Influence of psychological stress on Systolic-Diastolic Interval (SDI) interaction characteristics measured from the electrocardiogram (ECG) signal

Stress affects the ventricular repolarization and the ventricular mechanical function by increasing the QT interval variability and changing left ventricular ejection fraction respectively. As QT and TQ intervals are considered as surrogates of mechanical systolic and diastolic durations, alteration of QT and TQ interval dynamics can be used to analyse stress related changes in the systolic and diastolic function of the heart. The ratio of QT to TQ interval within a cardiac cycle (i.e. QTTQ ratio) represents the synchronized contraction and relaxation operation of the heart. Besides QTTQ, the ratio of TQ to RR interval (i.e. TQRR ratio) can also be used as a non-invasive measure of the diastolic function to analyse ventricular dysfunction. The stress related alteration of ventricular function is reported in subjects with coronary heart diseases, but the same was not reported in healthy subjects widely. In this study, the effect of stress on systolic-diastolic interval (SDI) ratios is analysed to investigate the stress related alteration in ventricular repolarization in healthy subjects. The study results indicate that stress induction increases the mean QTTQ ratio (mSDIQT-TQ) and decreases the TQRR ratio (mSDITQ-RR) indicating the effect of stress on systolic and diastolic functions. The increase in mSDIQT-TQ indicates the increases in the probability of arrhythmogenesis. However, the difference between stressed and unstressed conditions for theses ratio parameters was not significant (p>0.05). Alternatively, the variability of SDI parameters (i.e. variance of QTTQ and TQRR ratios) increased significantly, which can detect the induced stress in healthy individuals and significantly (p<;0.05) differentiated the stressed condition form natural steady state relaxed condition of the same individual. The significant increase in variability in QTTQ and TQRR ratio indicate the increased probability of arrhythmogenesis due to sympathetic activation during stressed conditions.

[1]  Marimuthu Palaniswami,et al.  Analyzing Systolic-Diastolic Interval Interaction Characteristics in Diabetic Cardiac Autonomic Neuropathy Progression , 2015, IEEE Journal of Translational Engineering in Health and Medicine.

[2]  Marimuthu Palaniswami,et al.  Effect of ECG-derived respiration (EDR) on modeling ventricular repolarization dynamics in different physiological and psychological conditions , 2014, Medical & Biological Engineering & Computing.

[3]  R. Quaglione,et al.  Effect of Acute Mental Stress on Heart Rate and QT Variability in Postmyocardial Infarction Patients , 2012, ISRN cardiology.

[4]  Pier D. Lambiase,et al.  Anger, Emotion, and Arrhythmias: from Brain to Heart , 2011, Front. Physio..

[5]  P. Marino,et al.  Do electrical parameters of the cardiac cycle reflect the corresponding mechanical intervals as the heart rate changes? , 2010, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[6]  N. Silverman,et al.  Doppler assessment of the ratio of the systolic to diastolic duration in normal children: relation to heart rate, age and body surface area. , 2009, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[7]  Peter Taggart,et al.  Repolarization Changes Induced by Mental Stress in Normal Subjects and Patients with Coronary Artery Disease: Effect of Nitroglycerine , 2009, Psychosomatic medicine.

[8]  K. Bybee,et al.  Stress-Related Cardiomyopathy Syndromes , 2008, Circulation.

[9]  Nenad Sarapa,et al.  Analyses of Dynamic Beat‐to‐Beat QT–TQ Interval (ECG Restitution) Changes in Humans under Normal Sinus Rhythm and Prior to an Event of Torsades de Pointes during QT Prolongation Caused by Sotalol , 2007, Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc.

[10]  Jennifer Healey,et al.  Detecting stress during real-world driving tasks using physiological sensors , 2005, IEEE Transactions on Intelligent Transportation Systems.

[11]  A. Kadish,et al.  Autonomic effects on QT-RR interval dynamics after exercise. , 2005, American journal of physiology. Heart and circulatory physiology.

[12]  Vladimir Shusterman,et al.  Effects of Psychologic Stress on Repolarization and Relationship to Autonomic and Hemodynamic Factors , 2005, Journal of cardiovascular electrophysiology.

[13]  J. Gottdiener,et al.  Effects of Acute Mental Stress and Exercise on T-Wave Alternans in Patients With Implantable Cardioverter Defibrillators and Controls , 2004, Circulation.

[14]  A. Steptoe,et al.  Systematic review of mental stress-induced myocardial ischaemia. , 2003, European heart journal.

[15]  R. Hasegawa,et al.  Effect of mental stress on left ventricular ejection fraction and its relationship to the severity of coronary artery disease , 2000, European Journal of Nuclear Medicine.

[16]  M. Viitasalo,et al.  Effects of cardiovascular autonomic function tests on QT dispersion in the 12-lead electrocardiogram of healthy patients. , 2000, Journal of electrocardiology.

[17]  M. Burg,et al.  Destabilizing effects of mental stress on ventricular arrhythmias in patients with implantable cardioverter-defibrillators. , 2000, Circulation.

[18]  R. Soufer,et al.  Effects of mental stress on left ventricular and peripheral vascular performance in patients with coronary artery disease. , 1998, Journal of the American College of Cardiology.

[19]  H. Calkins,et al.  Beat-to-beat QT interval variability: novel evidence for repolarization lability in ischemic and nonischemic dilated cardiomyopathy. , 1997, Circulation.

[20]  D. Spodick,et al.  Systolic Time Intervals , 1976, International Boehringer Mannheim Symposia.

[21]  C. Oral,et al.  Spin Angular Momentum in Human Walking : Magnitude , Dimensionality and Distribution , 2006 .

[22]  黒田 徹.  Effect of mental stress on left ventricular ejection fraction and its relationship to the severity of coronary artery disease , 2001 .