Heart Rate Variability Markers Research Articles

A framework for modeling performers' beat-to-beat heart intervals using music features and Interpretation Maps.

Music strongly modulates our autonomic nervous system. This modulation is evident in musicians' beat-to-beat heart (RR) intervals, a marker of heart rate variability (HRV), and can be related to music features and structures. We present a novel approach to modeling musicians' RR interval variations, analyzing detailed components within a music piece to extract continuous music features and annotations of musicians' performance decisions. A professional ensemble (violinist, cellist, and pianist) performs Schubert's Trio No. 2, Op. 100, Andante con moto nine times during rehearsals. RR interval series are collected from each musician using wireless ECG sensors. Linear mixed models are used to predict their RR intervals based on music features (tempo, loudness, note density), interpretive choices (Interpretation Map), and a starting factor. The models explain approximately half of the variability of the RR interval series for all musicians, with R-squared = 0.606 (violinist), 0.494 (cellist), and 0.540 (pianist). The features with the strongest predictive values were loudness, climax, moment of concern, and starting factor. The method revealed the relative effects of different music features on autonomic response. For the first time, we show a strong link between an interpretation map and RR interval changes. Modeling autonomic response to music stimuli is important for developing medical and non-medical interventions. Our models can serve as a framework for estimating performers' physiological reactions using only music information that could also apply to listeners.

Heart rate variability for neuro-prognostication after CA: Insight from the Parisian registry

BackgroundHypoxic ischemic brain injury (HIBI) induced by cardiac arrest (CA) seems to predominate in cortical areas and to a lesser extent in the brainstem. These regions play key roles in modulating the activity of the autonomic nervous system (ANS), that can be assessed through analyses of heart rate variability (HRV). The objective was to evaluate the prognostic value of various HRV parameters to predict neurological outcome after CA. MethodsRetrospective monocentric study assessing the prognostic value of HRV markers and their association with HIBI severity. Patients admitted for CA who underwent EEG for persistent coma after CA were included. HRV markers were computed from 5 min signal of the ECG lead of the EEG recording. HRV indices were calculated in the time-, frequency-, and non-linear domains. Frequency-domain analyses differentiated very low frequency (VLF 0.003–0.04 Hz), low frequency (LF 0.04–0.15 Hz), high frequency (HF 0.15–0.4 Hz), and LF/HF ratio. HRV indices were compared to other prognostic markers: pupillary light reflex, EEG, N20 on somatosensory evoked potentials (SSEP) and biomarkers (neuron specific enolase-NSE). Neurological outcome at 3 months was defined as unfavorable in case of best CPC 3–4-5. ResultsBetween 2007 and 2021, 199 patients were included. Patients were predominantly male (64%), with a median age of 60 [48.9–71.7] years. 76% were out-of-hospital CA, and 30% had an initial shockable rhythm. Neurological outcome was unfavorable in 73%. Compared to poor outcome, patients with a good outcome had higher VLF (0.21 vs 0.09 ms2/Hz, p < 0.01), LF (0.07 vs 0.04 ms2/Hz, p = 0.003), and higher LF/HF ratio (2.01 vs 1.01, p = 0.008). Several non-linear domain indices were also higher in the good outcome group, such as SD2 (15.1 vs 10.2, p = 0.016) and DFA α1 (1.03 vs 0.78, p = 0.002). These indices also differed depending on the severity of EEG pattern and abolition of pupillary light reflex. These time–frequency and non-linear domains HRV parameters were predictive of poor neurological outcome, with high specificity despite a low sensitivity. ConclusionIn comatose patients after CA, some HRV markers appear to be associated with unfavorable outcome, EEG severity and PLR abolition, although the sensitivity of these HRV markers remains limited.

The relationship between heart rate variability and glucose clearance in healthy men and women.

Heart rate variability (HRV) is a non-invasive indicator of the activity of the autonomic nervous system, which regulates many physiological functions including metabolism. The purpose of this study was to quantify the relationship between resting markers of HRV and oral glucose tolerance test (OGTT) response. Eighteen healthy individuals (10 males, 8 females, (23.8±2.9 years) underwent a 10-minute resting HRV recording. The final five minutes were evaluated via Kubios HRV Standard for: root mean square of successive differences (RMSSD), standard deviation of normal-to-normal sinus beats (SDNN), high frequency (HF), and low frequency (LF). A standard 2-hour OGTT was then administered. Glucose was measured via finger stick before, 30-minutes post, 1-hour post, and 2-hours post OGTT. Pearson correlations demonstrated that RMSSD, SDNN, HF and LF were strongly correlated to fasting blood glucose (FBG) for the group (p<0.05) but not for glucose area under the curve (AUC). When analyzed by sex, only males demonstrated significant correlations between AUC and RMSSD, SDNN, and LF (p<0.05). An independent samples t-test revealed no sex differences for FBG, AUC, RMSSD, SDNN, HF and LF. These findings provide new and interesting insights into the relationship of autonomic activity and glucose uptake, highlighting sex-based relationships.

Autonomic Rebound Following Maximal Exercise in Bodybuilders and Recreationally Active Participants.

The off-season for natural bodybuilders (BB) is characterized by increased training loads and fluctuations in caloric intake, which may lead to insufficient recovery. The autonomic nervous system (ANS) plays a pivotal role in recovery. The purpose of this study was to evaluate resting ANS activity and recovery following a maximal exercise bout in off-season BB and compare them to those of recreationally active individuals. Fifteen males participated; 7 recreationally active (RA) (24.6 ± 2.1 years, 81.1 ± 10.8 kg) and 8 BB (21.8 ± 2.9 years, 89.3 ± 13.0 kg). Each performed a graded exercise test. Heart rate variability (HRV) was measured at rest and during a 45 min recovery period. HRV was analyzed as: root mean square of successive differences (lnRMSSD), standard deviation of normal-to-normal sinus beats (lnSDNN), high frequency (lnHF), low frequency (lnLF), and the ratio of low frequency to high frequency (lnLF/lnHF). A one-way ANOVA showed no differences for any resting marker of HRV, HR, and HR recovery. A significant depression in all markers of HRV was observed in the BB group at the 15 min point, and no recovery was observed before 45 min when compared to RA. The results of this study demonstrated depressed HRV recovery following the graded exercise test in BB when compared to the RA group.

Facilitating ambulatory heart rate variability analysis using accelerometry-based classifications of body position and self-reported sleep

Objective. This study aimed to examine differences in heart rate variability (HRV) across accelerometer-derived position, self-reported sleep, and different summary measures (sleep, 24 h HRV) in free-living settings using open-source methodology. Approach. HRV is a biomarker of autonomic activity. As it is strongly affected by factors such as physical behaviour, stress, and sleep, ambulatory HRV analysis is challenging. Beat-to-beat heart rate (HR) and accelerometry data were collected using single-lead electrocardiography and trunk- and thigh-worn accelerometers among 160 adults participating in the SCREENS trial. HR files were processed and analysed in the RHRV R package. Start time and duration spent in physical behaviours were extracted, and time and frequency analysis for each episode was performed. Differences in HRV estimates across activities were compared using linear mixed models adjusted for age and sex with subject ID as random effect. Next, repeated-measures Bland–Altman analysis was used to compare 24 h RMSSD estimates to HRV during self-reported sleep. Sensitivity analyses evaluated the accuracy of the methodology, and the approach of employing accelerometer-determined episodes to examine activity-independent HRV was described. Main results. HRV was estimated for 31 289 episodes in 160 individuals (53.1% female) at a mean age of 41.4 years. Significant differences in HR and most markers of HRV were found across positions [Mean differences RMSSD: Sitting (Reference) − Standing (−2.63 ms) or Lying (4.53 ms)]. Moreover, ambulatory HRV differed significantly across sleep status, and poor agreement between 24 h estimates compared to sleep HRV was detected. Sensitivity analyses confirmed that removing the first and last 30 s of accelerometry-determined HR episodes was an accurate strategy to account for orthostatic effects. Significance. Ambulatory HRV differed significantly across accelerometry-assigned positions and sleep. The proposed approach for free-living HRV analysis may be an effective strategy to remove confounding by physical activity when the aim is to monitor general autonomic stress.

Adverse Effects of Meditation: Autonomic Nervous System Activation and Individual Nauseous Responses During Samadhi Meditation in the Czech Republic.

Buddhist meditation practices, including Samadhi meditation, which forms the basis for mindfulness practice, are broadly promoted as pathways to wellbeing, but evidence of their adverse effects is emerging. In a single-group observational study with assessments of autonomic system before, during, and after Samadhi meditation, we explore the relationship between post-meditation nausea symptoms and the degree of change in autonomic system activity during meditation as compared to before and after in 57 university students (42 women; mean age = 22.6) without any previous experience in meditation or yoga practices. We hypothesize that nauseous feelings in meditation are connected to a rapid increase of activity in the sympathetic nervous system, as indicated by decreased heart-rate variability (HRV). We additionally explore links between meditation-induced nausea and two markers of parasympathetic activity: increased HRV and vasovagal syncope. Engaging in meditation and increased nausea during meditation were both associated with increased markers of HRV parasympathetic activity, but 12 individuals with markedly higher nausea demonstrated increased HRV markers of sympathetic activity during meditation. Vasovagal syncope was observed but found to be unrelated to nausea levels. Drivers of adverse effects of meditation in some individuals require further investigation.

Heart rate variability analysis in obstructive sleep apnea patients with daytime sleepiness.

Recent studies suggest that sleepy patients with obstructive sleep apnea (OSA) are at higher risk for incident cardiovascular disease. This study assessed cardiac autonomic function in sleepy versus non-sleepy patients with OSA using heart rate variability (HRV) analysis. We hypothesized that HRV profiles of sleepy patients would indicate higher cardiovascular risk. Electrocardiograms (ECG) derived from polysomnograms (PSG) collected by the Sydney Sleep Biobank were used to study HRV in groups of sleepy (ESS ≥ 10) and non-sleepy OSA patients (ESS < 10). HRV parameters were averaged across available ECG signals during N2 sleep. A total of 421 patients were evaluated, with a mean age of 54 (14) years, body mass index of 33 (9) kg/m2, apnea-hypopnea index of 21 (28) events/h, and 66% male. The sleepy group consisted of 119 patients and the non-sleepy group 302 patients. Sleepy patients exhibited lower HRV values for: root mean square successive difference (RMSSD, p = 0.028), total power (TP, p = 0.031), absolute low frequency (LF, p = 0.045), and high-frequency (HF, p = 0.010) power compared to non-sleepy patients. Sleepy patients with moderate-to-severe OSA exhibited lower HRV values for: (RMSSD, p = 0.045; TP, p = 0.052), absolute LF (p = 0.051), and HF power (p = 0.025). There were no differences in other time and frequency domain HRV markers. This study shows a trend toward parasympathetic withdrawal in sleepy OSA patients, particularly in moderate-to-severe cases, lending mechanistic support to the link between the sleepy phenotype and CVD risk in OSA.

Autonomic Nerve Function Predicts Risk of Early Death after Discharge in Acute Medical Disease

BackgroundHeart rate variability, a marker of autonomic function, has shown promising prognostic results in specific populations, but has not been tested in a general medical population. We hypothesized that heart rate variability identifies high-risk medical patients early after admission to the hospital. MethodsThis was a single-center prospective cohort study of acutely admitted medical patients aged ≥18 years with a life expectancy ≥3 months, included between 2019-2023. Unstable patients needing direct admission to the intensive care unit were excluded. Heart rate variability was recorded within 24 hours of admission for 10 minutes. The standard deviation of normal-normal beats (SDNN) was the primary heart rate variability marker. Low SDNN was defined as the lowest tertile (≤22 ms). The primary outcome was 30-day all-cause mortality. The secondary outcome was 30-day readmission or mortality. ResultsAmong 721 patients included, low SDNN carried an 8-fold greater risk of 30-day mortality in univariate analysis (hazard ratio [HR] 8.3; P = .001); in multivariate analyses a 4-fold greater risk (HR 3.8; P = .037). Low SDNN was associated with the combined outcome of 30-day mortality or readmission (HR 1.5; P = .03) in multivariate analysis. In receiver operating characteristics analyses, low SDNN improved the predictive accuracy of early warning score for 30-day mortality or readmission from 0.63 to 0.71 (P = .008) but did not improve the accuracy for 30-day mortality alone. ConclusionsIn patients admitted due to acute medical illness, low heart rate variability predicted 30-day mortality and readmission, suggesting heart rate variability as a tool to identify patients at high and low risk of relevant endpoints.

Acute Hemodynamic, Metabolic, and Hormonal Responses to a Boxing Exergame with and without Blood Flow Restriction in Non-Athlete Young Individuals.

This study aimed to compare acute hemodynamic, metabolic (glucose and blood lactate concentrations), hormonal (growth hormone and normetanephrine), heart rate variability (HRV), and rating of perceived exertion (RPE) responses before and after bouts of a boxing exergame with and without blood flow restriction (BFR) in non-athlete young individuals. Fourteen participants (age: 30 ± 10 y; BMI: 21 ± 3 kg.m-2) participated in two sessions of a 20 min boxing exergame. During week one, the participants were randomly divided into two groups and played against one another under normal (n = 7) and BFR (n = 7) conditions. Over the next exercise session, participants were then reallocated to the opposite condition (normal vs. BFR) for data collection. Hemodynamic, metabolic, HRV, and hormonal parameters were measured before and immediately after the exercise protocols. Playing exergame led to a significant increase in hemodynamic variables (except for diastolic blood pressure) regardless of BFR condition with no between-group differences. Regarding HRV, significant reductions in total power (TP) and low-frequency (LF) waves were identified in the non-BFR group (p < 0.0001) compared with the BFR group. Conversely, a significant increase in very LF (VLF) waves was noted for the BFR group (p = 0.050), compared with the non-BFR group. Significant increases were observed in serum concentrations of growth hormone, normetanephrine, and blood lactate concentration from pre- to post-exercise under both conditions (p ≤ 0.05), with no significant differences between the groups. Moreover, no statistically significant changes were observed in glucose levels. RPE responses were significantly greater (p ≤ 0.05) in the BFR group compared with the non-BFR group throughout the exercise session. We observed similar hemodynamic, hormonal, and metabolic responses after an acute boxing exergame session in young individuals, whether conducted with or without BFR. However, notable differences were observed in certain HRV markers and RPE. Specifically, the inclusion of BFR resulted in an elevation of VLF and a heightened perceived exertion. These findings suggest that BFR may alter cardiac autonomic and perceptual responses during exergaming. Further research is warranted to understand the long-term implications and potential benefits of incorporating BFR into exergaming routines.

Psychophysiological Effects of Slow-Paced Breathing on Adolescent Swimmers' Subjective Performance, Recovery States, and Control Perception.

This study examined the effect of a Slow-Paced Breath (i.e., 6 breaths per minute) without Biofeedback (SPB-NoHRVB) protocol on semi-elite adolescent swimmers' psychological and physiological states during a seven-week ecological training period. A linear mixed-effects multilevel regression analysis approach was used with 13 adolescent national-level swimmers. Athletes were randomly assigned to an intervention group (n = 7) and a control group (n = 6). Seven waves of assessments were completed weekly during a seven-week training preparation in ecological conditions. During the protocol, swimmers completed subjective quantitative measures (RESTQ-36-R-Sport; cognitive perceived stress and control states about the training process, training subjective performance, and subjective internal training load) and physiological heart rate (HR) (HR of exercise, absolute and normalized HR recovery during the first 60 s of recovery; HRR60 and nHRR60) and heart rate variability (HRV) (MeanRR, RMSSD, LFnu and HFnu, LF/HF ration) tests (through a submaximal heart rate (5'-5' test) once a week. Results revealed that the SPB-NoHRVB protocol significantly predicts biopsychosocial recovery states, cognitive perception of control, and training subjective performance (i.e., a significant effect of the SPB-NoHRVB protocol with the dependent variables simple time trajectories). However, no significant effects were found for biopsychosocial stress scales, cognitively perceived stress, HR, or HRV markers. Our results suggest that SPB-NoHRVB induces simple evolutions over time for crucial variables in athletes' adaptation to the training process (i.e., cognitive appraisals and biopsychosocial states). In contrast, it highlights that SPB-NoHRVB does not induce better stress states. This specific effect on the resource component is an exciting result that will be discussed in the manuscript.

Exploring the Bob Ross effect: A psychophysiological investigation

Watching news broadcasts is known to elicit psychological stress. Conversely, the iconic painter Bob Ross (BR) has risen to pop culture status and amassed a following, as many find the messages and sounds of BR to be soothing and relaxing. Though, it has yet to be directly tested if such exposure can confer psychological or physiological benefit. The purpose of this study was to compare the effects of watching BR versus streaming news on markers of cardiovascular health and profile of mood states (POMS). It was hypothesized that watching BR would increase POMS scores and heart rate variability (HRV). It was also hypothesized that watching the news would increase blood pressure (BP), vascular stiffness (VS), and heart rate (HR). MethodsIn a randomized, controlled, crossover design, 18 young (21 ± 1 yrs, 9 female, 9 male) healthy participants (172.6 ± 9.9 cm, 69 ± 18 kg) were assessed for BP, VS, HR, HRV, and POMS before and after watching an episode of BR or the News matched for time (∼27 mins). Results: A significant interaction effect on POMS scores were observed for, anxiety (p = 0.01), anger (p = 0.008), depression (p = 0.003), fatigue (p = 0.001), and confusion (p = 0.01) domains after watching BR. The LF/HF ratio, an HRV marker of sympathovagal balance, was significantly lower after watching BR (p = 0.04). There were no significant time, condition, or interaction effects on systolic BP, mean arterial pressure, and diastolic BP. ConclusionThe “Bob Ross Effect” reduces overall mood disturbance, though appears to exert little influence on the cardiovascular system in this acute paradigm.

The frequency of atrial fibrillatory waves is modulated by the spatiotemporal pattern of acetylcholine release: a 3D computational study.

In atrial fibrillation (AF), the ECG P-wave, which represents atrial depolarization, is replaced with chaotic and irregular fibrillation waves (f waves). The f-wave frequency, F f, shows significant variations over time. Cardiorespiratory interactions regulated by the autonomic nervous system have been suggested to play a role in such variations. We conducted a simulation study to test whether the spatiotemporal release pattern of the parasympathetic neurotransmitter acetylcholine (ACh) modulates the frequency of atrial reentrant circuits. Understanding parasympathetic involvement in AF may guide more effective treatment approaches and could help to design autonomic markers alternative to heart rate variability (HRV), which is not available in AF patients. 2D tissue and 3D whole-atria models of human atrial electrophysiology in persistent AF were built. Different ACh release percentages (8% and 30%) and spatial ACh release patterns, including spatially random release and release from ganglionated plexi (GPs) and associated nerves, were considered. The temporal pattern of ACh release, ACh(t), was simulated following a sinusoidal waveform of frequency 0.125 Hz to represent the respiratory frequency. Different mean concentrations and peak-to-peak ranges of ACh (ΔACh) were tested. We found that temporal variations in F f, F f(t), followed the simulated temporal ACh(t) pattern in all cases. The temporal mean of F f(t), , depended on the fibrillatory pattern (number and location of rotors), the percentage of ACh release nodes and . The magnitude of F f(t) modulation, ΔF f, depended on the percentage of ACh release nodes and ΔACh. The spatial pattern of ACh release did not have an impact on and only a mild impact on ΔF f. The f-wave frequency, being indicative of vagal activity, has the potential to drive autonomic-based therapeutic actions and could replace HRV markers not quantifiable from AF patients.

Modifications of long-term heart rate variability produced in an experimental model of diet-induced metabolic syndrome.

Metabolic syndrome (MetS) has been linked to a higher prevalence of cardiac arrhythmias, the most frequent being atrial fibrillation, but the mechanisms are not well understood. One possible underlying mechanism may be an abnormal modulation of autonomic nervous system activity, which can be quantified by analysing heart rate variability (HRV). Our aim was to investigate the modifications of long-term HRV in an experimental model of diet-induced MetS to identify the early changes in HRV and the link between autonomic dysregulation and MetS components. NZW rabbits were randomly assigned to control (n = 10) or MetS (n = 10) groups, fed 28 weeks with high-fat, high-sucrose diet. 24-hour recordings were used to analyse HRV at week 28 using time-domain, frequency-domain and nonlinear analyses. Time-domain analysis showed a decrease in RR interval and triangular index (Ti). In the frequency domain, we found a decrease in the low frequency band. Nonlinear analyses showed a decrease in DFA-α1 and DFA-α2 (detrended fluctuations analysis) and maximum multiscale entropy. The strongest association between HRV parameters and markers of MetS was found between Ti and mean arterial pressure, and Ti and left atrial diameter, which could point towards the initial changes induced by the autonomic imbalance in MetS.

Heart rate variability and cardiovascular risk factors in patients with rheumatoid arthritis: A longitudinal study.

It is established that the risk of cardiovascular disease (CVD) is increased in patients with Rheumatoid Arthritis (RA). Heart rate variability (HRV) is a method for evaluating the activity in the cardiac autonomic nervous system. Our aim was to assess the longitudinal development of HRV in patients with RA and compare with healthy controls. Furthermore, we wanted to investigate associations between HRV, inflammatory disease activity and cardiovascular complications in patients with RA over time. HRV was assessed with frequency-domain analysis at baseline and after five years in 50 patients with early RA, all being younger than 60years. HRV indices were age-adjusted based on the estimated age-dependency in 100 age and sex matched healthy controls. Additionally, clinical data including serological markers, disease activity, and blood pressure were collected from the patients. Eleven years after inclusion CVD was assessed. At baseline, patients with RA presented with lower HRV compared to controls during deep breathing (6 breaths/min), paced normal breathing (12 breaths/min) and after passive tilt to the upright position. No significant change in HRV was observed at the five-year follow-up. A significant negative correlation was found between HRV parameters and systolic blood pressure (SBP) at baseline. A significant positive correlation was found between heart rate and inflammatory markers at baseline but not after five years. Nine patients had developed CVD after 11years, but no significant association was found with baseline HRV data. This study showed that patients with RA have autonomic imbalance both at an early stage of the disease and after five years, despite anti-rheumatic medication, but no correlation between HRV and inflammation markers were observed. Reduced HRV was also significantly negatively correlated with increased SBP. Hypertension is a common finding in patients with RA. Thus, significant decline of HRV could be a useful early marker for development of hypertension in patients with RA.

Effect of mandibular advancement splint therapy on cardiac autonomic function in obstructive sleep apnoea.

This study aimed to evaluate the effect of mandibular advancement splint (MAS) therapy on cardiac autonomic function in patients with obstructive sleep apnoea (OSA) using heart rate variability (HRV) analysis. Electrocardiograms (ECG) derived from polysomnograms (PSG) of three prospective studies were used to study HRV of patients with OSA before and after MAS treatment. HRV parameters were averaged across the entire ECG signal during N2 sleep using 2-min epochs shifted by 30s. Paired t-tests were used to compare PSG and HRV measures before and after treatment, and the percent change in HRV measures was regressed on the percent change in apnoea-hypopnea index (AHI). In 101 patients with OSA, 72% were Caucasian, 54% men, the mean age was 56±11 years, BMI 29.8±5.3 kg/m2, and treatment duration was 4.0±3.2 months. After MAS therapy, there was a significant reduction in OSA severity (AHI, - 18 ± 16 events per hour, p < 0.001) and trends towards increased low-frequency to high-frequency ratio, low-frequency power, and reduced high-frequency power (LF:HF, - 0.4 ± 1.5, p = 0.01; LF, - 3 ± 16 nu, p = 0.02, HF, 3.5 ± 13.7 nu, p = 0.01). Change in NN intervals correlated with the change in AHI (β(SE) = - 2.21 (0.01), t = - 2.85, p = 0.005). No significant changes were observed in the time-domain HRV markers with MAS treatment. The study findings suggestthat successful MAS treatment correlates with changes in HRV, specifically the lengthening of NN intervals, a marker for improved cardiac autonomic adaptability.

Entropy-Based Multifractal Testing of Heart Rate Variability during Cognitive-Autonomic Interplay.

Entropy-based and fractal-based metrics derived from heart rate variability (HRV) have enriched the way cardiovascular dynamics can be described in terms of complexity. The most commonly used multifractal testing, a method using q moments to explore a range of fractal scaling in small-sized and large-sized fluctuations, is based on detrended fluctuation analysis, which examines the power-law relationship of standard deviation with the timescale in the measured signal. A more direct testing of a multifractal structure exists based on the Shannon entropy of bin (signal subparts) proportion. This work aims to reanalyze HRV during cognitive tasks to obtain new markers of HRV complexity provided by entropy-based multifractal spectra using the method proposed by Chhabra and Jensen in 1989. Inter-beat interval durations (RR) time series were obtained in 28 students comparatively in baseline (viewing a video) and during three cognitive tasks: Stroop color and word task, stop-signal, and go/no-go. The new HRV estimators were extracted from the f/α singularity spectrum of the RR magnitude increment series, established from q-weighted stable (log-log linear) power laws, namely: (i) the whole spectrum width (MF) calculated as αmax - αmin; the specific width representing large-sized fluctuations (MFlarge) calculated as α0 - αq+; and small-sized fluctuations (MFsmall) calculated as αq- - α0. As the main results, cardiovascular dynamics during Stroop had a specific MF signature while MFlarge was rather specific to go/no-go. The way these new HRV markers could represent different aspects of a complete picture of the cognitive-autonomic interplay is discussed, based on previously used entropy- and fractal-based markers, and the introduction of distribution entropy (DistEn), as a marker recently associated specifically with complexity in the cardiovascular control.

Linear and non‑linear indices of vagal nerve in relation to sex and inflammation in patients with Covid‑19.

Hyperinflammation is one of the most important pathophysiological risk factors for poor prognosis in patients with coronavirus disease-2019 (Covid-19). Low vagal neuro-immune modulation can lead into this kind of immune dysregulation. The association between vagal activity, sex and inflammatory markers were investigated in patients with Covid-19. A total of 19 patients with Covid-19 were included in the present study. Vagus nerve activity was indexed by heart rate variability (HRV) derived from electrocardiogram at hospital admission. Linear HRV parameters included the root mean square of successive RR interval differences (RMSSD) and high-frequency HRV (HF-HRV), while non-linear parameters included 2 UV%. Immune/inflammatory parameters included C-reactive protein (CRP), interleukin-6 (IL-6), neutrophil/lymphocyte ratio (NLR), systemic inflammatory index (SII), and procalcitonin (PCT). It has been revealed that both linear HRV indices HF-HRV and RMSSD, are significantly negatively correlated with CRP and IL-6, independent of age. The non-linear index of 2 UV% is significantly negatively correlated with NLR and SII, which reflect subtle changes in the response of immunocompetent cells. Patients that received high-flow nasal oxygen therapy had significantly higher IL-6 and CRP levels and lower levels of HF-HRV and RMSSD. These patients also had a significantly longer length of stay in hospital (LOS) than patients receiving low-flow oxygen therapy. Men had higher plasma PCT levels and longer LOS in hospital than women, and PCT statistically explained (mediated) the association between sex and LOS. The present study showed different correlations of linear and non-linear vagal indexes of HRV and inflammatory markers in patients with Covid-19. Significant sex differences in certain inflammatory markers were also observed, which may very well verify previous findings of poor prognosis in men with Covid-19. HRV reflects a continuous interaction between the sympathetic and parasympathetic autonomic nervous systems, which are affected by mental or physical stress, and certain disease states. The increased sympathetic and decreased parasympathetic vagal tone contribute to a higher risk of diseases associated with inflammation, cardiovascular disease, cancer, pulmonary diseases and other pathologies, including infectious diseases such as Covid-19. The present study showed that higher RMSSD (a marker of vagal activity) in Covid-19 patients is associated with lower levels of inflammatory biomarkers, a lower need for treatment and is negatively correlated with intensive care unit admission, leading to a shorter hospital stay. These findings support the idea that activation of vagus nerve may help certain Covid-19 patients by reducing the cytokine storm and excessive inflammation.

Parental History of Hypertension: A Risk for Autonomic Dysfunction and Metabolic and Vascular Derangement in Normotensive Male Offspring.

Children of hypertensive parents have an increased propensity of developing hypertension, at an age very much prior to their parents. Understanding the pathophysiology of hypertension in such young individuals, especially baroreflex sensitivity (BRS), is necessary. Reduced heart rate variability (HRV), insulin resistance (IR), dyslipidemia, and decreased vasodilatory adipokines, namely, apelin and relaxin, in normotensives may predispose to the onset of hypertension. Thus, this study compared autonomic functions, vascular markers, and metabolic profiles between normotensive male offspring with and without parental hypertension. This analytical cross-sectional study comprised 40 male normotensive offspring of hypertensive parents, aged 18-35 years, recruited as the study group and 40 age- and body mass index (BMI)-matched normotensive male offspring with non-hypertensive parents enrolled as controls. Cardiovascular autonomic functions, including BRS, HRV, diastolic blood pressure response to isometric handgrip test (ΔDBPIHG), Valsalva ratio, and metabolic and vascular markers, were assessed. The study group exhibited reduced BRS, HRV, and Valsalva ratio and higher ΔDBPIHG compared to controls, indicating impaired autonomic functions. The study group had higher IR and triglyceride levels and reduced apelin and relaxin levels. BRS showed significant correlations with HRV, Valsalva ratio, ΔDBPIHG, and metabolic and vascular markers. Normotensive male offspring of hypertensive parents exhibit impaired autonomic functions, as evidenced by reduced BRS, HRV, and Valsalva ratio. Additionally, they have higher IR, dyslipidemia, and decreased levels of vasodilatory adipokines, indicating an increased risk for future hypertension development. These findings signify that early identification of hypertensive potential in this high-risk population is warranted, which would enable taking necessary preventive measures.

Vagal cardiac control in rats with LPS-induced lung injury

Heart rate variability (HRV) as an index of cardiac autonomic control in acute lung injury (ALI) has been evaluated in anaesthetized rats intratracheally instilled with bacterial lipopolysaccharide (LPS) and ventilated with breathing frequency of 60/min, 40% oxygen, inspiratory time 40%, tidal volume of 6 mL/kg. ECG was recorded before and 30, 60, 120, 180 and 240 min after LPS or saline (control) administration. HRV was quantified by time and frequency-domain analysis (mean RR interval, SDRR, RMSSD and spectral power in high frequency (HF) band. Lactate in plasma, and oxidative stress, IL-1β, IL-5, IL-12p70 and IL-13 and galectin-3 in heart tissue raised in LPS-injured rats. Overall HRV magnitude (SDRR) and marker of vagal heart rate control (RMSSD), as well as frequency domain parameter, spectral power HF was increased 120 and 180 min since ALI onset. In conclusion, LPS-induced ALI is accompanied by altered vagal cardiac control mediated by autonomic nervous system, likely based on the close relationship between immune response and vagally mediated autonomic nervous activity.

Heart rate variability: reference values and role for clinical profile and mortality in individuals with heart failure

AimsTo establish reference values and clinically relevant determinants for measures of heart rate variability (HRV) and to assess their relevance for clinical outcome prediction in individuals with heart failure.MethodsData from the MyoVasc study (NCT04064450; N = 3289), a prospective cohort on chronic heart failure with a highly standardized, 5 h examination, and Holter ECG recording were investigated. HRV markers were selected using a systematic literature screen and a data-driven approach. Reference values were determined from a healthy subsample. Clinical determinants of HRV were investigated via multivariable linear regression analyses, while their relationship with mortality was investigated by multivariable Cox regression analyses.ResultsHolter ECG recordings were available for analysis in 1001 study participants (mean age 64.5 ± 10.5 years; female sex 35.4%). While the most frequently reported HRV markers in literature were from time and frequency domains, the data-driven approach revealed predominantly non-linear HRV measures. Age, sex, dyslipidemia, family history of myocardial infarction or stroke, peripheral artery disease, and heart failure were strongly related to HRV in multivariable models. In a follow-up period of 6.5 years, acceleration capacity [HRperSD 1.53 (95% CI 1.21/1.93), p = 0.0004], deceleration capacity [HRperSD: 0.70 (95% CI 0.55/0.88), p = 0.002], and time lag [HRperSD 1.22 (95% CI 1.03/1.44), p = 0.018] were the strongest predictors of all-cause mortality in individuals with heart failure independently of cardiovascular risk factors, comorbidities, and medication.ConclusionHRV markers are associated with the cardiovascular clinical profile and are strong and independent predictors of survival in heart failure. This underscores clinical relevance and interventional potential for individuals with heart failure.ClinicalTrials.gov identifierNCT04064450.