Refined Multiscale Fuzzy Entropy to Analyse Post-Exercise Cardiovascular Response in Older Adults With Orthostatic Intolerance

Orthostatic intolerance syndrome occurs when the autonomic nervous system is incapacitated and fails to respond to the demands associated with the upright position. Assessing this syndrome among the elderly population is important in order to prevent falls. However, this problem is still challenging. The goal of this work was to determine the relationship between orthostatic intolerance (OI) and the cardiovascular response to exercise from the analysis of heart rate and blood pressure. More specifically, the behavior of these cardiovascular variables was evaluated in terms of refined composite multiscale fuzzy entropy (RCMFE), measured at different scales. The dataset was composed by 65 older subjects, 44.6% (n = 29) were OI symptomatic and 55.4% (n = 36) were not. Insignificant differences were found in age and gender between symptomatic and asymptomatic OI participants. When heart rate was evaluated, higher differences between groups were observed during the recovery period immediately after exercise. With respect to the blood pressure and other hemodynamic parameters, most significant results were obtained in the post-exercise stage. In any case, the symptomatic OI group exhibited higher irregularity in the measured parameters, as higher RCMFE levels in all time scales were obtained. This information could be very helpful for a better understanding of cardiovascular instability, as well as to recognize risk factors for falls and impairment of functional status.

[1]  L Faes,et al.  Univariate and multivariate conditional entropy measures for the characterization of short-term cardiovascular complexity under physiological stress , 2018, Physiological measurement.

[2]  Jennifer Healey,et al.  Multiscale entropy analysis of complex heart rate dynamics: discrimination of age and heart failure effects , 2003, Computers in Cardiology, 2003.

[3]  O. Williams,et al.  Syncope and orthostatic intolerance. , 2003, The Medical clinics of North America.

[4]  Madalena Costa,et al.  Multiscale entropy analysis of complex physiologic time series. , 2002, Physical review letters.

[5]  D. Kimmerly,et al.  Gender affects sympathetic and hemodynamic response to postural stress. , 2001, American journal of physiology. Heart and circulatory physiology.

[6]  N. T. Smith,et al.  A comparison of cardiac output derived from the arterial pressure wave against thermodilution in cardiac surgery patients. , 2001, British journal of anaesthesia.

[7]  Hong-Bo Xie,et al.  Measuring time series regularity using nonlinear similarity-based sample entropy , 2008 .

[8]  Hamed Azami,et al.  Refined multiscale fuzzy entropy based on standard deviation for biomedical signal analysis , 2016, Medical & Biological Engineering & Computing.

[9]  Breda Cullen,et al.  Screening for dementia in an Irish community sample using MMSE: a comparison of norm‐adjusted versus fixed cut‐points , 2005, International journal of geriatric psychiatry.

[10]  Victor A Convertino,et al.  Gender differences in autonomic functions associated with blood pressure regulation. , 1998, American journal of physiology. Regulatory, integrative and comparative physiology.

[11]  Daniele Marinazzo,et al.  Multiscale analysis of short term heart beat interval, arterial blood pressure, and instantaneous lung volume time series , 2007, Artif. Intell. Medicine.

[12]  Ihab Hajjar,et al.  Hypertension, Orthostatic Hypotension, and the Risk of Falls in a Community‐Dwelling Elderly Population: The Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly of Boston Study , 2011, Journal of the American Geriatrics Society.

[13]  Andrew P Blaber,et al.  Peripheral vascular responses of men and women to LBNP. , 2012, Aviation, space, and environmental medicine.

[14]  Michael J Joyner,et al.  Sex differences and blood pressure regulation in humans , 2016, Experimental physiology.

[15]  John F. Potter,et al.  Cerebral Autoregulatory Responses to Head-Up Tilt in Normal Subjects and Patients With Recurrent Vasovagal Syncope , 2001, Circulation.

[16]  Danilo P Mandic,et al.  Multivariate multiscale entropy: a tool for complexity analysis of multichannel data. , 2011, Physical review. E, Statistical, nonlinear, and soft matter physics.

[17]  J. Richman,et al.  Physiological time-series analysis using approximate entropy and sample entropy. , 2000, American journal of physiology. Heart and circulatory physiology.

[18]  Anne Humeau-Heurtier,et al.  The Multiscale Entropy Algorithm and Its Variants: A Review , 2015, Entropy.

[19]  M. Javorka,et al.  The effect of orthostatic stress on multiscale entropy of heart rate and blood pressure. , 2011, Physiological measurement.

[20]  Madalena Costa,et al.  Multiscale entropy analysis of biological signals. , 2005, Physical review. E, Statistical, nonlinear, and soft matter physics.

[21]  N. Goswami,et al.  Impairment of Cerebral Blood Flow Regulation in Astronauts With Orthostatic Intolerance After Flight , 2011, Stroke.

[22]  Raquel Cervigón Abad,et al.  Multiscale time irreversibility to predict orthostatic intolerance in older people , 2016, 2016 IEEE Statistical Signal Processing Workshop (SSP).

[23]  Bijan Najafi,et al.  Regulation of Cardiac Autonomic Nervous System Control across Frailty Statuses: A Systematic Review , 2015, Gerontology.

[24]  Yaneer Bar-Yam,et al.  Dynamics Of Complex Systems , 2019 .

[25]  Ming-ai Li,et al.  Applying Improved Multiscale Fuzzy Entropy for Feature Extraction of MI-EEG , 2017 .

[26]  T. Brismar,et al.  Comment on "Multiscale entropy analysis of complex physiologic time series". , 2004, Physical review letters.

[27]  Claude Gharib,et al.  [Orthostatic tolerance after spaceflight or simulated weightlessness by head-down bed-rest]. , 2002, Bulletin de l'Academie nationale de medecine.

[28]  Peter Grassberger,et al.  Information and Complexity Measures in Dynamical Systems , 1991 .

[29]  Nandu Goswami,et al.  Orthostatic Intolerance in Older Persons: Etiology and Countermeasures , 2017, Front. Physiol..

[30]  Richard E.A. van Emmerik,et al.  Multiscale entropy: A tool for understanding the complexity of postural control , 2016, Journal of sport and health science.

[31]  Luca Faes,et al.  Efficient Computation of Multiscale Entropy over Short Biomedical Time Series Based on Linear State-Space Models , 2017, Complex..

[32]  Pere Caminal,et al.  Refined Multiscale Entropy: Application to 24-h Holter Recordings of Heart Period Variability in Healthy and Aortic Stenosis Subjects , 2009, IEEE Transactions on Biomedical Engineering.

[33]  C. Peng,et al.  Analysis of complex time series using refined composite multiscale entropy , 2014 .

[34]  D. Streeten,et al.  Pathogenesis of hyperadrenergic orthostatic hypotension. Evidence of disordered venous innervation exclusively in the lower limbs. , 1990, The Journal of clinical investigation.

[35]  H. Lee,et al.  Orthostatic hypertension: An underestimated cause of orthostatic intolerance , 2016, Clinical Neurophysiology.

[36]  Aditi Vyas,et al.  Gender Differences in Orthostatic Hypotension , 2011, The American journal of the medical sciences.

[37]  Weiting Chen,et al.  Measuring complexity using FuzzyEn, ApEn, and SampEn. , 2009, Medical engineering & physics.

[38]  A. Porta,et al.  Progressive decrease of heart period variability entropy-based complexity during graded head-up tilt. , 2007, Journal of applied physiology.

[39]  Stephen R Lord,et al.  Blood pressure changes on upright tilting predict falls in older people. , 2002, Age and ageing.

[40]  D. L. Hudson,et al.  Applying continuous chaotic modeling to cardiac signal analysis , 1996 .

[41]  Sebastian Zaunseder,et al.  Entropy Analysis of RR and QT Interval Variability during Orthostatic and Mental Stress in Healthy Subjects , 2014, Entropy.

[42]  Zbigniew R. Struzik,et al.  Dynamical Pattern Representation of Cardiovascular Couplings Evoked by Head-up Tilt Test , 2018, Entropy.

[43]  Qi Fu,et al.  Hemodynamics of orthostatic intolerance: implications for gender differences. , 2004, American journal of physiology. Heart and circulatory physiology.

[44]  V. Dourado,et al.  The six-minute walk test and body weight-walk distance product in healthy Brazilian subjects. , 2009, Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas.

[45]  Wangxin Yu,et al.  Characterization of Surface EMG Signal Based on Fuzzy Entropy , 2007, IEEE Transactions on Neural Systems and Rehabilitation Engineering.