Lower Baseline Heart Rate Research Articles

Left atrial parameters predict incident atrial fibrillation and flutter in patients with heart failure with reduced ejection fraction

Abstract Background Left atrial (LA) function parameters have shown prognostic value in relation to incidence of atrial fibrillation in the general population, but this remains to be investigated in patients with heart failure with reduced ejection fraction (HFrEF). Purpose This study aimed to investigate the relationship between LA function parameters and the risk of incident atrial fibrillation/atrial flutter (AF/AFL) in patients with HFrEF. Methods Subjects free of AF/AFL were retrospectively included from a HF clinic and followed using the Danish National Patient Registry. Cox proportional hazards regression was used to assess the prognostic value of LA function parameters. These included LA ejection fraction (LAEF), peak atrial longitudinal strain (PALS), peak atrial contractile strain (PACS) and LA conduit strain (LACS). In addition, multivariable Cox regression was performed to adjust for demographic and echocardiographic parameters, including LA volume index (LAVi). The LA function parameters that remained significant in adjusted analysis were examined using cubic splines, and cutoff values corresponding to a hazard ratio (HR) equal to 1 were derived from these. Results The total study population consisted of 435 subjects with a left ventricular ejection fraction (LVEF) ≤45% (mean age 65.6±11.7 years, male sex 70.1%) free from AF/AFL at baseline. During a median follow-up of 11.4 years [IQR: 10.8, 14.2], 111 (25.5%) developed AF/AFL. Subjects who met the outcome were generally older (69.0±8.8 years vs. 64.4±12.4, p<0.001), had lower baseline heart rate, and a higher prevalence of moderate or severe valve disease (12.6% vs. 3.1%, p<0.001). They also had higher LV mass index and LV internal diastolic diameter index, but similar LVEF. These subjects had larger LAVi (30 ml/m2 [IQR: 24, 38] vs. 26 ml/m2 [IQR: 20, 32], p<0.001), while LAEF (33±14.8% vs. 39±14.9%, p<0.001), PALS (20.3% [IQR: 16.2, 26.5] vs. 23.2% [IQR: 18.6, 29.6], p=0.001), and PACS (9.7% [IQR: 6.9, 13.5] vs. 12.0% [IQR: 7.8, 16.4], p=0.004) were all significantly lower. LACS was similar between groups. In univariable Cox regression, all LA parameters were significant predictors of the AF/AFL (LAEF: HR 0.98 per 1% increase, 95% CI 0.96-0.99, p=0.0002, PALS: HR 0.96 per 1% increase, 95% CI 0.94–0.98, p=0.0008, PACS: HR 0.95 per 1%, 95% CI 0.93–0.98, p=0.0024, LACS: HR 0.96, 95% per 1% increase CI 0.92–0.998, p=0.039. In adjusted analysis, however, only LAEF (HR 0.98, 95% CI 0.976-0.995, p=0.0087) and PACS (HR 0.96, 95% CI 0.993–0.999, p=0.044) remained significant. Splines were constructed for LAEF and PACS (Figure 1), and a cutoff for increased risk of AF/AFL at 38% for LAEF and 12% for PACS, respectively, were derived (Figure 2). Conclusion LAEF and PACS are associated with risk of incident AF/AFL in patients with HFrEF, independent of clinical and echocardiographic risk factors. Our results suggest an increased risk of AF/AFL at LAEF below 38% and PACS below 12%.Figure 1 SplinesFigure 2 Cumulative incident curves

Effectiveness of emotion regulation strategies measured by self-report and EMG as a result of strategy used, negative emotion strength and participants’ baseline HRV

We investigated how emotion regulation (ER) effectiveness—on both a self-reported rating as well as emotional expression (corrugator supercilii muscle activity) level—is affected by the characteristics of the situation (low vs. high negativity), the strategy used (reinterpretation, distraction, suppression, no regulation control condition) and individual dispositions (low vs. high baseline Heart Rate Variability) as well as their interaction. For this purpose, 54 adult women participated in a laboratory study. All the included factors significantly influenced both corrugator activity and appraisals of pictures’ negativity (in specific experimental conditions). For example, for high HRV participants, (1) distraction, suppression and reinterpretation significantly decreased corrugator activity compared to the control condition, and (2) distraction decreased appraised picture negativity for high negativity photos. For low HRV participants, distraction and suppression were most effective in decreasing corrugator responses, while suppression was more effective than reinterpretation in decreasing perceived picture negativity in the high negativity condition. Subjectively reported effort and success in applying ER strategies were also dependent on manipulated and dispositional factors. Overall, our results lend support to the flexible emotion regulation framework, showing that emotion regulation effectiveness relies on situational context as well as individual dispositions and their interaction.

Hyperventilation in functional seizures: Evidence for subtypes

PurposeFunctional seizures (FS) are heterogenous, with no agreed way to subdivide them. One FS subtype frequently observed during EEG is those whose seizures are provoked by hyperventilation. We wished to see whether this subtype might reflect a different seizure mechanism. MethodsWe analysed the video-EEG/ECGs of all patients with FS from two hospitals in Melbourne from 2010-6. ResultsWe identified 120 patients during the study period, 107 of whom had usable recordings. Examining those 11 (10%) whose seizures had been induced by hyperventilation, we compared the heart rates of those where the seizure occurred during the hyperventilation, and those where they occurred afterwards. The during-hyperventilation group had a higher baseline heart rate which increased prior to their seizure; the after-hyperventilation group had a lower baseline heart rate and no pre-ictal increase. In those patients whose seizures were not hyperventilation-induced, the same two heart rate patterns could be found: those with a higher baseline heart rate showed increasing heart rate prior to seizure onset, while those with a lower baseline heart rate did not. Cluster analysis showed the sample was optimally divided into these two groups based on their pre-onset heart rate alone. ConclusionPatients with FS show two distinct patterns of pre-ictal heart rate, which may reflect two distinct seizure mechanisms.

Higher heart rate variability as a predictor of atrial fibrillation in patients with hypertension

The autonomic nervous system (ANS) plays an important role in the initiation and maintenance of atrial fibrillation (AF). However, the meaning of higher heart rate variability (HRV) in predicting AF remains unclear. Among 2100 patients in the Holter registry, a total of 782 hypertensive patients were included in this study. Baseline HRV was measured by time domain and frequency domain methods using 24-h Holter monitoring. The primary outcome was the development of AF. During an average follow-up of 1.1 years, 44 patients developed AF. Higher HRV parameters including high-frequency (P < 0.001), the square root of the mean squared differences of successive NN intervals (P < 0.001), and the percentage of NN intervals that are more than 50 ms different from the previous interval (P < 0.001) were associated with the occurrence of AF in univariate analysis. Premature atrial contractions burden, lower baseline heart rate, age, hemodialysis, coronary artery disease, and chronic heart failure were also associated with AF. In Cox regression analysis, higher HRV (representing excessive autonomic fluctuation) was an independent risk factor for AF. Excessive autonomic fluctuation represented by higher HRV in patients with hypertension was associated with an increased risk of AF.

Bispectral index monitoring in spinal anesthesia with sedation can prevent dexmedetomidine related bradycardia: a randomized clinical trial

Background: An unintentional large dose of dexmedetomidine during sedation can lead to increased side effects such as bradycardia and hypotension. We investigated whether the frequency of bradycardia in patients undergoing surgery under spinal anesthesia and sedation with dexmedetomidine was effected if bispectral index (BIS) was used to monitor the sedation.&#x0D; Methodology: Fifty patients between 20 and 60 y of age, who underwent spinal anesthesia, were included in this study. The patients were divided into two groups (control and BIS groups). Patients in the control group were administered a loading dose of 1 μg/kg dexmedetomidine for the first 10 min without BIS monitoring, followed by a maintenance dose of 0.2 μg/kg/h. Patients in the BIS group received a loading dose of 1 μg/kg dexmedetomidine for the first 10 min. The maintenance dose in this group was administered at the discretion of the anesthesiologist to maintain the BIS score between 50 and 70. The baseline heart rate (HR), lowest HR, and the difference between baseline and the lowest HR were calculated.&#x0D; Results: The baseline HR was 74.4 ± 11.0 beats per minute (bpm) and 80.9 ± 16.0 bpm, in the control and BIS groups respectively (p = 0.098). The difference between the baseline and lowest HR in the control and BIS groups was 19.4 ± 7.6 bpm and 25.5 ± 8.8 bpm, respectively (p = 0.011). Low baseline HR was positively correlated with a reduced lowest HR.&#x0D; Conclusions: The frequency of bradycardia during sedation with dexmedetomidine decreased with BIS monitoring. Patients with a low baseline HR were more likely to develop bradycardia during sedation with dexmedetomidine. Therefore, BIS monitoring may be helpful in patients with low baseline HR.&#x0D; Key words: Bispectral index monitor; Dexmedetomidine; heart rate; spinal anesthesia&#x0D; Citation: Kim J, Kim HY, Yun M, Lee J, Kim JD, Kang D. Bispectral index monitoring during sedation with dexmedetomidine in spinal anesthesia prevents bradycardia: a randomized clinical trial. Anaesth. pain intensive care 2021;26(1):14-19 ;&#x0D; DOI: 10.35975/apic.v26i1.1760

The Correlations between Admission Heart Rate and Corrected QT Interval Prolongations with Coronary Artery Disease in Patients with Acute Coronary Syndrome

Background: Coronary heart disease is a major cause of mortality and this health problem is reaching pandemic in both developed, and developing countries. ACS carries significant morbidity and mortality and the prompt diagnosis, and appropriate treatment is essential. HR was identified as a risk predictor of ACS. Both continuous increase in high baseline heart rate and decrease in low baseline heart rate are associated with higher risk of CVD. Decreased heart rate could also cause dispersion of atrial repolarization which, in turn, initiate cardiovascular events.&#x0D; Aim: The aim of this study was to assess the correlation between heart rate and severity of coronary artery disease in patient with acute coronary syndrome.&#x0D; Patients and Methods: The retrospective study was conducted on 120 patients that fulfilled the inclusion criteria were recruited from Cardiology department in Tanta university hospitals presented with acute coronary syndrome.&#x0D; Results: There was highly significant difference between both groups regarding admission heart rate &amp; QTc interval. Both groups of low AHR&lt; 60 bpm &amp; high AHR &gt;90bpm were significantly associated with severe CAD &amp;.Mainly those patients with higher admission heart rate were more likely to have higher Syntax scores (severe coronary lesion). Also, patients with prolonged QTc had severe coronary artery diseases, higher SS &amp; high probability to suffer adverse cardiac events more than patients without prolonged QTc interval.&#x0D; Conclusion: The current study showed that QTc interval prolongation and admission HR are independent predictors of the severity of coronary artery disease in patients with acute coronary syndrome.

Anatomical-functional discordance between quantitative coronary angiography and diastolic pressure ratio during wave-free period.

This study sought to determine the predictors of anatomical-functional discordance between quantitative coronary angiography (QCA) derived diameter stenosis (QCA-DS) and diastolic pressure ratio during wave-free period (dPRWFP ). The discrepancy between angiographical stenosis and physiological significance is frequently experienced in clinical practice. Although the anatomical-functional discordance between angiography and fractional flow reserve (FFR) has been intensively investigated, that of resting index including dPRWFP remains to be elucidated. In a total of 647 angiographically intermediate lesions with QCA-DS between 30 and 70% in 502 patients, predictors of having QCA-DS >50% and dPRWFP > 0.89 (QCA-dPRWFP mismatch), and those of having QCA-DS ≤50% and dPRWFP ≤ 0.89 (QCA-dPRWFP reverse mismatch) were determined. FFR ≤0.80 was defined as positive FFR and the predictors of QCA-FFR discordance were determined as well. QCA-dPRWFP mismatch and reverse mismatch were observed in 27.5 and 17.6% of cases, respectively. The predictors of mismatch were non-left anterior descending artery (LAD) lesion, large minimal lumen diameter, low baseline heart rate, and high coronary flow reserve (CFR), while those of reverse mismatch were LAD lesion, non-culprit lesion of acute coronary syndrome, long lesion length, low left ventricular ejection fraction, and low CFR and index of microcirculatory resistance. Age, sex, and the culprit vessel of prior myocardial infarction were not significant determinants of QCA-dPRWFP discordance unlike QCA-FFR discordance derived from the same cohort. Anatomical-functional discordance between angiography and dPRWFP was not uncommon. Predictors differed between QCA-dPRWFP discordance and QCA-FFR discordance.

Speeding up beta-blockade prior to coronary CT angiography: can we predict the dose of intravenous metoprolol required to achieve target heart rate in a given patient?

To evaluate the use and safety of intravenous (IV) metoprolol in a cohort of patients undergoing coronary computed tomographic angiography (CCTA) at a university hospital, and in particular, to establish if the minimum dose required to achieve the target heart rate (HR) in a given patient can be predicted from the baseline HR. Patients undergoing CCTA at a tertiary centre between January 2015 and May 2018, with baseline HR ≥60 bpm requiring IV metoprolol, were identified retrospectively from the database. Patients with a contraindication to beta-blockade or an indication for CCTA other than coronary disease were excluded. HR at baseline and at the time of scanning were recorded, together with the total dose of IV metoprolol administered. Of 625 patients identified, 330 (52.8%) achieved HR ≤60 with IV metoprolol. Patients who achieved target HR had lower baseline HR. They received a lower radiation exposure due to tight prospective gating and a lower tube voltage. The lower quartile dose of metoprolol administered was 5 mg for patients with baseline HR <65 beats per minute (bpm), but 10 mg for HR 65-74 bpm, and ≥20 mg for higher HRs. There were no cases of symptomatic bradycardia/hypotension. Patients with a resting HR of ≥60 bpm can reasonably be given an initial minimum dose of 5-20 mg metoprolol IV before CCTA, with additional doses as required.

Perioperative baseline β-blockers: An independent protective factor for post-carotid endarterectomy hypertension.

Post-carotid endarterectomy hypertension is a well-recognized phenomenon closely related to surgical complications. This study aimed to determine whether different kinds of perioperative antihypertensive drugs had a protective effect on post-carotid endarterectomy hypertension and influence on intraoperative hemodynamics. We retrospectively investigated 102 carotid stenosis patients who underwent conventional endarterectomy with a perioperative baseline antihypertensive regimen. Post-carotid endarterectomy hypertension was defined as a postoperative peak systolic blood pressure ≥160 mmHg and/or a requirement for any additional antihypertensive therapies. We compared the clinical characteristics and types of baseline perioperative antihypertensive drugs between patients with and without post-carotid endarterectomy hypertension and then determined the significant independent effect of antihypertensive drugs on post-carotid endarterectomy hypertension through multivariate regression and detected their influence on intraoperative hypertension (induction-related systolic blood pressure and vasodilators consumption) and hemodynamic depression (intra-arterial systolic blood pressure ≤100 mmHg and/or heart rate ≤50beats/min). We also investigated adverse events such as stroke, death, myocardial infarction, and cerebral hyperperfusion syndrome during the postoperative hospitalization. A total of 52/102 (51.0%) patients were defined as having post-carotid endarterectomy hypertension during the first three days postoperative, including eight patients with a postoperative systolic blood pressure that exceeded 160 mmHg at least once, 31 patients requiring postoperative antihypertensive treatment in addition to their baseline regimen, and 13 patients with both. The incidence of stroke/death/myocardial infarction and cerebral hyperperfusion syndrome after conventional endarterectomy during hospitalization were both 1.9%. A significantly increased risk of composite postoperative complications (including cerebral hyperperfusion syndrome, hyperperfusion-related symptoms, transient ischemic attacks, stroke, death, and cardiac complications) was observed in patients with post-carotid endarterectomy hypertension than without (15.4% versus 2.0%, p = 0.032). Patients free of post-carotid endarterectomy hypertension had a higher incidence of perioperative baseline β-blocker use than patients who suffered from post-carotid endarterectomy hypertension (46.0% versus 21%, p = 0.008). In multivariate analysis, β-blocker use was a significant independent protective factor for post-carotid endarterectomy hypertension (OR = 0.356, 95% CI: 0.146-0.886, p = 0.028). Patients taking β-blockers had a lower postoperative peak systolic blood pressure than the β-blocker-naïve population (137.1 ± 12.1 mmHg versus 145.0 ± 11.2 mmHg, p = 0.008), but the postoperative mean systolic blood pressure showed no intergroup difference. However, the incidence of hemodynamic depression during conventional endarterectomy was higher in patients with perioperative β-blocker use than in those without (44.1% versus 25.0%, p = 0.050). The difference in intraoperative hemodynamic depression became more prominent between the β-blocker and non-β-blocker groups (81.8% versus 33.3%, p = 0.014) for whose preoperative baseline heart rate was equal to or lower than 70beats/min. The perioperative use of β-blockers is a protective factor for post-carotid endarterectomy hypertension and contributes to stabilizing the postoperative peak systolic blood pressure three days after conventional endarterectomy. However, β-blockers might also lead to intraoperative hemodynamic depression, especially for patients with a low baseline heart rate.

Smoking and overweight associated with masked uncontrolled hypertension: a Hypertension Optimal Treatment (HOT) Sub-Study

Purpose The Hypertension Optimal Treatment (HOT) Study investigated the relationship between target office diastolic blood pressure (BP) ≤80, ≤85 or ≤90 mmHg and cardiovascular morbidity and mortality in 18,790 patients aged 50–80 years. The home BP sub-study enrolled 926 patients and the aim was to clarify whether the separation into the BP target groups in the office prevailed in the out-of-office setting. The present study aimed to identify variables that characterised masked uncontrolled hypertension (MUCH) and white coat uncontrolled hypertension (WUCH). Material and Methods The sub-study participants took their home BP when office BP had been up titrated. The cut-off for normal or high BP was set to ≥135/85 mmHg at home and ≥140/90 mmHg in the office. We analysed data by using multivariate and stepwise multivariate logistic regression with home and office BP combinations as the dependent variables. Results WUCH was associated with lower body mass index (BMI) (odds ratio (OR) 0.92, 95% confident intervals (CIs) 0.88–0.96, p < 0.001). MUCH was associated with smoking (OR 1.89, 95% CIs 1.25–2.86, p = 0.0025) and with lower baseline heart rate (OR 0.98, 95% CIs 0.97–0.99, p = 0.03) and higher BMI (OR 1.03, CIs 1.00–1.06, p = 0.04). MUCH remained associated with smoking (OR 2.76, 95% CIs 1.76–4.35, p < 0.0001) also when using ≥140/90 mmHg as the cut-off for both home and office BP. MUCH was also associated with higher BMI (OR 1.05, 95% CIs 1.01–1.09, p = 0.009) while WUCH was associated with lower BMI (OR 0.93, 95% CIs 0.90–0.97, p = 0.0005) when using ≥140/90 mmHg as a cut-off. Conclusion Our data support that ‘reversed or masked’ treated but uncontrolled hypertension (MUCH) is common and constitutes about 25% of treated hypertensive patients. This entity (MUCH) is rather strongly associated with current smoking and overweight while uncontrolled white coat (office) hypertension (WUCH) is associated with lower BMI.

Non-invasive continuous haemodynamic monitoring and response to intervention in haemodynamically unstable patients during rapid response team review

IntroductionDuring rapid response team (RRT) management of haemodynamic instability (HI), continuous non-invasive haemodynamic monitoring may provide supplemental physiological information. ObjectivesTo continuously and non-invasively obtain the cardiac index (CI) and mean arterial pressure (MAP) in patients with HI at baseline and during RRT management using the ClearSight™ device. MethodsWe performed a prospective observational study in adult patients managed by the RRT for tachycardia or hypotension or both. We assessed changes from baseline in heart rate (HR), MAP, CI, stroke volume index (SVI) and systemic vascular resistance index (SVRI) (i) at 5-minutely intervals up to 20 min, and (ii) over the entire 20-min period. We analysed patients by RRT trigger (tachycardia/hypotension) and intervention (fluid bolus therapy [FBT]/ no FBT). ResultsWe successfully recorded the CI in 47 of 50 (94%) patients. RRT reviews triggered by hypotension rather than tachycardia had a lower baseline HR (−45.4 bpm, p = <0.0001), MAP (−16.1 mmHg, p = 0.0007) and CI (1.0 L/min/m2, p = 0.0025). Compared to baseline, in the tachycardia group, there was a small increase in MAP overall and at the 15–20 min time-block from 83.2 mmHg to 87.1 mmHg (+3.9 mmHg, p = 0.0066) and 85.5 mmHg (+2.3 mmHg, p = 0.0061), respectively. In those who received FBT, there was a statistically significant increase in MAP overall and at the 15–20 min time-block compared to baseline, from 70.1 mmHg to 73.5 mmHg (+3.4 mmHg, p = 0.0036) and 74.3 mmHg (+4.2 mmHg, p = 0.0037), respectively. However, there were no statistically significant changes in mean HR, CI, SVI, or SVRI when comparing baseline to the entire 20-min period or 5-min time-blocks within any group. ConclusionsContinuous non-invasive measurement of haemodynamics during RRT management for HI was possible for 20 min. Patients with hypotension rather than tachycardia had lower baseline HR, MAP and CI values. There was a statistically significant but small increase in MAP at the 15–20 min time-block and overall, for both the tachycardia and FBT groups.

Association of resting heart rate and its change with incident cardiovascular events in the middle-aged and older Chinese

Whether heart rate change is associated with cardiovascular disease (CVD) in the general population is unclear. We conducted a prospective cohort study to assess the association of resting heart rate and its change with incident CVD in the middle-aged and older Chinese. Resting heart rate was measured during the baseline survey (September 2008 to June 2010) and the resurvey (2013). Incident CVD was followed up until December 31, 2016. Finally, a total of 20,828 participants were included in the analyses of baseline heart rate and 9132 participants were included in the analyses of heart rate change. The associations of baseline heart rate and heart rate change with incident CVD were assessed with multivariable Cox proportional hazards models. Compared with moderate baseline heart rate (65 to 80 bpm), low baseline heart rate (<65 bpm) was associated with higher risk of CVD (HR, 1.19; 95% CI, 1.07–1.32). Compared with stable heart rate (−5 to 15 bpm) in the moderate baseline heart rate group (65 to 80 bpm), an increase of heart rate (>15 bpm) in high baseline heart rate group (>80 bpm) (HR, 1.67; 95% CI, 1.02–2.71) or a decrease of heart rate (<−5 bpm) in low baseline heart rate group (<65 bpm) (HR, 2.48; 95% CI, 1.27–4.82) was associated with higher risk of CVD. In conclusion, low resting heart rate is associated with higher risk of CVD. Both continuous increase in high baseline heart rate and decrease in low baseline heart rate are associated with higher risk of CVD.

SPYRAL HTN-OFF MED TRIAL

Objective: Heart rate (HR) is associated with cardiovascular outcomes in hypertensive high-risk vascular patients and heart failure. Recently, the randomized, sham-controlled SPYRAL HTN-OFF MED trial showed reduction of office and ambulatory blood pressure (BP) at 3 months post-renal denervation. The objective of the current analysis is to evaluate the effect of renal denervation on HR in an uncontrolled hypertensive population without medication. Design and method: The SPYRAL HTN-OFF MED trial enrolled uncontrolled hypertensive patients who were drug naïve or removed from their antihypertensive medications. Patients were randomized 1:1 to renal denervation or sham control procedure. BP and HR were measured at baseline and 3 months post-procedure using ambulatory BP monitoring and in the office. For office BP and HR, each data point was an average of 3 measurements. Post-hoc analyses compared changes at 3 months in BP and HR for patients with baseline office HR above and below the median. Results: At 3 months, average office, 24-hour, daytime and night-time HR were significantly reduced in the renal denervation group but not in the sham control group (Table 1). Also, the change in 24-hour HR at 3 months was significantly different between groups. Three-month changes in 24-hour systolic BP, diastolic BP and HR were significantly lower for renal denervation patients with higher baseline HR compared to those with lower baseline HR (Table 2). Similar trends were not seen in the sham control group.Conclusions: In the SPYRAL HTN-OFF MED trial, significant reductions in HR were seen at 3 months in the renal denervation group but not in the sham control group. Post-hoc analyses suggest patients with higher baseline HR could experience greater reductions in ambulatory HR and BP post-renal denervation.

Changes in Heart Rate Associated with Exenatide Once Weekly: Pooled Analysis of Clinical Data in Patients with Type 2 Diabetes.

IntroductionGlucagon-like peptide-1 receptor agonists (GLP-1RAs) improve glycemia in patients with type 2 diabetes, but heart rate increases have been observed.MethodsA pooled post hoc analysis of 11 randomized clinical trials (N = 4595) of 10–30 weeks’ duration from the exenatide once-weekly (QW) development program evaluated heart rate with exenatide QW (intervention group) and exenatide twice daily (BID), liraglutide, and non-GLP-1RAs (insulin, metformin, pioglitazone, and sitagliptin) (comparison groups). The time course and size of heart rate changes from baseline and the relationship of heart rate change with baseline heart rate were studied. A multivariate analysis (9 studies; N = 3903) examined associations between patient characteristics or treatments and heart rate increases.ResultsMean baseline heart rate ± standard deviation was 75.0 ± 8.5 beats per minute (bpm) with exenatide QW (n = 2096), 75.8 ± 8.7 bpm with exenatide BID (n = 606), 75.2 ± 8.9 bpm with liraglutide (n = 450), and 74.5 ± 8.6 bpm with non-GLP-1RAs (n = 1443). Least-squares mean ± standard error changes from baseline to final heart rate were + 2.7 ± 0.2, + 1.0 ± 0.3, and + 3.0 ± 0.4 bpm with exenatide QW, exenatide BID, and liraglutide, respectively, and − 0.8 ± 0.2 bpm with non-GLP-1RAs. The size and direction of heart rate changes in individual patients varied within each treatment group at all time points. At posttreatment follow-up, heart rate reverted to the baseline level after GLP-1RA discontinuation. Heart rate changes correlated negatively with baseline heart rate for all therapies (r = − 0.3 to − 0.4). Baseline heart rate was the strongest predictor of increased heart rate.ConclusionsSmall increases in heart rate were associated with exenatide QW, exenatide BID, and liraglutide treatments but reverted to baseline after discontinuation. Increases were more likely in patients with a low baseline heart rate. The clinical relevance of these heart rate increases is unknown but will be clarified by several ongoing and recently completed cardiovascular outcome studies.Electronic supplementary materialThe online version of this article (10.1007/s13300-018-0370-z) contains supplementary material, which is available to authorized users.

Are changes in heart rate, observed during dobutamine stress echocardiography, associated with a response to cardiac resynchronisation therapy in patients with severe heart failure? Results of a multicentre ViaCRT study.

According to current European Society of Cardiology guidelines for the diagnosis and treatment of heart failure (HF), cardiac resynchronisation therapy (CRT) is indicated in patients suffering from HF with reduced ejection fraction (EF) with significantly widened QRS complexes. The presence of vital myocardium proven by dobutamine stress echocardiography (DSE) is considered as a good prognostic factor for responsiveness to this treatment. Chronotropic incompetence is, on the other hand, a known factor of unfavourable outcome in HF. The aim of this study was to analyse the relationship between heart rate (HR) response during DSE and resultant changes in echocardiographic parameters determined prior to CRT and six weeks post-implantation of the CRT system. The study included 72 men and 25 women with chronic HF and markedly deteriorated left ventricular (LV) sys-tolic function (EF < 35%). Low-dose DSE was performed prior to the CRT system implantation. Baseline echocardiographic parameters determined before CRT were compared to those measured six weeks after implantation. Implantation of the CRT system resulted in an improvement of LV systolic function. DSE showed a significant in-crease in HR, by 16.3 bpm on average. Patients with the least prominent increase in HR during DSE (< 7 bpm) presented with significantly greater end-diastolic LV dimension and volume, as well as with significantly lower EF than the subjects with the most evident increase in HR (> 24 bpm). Improvement in EF at six weeks was associated with lower baseline HR and its greater absolute and relative increase during DSE. Greater absolute increase in HR during DSE was also associated with more prominent decrease in systolic/diastolic LV volumes. Patients with better chronotropic response during DSE show significant improvement in LV parameters determined by echocardiography within six weeks of CRT. Chronotropic response to pharmacologic stress test may serve as a predictive factor in patients qualified for CRT.

Heart rate variability predicts inhibitory control in adults with autism spectrum disorders

Several studies suggest that inhibition difficulties among people with ASD might be related to atypical cardiac vagal control. We examined how low versus high baseline heart rate variability (HRV) influences prepotent response inhibition in 31 males with autism spectrum disorder (ASD; mean age: 32.2; mean IQ: 107.8) compared to 39 typically developing (TD) males (mean age: 30.5; mean IQ: 102.0) by administering a stop signal task. Moreover, we examined whether adding an affective manipulation would alter findings and whether this manipulation affected HRV. Findings indicated that baseline HRV influenced inhibition in ASD males. Specifically, an ASD subgroup with low baseline HRV performed significantly worse compared to an ASD subgroup with high baseline HRV. No influence of baseline HRV was found in TD males. The affective manipulation did negatively influence performance and also altered HRV. Although replication is required, these first findings indicate that baseline cardiac vagal control seems to affect inhibitory control in males with ASD.

Differing Developmental Trajectories in Heart Rate Responses to Speech Stimuli in Infants at High and Low Risk for Autism Spectrum Disorder.

We investigated heart rate (HR) in infants at 3, 6, 9, and 12 months of age, at high (HRA) and low (LRC) familial risk for ASD, to identify potential endophenotypes of ASD risk related to attentional responses. HR was extracted from functional near-infrared spectroscopy recordings while infants listened to speech stimuli. Longitudinal analysis revealed that HRA infants and males generally had lower baseline HR than LRC infants and females. HRA infants showed decreased HR responses to early trials over development, while LRC infants showed increased responses. These findings suggest altered developmental trajectories in physiological responses to speech stimuli over the first year of life, with HRA infants showing less social orienting over time.

1074 POSTTRAUMATIC STRESS DISORDER, CANINE COMPANIONSHIP, AND SLEEP: PRELIMINARY FINDINGS

Large numbers of Veterans with post-deployment psychological disorders have reported improvements in sleep in association with canine companionship. Studies have also provided support for an association between canine companionship and lower baseline heart rate. We tested both possibilities in a sample of combat Veterans undergoing inpatient treatment for posttraumatic stress disorder (PTSD) and participating in a Service Animal Training Intervention in which they shared custody of a service canine with another Veteran. Alternating custody enabled within-subjects modeling of associations between canine companionship and sleep. 18 military Veterans with deployment-related PTSD underwent mattress actigraphy for up to four weeks yielding 493 nights of sleep data. Mattress actigraphy relies upon accelerometers embedded in a mattress topper. The intended sleep period is delimited manually by blind raters after which sleep parameters are calculated automatically. Participants also rated morning restedness on a five-point scale following a total of 329 nights. Whether or not participants had custody of their service canines was carefully tracked. Linear mixed modeling was applied to the longitudinal data, controlling for AHI, snoring, and body movements. A random intercept was specified for each participant. Modeling morning restedness detected only main effects of minutes of actigraphic quiescence (F(1,324) = 4.44, p = 0.036) and canine presence (F(1,313) = 3.89, p = 0.049), both predictors having positive coefficients. Modeling of sleep heart rate also detected main effects of actigraphic quiescence (F(1,476) = 5.38, p = 0.021) and of canine presence (F(1,472) = 5.55, p = 0.018), as well as an effect of snoring (F(1,478) = 13.23, p = 0.0003). Quiescence and canine presence were negatively associated with sleep heart rate, while snoring was positively associated. After accounting for other predictors, canine presence was associated with lower sleep heart rate and greater morning restedness in Veterans with PTSD. Preliminarily, these results are consistent with Veterans’ reports of positive effects of a familiar canine presence on their sleep. This research was supported by Contract W81XWH-15-2-0005 to Steven H. Woodward, PhD, from the Defense Health Program, Military Operational Medical Research Program, and U.S. Army Medical Research and Materiel Command.

Heart rate variability and depressive symptoms: a cross-lagged analysis over a 10-year period in the Whitehall II study.

People with depression tend to have lower heart rate variability (HRV), but the temporal sequence is poorly understood. In a sample of the general population, we prospectively examined whether HRV measures predict subsequent depressive symptoms or whether depressive symptoms predict subsequent levels of HRV. Data from the fifth (1997-1999) and ninth (2007-2009) phases of the UK Whitehall II longitudinal population-based cohort study were analysed with an average follow-up of 10.5 years. The sample size for the prospective analysis depended on the analysis and ranged from 2334 (644 women) to 2276 (602 women). HRV measures during 5 min of supine rest were obtained. Depressive symptoms were evaluated by four cognitive symptoms of depression from the General Health Questionnaire. At follow-up assessment, depressive symptoms were inversely associated with HRV measures independently of antidepressant medication use in men but not in women. Prospectively, lower baseline heart rate and higher HRV measures were associated with a lower likelihood of incident depressive symptoms at follow-up in men without depressive symptoms at baseline. Similar but statistically insignificant associations were found in women. Adjustments for known confounders including sociodemographic and lifestyle factors, cardiometabolic conditions or medication did not change the predictive effect of HRV on incident depressive symptoms at follow-up. Depressive symptoms at baseline were not associated with heart rate or HRV at follow-up in either sex. These findings are consistent with an aetiological role of the autonomic nervous system in depression onset.

Incidence and Risk Factors of Severe Bradycardia During Spinal Anesthesia with Chronic β-Blockade

Background: Severe bradycardia and asystole after spinal anesthesia was considered a serious side effect. Beta (β)-blockers lower blood pressure with decrease resting heart rate and left ventricular function. In this study, we retrospectively recorded the incidence of severe bradycardia and asystole during spinal anesthesia in patients medicated with β-blockers and investi- gated risk factors contributing to the incidence of severe bradycardia. Methods: Anesthesia chart of 693 cases were retrospectively examined. All patients receive elective surgery in our institute with spinal anesthesia and received β-blockers until the day of operation. Bradycardia was defined as a heart rate <50 beats per minute for at least 1 minute. Ten variables as risk factors contributing to bradycardia were selected: gender, age, body mass index, spinal drug dose, and peak sensory block height, baseline heart rate, baseline systolic blood pressure, baseline diastolic blood pressure, baseline mean blood pressure, and history of diabetes. Results: Eighty six of the 693 (13.4%) patients experienced bradycardia. No asystole occurred. On univariate analysis, male gender, absence of diabetes, low baseline heart rate was associated with statistically higher incidence of bradycardia. In multivariate logistic regression, low baseline heart rate, absence of diabetes elevated the risk of bradycardia (Odds Ratio, 10.44 and 2.6 respectively). Conclusions: The incidence of severe bradycardia during spinal anesthesia was 13.4% in the patient receiving the β-blockers. Those with low baseline heart rate and absence of diabetes were more vulnerable to develop severe bradycardia.