Abstract
Heart rate variability (HRV) has been asso-ciated with a variety of clinical situations. However, few studies have examined the association between HRV and acute poi-soning. Organophosphate (OP) and car-bamate inhibit esterase enzymes, particu-larly acetylcholinesterase, resulting in an accumulation of acetylcholine and thereby promoting excessive activation of corre-sponding receptors. Because diagnosis and treatment of OP and carbamate poisoning greatly depend on the severity of choliner-gic symptoms, and because HRV reflects autonomic status, some HRV parameters may be of value in diagnosing OP and car-bamate poisoning among patients visiting the emergency department.Patients who visited the emergency de-partment of the study hospital between September 2008 and May 2010 with the chief complaint of acute poisoning or over-dose were included. Cases that involved ingestion of OP or carbamate insecticides were classified as poisoning by cholinest-erase inhibitors and compared with other cases of poisoning or overdose. The time-domain analysis included descriptive sta-tistics of R-R intervals and instantaneous heart rates. The frequency-domain analy-sis used fast Fourier transformation. A Poincaré plot, which is a scatterplot of R-R intervals against the preceding R-R inter-val, was used for the nonlinear analysis. Very-low-frequency (VLF) power and the ratio of low-frequency-to-high-frequency power (LF/HF) were the most effective pa-rameters for distinguishing cholinesterase inhibitor poisoning among cases of acute poisoning, with areas under the receiver-operating characteristic curve of 0.76 and 0.87, respectively. Cholinesterase inhibitor poisoning was a significant factor deter-mining VLF power and the LF/HF ratio after adjusting for possible confounding variables, including age over 40, gender, and tracheal intubation.Frequency-domain parameters of HRV, such as VLF power and the LF/HF ratio, might be considered as potential diagnos-tic methods to distinguish cholinesterase inhibitor poisoning from other cases of in-toxication in the early stages of emergency care.
Highlights
Heart rate dynamically responds to physiologic alterations, mediated by the autonomic nervous system via vagal and sympathetic nerve impulses. [1] Analysis of heart rate variability (HRV) using electrocardiographic (ECG) recording is an important method used to assess cardiovascular autonomic regulation
(4) Currently, the association of HRV and autonomic function is widely appreciated in clinical medicine. [1,2,3,4,13,17,18,19,20,21] As autonomic dysfunction largely characterizes the symptoms caused by cholinesterase inhibitor intoxication, HRV may be of diagnostic value in cases of pesticide poisoning
There is some debate regarding the interpretation of frequency-domain results, but it is generally believed that HF power reflects ventilator modulation of R-R intervals, and LF power is modulated by both sympathetic and parasympathetic nerve traffic to the heart. [1,4] LF power and HF power alone did not have significant diagnostic value based on the Receiver operating characteristic (ROC) curve, the low-frequency-to-high-frequency power (LF/HF) ratio exhibited good sensitivity and specificity
Summary
Heart rate dynamically responds to physiologic alterations, mediated by the autonomic nervous system via vagal and sympathetic nerve impulses. [1] Analysis of heart rate variability (HRV) using electrocardiographic (ECG) recording is an important method used to assess cardiovascular autonomic regulation. Time domain parameters are the most simple to analyze and are derived from statistical representation of R-R intervals or differences in consecutive R-R intervals. [8] Organophosphate (OP) and carbamate agents are widely used as pesticides in Asia These compounds inhibit esterase enzymes, acetylcholinesterase in synapses and on red cell membranes and butyrylcholinesterase in plasma. [9,11] Because diagnosis and treatment of OP and carbamate poisoning greatly depend on the severity of cholinergic symptoms and because HRV reflects autonomic status, the authors hypothesized that some HRV parameters may be of value in diagnosing OP and carbamate poisoning among patients visiting the emergency department (ED); we conducted this study to evaluate the utility of HRV
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