequency (HF; 0.15-0.4 Hz) of HRV and increased baroreflex sensitivity measures [Brr(LF) and Brr(HF)] compared with the omnivores. Total power, LF and HF of HRV, Brr(LF), and Brr(HF) were significantly and negatively correlated with LDL-cholesterol concentrations (P < 0.01). We concluded that the increases of cardiac vagal activity and baroreflex sensitivity by vegetarian diets in postmenopausal women are inversely related to LDL-cholesterol levels.     

Assessment of cardiac autonomic modulation during graded head-up tilt by symbolic analysis of heart rate variability

Two symbolic indexes, the percentage of sequences characterized by three heart periods with no significant variations (0V%) and that with two significant unlike variations (2UV%), have been found to reflect changes in sympathetic and vagal modulations, respectively. We tested the hypothesis that symbolic indexes may track the gradual shift of the cardiac autonomic modulation during an incremental head-up tilt test. Symbolic analysis was carried out over heart period variability series (250 cardiac beats) derived from ECG recordings during a graded head-up tilt test (0, 15, 30, 45, 60, 75, and 90 degrees ) in 17 healthy subjects. The percentage of subjects showing a significant linear correlation (Spearman rank-order correlation) with tilt angles was utilized to evaluate the performance of symbolic analysis. Spectral analysis was carried out for comparison over the same series. 0V% progressively increased with tilt angles, whereas 2UV% gradually decreased. The decline of 2UV% was greater than the increase of 0V% at low tilt angles. Linear correlation with tilt angles was exhibited in a greater percentage of subjects for 0V% and 2UV% than for any spectral index. Our findings suggest that symbolic analysis performed better than spectral analysis and, thus, is a suitable methodology for assessment of the subtle changes of cardiac autonomic modulation induced by a graded head-up tilt test. Moreover, symbolic analysis indicates that the changes of cardiac sympathetic and vagal modulations observed during this protocol were reciprocal but characterized by different absolute magnitudes.     

Identification of development and autonomic nerve activity from heart rate variability in preterm infants

Heartbeat intervals, which are determined basically by regular excitations of the sinoatrial node, show significant fluctuation referred to as the heart rate variability (HRV). The HRV is mostly due to nerve activities through the sympathetic and parasympathetic branches of the autonomic nervous system (ANS). In recent years, it has been recognized that the HRV shows a greater complexity than ever expected, suggesting that it includes much information about ANS activities. In this study, we investigated relationship between HRV and development in preterm infants. To this end, heartbeat intervals were continuously recorded from 11 preterm infants in NICU. The recording periods were ranging from several days to weeks depending on the individuals. The HRV at various ages was then characterized by several indices. They include power spectrum as well as the mean and standard deviation of the series. For the power spectrum, the low-frequency band power (LF), high-frequency band power (HF), LF/HF (the ratio between LF and HF), beta (scaling exponent of the spectrum) were estimated. The detrended fluctuation analysis (DFA) was also employed to obtain short- and long-range scaling exponents. Each of these indices showed a correlation with the age. We showed that the long-range scaling exponent, derived from the DFA, was most significantly correlated with the age, suggesting that it could be a robust index to characterize the development of preterm infants.     

The genetic contribution to heart rate and heart rate variability in quiescent mice

Recent studies have suggested a genetic component to heart rate (HR) and HR variability (HRV). However, a systematic examination of the genetic contribution to the variation in HR and HRV has not been performed. This study investigated the genetic contribution to HR and HRV using a wide range of inbred and recombinant inbred (RI) mouse strains. Electrocardiogram data were recorded from 30 strains of inbred mice and 29 RI strains. Significant differences in mean HR and total power (TP) HRV were identified between inbred strains and RI strains. Multiple significant differences within the strain sets in mean low-frequency (LF) and high-frequency (HF) power were also found. No statistically significant concordance was found between strain distribution patterns for HR and HRV phenotypes. Genomewide interval mapping identified a significant quantitative trait locus (QTL) for HR [LOD (likelihood of the odds) score = 3.763] on chromosome 6 [peak at 53.69 megabases (Mb); designated HR 1 (Hr1)]. Suggestive QTLs for TP were found on chromosomes 2, 4, 5, 6, and 14. A suggestive QTL for LF was found on chromosome 16; for HF, we found one significant QTL on chromosome 5 (LOD score = 3.107) [peak at 53.56 Mb; designated HRV-high-frequency 1 (Hrvhf1)] and three suggestive QTLs on chromosomes 2, 11 and 15. In conclusion, the results demonstrate a strong genetic component in the regulation of resting HR and HRV evidenced by the significant differences between strains. A lack of correlation between HR and HRV phenotypes in some inbred strains suggests that different sets of genes control the phenotypes. Furthermore, QTLs were found that will provide important insight to the genetic regulation of HR and HRV at rest.     

Vagal tone dominates autonomic control of mouse heart rate at thermoneutrality

It is generally accepted that cardiac sympathetic tone dominates the control of heart rate (HR) in mice. However, we have recently challenged this notion given that HR in the mouse is responsive to ambient temperature (T(a)) and that the housing T(a) is typically 21-23 degrees C, well below the thermoneutral zone ( approximately 30 degrees C) of this species. To specifically test the hypothesis that cardiac sympathetic tone is the primary mediator of HR control in the mouse, we first examined the metabolic and cardiovascular responses to rapid changes in T(a) to demonstrate the sensitivity of the mouse cardiovascular system to T(a). We then determined HR in 1) mice deficient in cardiac sympathetic tone ("beta-less" mice), 2) mice deficient in cardiac vagal tone [muscarinic M(2) receptor (M(2)R(-/-)) mice], and 3) littermate controls. At a T(a) of 30 degrees C, the HR of beta-less mice was identical to that of wild-type mice (351 +/- 11 and 363 +/- 10 beats/min, respectively). However, the HR of M(2)R(-/-) mice was significantly greater (416 +/- 7 beats/min), demonstrating that vagal tone predominates over HR control at this T(a). When these mice were calorically restricted to 70% of normal intake, HR fell equally in wild-type, beta-less, and M(2)R(-/-) mice (DeltaHR = 73 +/- 9, 76 +/- 3, and 73 +/- 7 beats/min, respectively), suggesting that the fall in intrinsic HR governs bradycardia of calorically restricted mice. Only when the T(a) was relatively cool, at 23 degrees C, did beta-less mice exhibit a HR (442 +/- 14 beats/min) that was different from that of littermate controls (604 +/- 10 beats/min) and M(2)R(-/-) mice (602 +/- 5 beats/min). These experiments conclusively demonstrate that in the absence of cold stress, regulation of vagal tone and modulation of intrinsic rate are important determinants of HR control in the mouse.     

Effect of energy drink dose on exercise capacity,heart rate recovery and heart rate variability after high-intensity exercise

[Purpose]

The purpose of this research was to investigate the effects of exercise capacity, heart rate recovery and heart rate variability after high-intensity exercise on caffeine concentration of energy drink.

[Methods]

The volunteers for this study were 15 male university student. 15 subjects were taken basic physical examinations such as height, weight and BMI before the experiment. Primary tests were examined of VO₂max per weight of each subjects by graded exercise test using Bruce protocol. Each of five subject was divided 3 groups (CON, ECGⅠ, ECGⅡ) by matched method based on weight and VO₂max per weight what gained of primary test for minimize the differences of exercise capacity and ingestion of each groups. For the secondary tests, the groups of subjects were taken their materials before and after exercise as a blind test. After the ingestion, subjects were experimented on exercise test of VO₂max 80% by treadmill until the all-out. Heart rate was measured by 1minute interval, and respiratory variables were analyzed VO2, VE, VT, RR and so on by automatic respiratory analyzer. And exercise exhaustion time was determined by stopwatch. Moreover, HRV was measured after exercise and recovery 3 min.

[Results]

Among the intake groups, ECGⅡ was showed the longest of exercise exhaustion time more than CON group (p = .05). Result of heart rate during exercise according to intake groups, there was significant differences of each time (p < .001), however, not significant differences of each groups and group verse time (p > .05). Result of RPE during exercise according to intake groups, there was significant differences of each time (p < .001), however, not significant differences of each groups and group verse time (p > .05).

[Conclusion]

In conclusion, EDGⅡ showed the significant increase of exercise exhaustion time more than CON group (p=.05) and not significant differences in HR, RPE, RER, HRV, HRR, blood pressure (p > .05). Therefore, 2.5 mg/kg^-1 ingestion of energy drink might be positive effect to increase exercise performance capacity without side-effect in cardiovascular disease.