Lower Heart Rate Variability Research Articles

Abstract P241: Stress-Induced Autonomic Dysfunction is Associated With Mental Stress-Induced Myocardial Ischemia in Patients With Coronary Artery Disease

Background: Mental stress-induced myocardial ischemia (MSIMI) is associated with adverse cardiovascular outcomes in individuals with coronary artery disease (CAD), but the mechanisms underlying this phenomenon are unknown. We examined the relationship between stress-induced autonomic dysfunction, measured by lower heart rate variability (HRV) in response to stress, and MSIMI in patients with stable CAD. We hypothesized that stress-induced autonomic dysfunction is associated with higher odds of MSIMI. Methods: In 735 participants with stable CAD, we measured high frequency (HF) and low frequency (LF) HRV in 5-minute intervals before and during a standardized laboratory-based speech stressor using Holter monitoring. MSIMI was evaluated with single-photon emission computed tomography myocardial perfusion imaging. HRV at rest and stress were categorized into low (lowest quartile) versus high (upper three quartiles) categories; low category was used as an indicator of autonomic dysfunction. Multivariable logistic regression models were used to examine the association of autonomic dysfunction with MSIMI. Results: The mean age was 58 (SD ±10) years, 35% were women, 44% were Black participants, and 16% developed MSIMI. Compared with high stress HRV, low stress HRV (both HF and LF) was associated with higher odds of MSIMI after adjusting for demographic and clinical factors. LF HRV at rest was also significantly associated with MSIMI with slightly reduced effect estimates. Conclusions: In individuals with CAD, mental stress-induced autonomic dysfunction may be an independent mechanism in the pathogenesis of MSIMI.

Heart Rate Variability (HRV) serves as an objective correlate of distress and symptom burden in multiple sclerosis

BackgroundAutonomic nervous system (ANS) dysfunction is frequently seen in people living with multiple sclerosis (MS). Heart rate variability (HRV) is an easy and objective index for evaluating ANS functioning, and it has been previously used to explore the association between ANS and the experience of symptom burden in other chronic diseases. Given ANS functioning can be influenced by physical and psychological factors, this study investigated whether emotional distress and/or the presence of ANS dysfunction is associated with symptom severity in people living with MS. MethodsParticipants with MS and healthy controls (HC) with no history of cardiac conditions were recruited to self-collect HR data sampled from a chest strap HR monitor (PolarH10). Short-term HR signal was collected for five minutes, and time and frequency HRV analyses were performed and compared between groups. HRV values were then compared to self-reported distress (Kessler Psychological Distress Scale) and MS participants’ self-reported measures of symptom burden (SymptoMScreen). ResultsA total of n = 23 adults with MS (51 ± 12 years, 65 % female, median Patient Determined Disease Steps [PDDS]: 3.0) and n = 23 HCs (43 ± 18 years, 40 % female) completed the study procedures. All participants were able to complete the chest strap placement and HR data capture independently. Participants with MS, compared to the HC participants, had a significantly lower parasympathetic activation as shown by lower values of the root mean square of successive differences between normal heartbeats (RMSSD: 21.86 ± 9.84 vs. 43.13 ± 20.98 ms, p = 0.002) and of high-frequency (HF) power band (HF-HRV: 32.69 ± 12.01 vs. 42.39 ± 7.96 nu, p = 0.016), indicating an overall lower HRV in the MS group. Among individuals with MS, HF-HRV was significantly correlated with the severity of self-reported MS symptoms (r = -0.548, p = 0.010). Participants with MS also reported higher levels of distress compared to HC participants (18.32 ± 6.05 vs. 15.00 ± 4.61, p = 0.050), and HRV correlated with the severity of distress in MS participants (r = -0.569, p = 0.007). A significant mediation effect was also observed, with emotional distress fully mediating the association between HRV and symptom burden. ConclusionsThese findings suggest the potential for ANS dysfunction, as measured by HRV (i.e., lower value of HF power), to be utilized as an objective marker of symptom burden in people living with MS. Moreover, it is apparent that the relationship between HRV and symptom burden is mediated by emotional distress.

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.

Correlative relationship between body mass index and heart rate variability in psychiatric disorders.

Indicators of heart rate variability (HRV) have been used to assess the autonomic activity. However, the influence of obesity on HRV in these patients remains to be determined. This study aimed to examine how obesity (measured with the body mass index [BMI]) affects HRV and determine whether the effect varies among different psychiatric disorders. We recruited 3159 consecutive patients, including 1744 with schizophrenia, 966 with mood disorders, and 449 with anxiety disorders. Patients were divided into four groups based on BMI: underweight (< 18.5), normal weight (18.5-23.9), overweight (24-27.9), and obese (≥ 28). The cardiovascular status was assessed using several time- and frequency-based HRV indicators, measured via electrocardiogram signals recorded for 5min. The mean BMI of the participants was 23.6 ± 4.0. The patients in theoverweight and obese groups were 29.4% and 13.6% of the total, respectively. The HRV indicators were higher in underweight and normal-weight patients than in the overweight and obese ones. After stratification based on the psychiatric diagnosis, the patients with mood disorders showed lower HRV than those with schizophrenia or anxiety disorder in the normal-weight group. In contrast, in the overweight and obese groups the patients with mood disorders showed higher HRV than those with the other disorders. The HRV variableswere significantly associated with BMI, and higher BMI was associated with higher heart rates and lower HRV. These results indicate that weight gain in psychiatric disorders is associated with an imbalance in autonomic nerve activity. However, the relationship between autonomic activity, weight gain, and psychiatric disorders warrants further investigation.

Tracking Cancer: Exploring Heart Rate Variability Patterns by Cancer Location and Progression.

Reduced heart rate variability (HRV) is an autonomic nervous system (ANS) response that may indicate dysfunction in the human body. Consistent evidence shows cancer patients elicit lower HRV; however, only select cancer locations were previously evaluated. Thus, the aim of the current study was to explore HRV patterns in patients diagnosed with and in varying stages of the most prevalent cancers. At a single tertiary academic medical center, 798 patients were recruited. HRV was measured via an armband monitor (Warfighter MonitorTM, Tiger Tech Solutions, Inc., Miami, FL, USA) equipped with electrocardiographic capabilities and was recorded for 5 to 7 min with patients seated in an upright position. Three time-domain metrics were calculated: SDNN (standard deviation of the NN interval), rMSSD (the root mean square of successive differences of NN intervals), and the percentage of time in which the change in successive NN intervals exceeds 50ms within a measurement (pNN50). Of the 798 patients, 399 were diagnosed with cancer. Cancer diagnoses were obtained via medical records one week following the measurement. Analysis of variance models were performed comparing the HRV patterns between different cancers, cancer stages (I-IV), and demographic strata. A total of 85% of the cancer patients had breast, gastrointestinal, genitourinary, or respiratory cancer. The cancer patients were compared to a control non-cancer patient population with similar patient size and distributions for sex, age, body mass index, and co-morbidities. For all HRV metrics, non-cancer patients exhibited significantly higher rMSSDs (11.1 to 13.9 ms, p < 0.0001), SDNNs (22.8 to 27.7 ms, p < 0.0001), and pNN50s (6.2 to 8.1%, p < 0.0001) compared to stage I or II cancer patients. This significant trend was consistently observed across each cancer location. Similarly, compared to patients with stage III or IV cancer, non-cancer patients possessed lower HRs (-11.8 to -14.0 bpm, p < 0.0001) and higher rMSSDs (+31.7 to +32.8 ms, p < 0.0001), SDNNs (+45.2 to +45.8 ms), p < 0.0001, and pNN50s (19.2 to 21.6%, p < 0.0001). The HR and HRV patterns observed did not significantly differ between cancer locations (p = 0.96 to 1.00). The depressed HRVs observed uniformly across the most prevalent cancer locations and stages appeared to occur independent of patients' co-morbidities. This finding highlights the potentially effective use of HRV as a non-invasive tool for determining common cancer locations and their respective stages. More studies are needed to delineate the HRV patterns across different ages, between sexes and race/ethnic groups.

Effects of cortisol administration on heart rate variability and functional connectivity across women with different depression histories

Abnormalities within the hypothalamic-pituitary-adrenal (HPA) axis and autonomic nervous system have been implicated in depression. Studies have reported glucocorticoid insensitivity and reduced heart rate variability (HRV) in depressive disorders. However, little is known about the effects of cortisol on HRV and resting-state functional connectivity (rsFC) of the central autonomic network (CAN) in depression. We collected resting-state fMRI and cardiac data for women with different depression histories (n = 61) after administration of cortisol and placebo using a double-blind crossover design. We computed rsFC for R-amygdala and L-amygdala seeds and assessed the change in HRV after cortisol (cortisol-placebo). Analyses examined the effects of acute cortisol administration on HRV and rsFC of the R-amygdala and L-amygdala. There was a significant interaction between HRV and treatment for rsFC between the amygdala and CAN regions. We found lower rsFC between the L-amygdala and putamen for those with a greater decrease in HRV after cortisol. There was also reduced rsFC between the R-amygdala and dorsomedial prefrontal cortex, putamen, middle cingulate cortex, insula, and cerebellum in those with lower HRV after cortisol. These results remained significant after adjusting for depression symptoms, age, and race. Our findings suggest that the effect of cortisol on CAN connectivity is related to its effects on HRV. Overall, these results could inform transdiagnostic interventions targeting HRV and the stress response systems across clinical and non-clinical populations.

Facial emotion processing in patients with borderline personality disorder as compared with healthy controls: an fMRI and ECG study

BackgroundMaladaptive behaviors and interpersonal difficulties in patients with borderline personality disorder (BPD) seem connected to biased facial emotion processing. This bias is often accompanied by heightened amygdala activity in patients with BPD as compared to healthy controls. However, functional magnetic resonance imaging (fMRI) studies exploring differences between patients and healthy controls in facial emotion processing have produced divergent results. The current study explored fMRI and heart rate variability (HRV) correlates of negative facial emotion processing in patients with BPD and healthy controls.MethodsThe study included 30 patients with BPD (29 females; age: M = 24.22, SD = 5.22) and 30 healthy controls (29 females; M = 24.66, SD = 5.28). All participants underwent the “faces” task, an emotional face perception task, in an fMRI session simultaneously with ECG. In this task, participants are presented with emotional expressions of disgust, sadness, and fear (as a negative condition) and with the same pictures in a scrambled version (as a neutral condition).ResultsWe found no differences in brain activity between patients with BPD and healthy controls when processing negative facial expressions as compared to neutral condition. We observed activation in large-scale brain areas in both groups when presented with negative facial expressions as compared to neutral condition. Patients with BPD displayed lower HRV than healthy controls in both conditions. However, there were no significant associations between HRV and amygdala activity and BPD symptoms.ConclusionThe results of this study indicate no abnormal brain activity during emotional facial processing in patients with BPD. This result contrasts with previous studies and more studies are needed to clarify the relationship between facial emotion processing and brain activity in patients with BPD. Possible reasons for the absence of brain activity differences are discussed in the study. Consistent with previous findings, patients showed lower HRV than healthy controls. However, HRV was not associated with amygdala activity and BPD symptoms.

Emotion regulation and heart rate variability may identify the optimal posttraumatic stress disorder treatment: analyses from a randomized controlled trial.

High variability in response and retention rates for posttraumatic stress disorder (PTSD) treatment highlights the need to identify "personalized" or "precision" medicine factors that can inform optimal intervention selection before an individual commences treatment. In secondary analyses from a non-inferiority randomized controlled trial, behavioral and physiological emotion regulation were examined as non-specific predictors (that identify which individuals are more likely to respond to treatment, regardless of treatment type) and treatment moderators (that identify which treatment works best for whom) of PTSD outcome. There were 85 US Veterans with clinically significant PTSD symptoms randomized to 6 weeks of either cognitive processing therapy (CPT; n = 44) or a breathing-based yoga practice (Sudarshan kriya yoga; SKY; n = 41). Baseline self-reported emotion regulation (Difficulties in Emotion Regulation Scale) and heart rate variability (HRV) were assessed prior to treatment, and self-reported PTSD symptoms were assessed at baseline, end-of-treatment, 1-month follow-up, and 1-year follow-up. Greater baseline deficit in self-reported emotional awareness (similar to alexithymia) predicted better overall PTSD improvement in both the short- and long-term, following either CPT or SKY. High self-reported levels of emotional response non-acceptance were associated with better PTSD treatment response with CPT than with SKY. However, all significant HRV indices were stronger moderators than all self-reported emotion regulation scales, both in the short- and long-term. Veterans with lower baseline HRV had better PTSD treatment response with SKY, whereas Veterans with higher or average-to-high baseline HRV had better PTSD treatment response with CPT. To our knowledge, this is the first study to examine both self-reported emotion regulation and HRV, within the same study, as both non-specific predictors and moderators of PTSD treatment outcome. Veterans with poorer autonomic regulation prior to treatment had better PTSD outcome with a yoga-based intervention, whereas those with better autonomic regulation did better with a trauma-focused psychological therapy. Findings show potential for the use of HRV in clinical practice to personalize PTSD treatment. ClinicalTrials.gov identifier, NCT02366403.

Perceived Parenting Stress Is Related to Cardiac Flexibility in Mothers: Data from the NorBaby Study.

Heart rate variability (HRV) is an indicator of autonomic nervous system activity, and high levels of stress and/or depressive symptoms may reduce HRV. Here, we assessed whether (a) parental stress affected HRV in mothers during the perinatal period and whether this is mediated by bonding and (b) whether antenatal maternal mental states, specifically repetitive negative thinking, depressive symptoms, and pregnancy-related anxiety, have an impact on infant HRV, and lastly, we investigated (c) the relationship between maternal HRV and infant HRV. Data are from the Northern Babies Longitudinal Study (NorBaby). In 111 parent-infant pairs, cardiac data were collected 6 months after birth. In the antenatal period, we used the Pregnancy-Related Anxiety Questionnaire-Revised, the Edinburgh Postnatal Depression Scale, and the Perseverative Thinking Questionnaire; in the postnatal period, we used the Parenting Stress Index and the Maternal Postnatal Attachment Scale. Higher levels of perceived parenting stress but not depressive symptoms were associated with lower HRV in mothers (τ = -0.146), and this relationship was not mediated by maternal bonding. Antenatal maternal mental states were not associated with infant HRV. There was no significant correlation between maternal HRV and infant HRV. Our observational data suggest that perceived stress reduces cardiac flexibility. Future studies should measure HRV and parenting stress repeatedly during the perinatal period.

Is reduced heart rate variability associated with functional somatic disorders? A cross-sectional population-based study; DanFunD

ObjectivesIt has been hypothesised that functional somatic disorders (FSD) could be initiated by sympathetic predominance in the autonomic nervous system as measured by low heart rate variability (HRV). Earlier studies...

Need to Take Heart? Talk to Your Psychiatrist for 20 Minutes.

A powerful correlation exists between the equilibrium of the sympathetic and parasympathetic nervous systems and heart rate variability (HRV). Thus, HRV is useful as a physiological index of both physical and emotional health; autonomic nervous system dysregulation, with a sympathetic predominance and a low HRV, has been associated with a variety of physical (cardiovascular, neurological) and psychiatric disorders. We used a validated algorithm of measuring the HRV (noninvasive, 2-minute approach) in new psychiatric outpatients in first author's private practice. The subjects had an initial measurement, followed by a 20-minute consultation with minimal supportive psychotherapy, followed by an exit measurement. The initial study spanned the "COVID months"; to control for this variable, an identical study was performed in 2023. There was a highly significant decrease in the sympathetic predominance in the test groups; no such trend was found in the control groups. A short psychiatry consultation may be sufficient to decrease patients' sympathetic hyperactivity and improve their well-being.

The effectiveness of an osteopathic manual technique compared with a breathing exercise on vagal tone as indicated by heart rate variability, a crossover study

IntroductionParasympathetic nervous system (PSNS) function can be inferred by heart rate variability (HRV) providing indications about an individual's health. Manual therapy may influence PSNS function, however the research outcomes in this regard are equivocal. This study explored the PSNS effect of a measured breathing technique with suboccipital balanced ligamentous tension, an osteopathic manipulative therapy technique. Methods: Healthy adult participants in this crossover study (n = 18) were randomly allocated into two groups with differing order of interventions. A 1:1 breathing rate of 6 breaths per minute maintained for 5 min was compared to the osteopathic intervention. HRV was measured for 5 min before and after each intervention and analysed using the root mean square of successive differences (RMSSD) between normal heartbeats and high frequency normalised units (HFnu). Results: The RMSSD data demonstrated no significant difference between groups or within groups (p > 0.05) over time. HFnu results showed a significant between-group difference over the four time points (p = 0.004) with a medium effect size (ηp2 = 0.240), and no significant within-group difference (p > 0.05). Discussion: The osteopathic intervention raised HRV to a small extent, however measured breathing lowered HRV. In the group that received the osteopathic technique first, HFnu values continued to rise post-osteopathic treatment possibly indicating an increasing parasympathetic effect over time. Recommendations for future studies include changing the breathing ratio to ensure parasympathetic response, take into account potential delayed effects of interventions, consider outcome measures less variable than HRV, and longer follow up times. Conclusion: This study suggests parasympathetic stimulation may occur with the application of suboccipital balanced ligamentous tension and sympathetic stimulation from measured breathing.

Disinhibited or Disconnected? Dietary Restraint Attenuates the Relationship Between Heart Rate Variability and Stress-Induced Suppression of Food Intake

Abstract: Literature on restrained eaters posits that the capacity to successfully diet is cognitively demanding, requiring exertion of cognitive control over one’s eating behaviour. Demands that deplete this limited inner resource can thus lead restrained eaters to become disinhibited and consume large amounts of food. Although self-regulation is inferred to play a role, it has not yet been studied in combination with its physiological correlates. As low heart rate variability (HRV) is associated with lower self-regulatory capacity, and acute mental stressors decrease HRV, it was hypothesized that reduced HRV during stress may mediate the relationship between stress and food intake, and that the mediation may be moderated by dietary restraint. Specifically, the moderation hypothesis predicted more restrained eaters would exhibit a stronger relationship between low HRV and intake. Female undergraduates ( n = 92) were randomized to a stress or control condition while HRV was recorded. Participants subsequently engaged in a bogus taste test to quantify post-stress consumption. Restraint was conceptualized using Hagan and colleagues’ (2017) latent restraint factors. A significant moderated mediation emerged for Weight-Focused Restraint, ab3 = .196, SE = .077, 95% CI [.060, .361] and Calorie Counting, ab3 = .062, SE = .023, 95% CI [.024, .115]. However, contrary to expectation, stress-induced HRV reduction was associated with decreased intake for those low in restraint, whereas intake was unrelated to HRV for individuals with higher dietary restraint. Further, there was no evidence of traditionally-defined disinhibition in more restrained eaters. Results suggest those with higher restraint show a relative disconnection from internal physiological cues shown to affect intake under stress in less restrained individuals.

Association of heart rate variability and C-reactive protein in patients with depression.

Depression has been shown to be correlated with cardiovascular (CV) morbidity and mortality. Inflammation and autonomic nervous system (ANS) dysfunction are possible causes. Numerous clinical studies have found an association between inflammatory pathways and the ANS. The aim of this study was to investigate the relationship between different heart rate variability (HRV) parameters and C-reactive protein (CRP) levels in depressed patients without concomitant diseases. Sixty-five depressed patients who were not taking medication participated in this cross-sectional study. The Tenth Revision of the International Classification of Diseases and Related Health Problems (ICD-10) categorization of mental and behavioral disorders served as the basis for the diagnosis of depression. HRV processing and analysis were performed using ADInstrument's Pro LabChart (PowerLab 8Pro) data analysis software. HRV was recorded for 5 min in an upright sitting position using a lead II electrocardiogram (ECG) (short-term HRV). CRP levels were measured using an ELISA (enzyme-linked immunosorbent assay) test. None of the measures of HRV showed a significant relationship with pulse rate, systolic blood pressure, diastolic blood pressure, or body mass index (BMI). Weight and BMI were strongly positively related (r = 0.420, P = 0.003) to pRR50 (percentage of successive RR intervals differing by more than 50 ms). Very low frequency (VLF), low frequency (LF), and the LF/HF (high frequency) ratio were all strongly positively correlated with CRP (r = 0.595, P = 0.001), whereas HF was also significantly negatively correlated (r = 0.383, P = 0.007). CRP had a significant negative correlation with the logarithm (ln) HF and a significant positive correlation with lnVLF, lnLF, and lnLF/HF. Measurement of resting HRV and CRP may be helpful in detecting CV disease in depressed patients. Low HRV and elevated serum CRP should prompt physicians to begin treatment for risk CV as soon as possible.

INTEGRATING HEART RATE VARIABILITY AND PSYCHOMETRIC ASSESSMENTS TO EVALUATE STRESS AND BURNOUT IN ICU NURSING STAFF: A PILOT STUDY

Background: Intensive Care Units (ICUs) are recognized as highly demanding environments that significantly contribute to stress and burnout among nursing staff. Despite increasing concern over burnout in healthcare, the relationship between physiological stress indicators, such as Heart Rate Variability (HRV), and psychometric assessments has not been thoroughly explored in this setting. Objective: This pilot study aimed to evaluate the relationship between HRV metrics and psychometric assessments of stress and anxiety in ICU nursing staff. Additionally, it explored the influence of shift type, shift duration, demographic factors, and lifestyle habits on these stress indicators. Methods: An observational cross-sectional pilot study was conducted with 24 ICU healthcare professionals at a University Hospital in Madrid, Spain. HRV data were collected under controlled conditions, with measurements taken at the beginning and end of shifts. Psychometric assessments were conducted using the State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS-14), Nursing Stress Scale (NSS) and a Visual Analogue Scale for Stress (VASS). Non-parametric statistical tests were used to analyze correlations between HRV metrics, psychometric scores, and demographic/lifestyle variables. Results: Significant negative correlations were observed between HRV metrics and perceived stress levels, particularly between the Low-Frequency to High-Frequency (LF/HF) ratio and stress measures. Night and extended shifts were associated with elevated stress, as indicated by lower HRV and higher psychometric stress scores. These findings suggest that shift type and duration significantly influence stress levels in ICU nursing staff. Conclusion: This pilot study highlights the potential of HRV as an objective measure of stress in ICU nursing staff, with significant correlations observed between HRV metrics and psychometric assessments. The findings suggest that HRV could be a valuable tool for monitoring stress in real time and identifying individuals at risk of burnout. However, further research with larger samples and a longitudinal approach is needed to validate these results and explore their implications for occupational health practices in ICU settings.

Cardiovascular autonomic nervous function in children conceived by assisted reproductive technology with frozen or fresh embryo transfer.

As a result of epigenetic changes, children conceived by assisted reproduction may be at risk of premature cardiovascular aging with notably increased blood pressures. Their cardiovascular autonomic nervous function is unknown. Therefore, this study investigated the cardiovascular autonomic nervous function in 8-12-yr-old children (51% girls) conceived naturally (n = 33) or by assisted reproduction with frozen (n = 34) or fresh (n = 38) embryo transfer by evaluating heart rate variability, during rest; from provocation maneuvers; and from baroreflex function. Heart rate and blood pressure response to provocation maneuvers and baroreflex function were comparable between children conceived naturally or by assisted reproduction. The mean RR-interval and high-frequency component of heart rate variability were lower in children conceived by assisted reproduction than in children conceived naturally. Children conceived by fresh embryo transfer had ∼17% lower heart rate-corrected standard deviation of normal-to-normal R-R intervals; ∼22% lower heart rate-corrected square root of the mean of the squared difference between successive R-R intervals; and ∼37% higher low-frequency/high-frequency ratio than naturally conceived children. Children conceived by assisted reproduction still had lower heart rate variability and vagal modulation than naturally conceived children after adjustment for confounders. Thus, these results raise the possibility of sympathetic predominance in children conceived by assisted reproduction. Therefore, it is important to reproduce these results in larger and older cohorts as sympathetic predominance relates with cardiovascular and metabolic diseases.NEW & NOTEWORTHY We observed that children conceived by assisted reproductive technology (both frozen and fresh embryo transfer) had lowered heart rate variability during rest as compared with children conceived naturally. During physiological stress maneuvers, however, the cardiovascular autonomic nervous regulation was comparable between children conceived by assisted reproductive technologies and naturally. Our findings highlight the potential that lowered heart rate variability during rest in children conceived by assisted reproductive technologies may precede premature hypertension.

Long term intraocular pressure fluctuation and epiretinal membrane in patients with glaucoma or glaucoma suspect

Aims/Purpose: The associations between ERM and glaucoma were suggested in several studies. In an animal model undergoing intermittent IOP elevations, a reactive gliosis, a phenotype of ERM, was found in the optic nerve head. We investigated the association between intraocular pressure (IOP) fluctuation and idiopathic ERM in patients with glaucoma or glaucoma suspect.Methods: In this retrospective study, a total of 84 patients with glaucoma or glaucoma suspect were included. Among them, forty one patients had no ERM and forty three patients had ERM. Long‐term fluctuation of IOP was defined as the standard deviation (SD) of IOP at all visits. Patients were divided into two groups according to the median value of SD of IOP: the low IOP fluctuation group and high IOP fluctuation group. Among patients with available heart rate variability (HRV) data, the relationship between the HRV parameter and IOP fluctuation was analysed.Results: Patients with ERM was older and had higher IOP fluctuation and higher proportion of having history of cataract surgery and greater macular thickness (p = 0.018, 0.049, 0.013, &lt; 0.001). The high IOP fluctuation group showed higher proportion of patients with ERM (62.5%) than the low IOP fluctuation group (36.4%, p = 0.028). In the multiple logistic analysis, higher IOP fluctuation group were associated with the presence of ERM (p = 0.047). Among patients with ERM, eyes with stage 3 or 4 ERM had worse visual field defects based on mean deviation than those with stage 1 or 2 ERM (p = 0.025). The high IOP fluctuation group showed higher level of low frequency HRV, an index of sympathetic cardiac control than the low IOP fluctuation group (p = 0.027). Intereye comparison in eyes with ERM and the fellow eyes without ERM, eyes with ERM (2.2 ± 0.9 mmHg) had higher fluctuation of IOP than those without ERM (2.0 ± 0.8 mmHg, p = 0.029).Conclusions: In conclusion, long‐term IOP fluctuation had the relevance to idiopathic ERM in patients with glaucoma or glaucoma suspect. In glaucoma patients with ERM, more advanced stage ERMs were associated with worse visual field damage. Further studies are needed to determine if long‐term IOP fluctuation affects the progression of glaucoma and ERM.

Heart rate of fire: exploring direct implementation of physiological measurements in realistic shoot/don't-shoot simulations.

Shooting simulations provide an excellent opportunity to train use-of-force decisions in controlled environments. Recently, military and law enforcement organizations have expressed a growing desire to integrate physiological measurement into simulations for training and feedback purposes. Although participants can easily wear physiological monitors in these scenarios, direct implementation into training may not be simple. Theoretical problems exist in the ultra-short heart rate variability windows associated with use-of-force training, and practical problems emerge as existing scenario libraries at training organizations were not designed for physiological monitoring. The current study explored the challenges and possibilities associated with direct implementation of physiological monitoring into an existing library of firearms training scenarios. Participants completed scenarios in a shooting simulator using existing military training scenarios while wearing a device to monitor their heart rate. The results revealed lower heart rate variability (approximately 6%) occurred in scenarios where participants did not have to fire weapons, indicating that don't-shoot scenarios may actually impose more cognitive stress on shooters. Additional evidence further demonstrated how both behavioral and physiological factors could be used concomitantly to predict unintentionally firing on non-hostile actors. However, behavioral measures were more predictive (e.g., β = .221) than physiological measures (e.g., β = -.132) when the latter metrics were limited to specific scenarios. Qualitative results suggest that simply applying physiological monitoring to existing shooting simulations may not yield optimal results because it would be difficult to directly integrate physiological measurement in a meaningful way without re-designing some elements of the simulations, the training procedure, or both. Future use-of-force shooting simulations should consider designing novel scenarios around the physiological measurement rather than directly implementing physiological assessments into existing libraries of scenarios.

THE EMOTION PARADOX IN THE AGING BODY AND BRAIN

Abstract With age, parasympathetic activity decreases while sympathetic activity increases. Thus, the typical older adult has low heart rate variability (HRV) and high noradrenergic activity. Younger adults with this physiological profile tend to be chronically unhappy and stressed. Yet, with age, emotional experience tends to improve. Why doesn’t older adults’ emotional well-being suffer as their HRV decreases? To address this apparent paradox, I present the autonomic compensation model. In this model, failing organs and initial phases of Alzheimer’s pathology trigger noradrenergic hyperactivity in older adults. Older brains attempt to compensate by increasing autonomic regulatory processes in ventromedial prefrontal (vmPFC) cortex. Age-related declines in nerve conduction reduce the ability of these compensatory attempts to reduce hyperactive noradrenergic activity and increase peripheral HRV. However, despite their muted effects on peripheral autonomic activity, these autonomic compensation attempts bias brain processing in favor of stimuli that tend to increase parasympathetic activity and against stimuli that tend to increase sympathetic activity. The autonomic compensation model can account for the “age-related positivity effect” in which, compared with younger adults, older adults show attentional and memory biases favoring positive over negative stimuli. Consistent with the autonomic compensation model, the age-related positivity effect is associated with vmPFC activity and functional connectivity and is evident even in early attention processes resistant to goal-directed processing. The autonomic compensation model posits that the aging brain responds to sympathetic hyperactivity in ways that amplify on-going automatic emotion regulation processes and so help maintain emotional well-being.

THE AGING BRAIN: A NEUROVISCERAL INTEGRATION PERSPECTIVE

Abstract Healthy aging is associated with significant changes in both the brain and the heart. The changes between these, the two most important organs of the body, are linked via the vagus nerve. Using a model of Neurovisceral Integration I will describe how autonomic imbalance and decreased parasympathetic tone in particular may be the final common pathway linking negative affective states and conditions to ill health. The central nervous system network that regulates autonomic balance is closely related and partially overlaps with networks serving executive, social, affective, cognitive, and motivated behavior. This inhibitory cortico-subcortical circuit may structurally as well as functionally, link psychological processes with health-related physiology. When the prefrontal cortex is taken “offline” for whatever reason, parasympathetic inhibitory action is withdrawn and a relative sympathetic dominance associated with disinhibited defensive circuits is released, which can be pathogenic when sustained for long periods. This state is indicated by low heart rate variability (HRV), which is a marker for low parasympathetic activation and prefrontal hypoactivity. In this presentation, I examine the normative changes with aging and the effect that stress may have on how the brain–heart connection changes with age. I will present data linking peripheral physiology to brain structure and function. I conclude by noting that significant sex and ethnic differences exist but that future studies are needed to more fully explicate how they may influence the aging brain and its association with the cardiovascular system.