Quantitative analysis of the balanced state of neurogenic influences on the heart rate

A technique has been developed for the analysis of differences between successive RR intervals in the long-term records of the cardiac rhythm. The differences corresponded to certain patterns of changes in the heart rate, such as deceleration and acceleration. The patterns of differences characterized the state of the heart and the body as a whole.     

Dynamics of histograms of differences between the successive electrocardiogram <Emphasis Type="Italic">RR</Emphasis> intervals over 24 hours as an index of the balanced state of neurogenic influences on the heart rate

The quantitative parameters of the balanced influence of the sympathetic and parasympathetic divisions of the autonomic nervous system, including the variation range of the histogram of differences between successive electrocardiogram RR intervals, the number of zero differences, and the sum of differences between successive RR intervals, are suggested.     

Oesophageal acid stimulation in humans: does it alter baroreflex function?

The aim of this study was to investigate if oesophagel acid stimulation (Bernstein test) had an influence on heart rate and blood prsure variability and baroreflex gain. We compared the cardiovascular responses in 10 patients with established gastro-esophageal reflux disease (Group 1) and 10 control subjects (Group 2) during esophageal saline and 0.1 mol/l hydrochloric acid instillation. Indices of heart rate and blood pressure variability and baroreflex gain (derived from linear spontaneous sequences and cross spectral analysis) were calculated. In Group 1 the standard deviation of RR intervals (SDRR: 46 ms vs 51 ms, p=0.030) and the root mean square of successive differences (RMSSD: 24 ms vs. 26 ms p=0.027) were significantly lower during acid infusions, than during saline. We found no significant difference in minimum, maximum and mean RR intervals and systolic blood pressures and in the percentage of RR intervals, which differed from adjacent cycles by more than 50 ms (PNN50). The power spectra of RR intervals in the high frequency band tended to be lower during acid infusion (p=0.055). There was no significant difference in blood pressure spectra, neither in low nor in high frequency band. In Group 2 there was no significant difference between any parameters measured during acid and saline. The baroreflex gain was not changed during the studied conditions in any group. Neither increased vagal tone, nor increased vagal variability occurred and the baroreflex gain was not altered during oesophageal acid simulation.     

Significance of the statistical characteristics of the sinus rhythm of the heart

Statistical analysis of prolonged continuous recordings of the ECG RR intervals was carried out in 64 patients with purulent surgical infection. The following indices were considered: the mean value of the RR intervals, the mean quadratic deviation (delta), the variation amplitude, the 1st and the 3rd correlation coefficients, the excess, asymmetry, the RR/delta ratio. Besides, the size and the shape of the autoregression could was analyzed. Statistically significant differences of the RR/delta ratio, of the mean quadratic deviation, and of the variation amplitude were revealed in 3 groups of patients differing by the severity of condition. These differences were reflected in the size and shape of the autoregression cloud. The results obtained suggest that statistical characteristics of prolonged recordings of the cardiac rhythm could be used for objective assessment of the severity of the patient's condition and of the therapeutic effect in the patients with a purulent surgical infection.     

Adaptation of the circulatory system to frequently repeated submaximal workloads in the light of left ventricular contraction analysis

In two groups of healthy men aged 20-22 years the left ventricular systolic time intervals were evaluated by the method of Weissler et al. during frequently repeated workloads and restitution. Each exercise was carried out on a Zimmerman cycle ergometer during 10 minutes, and was repeated five times at 50-minutes intervals from 8.00 o'clock a.m. Group I (15 subjects) performed the exercise at a stable workload which produced during the first exercise heart rate acceleration to 170/min, but gave a successive further rise in the heart rate during consecutive exercises. Group II (11 subjects) performed all exercises to a stable rise in heart rate to 170/min with decreasing workloads. It was found that successive exercises caused in both groups a similar decrease of the left ventricular ejection time index (LVETI), pre-ejection period (PEP), isovolumetric contraction time (ICT), and decrease of the PEP/LVET index (p less than 0.05). Each successive exercise began with higher values of LVETI, PEP, ICT and PEP/LVET than the first one. No significant differences were found in the values of left ventricular systolic time intervals in both groups (p greater than 0.05). The duration of restitution of normal values of the left ventricular systolic time intervals after successive exercises was not changing but the tolerance of these exercises measured by heart rate increase and work performed decreased successively.     

Roles of the AV junction in determining the ventricular response to atrial fibrillation.

The statistical properties of RR interval sequences during cholinergic atrial fibrillation were studied in anesthetized dogs both in control conditions and after the selective injection of dromotropic agents into the atrioventricular (AV) node artery. It was observed that RR interval histogram configurations depended mainly on the mean heart rate, regardless of whether it was a control or a post-injection sequence. The sequences were found to vary from almost regular at fast rates to highly irregular at slow rates, covering all intermediate possibilities. Since the injections of dromotropic agents into the AV node artery were carried out during sinus rhythm between the episodes of fibrillation, their influences on the AV junction, as reflected both on the length of the PR interval during sinus rhythm and on the RR interval dispersion during fibrillation, could be compared. The dispersion of RR intervals was found to increase as the PR interval duration became longer. In addition, it was observed that the generally random character of the RR interval sequences during fibrillation was not affected by the injection of dromotropic agents into the AV node artery. These results were interpreted as an indication that, for a well-established atrial fibrillation, the degree of ventricular irregularity (dispersion of RR intervals) is related to the conductivity within the AV junction and that the random character of RR interval sequences is related to the atrial fibrillatory activity itself.     

Heart rate and heart rate variability in pregnant warmblood and Shetland mares as well as their fetuses

Heart rate (HR) is an important parameter of fetal well-being. In horses, HR and heart rate variability (HRV) can be determined by fetomaternal electrocardiography (ECG) from mid-pregnancy to foaling. Normal values for physiological parameters in larger breeds are often used as reference values in ponies. However, HR increases with decreasing size of the animal and in ponies is higher than in warmblood horses. It is not known if fetal HR is affected by breed and if values obtained in larger breeds can be used to assess Shetland fetuses. We have determined fetomaternal beat-to-beat (RR) interval (inversely correlated to HR) and HRV in warmblood (n=6) and Shetland pregnancies (n=7) at days 280 and 300 of gestation by ECG. Maternal RR interval was lower in pony than in warmblood mares (day 280: Shetland: 958±110, warmblood: 1489±126ms, p<0.01) The SDRR (standard deviation of RR interval) and the RMSSD (root mean square of successive RR differences) did not differ between breeds at any time. Also RR interval as well as HRV did not differ between warmblood and pony fetuses (RR interval day 280: Shetland: 606±39, warmblood: 589±38ms). In conclusion, although maternal RR interval is clearly higher in Shetland than in warmblood mares, fetal RR interval in the two breeds is on the same level.     

Properties of fetal heartbeat intervals during labour

This study was designed to investigate the range of beat-to-beat changes in fetal inter-beat (RR) intervals during routine clinical monitoring in labour. Fetal RR intervals were automatically measured and collected from 10 fetuses. Intervals which were incorrectly measured were excluded, and the remaining 23510 intervals were used to compile the distribution of beat-to-beat changes. The inter-quartile range of this distribution was 23 ms and the 99th centile fell at approximately 50 ms. No relationship could be established between beat-to-beat changes and the absolute RR interval. These findings differ from the results published by other workers on the basis of data obtained antenatally or during early labour. In addition, the results suggest possibilities for improving algorithms designed to enhance data quality in fetal heart rate monitoring.     

Low-frequency component of photoplethysmogram reflects the autonomic control of blood pressure

The question of how much information the photoplethysmogram (PPG) signal contains on the autonomic regulation of blood pressure (BP) remains unsolved. This study aims to compare the low-frequency (LF) and high-frequency components of PPG and BP and assess their correlation with oscillations in interbeat (RR) intervals at similar frequencies. The PPG signal from the distal phalanx of the right index finger recorded using a reflective PPG sensor at green light, the BP signal from the left hand recorded using a Finometer, and RR intervals were analyzed. These signals were simultaneously recorded within 15 min in a supine resting condition in 17 healthy subjects (12 males and 5 females) aged 33 ± 9 years (mean ± SD). The study revealed the high coherence of LF components of PPG and BP with the LF component of RR intervals. The high-frequency components of these signals had low coherence. The analysis of the signal instantaneous phases revealed the presence of high-phase coherence between the LF components of PPG and BP. It is shown that the LF component of PPG is determined not only by local myogenic activity but also reflects the processes of autonomic control of BP.     

Remark on the input-output relation of formalized neurons in case of randomized stimuli

A formalized neuron receiving stimuli at random is considered. Formulae are derived for the probability distribution and expected value of the intervals between successive firings.     

Correlation properties of heartbeat dynamics

In this study, we investigate correlation properties of fluctuations in heart interbeat (RR) time series in a broad range of physiological and pathological conditions. Using detrended fluctuation analysis (DFA) method we determined short-term (alpha (1)) and long-term (alpha (2)) scaling exponent. In addition, we calculated standard deviation of RR intervals (SDRR) as the simplest variability measure. We found that the difference between alpha (1) and alpha (2) is related to RR interval length. At the shortest RR intervals, which correspond to extreme physiological and pathological conditions, we found the highest reduction of variability and the biggest difference between scaling exponents. In this case, DFA reveals a white noise over short scales (alpha (1 )about 0.5) and strongly correlated noise over large scales (alpha (2) about 1.5). With an increase in RR interval, accompanied by increased variability (increase in parasympathetic control), the difference between alpha (1) and alpha (2) decreases. The difference between scaling exponents disappeared in a state of efficient autonomic control. We suggest that the complexity in heart rhythm is achieved through coupling between intrinsically controlled heart rhythm and autonomic control, and that the model of stochastic resonance mechanism could be applied to this system.     

Breathing cardiovascular variability and baroreflex in mechanically ventilated patients

Heart rate and blood pressure variations during spontaneous ventilation are related to the negative airway pressure during inspiration. Inspiratory airway pressure is positive during mechanical ventilation, suggesting that reversal of the normal baroreflex-mediated pattern of variability may occur. We investigated heart rate and blood pressure variability and baroreflex sensitivity in 17 mechanically ventilated patients. ECG (RR intervals), invasive systolic blood pressure (SBP), and respiratory flow signals were recorded. High-frequency (HF) amplitude of RR and SBP time series and HF phase differences between RR, SBP, and ventilatory signals were continuously computed by Complex DeModulation (CDM). Cross-spectral analysis was used to assess the coherence and the gain functions between RR and SBP, yielding baroreflex sensitivity indices. The HF phase difference between SBP and ventilatory signals was nearly constant in all patients with inversion of SBP variability during the ventilator cycle compared with cycling with negative inspiratory pressure to replicate spontaneous breathing. In 12 patients (group 1), the phase difference between RR and ventilatory signals changed over time and the HF-RR amplitude varied. In the remaining five patients (group 2), RR-ventilatory signal phase and HF-RR amplitude showed little change; however, only one of these patients exhibited a RR-ventilatory signal phase difference mimicking the normal pattern of respiratory sinus arrhythmia. Spectral coherence between RR and SBP was lower in the group with phase difference changes. Positive pressure ventilation exerts mainly a mechanical effect on SBP, whereas its influence on HR variability seems more complex, suggesting a role for neural influences.     

Macrogeographic variation in the call of the corncrake Crex crex

This study was conducted to characterise macrogeographic variation in the vocalisation of the corncrake Crex crex, a bird species with a non‐learned and highly stereotyped call. We also examined: 1) whether call characteristics remained stable across successive breeding seasons within two of the study populations and 2) whether call similarity was related to distance between populations. Recordings of 352 males from eight populations were analysed. The analyses focused on variation in 1) temporal characteristics (duration of syllables and intervals, duration of the intervals between consecutive maximal amplitude peaks within syllables, called pulse‐to‐pulse duration (PPD)), and 2) spectral characteristics (minimal and maximal frequency, frequencies below which 25%, 50% and 75% acoustic energy of signal is distributed). We found significant differences in most of the temporal and all of the spectral characteristics between populations. No differences were found in PPD. Significant interannual differences in spectral characteristics were found in both of the populations examined, whereas differences in temporal characteristics were only observed in one population. In general, geographic variation in calls showed clinal distance‐dependence, where distant populations showed larger differences in call than neighbouring populations. Our results show that geographic variation in corncrake calls may be very dynamic in the short term and that within‐population variation may occur on the same scale as between‐population variation. This finding is surprising because call characteristics in non‐learners are essentially inherited, and genetic transmission should be very slow. We suggest that the social interactions between males and/or the specific dispersal patterns of this species and the low site fidelity of adult and young birds may be responsible for such pattern.     

High N-Terminal Pro-B-Type Natriuretic Peptide Levels Are Associated with Reduced Heart Rate Variability in Acute Myocardial Infarction

Aim

We investigated the relationships between the autonomic nervous system, as assessed by heart rate variability (HRV) and levels of N-terminal Pro-B-type Natriuretic Peptide (Nt-proBNP) in patients with acute myocardial infarction (MI).

Methods and Results

The mean of standard deviation of RR intervals (SDNN), the percentage of RR intervals with >50 ms variation (pNN50), square root of mean squared differences of successive RR intervals (rMSSD), and frequency domain parameters (total power (TP), high frequency and low frequency power ratio (LF/HF)) were assessed by 24 h Holter ECG monitoring. 1018 consecutive patients admitted <24 h for an acute MI were included. Plasma Nt-proBNP (Elecsys, Roche) was measured from blood samples taken on admission. The median (IQR) Nt-proBNP level was 681(159–2432) pmol/L. Patients with the highest quartile of Nt-proBNP were older, with higher rate of risk factors and lower ejection fraction. The highest Nt-proBNP quartile group had the lowest SDNN, LF/HF and total power but similar pNN50 and rMSSD levels. Nt-proBNP levels correlated negatively with SDNN (r = −0.19, p<0.001), LF/HF (r = −0.37, p<0.001), and LF (r = −0.29, p<0.001) but not HF (r = −0.043, p = 0.172). Multiple regression analysis showed that plasma propeptide levels remained predictive of LF/HF (B(SE) = −0.065(0.015), p<0.001)), even after adjustment for confounders.

Conclusions

In conclusion, our population-based study highlights the importance of Nt-proBNP levels to predict decreased HRV after acute MI.     

Dependence of the vulnerability index on the heart cycle length

Index of vulnerability is a parameter based on ventricular gradient evaluating the risk of arrhythmia development. The index is derived from isointegral maps of the QT interval. Individual characteristics of isointegral maps are influenced by different factors, which contribute to the relatively high variability among measured parameters of maps in measured subjects. While several electrocardiographic indexes have been introduced, there are only few studies of their dependence on heart rate. In this study we set out to establish the dependence of vulnerability index on the RR interval or heart rate in healthy population. A positive linear correlation between RR intervals and mean and minimum values of vulnerability indexes was found.     

Inheritance of heart rate variability: the kibbutzim family study

Heart rate variability (HRV) measures are associated with coronary heart disease incidence and mortality. Therefore insight into the genetic and environmental determinants of these measures may have clinical relevance. We assessed the role of genetic and environmental factors of time domain and frequency domain HRV indices. Participants were 451 kibbutz members, aged 15 and up, belonging to 80 families. HRV indices were calculated from Holter recordings measured over 5 min. Our data indicate that for the two time- and four frequency domain indices, a mixture of two normal distributions fit the data significantly better than a single normal distribution (P<0.05). We used complex segregation analysis to infer the modes of inheritance of these HRV measures. We found evidence for possible involvement of a recessive major gene in the inheritance of the root mean square of successive differences in RR intervals (RMSSD), which is predominantly vagally mediated. A putative major gene explains 28%-34% of the adjusted inter-individual variability. The SD, determined by a mixture of mechanisms, is influenced by environmental and polygenic effects, but not by a major gene. The findings regarding the heritability of the frequency domain indices were not conclusive. However, the involvement of genetic factors was not rejected. Additional studies in extended families are needed to confirm the involvement of major genes in the determination of the autonomic activity.     

Electrocardiographic analysis of auricular electric systole in the sheep

The different components of the electric auricular systole, as well as the possible relationship between them have been studied in 302 ECG from Merino Precoz sheep breed. A gradual increase in the P wave duration, RR interval, PQ interval and PQ segment accompanying the growth of the animal, has been obtained, whereas the P wave voltage decreases both gradually and significantly. An analysis of the P wave morphology shows a higher incidence of double waves over simple waves in 1 year old animals than in younger ones. A high correlation between the RR and PQ intervals as well as between the PQ interval and the PQ segment has been observed in all groups of the three leads studied.     

Physiologic modulations of the systolic time intervals in the fetal lamb

To examine the modulation of fetal systolic time intervals of the ovine fetus in relation to fetal maturation, heart rate, respiratory activity, and circadian rhythm, studies were carried out on 13 fetal-maternal sheep preparations. The data obtained showed that there was a significant correlation between the ejection time (ET) and the RR intervals of the electrocardiogram. The pre-ejection period (PEP) and PEP/ET increased in relation to the fetal maturation (38 ms and 0.25 at 120 days to 52 ms and 0.33 at 145 days of gestation, respectively). When the circadian rhythmicity was analyzed, a relative tachycardia was in evidence during the 21- to 03-h period but systolic time intervals remained unchanged. Except for some tachycardia and cardiac rhythm variability, respiratory activity also had no influence on the systolic time intervals.