Similar Heart Rate Research Articles

Cardiovascular changes during daily torpor in the laboratory mouse

The laboratory mouse is a facultative daily heterotherm in that it experiences bouts of torpor under caloric restriction. Mice are the most frequently studied laboratory mammal, and often, genetically modified mice are used to investigate many physiological functions related to weight loss and caloric intake. As such, research documenting the cardiovascular changes during fasting-induced torpor in mice is warranted. In the current study, C57BL/6 mice were implanted either with EKG/temperature telemeters or blood pressure telemeters. Upon fasting and exposure to an ambient temperature (T(a)) of 19 degrees C, mice entered torpor bouts as assessed by core body temperature (T(b)). Core T(b) fell from 36.6 +/- 0.2 degrees C to a minimum of 25.9 +/- 0.9 degrees C during the fast, with a concomitant fall in heart rate from 607 +/- 12 beats per minute (bpm) to a minimum of 158 +/- 20 bpm. Below a core T(b) of 31 degrees C, heart rate fell exponentially with T(b), and the Q(10) was 2.61 +/- 0.18. Further, mice implanted with blood pressure telemeters exhibited similar heart rate and activity profiles as those implanted with EKG/temperature telemeters, and the fall in heart rate and core T(b) during entrance into torpor was paralleled by a fall in blood pressure. The minimum systolic, mean, and diastolic blood pressures of torpid mice were 62.3 +/- 10.2, 51.9 +/- 9.2, 41.0 +/- 7.5 mmHg, respectively. Torpid mice had a significantly lower heart rate (25-35%) than when euthermic at mean arterial pressures from 75 to 100 mmHg, suggesting that total peripheral resistance is elevated during torpor. These data provide new and significant insight into the cardiovascular adjustments that occur in torpid mice.

Maternal renal dysfunction in sheep is associated with salt insensitivity in female offspring

To examine the programming effects of maternal renal dysfunction (created by subtotal nephrectomy in ewes prior to mating; STNx), renal and cardiovascular function were studied in 6-month-old male and female offspring of STNx and control pregnancies. After studies were conducted on a low salt diet (LSD) some female offspring underwent salt loading (0.17 M NaCl in the drinking water for 5-7 days; HSD). On LSD both male and female offspring of STNx had similar mean arterial pressures (MAP), heart rates, cardiac outputs and renal function to those measured in offspring of control ewes. In female STNx offspring on a HSD, plasma sodium levels increased and haematocrits fell, indicating volume expansion (P < 0.05). Plasma renin levels were not suppressed despite the increases in plasma sodium concentrations, but aldosterone levels were reduced. In control animals plasma renin levels fell (P < 0.05) but there was no change in plasma aldosterone concentrations. There was a positive relationship between GFR and MAP which was present only in female STNx offspring. In conclusion, in STNx offspring there was an impaired ability to regulate glomerular filtration independent of arterial pressure, renin release was insensitive to a high salt intake and control of aldosterone secretion was abnormal. This study provides evidence of abnormal programming of the renin-angiotensin system and glomerular function in offspring of pregnancies in which there is impaired maternal renal function.

ECG-Edited Middiastolic Phase Reconstruction Improves Image Quality at 64-MDCT Coronary Angiography of Patients with Atrial Fibrillation

The aims of this study were to evaluate image quality at the absolute middiastolic and absolute end-systolic phases of 64-MDCT coronary angiography of patients with atrial fibrillation and to compare the findings with those among patients in sinus rhythm. Nineteen consecutively registered patients with atrial fibrillation and 19 patients in sinus rhythm taking heart-rate-lowering agents as needed underwent MDCT. Images were reconstructed with a half-scan reconstruction algorithm after ECG editing (deletion of short R-R intervals, insertion of additional temporal windows into the middiastolic phase of long R-R intervals, and shift of R points). We used a 5-point scale (4, no motion artifacts; 0, unevaluable) to evaluate motion artifacts and coronary artery image discontinuities greater than 1 mm on the curved multiplanar reconstruction images. Each coronary artery image with a motion score of 2 or greater for all segments and with 2 or fewer discontinuities was considered acceptable for diagnosis. Middiastolic images of patients with atrial fibrillation showed fewer motion artifacts and image discontinuities than did end-systolic images of patients with atrial fibrillation. Despite greater heart rate variability under the condition of similar mean heart rates in patients with atrial fibrillation, motion artifacts and image discontinuities on middiastolic images were not significantly different from those on sinus rhythm images. Acceptable quality was achieved on 91% of middiastolic atrial fibrillation images and 93% of sinus rhythm images. ECG-edited middiastolic atrial fibrillation images with aggressive heart rate control were of better quality than end-systolic images in patients with atrial fibrillation. The diagnostic image quality of the middiastolic images was comparable with that of sinus rhythm images.

Cardiovascular function in humans during exercise: role of the muscle pump

Cardiovascular function in humans during exercise: role of the muscle pump

Nuclear magnetic resonance‐based metabolomics predicts exercise‐induced ischemia in patients with suspected coronary artery disease

The purpose of this study was to develop a (1)H-nuclear magnetic resonance metabolomic approach capable of predicting the occurrence of exercise-induced ischemia in patients with suspected coronary artery disease and to identify the metabolite patterns that contribute most importantly to the prediction. In 31 patients with suspected effort angina and without previous myocardial infarction, serum was obtained just prior to a stress single-photon emission computed tomography. Serum NMR spectra were acquired with pulse-and-acquire and T(2)-edited sequences. The region between 0.50 and 4.25 ppm was used for analysis. Twenty-two patients had reversible myocardial perfusion defects and nine did not. Both groups had similar age and clinical profile, except for more smokers and diabetics in the ischemia group, and attained a similar peak heart rate. The best separation was achieved with long T(2)-edited spectra, 84% of patients being correctly classified based on the partial least square discriminant analysis. The main contributors to discrimination were lactate, glucose, as well as methyl and methylene moieties of lipids and long-chain amino acids. Metabolomic analysis of serum can predict exercise-inducible ischemia in patients with suspected coronary artery disease. This capability could be useful in screening and risk stratification of patients with coronary risk factors.

Functional effects of cardiac sympathetic denervation in neurogenic orthostatic hypotension

Background Diseases characterized by neurogenic orthostatic hypotension (NOH), such as Parkinson disease (PD) and pure autonomic failure (PAF), are associated with cardiac sympathetic denervation, as reflected by low myocardial concentrations of 6-[ 18F]fluorodopamine-derived radioactivity. We studied the impact of such denervation on cardiac chronotropic and inotropic function. Methods Cardiac inotropic function was assessed by the pre-ejection period index and the systolic time ratio index in response to the directly acting beta-adrenoceptor agonist, isoproterenol, and to the indirectly acting sympathomimetic amine, tyramine, in patients with PD + NOH or PAF (PD + NOH/PAF group, N = 13). We compared the results to those in patients with multiple system atrophy, which usually entails NOH with normal cardiac sympathetic innervation (MSA, N = 15), and in normal control subjects ( N = 5). Results The innervated and denervated groups did not differ in baseline mean pre-ejection period index or systolic time ratio index. Tyramine increased cardiac contractility in the MSA patients and controls but not in the PD + NOH/PAF group. For similar heart rate responses, the PD + NOH/PAF group required less isoproterenol ( p < 0.01) and had lower plasma isoproterenol levels ( p < 0.01) than did the MSA group. Conclusions Among patients with NOH those with cardiac sympathetic denervation have an impaired inotropic response to tyramine and exaggerated responses to isoproterenol. This pattern suggests that cardiac denervation is associated with decreased ability to release endogenous norepinephrine from sympathetic nerves and with supersensitivity of cardiac beta-adrenoreceptors.

Comparison of pharmacodynamics between carvedilol and metoprolol in rats with isoproterenol-induced cardiac hypertrophy: Effects of carvedilol enantiomers

A recent clinical study has shown that carvedilol has a significantly more favorable effect than metoprolol on survival rate in patients with heart failure. This may be due to actions of carvedilol such as β2-adrenoceptor blockade, α-adrenergic receptor blockade and other properties such as anti-oxidant effects that are not yet fully understood. We compared the effects of racemic carvedilol, metoprolol and carvedilol enantiomers on cardiac hypertrophy at similar heart rate in rats with isoproterenol-induced cardiac hypertrophy. Continuous administration of isoproterenol for 2 weeks produced heart failure, which is characterized by an increased heart rate, cardiac hypertrophy and downregulation of β-adrenoceptors. The doses of racemic carvedilol and metoprolol were adjusted to obtain a similar heart rate in rats with isoproterenol-induced cardiac hypertrophy. The reduction of left ventricular weight and improvement of cAMP production induced by carvedilol were superior to those induced by metoprolol. Although heart rate, blood pressure and cAMP production were not affected by R-carvedilol, left ventricular weight was significantly reduced as a result of α-adrenoceptor blockade. The improvement of cAMP production by S-carvedilol was significantly higher than that induced by coadministration of R-carvedilol and metoprolol, suggesting that β2-adrenoceptor blockade partly contributed to the improvement of signal transduction in rats with isoproterenol-induced cardiac hypertrophy. This study has demonstrated that the effects of carvedilol on cAMP production and cardiac hypertrophy in rats with isoproterenol-induced cardiac hypertrophy are superior to those induced by metoprolol at a similar heart rate.

Watching emotional movies: Affective reactions and gender differences

Previous studies have found that unpleasant film clips depicting mutilated bodies or injuries evoke a sustained heart rate deceleration which has been interpreted as reflecting a stimulus-specific aversive response or as increased orienting and attentional processing that varies with stimulus significance. Few studies, however, have examined cardiac changes during the viewing of high arousal pleasant films. To clarify this issue, the present study assessed evaluative, facial and autonomic reactions in both men and women during the viewing of highly arousing pleasant, as well as unpleasant, films. Results indicated a similar skin conductance increase and heart rate deceleration which were greater than those observed during the viewing of a neutral film. Compared to men, women rated both films as less pleasant and rated the unpleasant film as more arousing. The present findings suggest that sustained exposure to pleasant and unpleasant stimuli elicit similar cardiac orienting when stimuli are equated for subjective report of emotional arousal.

Restrictive Left Ventricular Filling Pattern Does Not Result From Increased Left Atrial Pressure Alone

The restrictive filling pattern seen with severe heart failure (HF) may be due to diastolic dysfunction with elevated left ventricular (LV) diastolic pressure or may be merely a manifestation of an overfilled LV as a result of increased left atrial (LA) pressure. We investigated whether the LV restrictive filling pattern is due to elevated LA pressure alone. We studied conscious dogs instrumented to measure LA pressure, LV pressure, and 3 LV diameters. LV filling dynamics were evaluated in 2 situations with similar elevations of LA pressure: in normal animals after rapid volume loading with dextran 500 mL and in animals with pacing-induced HF with restrictive filling. With HF, there was increased LV chamber stiffness and slow relaxation. Volume loading and HF had similar heart rates (129+/-19 versus 131+/-15 bpm) and LA pressure (22.1+/-5.8 versus 22.6+/-3.3 mm Hg). The peak early filling rate (E) was increased with both HF and volume loading. However, in HF, the peak mitral annular velocity (E') was decreased and delayed, and the E deceleration time was shorter. In contrast, with volume loading, E' was increased and not delayed. The restrictive filling pattern is distinguished from overfilling of a normal ventricle by a reduced and delayed E' and a shortened E deceleration time that reflect slow relaxation and increased LV stiffness.

Daily Physical Activity and Heart Rate Response in People With a Unilateral Traumatic Transtibial Amputation

Bussmann JB, Schrauwen HJ, Stam HJ. Daily physical activity and heart rate response in people with a unilateral traumatic transtibial amputation. Objectives To test the hypothesis that people with a unilateral traumatic transtibial amputation are less active than people without an amputation, and to explore whether both groups have a similar heart rate response while walking. Design A case-comparison study. Setting General community. Participants Nine subjects with a unilateral traumatic transtibial amputation and 9 matched subjects without known impairments. Interventions Not applicable. Main Outcome Measures Percentage of dynamic activities in 48 hours (expressing activity level). Additionally, we examined heart rate and percentage heart rate reserve during walking (expressing heart rate response) and body motility during walking (expressing walking speed). These parameters were objectively measured at participants’ homes on 2 consecutive days. Results Subjects with an amputation showed a lower percentage of dynamic activities (6.0% vs 11.7% in a 48-h period, P=.02). No significant differences were found between the 2 groups in heart rate (91.1bpm vs 89.5bpm, P=.86) and percentage heart rate reserve during walking (28.2% vs 27.5%, P=1.0). Body motility during walking was lower in the amputation group (.14 g vs .18 g, P<.01). Conclusions Our results support our hypothesis that persons with a unilateral traumatic transtibial amputation are considerably less active than persons without known impairments. The results indicate that heart rate response during walking is similar in both groups, and is probably regulated by adapting one’s walking speed.

Persistent Atrial Fibrillation Is Associated With Reduced Risk of Torsades de Pointes in Patients With Drug-Induced Long QT Syndrome

The goal of this study was to identify markers of torsades de pointes (TdP) in patients with drug-associated long QT syndrome (LQTS). Drug-induced LQTS includes individuals developing marked prolongation of ventricular repolarization on exposure to an offending drug. Under these conditions, TdP develops in some but not all patients. This was a case-control study of 123 adults with drug-associated LQTS. Patients were divided into LQTS only (LQTS; n = 40, QT >500 ms on drug) and LQTS + TdP (TdP; n = 83). Baseline QT intervals were similar in the 2 groups (381 +/- 38 ms [LQTS] vs. 388 +/- 43 ms [TdP]). Clinical variables associated with risk of TdP included hypokalemia and female gender; by contrast, persistent atrial fibrillation (AF) at the time of drug discontinuation for QT prolongation was protective despite similar heart rates in AF and sinus rhythm (n = 20, 71 +/- 13 beats/min vs. 69 +/- 13 beats/min). Electrocardiographic variables that significantly increased the risk for TdP included absolute and rate-corrected QT intervals (QTc) on drug therapy, the magnitude of QT and QTc interval prolongation, and the change in T(peak) to T(end) (DeltaT(p)-T(e)), a relatively new index of transmural dispersion of repolarization and potential arrhythmogenicity. Multivariable logistic regression analysis revealed that only gender was predictive for TdP, whereas persistent AF at the time of drug discontinuation for QT prolongation (odds ratio 0.14, 95% confidence interval 0.03 to 0.63, p = 0.01) was negatively associated with the arrhythmia. This study strongly suggests that despite ongoing rate irregularity, AF reduces the likelihood of developing TdP after the administration of drugs that prolong cardiac repolarization.

Effect of time of preparation on pentagastrin-induced symptom, endocrine and cardiovascular responses

Pentagastrin is a cholecystokinin (CCK)-B agonist and laboratory panicogenic agent that produces endocrine (ACTH and cortisol), symptom (anxiety, panic) and cardiovascular (heart rate) responses. Although in vitro data have supported its chemical stability, preliminary data suggested that increasing time between drug preparation and drug infusion could reduce the magnitude of endocrine and symptom responses. The current study examined this possibility. Twenty-one healthy subjects presented at the University of Michigan General Clinical Research Center (GCRC) and had an intravenous catheter inserted. Heart rate, cortisol levels and subjective anxiety were measured before and after pentagastrin and placebo injections. Pentagastrin was prepared either within 60 min of IV infusion (Normal Preparation group) or at least 3.5 h prior to infusion (Early Preparation group). Relative to the Normal Preparation group, Early Preparation subjects had similar heart rate responses but significantly smaller cortisol and subjective anxiety responses. Early preparation of pentagastrin thus appears to weaken endocrine and subjective anxiety responses, highlighting the importance of attending to often overlooked procedural variables (e.g., time between preparation and administration) in studies of this type. The sensitivity of cortisol and anxiety responses to preparation time, but insensitivity of heart rate, is consistent with previous studies suggesting different thresholds of activation for the three response modalities. These differential sensitivities may suggest different and separable CCK-B stimulated pathways for each response, which combine to produce panic, rather than a single, unified CCK-B mediated panicogenic response.

Comparative Dose Titration Responses to the Introduction of Bisoprolol or Carvedilol in Stable Chronic Systolic Heart Failure

Several beta blocking drugs (BB) reduce mortality in systolic heart failure (LVSD). We have compared the initial response to introduction of carvedilol and bisoprolol during the standard dose titration protocols for each drug. Approximately 31 unselected patients with stable LVSD were randomised to either carvedilol or bisoprolol measuring blood pressure, heart rate responses and both time and frequency domain heart rate variability (HRV). One subject died; five withdrew due to intolerable BB related side effects. Carvedilol (n = 13) and bisoprolol (n = 12) attained similar maximal heart rate reduction and induced comparable falls in systolic and diastolic blood pressure. Higher carvedilol doses were associated with lower blood pressure compared to baseline. Individual time domain HRV indices remained unchanged over the initial titration period. Significant increases in triangular Index (TI) were seen with both BB. Carvedilol demonstrated greater (but non-significant) rises in TI compared to Bisoprolol. In this study we found similar degrees and rate of onset of HR, HRV and BP response to both carvedilol and bisoprolol in treated LVSD patients. Carvedilol appears to show superior HRV rises compared to bisoprolol during initial titration. Any significant increases in HRV attributable to carvedilol compared to bisoprolol may emerge over a longer treatment interval in LVSD.

A quantitative assessment of T-wave morphology in LQT1, LQT2, and healthy individuals based on Holter recording technology

The clinical course and the precipitating risk factors in the congenital long QT syndrome (LQTS) are genotype specific. The goal of this study was to develop a computer algorithm allowing for electrocardiogram (ECG)-based identification and differentiation of LQT1 and LQT2 carriers. Twelve-lead ECG Holter monitor recordings were acquired in 49 LQT1 carriers, 25 LQT2 carriers, and 38 healthy subjects as controls. The cardiac beats were clustered based on heart-rate bin method. Scalar and vectorial repolarization parameters were compared for similar heart rates among study groups. The Q to Tpeak (QTpeak), the Tpeak to Tend interval, T-wave magnitude and T-loop morphology were automatically quantified using custom-made algorithms. QTpeak from lead II and the right slope of the T-wave were the most discriminant parameters for differentiating the 3 groups using prespecified heart rate bin (75.0 to 77.5 beats/min). The predictive model utilizing these scalar parameters was validated using the entire spectrum of heart rates. Both scalar and vectorcardiographic models provided very effective identification of tested subjects in heart rates between 60 and 100 beats/min, whereas they had limited performance during tachycardia and slightly better discrimination in bradycardia. In the 60 to 100 beats/min heart rate range, the best 2-variable model identified correctly 89% of healthy subjects, 84% of LQT1 carriers, and 92% of LQT2 carriers. A model including 3 parameters based purely on scalar ECG parameters could correctly identify 90% of the population (89% of healthy subjects, 90% of LQT1 carriers, and 92% of LQT2 carriers). Automatic algorithm quantifying T-wave morphology discriminates LQT1 and LQT2 carriers and healthy subjects with high accuracy. Such computerized ECG methodology could assist physicians evaluating subjects suspected for LQTS.

Improved Exercise Capacity during Single Ventricle Cycle Ergometry in Fontan Patients Post TVanscatheter Fenestration Closure

PURPOSE: To evaluate the exercise capacity of patients that have undergone a transcatheter Fontan fenestration closure. METHODS: We evaluated 11 patients (6 males, mean age 15 yrs) pre and post closure with a standardized cycle ergometer protocol developed for patients with single ventricle physiology. The average time between the two tests was 132 days. Successful fenestration closure was accomplished in all using an Amplatzer device 8.9 ± 2.9 years post Fontan. All had suitable anatomy and hemodynamics. RESULTS: Immediately following closure during cardiac catheterization, arterial saturation increased from 91 to 95% and cardiac index decreased from 2.4 to 1.8 (L/min/m2) (p<0.05). Similar peak heart rates were achieved during both exercise tests. Rest, submaximal and peak exercise O2 saturation increased from 88, 84 and 81% to 95, 94 and 92% respectively. Peak VO2, total working capacity and exercise duration increased by 7%, 17% and 11% respectively (p<0.005, p<0.05).TableCONCLUSION: O2 saturation improves throughout exercise after transcatheter fenestration closure in Fontan patients resulting in an increased aerobic and exercise capacity. These results indicate that during dynamic exercise, improved oxygen saturation increases oxygen uptake and more than compensates for the restricted resting cardiac output obtained immediately after fenestration closure with the Amplatzer device.

Is aerobic endurance a determinant of cardiac autonomic regulation?

The aim of this study was to determine if subjects matched for VO2max but with differing aerobic endurance displayed similar heart rate variability (HRV) at rest and heart rate recovery (HRR) after maximal exercise. We hypothesized that the higher the aerobic endurance, the higher the HRV and the faster the HRR. Twenty-eight well trained middle- and long-distance runners (24 men and 4 women) performed a maximal continuous graded exercise test for the determination of maximal oxygen consumption (VO2max), ventilatory threshold (VT), peak treadmill velocity (PTV) and HRR, as well as a test to measure the autonomic regulation of heart rate during supine rest, using HRV analysis. Once both tests were completed, subjects were matched for VO2max and assigned to the low endurance or the high endurance group, depending on the %PTV at which VT occurred (81.9 +/- 2.9 and 88.3 +/- 3.1%PTV for both groups, respectively; P < 0.0001). Contrary to our hypotheses, neither HRV nor HRR parameters were different between groups or associated with aerobic endurance. VO2max (59.0+/-7.3 ml min(-1) kg(-1)) was inversely correlated with ln SDNN (r = -0.44, P < 0.05), ln HF (r = -0.52, P < 0.05), ln LF + HF (r = -0.53, P < 0.05). These results suggest that aerobic endurance is not associated with cardiovascular autonomic control, as measured by HRV and HRR.

Conversion of post-systolic wall thickening into ejectional thickening by selective heart rate reduction during myocardial stunning

Post-systolic wall thickening (PSWT) occurs after aortic valve closure. This waste of thickening does not participate in ejection. PSWT increases with myocardial ischaemia and stunning but the effects of anti-anginal drugs on PSWT during myocardial dysfunction remain unknown. The effects of two heart rate reducing agents, i.e. the beta-blocker atenolol and the selective I(f) current inhibitor ivabradine, were compared on PSWT. Coronary stenosis was calibrated in six conscious instrumented dogs to suppress increase in coronary blood flow during a 10 min treadmill exercise to induce myocardial stunning. After exercise completion, stenosis was relieved and saline, atenolol or ivabradine (both at 1 mg/kg iv) were administered. For similar heart rate reduction, ivabradine attenuated stunning, whereas atenolol further depressed systolic wall thickening. PSWT to total wall thickening ratio was significantly decreased by ivabradine vs. saline, whereas total wall thickening was similar. Thus, ivabradine devoted a greater part of thickening to systole by converting PSWT into ejectional thickening. In contrast, atenolol failed to reduce PSWT vs. saline. Atrial pacing abolished the effects of ivabradine but not those of atenolol. Selective heart rate reduction with ivabradine converts PSWT into ejectional thickening but not with atenolol secondary to its negative inotropism.

Integrated assessment of multilevel biomarker responses and chemical analysis in mussels from São Sebastião, São Paulo, Brazil

The aim of the present study was to investigate the presence of contaminants in the mussel Perna perna from São Sebastião Channel, São Paulo, Brazil, and to evaluate the effects of these contaminants on these organisms at biochemical (catalase [CAT], glutathione-S-transferase [GST], and cholinesterase [ChE]), cellular (neutral red retention time [NRRT] assay), and physiological (cardiac monitoring) levels. Two sampling surveys were performed (winter of 2001 and summer of 2002) at six stations along the channel: Cigarras, station 1; Iate Clube de Ilhabela, station 2; Oil Terminal, station 3; Toque Toque, station 4; Ponta da Sela, station 5 (reference station); and Taubaté, station 6. Differences in CAT activity were observed between mussels from stations 3 and 5 during the winter, but no differences were detected in the summer. No differences in GST activity were found among stations during the winter, although animals from station 3 showed higher activity during the summer. The ChE activity was significantly higher in the mussels from stations 1 and 2 during the winter and from stations 1 and 3 during the summer. Organisms from stations 1 through 4 showed statistically lower NRRT in both seasons. Similar heart rates were observed in the mussels from all stations. Hydrocarbons were detected in organisms from all the stations in both seasons. During the winter, higher polycyclic aromatic hydrocarbon (PAH) levels were observed in organisms from station 3, whereas during the summer, higher levels of metals were found in organisms from stations 1, 3, and 4. The multivariate analyses showed a strong influence of PAHs on the winter biological results, but metals showed higher influence on these responses in the summer, indicating multiple contaminant sources.

QT hysteresis in long-QT syndrome children with exercise testing

Congenital long QT syndrome (LQTS) is an inherited ion channel disorder resulting in abnormal cardiac repolarization that can cause syncope and sudden death associated with a prolonged rate-corrected QT interval and polymorphic ventricular tachycardia. Several studies in adults showed that LQTS patients have altered QT adaptation to heart rate changes compared with normal subjects which forming a "hysteresis loop" in the QT-circle length plot. This study was to observe the QT interval changing during exercise testing in children long QT syndrome (LQTS) patients, explore the new diagnosis methods of LQTS. The subjects were divided into 3 groups according to 1993 LQTS diagnostic criteria. Group 1: LQTS group (n = 17) who scored > or = 4 points indicating definite LQTS. Group 2: Middle group (n = 16), patients who have prolonged QT interval but scored 1.5 to 3.5. Group 3: Normal control group (n = 18). The average age of all study population is (12.3 +/- 5.8) years. No case had beta-adrenergic antagonists administration before exercise testing. All subjects were underwent tread mill exercise testing and electrocardiograph in whole exercise testing and recovery were recorded. QT and heart rate changing during whole exercise testing period were recorded. DeltaQT, the QT interval at 1, 2, 4, 6 minutes into recovery subtract from the QT interval at a similar heart rate during exercise, were calculated. In all three groups, QT intervals were shortening with the increasing of heart rate, but QTc had no significant change. DeltaQT at 1 minute ((45 +/- 11) ms), 2 minutes ((37 +/- 15) ms), 4 minutes ((23 +/- 12) ms) into recovery in LQTS group were significantly greater than that of the other two groups (P < 0.05, P < 0.01, P < 0.01, respectively). There was no DeltaQT significant difference between middle group and normal control group at recovery time. During the recovery phase in LQTS group, the QT interval remained shortened despite a decelerating heart rate, forming a hysteresis "loop" in the curve relating the QT interval to the cycle length. In children LQTS patients, there is significant QT hysteresis loop in the relation of QT interval with heart rate during recovery of exercise testing, which could be useful to the early diagnosis for LQTS.

Heart rate reduction by inhibition of If or by β‐blockade has different effects on postsystolic wall thickening

Postsystolic wall thickening (PSWT) is part of thickening that occurs after end-systole and represents wasted effort as it does not contribute to ejection. The effects of antianginal drugs on PSWT remain to be established. We compared the effects on PSWT of two agents that reduce heart rate, the beta-blocker atenolol and the selective inhibitor of If current, ivabradine. Six dogs were prepared to measure wall thickening by sonomicrometry in the conscious state, at rest and during exercise, after administration of saline, atenolol (1 mg.kg-1) or ivabradine (1 mg.kg-1). Atenolol and ivabradine similarly reduced heart rate vs saline at rest (about 10-20%) and during exercise (about 30%). Atenolol but not ivabradine decreased dP/dtmax. Concomitantly, PSWT increased with atenolol vs saline at rest (0.35+/-0.07 vs 0.21+/-0.03 mm, respectively) and during exercise (0.30+/-0.04 vs 0.15+/-0.04 mm, respectively). In contrast, ivabradine did not alter PSWT. Importantly, atenolol but not ivabradine increased the ratio of postsystolic to systolic wall thickening by 80+/-23%. This enhanced thickening during diastole with atenolol was accompanied by impeded isovolumic relaxation of the left ventricle, as illustrated by the significant correlation between the isovolumic relaxation time constant tau and the postsystolic to systolic wall thickening ratio. None of these effects of atenolol were abolished when heart rate was controlled with atrial pacing. For a similar heart rate reduction at rest and during exercise, ivabradine, but not atenolol, did not alter PSWT and preserved the part of thickening contributing to ejection.