Heart Rate Turbulence Parameters Research Articles

EVALUATION OF AUTONOMIC NERVOUS SYSTEM WITH HEART RATE TURBULENCE IN PATIENTS WITH STROKE

Introduction: Autonomic dysfunction usually develops after cerebrovascular diseases. Heart rate turbulence is one of the tests to show autonomic dysfunction. We aimed to evaluate autonomic dysfunction using heart rate turbulence parameters after acute ischemic stroke in this study. Methods: We included 30 patients hospitalized with acute ischemic stroke and 15 healthy individuals in the study. Computed tomography and magnetic resonance images taken during the hospitalization of the patients were examined. It was divided into 3 classes the right hemisphere, left hemisphere, and brainstem cerebellum lesions. Holter ECG(electrocardiography) records inserted within the first 24 hours of hospitalization of the patients were examined. Turbulence onset (TO) and turbulence slope (TS) parameters, which are heart rate turbulence parameters, were compared with the control group. Results: There was no significant difference between the groups included in the study in terms of gender, age, hypertension, hyperlipidemia smoking, and biochemical parameters. When TO and TS values were compared with the control group, no significant difference was found. (TO -0.004970 (± 0.02), -0.013627 (± 0.01) p: 0.14, TS 6.81 (± 7.30), 7.67 (± 5.30) p: 0.11). Although there were more abnormal values for TO and TS in patients with left hemisphere lesions, no statistical difference was found. Conclusion: No relationship has been shown between acute stroke and heart rate turbulence.

Evaluation of Cardiovascular Autonomic Dysfunction According to Heart Rate Turbulence and Variability in Patients with Benign Paroxysmal Positional Vertigo

Introduction: The relationship between benign paroxysmal positional vertigo (BPPV) and cardiovascular autonomic dysfunction is not clear. Disruption of the balance between the sympathetic and parasympathetic systems causes various diseases. It is believed that disorders of the parasympathetic system, particularly, may be responsible for causing BPPV. Heart rate variability (HRV) and HRT (heart rate turbulence), which show autonomic dysfunction, are two non-invasive tests that show the relationship of the heart rate with the autonomic nervous system. The purpose of the present study was to evaluate the relationship between autonomic dysfunction and BPPV in patients with BPPV by using HRV and HRT, which are non-invasive laboratory parameters. Patients and Methods: A total of 100 age- and gender-matched volunteers and 100 patients with BPPV were selected for the study between January 2015 and January 2020. We obtained HRT and HRV parameters from 24-hour ECG Holter recordings. We considered a TO above 0 and a TS above 2.5 to be abnormal. We compared the parameters between groups. Results: A significant difference was observed between the BPPV and control groups in the HRV parameters SDNNI (p= 0.036), SDANN (p= 0.045), and HRT parameter TS (p= 0.048). We showed that abnormal TO (p= 0.025) and TS (p= 0.038) values were significantly higher in the patient group. Conclusion: Parasympathetic autonomic dysfunction was demonstrated by the lower HRV and HRT values observed in the patients with BPPV compared to the control group in the present study. The present findings must be confirmed with a much larger number of patients and multi-center studies.

Dapagliflozin Improves Cardiac Autonomic Function Measures in Type 2 Diabetic Patients with Cardiac Autonomic Neuropathy.

Cardiac autonomic neuropathy is a frequent complication of type 2 diabetes mellitus. Cardiac autonomic neuropathy, in which sympathetic tone predominates over parasympathetic activity, increases both cardiovascular morbidity and mortality and unfortunately has no definitive treatment. Sodium-glucose cotransporter-2 inhibitors have been suggested to reduce sympathetic nervous system activity, based on the results from previous studies. In this study, we aimed to investigate the effect of 24-week treatment with dapagliflozin, a sodium-glucose cotransporter-2 inhibitor, on cardiac autonomic function measures in patients with type 2 diabetes mellitus and cardiac autonomic neuropathy. Dapagliflozin 10 mg/day (n=42) or non-sodium-glucose cotransporter-2 inhibitor oral antidiabetic(s) (n=38) was added to the treatment of patients whose glycemic control could not be achieved with existing treatments. The patients with definite or confirmed cardiac autonomic neuropathy diagnosed by cardiovascular autonomic reflex tests underwent 24-hour Holter-electrocardiogram recordings to obtain heart rate variability and heart rate turbulence parameters before starting additional medication and after a 24-week treatment period. In-group analyses showed that dapagliflozin 10 mg/day for 24 weeks improved heart rate variability and heart rate turbulence parameters and decreased the frequency of ventricular premature beats relative to their baseline values. No such findings were observed in the control group despite similar glycemic control. Comparisons between dapagliflozin group and the control group showed that these effects of dapagliflozin were significantly better than non-sodium-glucose cotransporter-2 inhibitor oral antidiabetics. Dapagliflozin improves measures of cardiac autonomic function compared to the control group in type 2 diabetic patients with cardiac autonomic neuropathy. This intergroup benefit, demonstrated for the first time, may be promising for the regression of cardiac autonomic neuropathy with sodium-glucose cotransporter-2 inhibitors.

Effectiveness of beta-blockers in the treatment of idiopathic premature ventricular contractions in children

Aim. To evaluate the effectiveness of beta-blockers (BB) in the treatment of idiopathic premature ventricular contractions (PVCs) in children.Material and methods. BBs were prescribed to 27 children with idiopathic PVCs. In 3 (11,1%) patients, side effects (hypotension, bronchial obstruction) was revealed at the beginning of therapy. A total of 24 children were included in the further study (15 boys (62,5%), 9 girls (37,5%). The mean age was 8,3±5,4 years. Data from anamnesis, electrocardiography (ECG), 24-hour ECG monitoring, and echocardiography were analyzed.Results. The 24-hour PVC rate was 33,2±17,7 thousand/day or 26,6±13,2%. In 14 (58,3%) children, we recorded paired PVCs, in 3 (12,5%) — multiform, in 10 (41,7%) — runs of non-sustained VT. There were complaints in 7 (29,2%) children. The follow-up period lasted 369,8±119,1 days. Propranolol was received by 17 (70,8%) patients, metoprolol — by 7 (29,2%). The therapy was effective in 11 (45,8%) patients, while ineffective in 13 (54,2%), among which 5 (20,8%) had an increase in the number of PVCs. The effectiveness of BBs was higher in children under the age of 1 year (p=0,043). Propranolol showed greater efficacy than metoprolol (p=0,047). Less efficiency was observed in female patients and those with pathological heart rate turbulence parameters (p=0,04).Conclusion. The effectiveness of BBs in children with idiopathic PVCs is 45,8%, higher in children aged <1 year and declines with age, decreasing in adolescents to 25%. The use of BBs is limited by non-cardiac side effects in 11,1% of children. Propranolol is more effective than metoprolol.

Altered Heart Rate Turbulence and Variability Parameters Predict 1-Year Mortality in Heart Failure with Preserved Ejection Fraction.

Background: Heart failure with preserved ejection fraction (HFpEF) is a complex and heterogeneous clinical syndrome. In the absence of effective and potent treatment strategies, the main challenge in HFpEF management remains the availability of strong predictors of unfavourable outcomes. In our study, we sought to evaluate the potential prognostic value of heart rate turbulence (HRT) and variability (HRV) parameters on mortality in ambulatory HFpEF patients. Methods: This was a case–control study comparing HRT and HRV parameters in HFpEF survivors vs. non-survivors. Patients from the RESPOND Heart Failure Registry with HFpEF who underwent 24 h ECG monitoring (Holter) were included; HRT parameters (i.e., turbulence onset (TO) and turbulence slope (TS)) and HRV parameters (i.e., standard deviation of NN intervals (SDNN)) derived from 24 h Holter ECGs were calculated in patients who died within 12 months, and compared to their age-, gender-, LVEF-, ECHO-, aetiology-, and therapy-matched alive controls. Results: A total of 22 patients (mean age 80 ± 7 years, 18% female, mean LVEF 57 ± 9%) were included in the final analysis. In deceased patients, values of TO were significantly higher, and values of TS and SDNN were significantly lower as compared to survivors. Conclusions: HRT and HRV parameters have the ability to differentiate individuals with HFpEF who are at the greatest risk of unfavourable outcomes. The extent of autonomic disbalance as determined by HRT and HRV could potentially assist in the prognostic assessment and risk stratification of HFpEF patients.

Triglyceride glucose index is related with cardiac autonomic dysfunction in patients with metabolic syndrome.

Aim Cardiac autonomic dysfunction is encountered in approximately 25 % of patients with metabolic syndrome (MetS). 24 hr Holter-ECG based heart rate variability (HRV) and heart rate turbulence (HRT) parameters are used to evaluate cardiac autonomic function. We aimed to investigate the relationship between a novel insulin resistance marker, triglyceride glucose (TyG) index and cardiac autonomic dysfunction in patients with MetS.Material and methods We examined a total of 400 non-diabetic subjects, 136 with MetS and 264 without MetS. All underwent TyG index calculations, and 24 hr Holter-ECG recordings for the measurement of HRV and HRT parameters.Results HRV and HRT parameters were lower or higher in patients with MetS than in subjects without MetS, indicating cardiac autonomic dysfunction. We observed significant correlations between TyG index and measures of cardiac autonomic function. Multiple linear regression analysis showed that the TyG index was an independent predictor of almost all HRV and HRT parameters.Conclusion This study demonstrates the independent relationship between cardiac autonomic dysfunction and the TyG index, a novel marker of insulin resistance in non-diabetic patients with MetS.

The role of heart rate variability and heart rate turbulence in diabetic retinopathy.

The aim of this study was to evaluate the cardiac autonomic functions of individuals with asymptomatic diabetic retinopathy (DR) and no obvious heart disease by heart rate turbulence (HRT) and heart rate variability (HRV) analysis. A total of 72 patients with type 2 diabetes mellitus: 20 non-retinopathic (NRDM), 26 non-proliferative retinopathic patients (NPDR) and 26 proliferative retinopathic patients (PDR) were enrolled in this cross-sectional study. The HRV parameters of Standard deviation of NN intervals (SDNN) (119.8±11.7, 101.1±20.2, 100.6±17.04), standard deviation of the average NN intervals (108.3±10.8, 91.2±17.5, 93.6±18.4), SDNN Index (49.5±5.1, 40.1±13.4, 38.6±12.7), Root mean square of successive RR interval differences (28.3±5.1, 22.3±7.5, 26±9.2) and Triangular index (34.4±4.3, 29.7±8.8, 27.3±6.7) were significantly lower in the NPDR and PDR groups than in the NRDM group (for all P<0.05). Also, there was a statistically significant higher Turbulence Onset (-1.80±0.7, -1.1±0.9, -0.43±0.81) and lower Turbulence Slope (8.05±2.59, 5.82±3.39, 4.53±2.07) in HRT parameters in patients in the NPDR and PDR groups than in the NRDM group (P<0.001). We found that HRV and HRT parameters had a significant deterioration in retinopathic individuals compared to the group without retinopathy. We think that HRV and HRT analysis can have an important role in the evaluation of these patients.

Abstract 10923: Heart Rate Turbulence and Severity of Atherosclerotic Coronary Lesion in Patients with History of Myocardial Infarction

Introduction: Prediction of adverse outcomes in patients after myocardial infarction (MI) remains a serious and not completely resolved problem, which pushes researchers to search for new technologies. One of the relatively promising non-invasive methods for predicting sudden coronary death in patients with coronary heart disease may be an assessment of heart rate turbulence (HRT). Hypothesis: to study the association between components of heart rate turbulence (HRT) and severity of atherosclerotic coronary lesion assessed by the SYNTAX and SYNTAX II Scores in patients with a history of myocardial infarction. Methods: study enrolled 106 patients with a history of MI in the mean age of 63.6±8.3 years (median age 64 [58; 69] years). The severity of coronary lesions was estimated by diagnostic selective coronary angiography with an assessment of SYNTAX and SYNTAX II Scores. All patients underwent 24-h Holter ECG monitoring. HRT was determined using two indicators: Turbulence Onset (To, %) and Turbulence Slope (Ts, ms/RRi). Results: after HRT quantification measurements were as follows: To= -1.28±1.75% (-1.09 [-2.21; -0.40]); Ts= 4.98±4.51 ms/RRi (3.66 [1.65; 7.24]). Mean SYNTAX Score was 16.8±8.5 (16.0 [10.0; 21.5]); SYNTAX Score II PCI - 30.8±8.9 (30.2 [24.7; 37.0]); SYNTAX Score II CABG - 23.8±7.7 (23.6 [19.0; 29.1]); 4 year PCI mortality - 9.4±9.1% (6.9 [4.4; 11.9]); 4 year CABG mortality - 5.0±3.7% (4.1 [2.8; 6.4]). Spearmen analysis revealed positive correlation between To (r=0.266; p=0.047) and SYNTAX Score II PCI and estimated 4-year PCI mortality rate (r=0.267; p=0.047). Negative correlation relationships were observed between Ts indicator and SYNTAX Score II PCI (r= -0.539; p&lt;0.001), SYNTAX Score II CABG (r= -0.318; p=0.017), 4-year PCI mortality rate (r= -0.539; p&lt;0.001) and 4-year CABG mortality rate (r= -0.348; p=0.008). There were no significant correlations between the rests of the analyzed indicators. Conclusions: Components of HRT have an association with SYNTAX and SYNTAX II scores. In patients with a history of MI, progressive impairment of baroreflex activity, as evidenced by changes in HRT parameters may indicate a more pronounced lesion of coronary arteries.

How intravenous iron therapy affects arrhythmia burden and functional status in patients with advanced heart failure and implantable devices

Abstract Background Heart failure with reduced ejection fraction (HFrEF) is a disease that confers significant morbidity and mortality to patients. Patients suffer from increased arrhythmia burden; lethal ventricular arrhythmias are frequent. Iron deficiency (ID) is increasingly recognized as a common comorbidity that constitutes a further detriment to patients' cardiorespiratory capacity and an independent prognosticator of mortality. ID treatment with intravenous ferric carboxymaltose (IV FCM) has proven beneficial, improving QoL and exercise capacity in HFrEF patients with ID. Iron depletion is linked to disturbed myocyte electromechanical balance, especially in HF. However, the role of IV FCM arrhythmic burden in HFrEF patients with ID has not been examined. Purpose Investigate the effect of IV FCM treatment on the functional capacity, QoL and arrhythmic burden of in HFrEF patients with ID and cardiac implantable electronic devices (CIED). Methods HFrEF patients with ID and CIEDs were recruited from our outpatient HF clinic. CIED telemetry revealed their arrhythmic burden for the 6 months preceding IV FCM administration. Patients underwent physical examination, blood testing, 6-minute walk testing, 24-hour Holter monitoring, QoL quantification with the KCCQ and EQ-5D-5L questionnaires and repeat CIED telemetry at study baseline (IV FCM administration) and 6-months. Microvolt T-wave alternans (MTWA) and heart rate turbulence (HRT) slope and onset were quantified through the 24-hour ECG recordings. HRT results are reported as HRT0, HRT1 or HRT2 based on the number of abnormal HRT parameters. Results So far, 83 (aged 68.3±8.7 years, 82% male) out of a total of 96 recruited patients have completed the 6-month follow-up (3 of 83 died before the 6-month mark). Picture 1 contains patients' baseline characteristics and 6-month results. Patients received a mean of 1.43±0.61g of IV FCM during the follow-up period, which significantly ameliorated iron status (Picture 1). The 6MWD increased by 32.4m (95% CI: 14.7–47.2, P&amp;lt;0.001), as did the KCCQ total score (P=0.008). Patients' CIEDs recorded significantly more nsVTs in the 6 months preceding IV FCM administration (2.2±15.7 per month) opposed to the subsequent period (0.06±3.1 per month, P=0.006). Patients' MTWA improved at 6-months over baseline (P=0.004), and a trend for improvement in HRT scores was observed (P=0.06). Hospitalization-free survival curves of these time periods reveal a non-significant trend for lower hospitalization risk following IV FCM (HR=1.9, P=0.09). Conclusions After 6 months of IV FCM treatment, HFrEF patients with ID had significantly better exercise capacity and quality of life. Regarding arrhythmias, a tentative improvement in CIED- and Holter-derived arrhythmic markers was observed. Extended follow-up of a larger sample size will provide further insight for the effect of IV FCM in these patients' arrhythmic burden. Funding Acknowledgement Type of funding sources: None. Baseline and 6-month resultsHospitalization curves pre-post IV FCM

Heart rate variability and heart rate turbulence in patients with vasovagal syncope.

Aim The autonomic nervous system plays an important role in the pathogenesis of vasovagal syncope, but studies on the effect of basal autonomic tone have found confusing results. The aim of this study was to investigate the effect of basal autonomic functions, as assessed by heart rate variability (HRV) and heart rate turbulence (HRT), in patients with vasovagal syncope.Material and methods Patients who underwent head-up tilt test (HUTT) due to unexplained syncope and who had a 24 hr Holter ECG recording in the same period were retrospectively analyzed. Patients with diabetes, a history of myocardial infarction, heart failure, orthostatic hypotension, atrial fibrillation, or use of vasoactive drugs, such as beta blockers, were excluded from the study. 161 patients who met these criteria were included in the study. Time domain HRV parameters from Holter ECG recordings and HRT parameters from patients with sufficient number of ventricular premature contractions were measured.Results The age of the patients varied from 16 to 75 yrs (mean: 44.8±18.5 yrs). HUTT results of 60 (37.2 %) patients were evaluated as positive. There were no significant differences in the basal demographic, clinical, or laboratory findings of the tilt-positive and tilt-negative patient groups. Likewise, there were no significant differences between the time domain HRV parameters and HRT parameters of both groups.Conclusion HRV and HRT parameters reflecting basal autonomic function were not different between HUTT positive and HUTT negative patient groups. These findings suggest that basal autonomic functions have no effect on vasovagal syncope pathogenesis.

Relationship between heart rhythm turbulence and ventricular arrhythmia in patients with multivessel lesion of coronary arteries

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): MoH Research Grant "Development of methods for differentiated prevention and treatment of potentially dangerous heart rhythm disorders" Prediction of adverse outcomes in patients after myocardial infarction (MI) remains a serious and not completely resolved problem, which pushes researchers to search for new technologies. One of the relatively promising new non-invasive methods for predicting sudden coronary death in patients with coronary heart disease and ventricular arrhythmias (VA) may be an assessment of heart rate turbulence (HRT). Given its important prognostic role, primarily in patients after MI, the aim of this work was to study the relationship between HRT and cardiovascular remodeling in patients with VA with history of MI and multivessel nature of coronary lesions. Materials and research methods 123 patients with history of MI, aged 38 to 76 years (average age 61.0 ± 7.6 years), were included into the study. The multivessel nature of coronary lesions was established based on the results of diagnostic selective coronary angiography. All patients underwent Holter monitoring of the electrocardiogram (HMECG). HRT was determined using two indicators, in accordance with the guidelines: Turbulence Onset (To, %) and Turbulence Slope (Ts, ms/RRi). Results Potentially dangerous ventricular arrhythmias (PDVA) were noted in more than half of the examined patients (n = 67; 54.5%). In analyze of the structure of PDVA, II class of VA, as the highest class, was not observed in any of the examined patients, class III was detected in 35% of cases, IVA – in 37.5%, and IVB – in 27.5%. In assessing the frequency of VAs, according to the Bigger classification, frequent PVC &amp;gt;10 VA/hour was detected in 41.5% of patients. The analysis of the HRT indicators did not reveal a decrease in the mean values both To (-1.2 ± 1.5%) and Ts (3.9 ± 3.1 ms/RRi) indicators in the main group of patients. However, after appropriate separation of the main group, 21.1% of them had disorders of only one (category 1; 15.4%) or both of the HRT indicators (category 2; 5.7%). Category 0 included patients without any disorder of HRT indicators. In analysis of the relationship between the PDVA and the category of HRT reduction, a significant interrelation between them was revealed (Table 1). Result Our study demonstrates presence of strong interrelation between HRT parameters disorder and severity of PDVA. Thus, study of HRT in patients after MI could be a strong and independent predictor of cardiovascular events including sudden cardiac death. Abstract Figure. Tab. 1. Interrelation between HRT and VA

Sağlıklı Postmenopozal Kadınlarda Kalp Hızı Türbülansı Analizi

Objective: The aim of the present study was to investigate heart rate turbulence (HRT) parameters in postmenopausal women. Material and Methods: A total of 40 postmenopausal women and 43 healthy, regularly menstruating premenopausal women were taken as study and control groups, respectively. All patients had biochemical blood examination, 2-D echocardiography and 24-hour Holter monitorization. HRT parameters, namely turbulence onset (TO) and turbulence slope (TS) were calculated. Results: Age, body mass index (BMI), systolic and diastolic pressure, total cholesterol and LDL levels were higher in the postmenopausal group, whereas HDL levels were higher in the premenopausal group (p<0.05). TO was significantly higher, TS was significantly lower in postmenopausal women compared to premenopausal women (-2.76±1.34 vs 0.60±1.30 and 3.60±1.54 vs 1.60±1.48, p=0.000 for both, respectively). TO was positively correlated, TS negatively correlated with age, BMI, systolic and diastolic blood pressure and LDL cholesterol level. According to multivariate analysis only menopausal status and age had an independent effect on HRT parameters. Receiver operating characteristic analysis showed that the cut-off values of TO and TS for predicting menopausal status were 0.959 and 0.165, respectively (0.835 anti-image). These results showed that TO and TS had diagnostic value for predicting menopausal status. Conclusion: Postmenopausal women had blunted HRT response. It is a simple and easily obtainable test and should be implemented in cardiac evaluation in daily practice.

The evaluation of ventricular arrhythmia risk by using electrocardiographic parameters in patients with dipper and non-dipper hypertension

Aim: Non-dipper hypertension (NDHT) is associated with increased cardiovascular mortality. Lots of different electrocardiographic parameters can be used for this purpose. Some electrocardiographic repolarization parameters and some particular parameters obtained from 24 hours holter recordings frequently were used. The aim of this study was to evaluate ventricular arrhythmia risk by using most of this electrocardiographic parameters in patients with dipper hypertension (DHT) and NDHT.Material and methods: 220 patients with hypertension were included this study. Patients were divided into two groups as DHT and NDHT according to the 24 hours ambulatory blood pressure monitoring. Two groups were compared with electrocardiography and echocardiography parameters and also were compared with heart rate variability (HRV) and heart rate turbulence (HRT) parameters.Results: There were no significant differences between DHT and NDHT groups with regard to demographic and laboratory datas. Also echocardiography parameters normally distributed and have no significant differences between two groups. There were no significant differences between DHT and NDHT groups with regard to left ventricular mass index (p=0.280). Although QT, QT dispersion, HRV and HRT parameters differences were not statistically significant , results were in favour of DHT in terms of ventricular arrhythmia risk. Conclusion: When hypertensive patients having no statistically significant differences in terms of left ventricular diamaters and left ventricular mass between them were divided as DHT and NDHT; there were no statistically significant differences between two groups with regard to electrocardiographic ventricular arrhythmia parameters although results were in favour of DHT.

Heart Rate Turbulence Predicts Survival Independently From Severity of Liver Dysfunction in Patients With Cirrhosis.

BackgroundReduced heart rate variability (HRV) is an independent predictor of mortality in patients with cirrhosis. However, conventional HRV indices can only be interpreted in individuals with normal sinus rhythm. In patients with recurrent premature ventricular complexes (PVCs), the predictive capacity of conventional HRV indices is compromised. Heart Rate Turbulence (HRT) represents the biphasic change of the heart rate after PVCs. This study was aimed to define whether HRT parameters could predict mortality in cirrhotic patients.Materials and Methods24 h electrocardiogram recordings were collected from 40 cirrhotic patients. Turbulence Onset was calculated as HRT indices. The enrolled patients were followed up for 12 months after the recruitment in relation to survival and/or transplantation.ResultsDuring the follow-up period, 21 patients (52.5%) survived, 12 patients (30%) died and 7 patients (17.5%) had liver transplantation. Turbulence Onset was found to be strongly linked with mortality on Cox regression (Hazard ratio = 1.351, p < 0.05). Moreover, Turbulence Onset predicted mortality independently of MELD and Child-Pugh’s Score.ConclusionThis study provides further evidence of autonomic dysfunction in cirrhosis and suggests that HRT is reliable alternative to HRV in patients with PVCs.

Evolution of Heart Rate Variability and Heart Rate Turbulence in Patients with Depressive Illness Treated with Selective Serotonin Reuptake Inhibitors.

Background and objectives: Major depressive disorder (MDD) and cardiovascular diseases (CVDs) represent serious and prevalent medical conditions. Autonomic nervous system (ANS) dysfunctions, expressed by parameters of heart rate variability (HRV) and heart rate turbulence (HRT), have been repeatedly associated with depression. The aim of our study was to identify potential HRV and HRT alterations in patients with MDD, before and after selective serotonin reuptake inhibitor (SSRI) therapy, and to observe any correlations between these parameters and the severity of depressive symptoms. Another aim was to evidence if there was a normalization or improvement of HRV and HRT parameters that paralleled the reduction of the intensity of depressive symptoms. Materials and Methods: We studied heart rate variability (HRV) and heart rate turbulence (HRT) in a sample of 78 patients, aged under 51 years, who were referred to our outpatient clinic between June 2017 and December 2019, for complaints in the context of a new onset major depressive disorder (MDD), before and after therapy with SSRIs. Results: By using 24 h Holter ECG monitoring, we evidenced alterations of HRV and HRT parameters, significantly correlated with the severity of depressive symptoms (p < 0.001), as assessed by the Montgomery–Åsberg Depression Rating Scale (MADRS). Our results indicated that these parameters improved following one and six months of SSRI therapy, when a partial or total remission of depressive symptoms was achieved (p < 0.001). Changes in HRV parameters were correlated with the reduction of the severity of depression. Conclusions: In our study group, we highlighted, through 24 h ECG Holter monitoring, frequent and clear HRV and HRT abnormalities that were statistically correlated with the severity of depressive symptoms. Furthermore, we were able to document a progressive improvement of these parameters, which corresponded with the improvement of depressive symptoms under SSRI therapy, when compared to the values measured before the commencement of antidepressant pharmacotherapy.

PREDICTORS OF RISK IN PATIENTS WITH CORONARY AND NON-CORONARY HEART DISEASES AND VENTRICULAR EXTRASYSTOLES, DEPENDING ON HEART RHYTHM TURBULENCE

Purpose. This investigation examines changes in the parameters of heart rate turbulence and spatial dispersion of repolarization in persons with ventricular extrasystoles (VE), depending on constellation with stable angina (SA), post inflammation myocardial fibrosis (PIMF), including the effects of hypertension (AH), compared with patients without organic pathology with diagnosis of neurocirculatory dystonia (NCD). Material and methods. Thirty patients were examined in the following distribution of diagnoses: SA, PIMF, NCD and AH, which occurred in combination with other pathologies. All patients underwent a standard examination plan and Holter ECG monitoring (HM ECG) with analysis of electrocardiographic changes and assessment of turbulence onset parameters and T peak-T end interval dispersion of repolarization phase. VE and supraventricular extrasystoles (SVE) were diagnosed in all patients according to HM ECG. For statistical analysis we used the determination of the sample mean, the standard error of the mean, determined the significance of differences in quantitative parameters using the zero hypothesis for the paired t-test Student for normal distribution and t-criterion Wilkoxon at distribution other than normal. Results. When analyzing changes in turbulence onset and “Tpeak-Tend” (TpTe) intervals, a favorable distribution of TpTe (65.0+6.19 vs. 90.43+2.77ms, p 0%) under conditions of structural pathology of the heart. Conclusion. Analysis of the distribution of TpTe indicates a smaller effect of functional pathology in reducing the value of TpTe (p 0%).

Indentify a High-Risk Group of Cardiovascular Complications in Hypertensive Patients by Analyzing Heart Rate Variability and Heart Rate Turbulence Parameters

Indentify a High-Risk Group of Cardiovascular Complications in Hypertensive Patients by Analyzing Heart Rate Variability and Heart Rate Turbulence Parameters

Comparison of the effects of ticagrelor and clopidogrel on heart rate variability and heart rate turbulence in patients with percutaneous coronary interventions.

IntroductionClopidogrel and ticagrelor are commonly used, antiplatelet agents. Ticagrelor has an effect of enhancing the plasma level of adenosine that may alter the autonomic function. The aim of this study is to compare the effects of ticagrelor and clopidogrel on heart rate variability (HRV) and heart rate turbulence (HRT).MethodsThirty subjects who performed percutaneous coronary intervention (PCI) were included in the randomized, crossover study. These patients were divided into two groups. Clopidogrel or ticagrelor was administered in two different testing sessions (1-month treatment for each session). In group 1, clopidogrel and ticagrelor treatment were used while in group 2, ticagrelor and clopidogrel treatment were used respectively. Three times rhythm Holter recording (baseline, 1st and 2nd month) was performed. The HRV (time domain and frequency domain) and HRT (turbulence onset (TO) and turbulence slope (TS)) parameters were analyzed from the Holter recordings.ResultsAccording to baseline Holter recording, pNN50 (5.82 ± 5.83 vs 10.56 ± 8.28; p = 0.03) and HF(nu) (6.85 ± 9.33 vs 9.53 ± 7.41; p = 0.04) parameters were higher in group 2 than in group 1, while TO(0.004 ± 0.02 vs −0.01 ± 0.02; p = 0.01) parameter was positive and higher in group 1 than in group 2. In the second month, the LF/HF ratio (4.47 ± 2.43 vs 3.18 ± 2.45; p = 0.04) was higher in group 1 than in group 2. However, when the evaluation was done within the groups themselves, there were no statistically significant differences in HRV and HRT parameters obtained before and after clopidogrel and ticagrelor administration in group 1 and group 2.ConclusionTicagrelor and clopidogrel treatments did not have a significant effect on HRV and HRT parameters.

Evaluation of cardiovascular autonomic dysfunction according to heart rate turbulence and variability in patients with relapsing remitting multiple sclerosis

Background/aim Multiple sclerosis (MS) is an autoimmune disease characterized by neurodegeneration or demyelination; the relapsing–remitting phase of MS is characterized by acute exacerbation of disease activity. The most commonly used noninvasive approach to assess autonomic function is the determination of heart rate turbulence (HRT) and heart rate variability (HRV). The aim of this study was to evaluate the presence of cardiovascular autonomic dysfunction using HRT and HRV parameters determined via 24-h Holter ECG monitoring in patients with relapsing–remitting MS without known heart disease.Materials and methods The study included 26 patients diagnosed with relapsing–remitting MS and 22 age- and sex-matched healthy controls. HRT and HRV parameters were analyzed via 24-h Holter ECG monitoring. Magnetic resonance imaging findings were reevaluated to identify any demyelinating lesions in the brain stem.Results The HRV parameters of SDNNI (mean of the standard deviations of all normal sinus RR intervals in all 5-min segments), rMSSD (root–mean–square successive difference), and sNN50 (percentage of successive normal sinus RR intervals >50 ms) were significantly lower in the MS group than in the control group (P < 0.05). Conclusion This study revealed that the patients with MS had reduced HRV; this was demonstrated by dysfunction with regard to parasympathetic and sympathetic parameters in HRV analysis.

Evaluation of cardiac autonomic nervous system in patients with ankylosing spondylitis using 12-lead electrocardiography and Holter monitoring.

Ankylosing spondylitis (AS) is associated with increased risk of cardiovascular problems, including complications such as conduction defects and arrhythmias, which might lead to increased morbidity and/or mortality. The objective of the present study is to evaluate the electrocardiographic (ECG) parameters, including T-peak to T-end intervals (Tpe), Tpe/corrected QT (QTc) ratio, heart rate variability (HRV), and heart rate turbulence (HRT) in AS patients. Seventy-six AS patients and 55 control subjects were included in the study. 12-lead ECG and 24-h Holter monitoring recordings were obtained. Tpe and Tpe/QTc were measured using the 12-lead ECG and HRV and HRT parameters were assessed using 24-h Holter ECG recordings. Subjects were assigned into three groups based on their HRT parameters (Tonset (TO) and Tslope (TS)) (HRT-0, normal TO or TS; HRT-1, abnormal TO or TS; HRT-2, abnormal TO and TS). Tpe was prolonged and Tpe/QTc ratio was higher in AS patients (p < 0.001 for both). Moreover, Tpe and Tpe/QTc ratio significantly correlated with disease duration. All HRV parameters (VLF, LF, HF, SDNN, SDANN, ASDNN, rMSSD, pNN50) were decreased in AS patients in comparison with those in control subjects (p < 0.05 for all parameters). Controls were significantly more likely to have normal TO and TS (82% vs 53%, p < 0.001). There was negative correlation between Holter parameters and disease duration, as well as Tpe and Tpe/QTc ratio (p < 0.05 for all parameters). This study demonstrated that AS patients have disrupted ventricular repolarization (increased Tpe, Tpe/QTc ratio). Results suggest a decreased cardiac impact of the parasympathetic system in AS patients. Key Points • This study demonstrated that AS patients have disrupted ventricular repolarization. • The study also finds that heart rate turbulence and heart rate variability are impaired in AS patients. • Impaired Holter and ECG parameters may be one of the high cardiovascular risk factors in AS patients.