Autonomic Dysfunction and Risk Stratification Assessed from Heart Rate Pattern

The modulation of the autonomic nervous system (ANS) under physiological and pathophysiological conditions is in focus of recent research. Many patients with cardio- and cerebrovascular diseases display features of sympathovagal dysregulation. Measuring specific ANS parameters could improve risk stratification. Thus, the early diagnosis of ANS dysfunction in these patients poses a great challenge with high prognostic relevance.The most relevant methods and measures of Heart Rate Variability (HRV) analysis and HRV monitoring will be described in detail in this chapter. The grown importance of these easily obtainable heart rate patterns in stratifying the risk of patients with myocardial infarction and heart failure as well as ischemic stroke will be demonstrated based on recent clinical studies. In order to perspectively improve clinical management of these patients further large scale clinical investigations on the role of ANS dysfunction will be useful.

[1]  C. Caltagirone,et al.  Cardiac autonomic dysfunction and functional outcome after ischaemic stroke , 2007, European journal of neurology.

[2]  S M Pincus,et al.  Approximate entropy as a measure of system complexity. , 1991, Proceedings of the National Academy of Sciences of the United States of America.

[3]  C. Szabó,et al.  Regulation of cytokine and chemokine production by transmitters and co-transmitters of the autonomic nervous system. , 1998, Biochemical pharmacology.

[4]  C. Peng,et al.  Fractal analysis of heart rate dynamics as a predictor of mortality in patients with depressed left ventricular function after acute myocardial infarction. TRACE Investigators. TRAndolapril Cardiac Evaluation. , 1999, The American journal of cardiology.

[5]  H. Stanley,et al.  Quantification of scaling exponents and crossover phenomena in nonstationary heartbeat time series. , 1995, Chaos.

[6]  Gian Domenico Pinna,et al.  Baroreflex Sensitivity: Measurement and Clinical Implications , 2008, Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc.

[7]  Junichiro Hayano,et al.  Low heart rate variability and the effect of depression on post-myocardial infarction mortality. , 2005, Archives of internal medicine.

[8]  H V Huikuri,et al.  Dynamic behavior of heart rate in ischemic stroke. , 1999, Stroke.

[9]  J. Fleiss,et al.  Power law behavior of RR-interval variability in healthy middle-aged persons, patients with recent acute myocardial infarction, and patients with heart transplants. , 1996, Circulation.

[10]  A. Aubert,et al.  Heart Rate Variability in Athletes , 2003, Sports medicine.

[11]  A. Oto,et al.  Effects of stroke localization on cardiac autonomic balance and sudden death. , 1999, Stroke.

[12]  A. Malliani,et al.  Heart rate variability. Standards of measurement, physiological interpretation, and clinical use , 1996 .

[13]  U. Dirnagl,et al.  Central nervous system injury-induced immune deficiency syndrome , 2005, Nature Reviews Neuroscience.

[14]  Dirk Hoyer,et al.  The alteration of autonomic function in multiple organ dysfunction syndrome. , 2008, Critical care clinics.

[15]  Giuseppe Baselli,et al.  Measuring regularity by means of a corrected conditional entropy in sympathetic outflow , 1998, Biological Cybernetics.

[16]  D. Hoyer,et al.  Autonomic Response to Cardiac Dysfunction in Chronic Heart Failure: A Risk Predictor Based on Autonomic Information Flow , 2008, Pacing and clinical electrophysiology : PACE.

[17]  Carlo Caltagirone,et al.  Cardiac Autonomic Derangement and Arrhythmias in Right-Sided Stroke With Insular Involvement , 2004, Stroke.

[18]  Ki H. Chon,et al.  Mutual information function assesses autonomic information flow of heart rate dynamics at different time scales , 2005, IEEE Transactions on Biomedical Engineering.

[19]  G. Breithardt,et al.  Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. , 1996 .

[20]  P. Stein,et al.  Heart Rate Variability: Measurement and Clinical Utility , 2005, Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc.

[21]  R. Passman,et al.  American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society scientific statement on noninvasive risk stratification techniques for identifying patients at risk for sudden cardiac death: a scientific statement from the American Heart Association Council on Clinical Cardi , 2008, Circulation.

[22]  R. Adams,et al.  Medical and neurological complications of ischemic stroke: experience from the RANTTAS trial. RANTTAS Investigators. , 1998, Stroke.

[23]  U. Rajendra Acharya,et al.  Heart rate variability: a review , 2006, Medical and Biological Engineering and Computing.

[24]  R. Burr,et al.  Interpretation of normalized spectral heart rate variability indices in sleep research: a critical review. , 2007, Sleep.

[25]  B. Lemmer.  Circadian Rhythm Regulations of the Cardiovascular System in Rats and Mice , 2007, IEEE Engineering in Medicine and Biology Magazine.

[26]  J. Kurths,et al.  Quantitative analysis of heart rate variability. , 1995, Chaos.

[27]  P. Stein.  Measures of parasympathetic function and risk stratification in critical care. , 2008, Critical care medicine.

[28]  A. Federico,et al.  Cardiac Autonomic Nervous System and Risk of Arrhythmias in Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy (CADASIL) , 2007, Stroke.

[29]  K. Tracey,et al.  Vagus nerve stimulation attenuates the systemic inflammatory response to endotoxin , 2000, Nature.

[30]  B. Schmitz,et al.  Lateralization in autononic dysfunction in ischemic stroke involving the insular cortex , 2004, Neuroreport.

[31]  Barry J Maron,et al.  American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society Scientific Statement on Noninvasive Risk Stratification Techniques for Identifying Patients at Risk for Sudden Cardiac Death. A scientific statement from the American Heart Association Council on Clinical Cardi , 2008, Journal of the American College of Cardiology.

[32]  A. Camm,et al.  Heart-rate turbulence after ventricular premature beats as a predictor of mortality after acute myocardial infarction , 1999, The Lancet.

[33]  G. Schmidt,et al.  Risk Stratification After Acute Myocardial Infarction by Heart Rate Turbulence , 2003, Circulation.

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

[35]  C. Caltagirone,et al.  Prognostic Implications of Right-Sided Insular Damage, Cardiac Autonomic Derangement, and Arrhythmias After Acute Ischemic Stroke , 2005, Stroke.

[36]  Alberto Porta,et al.  Different spectral components of 24 h heart rate variability are related to different modes of death in chronic heart failure. , 2005, European heart journal.

[37]  R. Prescott,et al.  Prospective study of heart rate variability and mortality in chronic heart failure: results of the United Kingdom heart failure evaluation and assessment of risk trial (UK-heart). , 1998, Circulation.

[38]  Alan Murray,et al.  Autonomic Function Is Impaired in Elderly Stroke Survivors , 2005, Stroke.

[39]  A. Malliani,et al.  Changes in Autonomic Regulation Induced by Physical Training in Mild Hypertension , 1988, Hypertension.

[40]  B. Joung,et al.  Power spectral analysis of heart rate variability and autonomic nervous system activity measured directly in healthy dogs and dogs with tachycardia-induced heart failure. , 2009, Heart rhythm.

[41]  T. Penzel,et al.  Dynamics of Heart Rate and Sleep Stages in Normals and Patients with Sleep Apnea , 2003, Neuropsychopharmacology.

[42]  Roberto Sassi,et al.  Assessing nonlinear properties of heart rate variability from short-term recordings: are these measurements reliable? , 2007, Physiological measurement.

[43]  D L Eckberg,et al.  Mechanisms underlying very-low-frequency RR-interval oscillations in humans. , 1998, Circulation.

[44]  A. Pedotti,et al.  Evaluation of the Baroreceptor‐Heart Rate Reflex by 24‐Hour Intra‐arterial Blood Pressure Monitoring in Humans , 1988, Hypertension.

[45]  Khusru Asadullah,et al.  Sympathetic activation triggers systemic interleukin-10 release in immunodepression induced by brain injury , 1998, Nature Medicine.

[46]  J. Bigger,et al.  Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction , 1998, The Lancet.

[47]  S. Cerutti,et al.  Autonomic Nervous Activity during Sleep in Middle Cerebral Artery Infarction , 1998, Cerebrovascular Diseases.

[48]  P. Ivanov,et al.  Scale-invariant aspects of cardiac dynamics. Observing sleep stages and circadian phases. , 2007, IEEE engineering in medicine and biology magazine : the quarterly magazine of the Engineering in Medicine & Biology Society.

[49]  P. Stein.  Potential role of different components of heart rate variability for risk-stratification in critical care. , 2005, Critical care medicine.

[50]  B. Wallin,et al.  Reduced heart rate variability after right-sided stroke. , 1996, Stroke.

[51]  J. Kurths,et al.  The application of methods of non-linear dynamics for the improved and predictive recognition of patients threatened by sudden cardiac death. , 1996, Cardiovascular research.

[52]  Dirk Hoyer,et al.  Autonomic information flow improves prognostic impact of task force HRV monitoring , 2006, Comput. Methods Programs Biomed..

[53]  B. Conrad,et al.  Prognostic relevance of pathological sympathetic activation after acute thromboembolic stroke , 2001, Neurology.

[54]  P. Ivanov.  Scale-invariant Aspects of Cardiac Dynamics Across Sleep Stages and Circadian Phases , 2007, 2006 International Conference of the IEEE Engineering in Medicine and Biology Society.

[55]  S. Boveda,et al.  Depressed low frequency power of heart rate variability as an independent predictor of sudden death in chronic heart failure. , 2000, European heart journal.

[56]  Phyllis K Stein,et al.  Cardiac autonomic modulation. Analyzing circadian and ultradian rhythms. , 2007, IEEE engineering in medicine and biology magazine : the quarterly magazine of the Engineering in Medicine & Biology Society.

[57]  Dirk Hoyer,et al.  Autonomic dysfunction predicts mortality in patients with multiple organ dysfunction syndrome of different age groups* , 2005, Critical care medicine.

[58]  M. P. Griffin,et al.  Sample entropy analysis of neonatal heart rate variability. , 2002, American journal of physiology. Regulatory, integrative and comparative physiology.

[59]  R. Maestri,et al.  Short-Term Heart Rate Variability Strongly Predicts Sudden Cardiac Death in Chronic Heart Failure Patients , 2003, Circulation.

[60]  P. Stein,et al.  Autonomic information flow improves prognostic value of heart rate patterns after abdominal aortic surgery. , 2008, Journal of critical care.

[61]  Dirk Hoyer,et al.  Nonlinear Analysis of the Cardiorespiratory Coordination in a Newborn Piglet , 1998 .

[62]  D. Hoyer,et al.  Autonomic Information Flow Rhythms-From Heat Beat Interval to Circadian Variation , 2007, IEEE Engineering in Medicine and Biology Magazine.

[63]  Circadian and Ultradian Rhythms in Cardiac Autonomic Modulation , 2007, 2006 International Conference of the IEEE Engineering in Medicine and Biology Society.

[64]  Dirk Hoyer,et al.  Prognostic impact of autonomic information flow in multiple organ dysfunction syndrome patients. , 2006, International journal of cardiology.

[65]  H. Huikuri,et al.  Heart rate dynamics predict poststroke mortality , 2004, Neurology.

[66]  A. Rebuzzi,et al.  Prognostic value of ventricular arrhythmias and heart rate variability in patients with unstable angina , 2005, Heart.

[67]  Stephen A. Barron,et al.  Autonomic Consequences of Cerebral Hemisphere Infarction , 1994, Stroke.

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

[69]  S. Schwab,et al.  Cardiovascular autonomic function in poststroke patients , 2007, Neurology.

[70]  J. Fleiss,et al.  Correlations among time and frequency domain measures of heart period variability two weeks after acute myocardial infarction. , 1992, The American journal of cardiology.