Visualization of Heart Rate Variability of Long-Term Heart Transplant Patient by Transition Networks: A Case Report.

Joanna Wdowczyk,Karolina Dorniak,Danuta Makowiec,Marcin Gruchała

doi:10.3389/fphys.2016.00079

Joanna Wdowczyk, Karolina Dorniak + Show 2 more

Open Access

https://doi.org/10.3389/fphys.2016.00079

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Abstract

We present a heart transplant patient at his 17th year of uncomplicated follow-up. Within a frame of routine check out several tests were performed. With such a long and uneventful follow-up some degree of graft reinnervation could be anticipated. However, the patient's electrocardiogram and exercise parameters seemed largely inconclusive in this regard. The exercise heart rate dynamics were suggestive of only mild, if any parasympathetic reinnervation of the graft with persisting sympathetic activation. On the other hand, traditional heart rate variability (HRV) indices were inadequately high, due to erratic rhythm resulting from interference of the persisting recipient sinus node or non-conducted atrial parasystole. New tools, originated from network representation of time series, by visualization short-term dynamical patterns, provided a method to discern HRV increase due to reinnervation from other reasons.

Highlights

In patients with end-stage heart disease, heart transplantation (HTx) is associated with significant improvement in survival and in quality of life
Higher heart rate variability (HRV) indices were associated with graft reinnervation by many authors (Uberfuhr et al, 2000; Cornelissen et al, 2012; Vanderlaan et al, 2012)
The scars in the atria act as conduction barriers and can predispose to atrial flutter (Elsik et al, 2012). In this case part of the heart rate variability (HRV) arises from a biatrial surgical technique and interference of the persisting recipient sinus node, FIGURE 3 | Adjacency matrices of transition networks obtained from increments RR as probability density plots of the core parts of networks, for: (A) the patient under study when he was 17 years after HTx, (B) the patient under study when he was 10 years after HTX, (C) a typical sexagenarian, and (D) a typical HTx patient a year after HTx

Summary

INTRODUCTION

In patients with end-stage heart disease, heart transplantation (HTx) is associated with significant improvement in survival and in quality of life. Complete denervation of the transplant significantly affects reactivity of transplanted heart and hemodynamics of circulation (Willmann et al, 1963) Cardiac reinnervation, both sinus and myocardial, was extensively studied with a variety of methods, including heart rate variability (HRV), PET with C-11 hydroxyephedrine, MIBI-SPECT and others, and proved non-uniform and occurring at variable time (Kaye et al, 1993; Uberfuhr et al, 2000; Vanderlaan et al, 2012; Imamura et al, 2014). Within a frame of routine check out several tests were performed With such a long and uneventful follow-up some degree of graft reinnervation could be anticipated. The exercise heart rate (HR) dynamics were suggestive of only mild, if any parasympathetic reinnervation of the graft with persisting sympathetic activation via plasma catecholamines. We represent the short-term dynamics of nocturnal RR-intervals by the novel complex network tools (a transition network and its adjacency matrix, Donner et al, 2010; Makowiec et al, 2014, 2015) and explore the visualization of this representation in assessment of HRV

Case Presentation

HRV analysis

DISCUSSION

CONCLUDING REMARKS