Time Domain Heart Rate Variability Research Articles

Long term follow-up of heart rate variability in healthcare workers with mild COVID-19

IntroductionPrior investigations into post-COVID dysautonomia often lacked control groups or compared affected individuals solely to healthy volunteers. In addition, no data on the follow-up of patients with SARS-CoV-2-related autonomic imbalance are available.MethodsIn this study, we conducted a comprehensive clinical and functional follow-up on healthcare workers (HCWs) with former mild COVID-19 (group 1, n = 67), to delineate the trajectory of post-acute autonomic imbalance, we previously detected in a case–control study. Additionally, we assessed HCWs for which a test before SARS-CoV-2 infection was available (group 2, n = 29), who later contracted SARS-CoV-2, aiming to validate findings from our prior case–control investigation. We evaluated autonomic nervous system heart modulation by means of time and frequency domain heart rate variability analysis (HRV) in HCWs during health surveillance visits. Short-term electrocardiogram (ECG) recordings, were obtained at about 6, 13 months and both at 6 and 13 months from the negative SARS-CoV-2 naso-pharyngeal swab (NPS) for group 1 and at about 1-month from the negative NPS for group 2. HCWs who used drugs, had comorbidities that affected HRV, or were hospitalized with severe COVID-19 were excluded.ResultsGroup 1 was split into three subgroups clinically and functionally followed at, about 6 months (subgroup-A, n = 17), 13 months (subgroup-B, n = 37) and both at 6 and 13 months (subgroup-C, n = 13) from the negative SARS-CoV-2 NPS. In subgroup-A, at 6-month follow-up compared with baseline, the spectral components in the frequency domain HRV parameters, showed an increase in normalized high frequency power (nHF) (t = 2.99, p = 0.009), a decrease in the normalized low frequency power (nLF) (t = 2.98, p = 0.009) and in the LF/HF ratio (t = 3.13, p = 0.006). In subgroup B, the comparison of the spectral components in the frequency domain HRV parameters, at 13-month follow-up compared with baseline, showed an increase in nHF (t = 2.54, p = 0.02); a decrease in nLF (t = 2.62, p = 0.01) and in the LF/HF ratio (t = 4.00, p = 0.0003). In subgroup-C, at both 6 and 13-month follow-ups, the spectral components in the frequency domain HRV parameters were higher than baseline in nHF (t = 2.64, p = 0.02 and (t = 2.13, p = 0.05, respectively); lower in nLF (t = 2.64, p = 0.02 and (t = 2.13, p = 0.05, respectively), and in LF/HF (t = 1.92, p = 0.08 and (t = 2.43, p = 0.03, respectively). A significant proportion of HCWs reported persistent COVID-19 symptoms at both the 6 and 13-month follow-ups, seemingly unrelated to cardiac autonomic balance. In group 2 HCWs, at 1-month follow-up compared with baseline, the spectral components in the frequency domain HRV parameters, showed a decrease in nHF (t = 2.19, p = 0.04); an increase in nLF (t = 2.15, p = 0.04) and in LF/HF (t = 3.49, p = 0.002).ConclusionThese results are consistent with epidemiological data suggesting a higher risk of acute cardiovascular complications during the first 30 days after COVID-19. The SARS-CoV-2 associated autonomic imbalance in the post-acute phase after recovery of mild COVID-19 resolved 6 months after the first negative SARS-CoV-2 NPS. However, a significant proportion of HCWs reported long-term COVID-19 symptoms, which dot not seems to be related to cardiac autonomic balance. Future research should certainly further test whether autonomic imbalance has a role in the mechanisms of long-COVID syndrome.

The effect of sitting baduanjin in patients with ST-segment elevation acute myocardial infarction after percutaneous coronary intervention: A quasi-experimental study

BackgroundEarly cardiac rehabilitation plays a crucial role in the recovery of patients with ST-segment elevation acute myocardial infarction (STEMI) following percutaneous coronary intervention (PCI). This study sought to determine the effect of a program of sitting Baduanjin exercises on early cardiac rehabilitation. ObjectiveThe goal of this study was to investigate the effects of sitting Baduanjin exercises on cardiovascular and psychosocial functions in patients with STEMI following PCI. MethodsThis quasi-experimental study employed a randomized, non-equivalent group design. Patients in the intervention group received daily sitting Baduanjin training in addition to a series of seven-step rehabilitation exercises, whereas those in the control group received only the seven-step rehabilitation training, twice daily. Differences in heart rate variability (HRV) indicators, exercise capacity (Six-Minute Walking Distance; 6-MWD), anxiety (Generalized Anxiety Disorder-7; GAD-7), and depression (Patient Health Questionnaire-9; PHQ-9) between the two study groups during hospitalization were analyzed. ResultsPatients in the intervention group exhibited lower rates of abnormalities in the time domain and frequency domain parameters of HRV. The median scores of GAD-7 and PHQ-9 in both groups were lower than those at the time of admission, with the intervention group exhibiting lower scores than the control group (P < 0.001; P < 0.001, respectively). The 6-MWD after the intervention was greater in the intervention group compared to the control group (P = 0.014). ConclusionsWe found that sitting Baduanjin training has the potential to enhance HRV, cardiac function, and psychological well-being in patients with STEMI after PCI. This intervention can potentially improve the exercise capacity of a patient before discharge.

Effects of three weeks base training at moderate simulated altitude with or without hypoxic residence on exercise capacity and physiological adaptations in well-trained male runners.

To test the hypothesis that 'live high-base train high-interval train low' (HiHiLo) altitude training, compared to 'live low-train high' (LoHi), yields greater benefits on performance and physiological adaptations. Sixteen young male middle-distance runners (age, 17.0 ± 1.5 y; body mass, 58.8 ± 4.9 kg; body height, 176.3 ± 4.3 cm; training years, 3-5 y; training distance per week, 30-60 km.wk-1) with a peak oxygen uptake averaging ~65 ml.min-1.kg-1 trained in a normobaric hypoxia chamber (simulated altitude of ~2,500 m, monitored by heart rate ~170 bpm; thrice weekly) for 3 weeks. During this period, the HiHiLo group (n = 8) stayed in normobaric hypoxia (at ~2,800 m; 10 h.day-1), while the LoHi group (n = 8) resided near sea level. Before and immediately after the intervention, peak oxygen uptake and exercise-induced arterial hypoxemia responses (incremental cycle test) as well as running performance and time-domain heart rate variability (5-km time trial) were assessed. Hematological variables were monitored at baseline and on days 1, 7, 14 and 21 during the intervention. Peak oxygen uptake and running performance did not differ before and after the intervention in either group (all P > 0.05). Exercise-induced arterial hypoxemia responses, measured both at submaximal (240 W) and maximal loads during the incremental test, and log-transformed root mean square of successive R-R intervals during the 4-min post-run recovery period, did not change (all P > 0.05). Hematocrit, mean reticulocyte absolute count and reticulocyte percentage increased above baseline levels on day 21 of the intervention (all P < 0.001), irrespective of group. Well-trained runners undertaking base training at moderate simulated altitude for 3 weeks, with or without hypoxic residence, showed no performance improvement, also with unchanged time-domain heart rate variability and exercise-induced arterial hypoxemia responses.

Analysis of the factors of heart rate variability affected after a hypoxia tolerance test as a function of gender

Heart rate variability (HRV), the variation of time intervals between heartbeats, reflects the result of the interaction between the autonomic nervous system and the cardiovascular system. Hypoxia is a stressor that causes changes in HRV and a decrease in arterial oxygen saturation (SaO2). The aim of our study is to analyse if the time and frequency domains of HRV are affected after a hypoxia tolerance test in healthy participants as a function of gender. Material and methods: 23 healthy volunteers (11 women and 12 men) with a mean age of 23.08±2.99 performed a hypoxia tolerance test (11%, 5050 m) with the iAltitude simulator. Heart rate and SaO2 were monitored during the test and HRV frequency domain (FD) and time domain (TD) data were obtained. We analysed the five minutes before and after each session. Outcomes: Simulated altitude-induced hypoxia can cause changes in HRV in a group of healthy individuals. Statistically significant differences were also found between before and after the normobaric hypoxia test in the time-domain variables RRm, SDNN, HRm, HR STD, pNN50. In addition, in women statistically significant differences were found in RMSSD, and in the frequency-domain variables HF and LF/HF. While in males, statistically significant differences were found in SDNN. In both men and women, significant differences were observed in RRm, HRm and pNN50. Conclusion: The differences found in HRV after the hypoxia tolerance test indicate that females show a greater activation of the parasympathetic nervous system compared to males. While males showed greater sympathetic activation. Keywords: Heart rate variability, normobaric hypoxia, stress, autonomic nervous system.

Heart Rate Variability Analysis in Obstructive Sleep Apnoea Patients with Daytime Sleepiness.

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

Changes in heart rate variability over time from symptom onset of transient global amnesia

Transient global amnesia (TGA) often involves precipitating events associated with changes in autonomic nervous system (ANS), and heart rate variability (HRV) reflects the ANS state. This study aimed to investigate HRV changes after TGA. A retrospective analysis of HRV included patients diagnosed with TGA between January 2015 and May 2020. The time and frequency domains of HRV were compared among three groups: early (< 1 week after TGA, n = 19), late (1–4 weeks after TGA, n = 38), and healthy control (HC, n = 19). The Pearson’s correlation between time and time-domain HRV was also examined. The standard deviation of NN intervals (SDNN) (early, 47.2; late, 35.5; HC, 41.5; p = 0.033) and root mean square of successive RR interval differences (RMSSD) (early, 38.5; late, 21.3; HC, 31.0; p = 0.006) differed significantly among the three groups. Post-hoc analysis showed statistically significant differences only in the early and late groups in both SDNN (p = 0.032) and RMSSD (p = 0.006) values. However, the frequency domain with total power, low-frequency and high-frequency powers, and low-frequency/high-frequency ratio did not differ. SDNN (Pearson correlation coefficient =− 0.396, p = 0.002) and RMSSD (Pearson correlation coefficient =− 0.406, p = 0.002) were negatively correlated with time after TGA. Changes in HRV occurred over time after the onset of TGA, with the pattern showing an increase in the first week and then a decrease within 4 weeks.

Do Longer Exhalations Increase HRV During Slow-Paced Breathing?

Slow-paced breathing at an individual's resonance frequency (RF) is a common element of heart rate variability (HRV) biofeedback training (Laborde et al. in Psychophysiology 59:e13952, 2022). Although there is strong empirical support for teaching clients to slow their respiration rate (RR) to the adult RF range between 4.5 and 6.5bpm (Lehrer & Gevirtz, 2014), there have been no definitive findings regarding the best inhalation-to-exhalation (IE) ratio to increase HRV when breathing within this range. Three methodological challenges have frustrated previous studies: ensuring participants breathed at the target RR, IE ratio, and the same RR during each IE ratio. The reviewed studies disagreed regarding the effect of IE ratios. Three studies found no IE ratio effect (Cappo & Holmes in J Psychosom Res 28:265-273, 1984; Edmonds et al. in Biofeedback 37:141-146, 2009; Klintworth et al. in Physiol Meas 33:1717-1731, 2012). One reported an advantage for equal inhalations and exhalations (Lin et al. in Int J Psychophysiol 91:206?211, 2014). Four studies observed an advantage for longer exhalations than inhalations (Bae et al. in Psychophysiology 58:e13905, 2021; Laborde et al. in Sustainability 13:7775, 2021; Strauss-Blasche et al. in Clin Exp Pharmacol Physiol 27:601?60, 2000; Van Diest et al. in Appl Psychophysiol Biofeedback 39:171?180, 2014). One study reported an advantage for longer inhalations than exhalations (Paprika et al. in Acta Physiol Hung 101:273?281, 2014). We conducted original (N = 26) and replication (N = 16) studies to determine whether a 1:2 IE ratio produces different HRV time-domain, frequency-domain, or nonlinear metrics than a 1:1 ratio when breathing at 6bpm. Our original study found that IE ratio did not affect HRV time- and frequency-domain metrics. The replication study confirmed these results and found no effect on HRV nonlinear measurements.

Abstract P299: Alteration of Cardiac Autonomic Function Through Inhalation of Biogenic Volatile Organic Compounds

Background: There is an inverse relationship between exposure to greenspaces and prevalence of cardiovascular disease and cardiovascular disease risk factors. More specifically, green exposure is associated with electrocardiogram (ECG) changes, suggesting a potential alteration of cardiac autonomic balance. One proposed mechanism by which cardiac autonomic balance may be altered is a direct physiologic effect of inhalable plant derived compounds, or biogenic volatile organic compounds (bVOCs), including limonene, α- and β-pinene which are commonly released from vegetation. Therefore, we examined the relationship between acute exposure of isolated bVOCs and cardiac autonomic tone. Hypothesis: We hypothesize that controlled exposure to isolated individual bVOCs will decrease cardiac sympathetic tone. Methods: Under controlled conditions after a bVOC washout period, healthy adults ages 18-70 were exposed to limonene (n=32), α-pinene (n=24), β-pinene (n=17), and a control (room air, n=9). Exposure consisted of one inhalation every 30 seconds for a total of 5 minutes (10 inhalations total). Pre- and post-exposure measurements of supine heart rate variability (HRV) were conducted following a 10-minute rest period. HRV was analyzed using a clean, 5-minute epoch with &gt;95% effective data length. Statistical analysis was performed using paired t-tests to determine changes in HR and HRV. Significance level was set at p&lt;0.05, a priori . Results: Our population was primarily female (56%, 18 of 32), white (53%, 17 of 32), high income (47%, 15 of 32), and had an education higher than a 4-year degree (62.5%, 20 of 32). There were significant decreases in HR when exposed to limonene (pre: 64.87±9.86bpm vs. post: 63.26±9.10bpm, p&lt;.001) and α-pinene (pre: 63.98±9.32bpm vs. post: 61.64±9.72bpm, p=.008), along with trends seen in β-pinene (pre: 65.78±10.60bpm vs. post: 63.74±9.65bpm, p=.066). Control exposure showed no difference (pre: 65.40±8.38bpm vs. post: 64.14±9.35bpm, p=.301). Normalized low- (LF) and high-frequency (HF) HRV parameters showed no change across isolated bVOCs, however the LF/HF ratio scores decreased significantly following β-pinene exposure (pre: 1.62±1.69 vs. post: 0.96±0.96, p=.039). HRV time-domain parameters RMSSD and SDNN did not change following isolate exposure. Conclusions: Post-exposure decreases in HR and LFHF ratios indicate the potential for cardiovascular disease risk reduction from bVOC exposure leading to decreased sympathetic tone. Additional work is required to determine the mechanism of exposure-related changes.

Cardiac remodeling in patients with heart failure with mildly reduced ejection fraction and metabolic disorders: association with biomarkers and autonomic nervous system parameters

Aim. The high prevalence of obesity in a cohort of patients with heart failure and mildly reduced ejection fraction (HFmrEF) determines the relevance of clarifying the role of biomarkers and autonomic imbalance in myocardial remodeling, taking into account metabolic risk factors.Material and methods. We examined 19 men with postinfarction cardiosclerosis and class II HFmrEF (median age 62 years), overweight/class I-II obesity, type 2 diabetes in 53/47%, 48% of cases, respectively, who received therapy. The biomarker panel included N-terminal pro-brain natriuretic peptide (NT-proBNP), galectin-3, pro-collagen I C-terminal propeptide (PICP), N-terminal propeptide of procollagen type III (PIIINP), C-terminal telopeptide of type I collagen, matrix metalloproteinase-9 (MMP-9), tissue inhibitor of matrix proteinase-1 (TIMP-1), leptin and adiponectin. Heart rate variability (HRV) and turbulence were obtained using 24-hour Holter monitoring. We assessed the time and frequency domains of HRV (24 h) and 5 min recordings of wakefulness at rest, calculated TO (turbulence onset) and TS (turbulence slope).Results. Significant positive associations of leptin and TIMP-1 levels with left ventricular hypertrophy markers were confirmed. Positive correlations of peak e' with following HRV indicators were revealed: SDNN (r=0,68; p=0,02) and RMSSD (r=0,69; p=0,003). Lower TS values were associated with higher index parameters of left ventricular mass (p&lt;0,05 for all). Associations of biomarkers with autonomic nervous system (ANS) were observed: MMP-9 with RMSSD (r=0,54) and pNN50 (r=0,51); TIMP-1 with TO (r=0,46); PICP/PIIINP ratio with HFn (5 min) (r=-0,49); NT-proBNP/adiponectin ratio with SDNN (r=-0,49); leptin level with TS (r=-0,54) (p&lt;0,05 for all).Conclusion. In patients with HFmrEF of ischemic origin and additional metabolic risks, serum biomarkers of fibrosis, adipokines, and ANS parameters are associated mainly with markers of increased left ventricular filling pressure. The study results predetermine the further search for potential risk-stratification markers of unfavorable myocardial remodeling and prognosis in large samples of patients with metabolic deviations and HF with EF &gt;40% against the background of modern drug therapy.

Sex differences in heart rate variability measures that predict alcohol drinking in rats.

Problem alcohol drinking continues to be a substantial cost and burden. In addition, alcohol consumption in women has increased in recent decades, and women can have greater alcohol problems and comorbidities. Thus, there is a significant need for novel therapeutics to enhance sex-specific, individualized treatment. Heart rate (HR) and HR variability (HRV) are of broad interest because they may be both biomarkers for and drivers of pathological states. HRV reflects the dynamic balance between sympathetic (SNS, 'fight or flight') and parasympathetic (PNS, 'rest and digest') systems. Evidence from human studies suggest PNS predominance in women and SNS in men during autonomic regulation, indicating the possibility of sex differences in risk factors and physiological drivers of problem drinking. To better understand the association between HRV sex differences and alcohol drinking, we examined whether alcohol consumption levels correlated with time domain HRV measures (SDNN and rMSSD) at baseline, at alcohol drinking onset, and across 10min of drinking, in adult female and male Wistar rats. In particular, we compared both HRV and HR measures under alcohol-only and compulsion-like conditions (alcohol + 10mg/L quinine), because compulsion can often be a significant barrier to treatment of alcohol misuse. Importantly, previous work supports the possibility that different HRV measures could be interpreted to reflect PNS versus SNS influences. Here, we show that females with higher putative PNS indicators at baseline and at drinking onset had greater alcohol consumption. In contrast, male intake levels related to increased potential SNS measures at drinking onset. Once alcohol was consumed, HR predicted intake level in females, perhaps a pharmacological effect of alcohol. However, HRV changes were greater during compulsion-like intake versus alcohol-only, suggesting HRV changes (reduced SNS in females, reduced PNS and increased HR in males) specifically related to aversion-resistant intake. We find novel and likely clinically relevant autonomic differences associated with biological sex and alcohol drinking, suggesting that different autonomic mechanisms may promote differing aspects of female and male alcohol consumption.

Effect of Prenatal Yoga versus Moderate-Intensity Walking on Cardiorespiratory Adaptation to Acute Psychological Stress: Insights from Non-Invasive Beat-to-Beat Monitoring.

We recently reported enhanced parasympathetic activation at rest throughout pregnancy associated with regular yoga practice. The present study presents a secondary analysis of data collected within a prospective cohort study of 33 pregnant women practicing yoga once weekly throughout pregnancy and 36 controls not involved in formal pregnancy exercise programs. The objective was to assess the impact of prenatal yoga on the autonomic nervous system stress response. Healthy pregnant women with singleton pregnancies were recruited in the first trimester. There was no significant difference in the maternal body mass index (BMI) between the yoga group and the controls (24.06 ± 3.55 vs. 23.74 ± 3.43 kg/m2, p = 0.693). Women practicing yoga were older (28.6 ± 3.9 vs. 31.3 ± 3.5 years, p = 0.005) and more often nulliparous (26 (79%) vs. 18 (50%), p = 0.001). We studied heart rate variability (HRV) parameters in the time domain (SDNN, standard deviation of regular R-R intervals, and RMSSD, square root of mean squared differences of successive R-R intervals) and frequency domain (ln(LF/HF), natural logarithm of low-frequency to high-frequency power), as well as synchronization indices of heart rate, blood pressure and respiration during and immediately following acute psychological stress of a standardized mental challenge test. Measurements were performed once per trimester before and after yoga or a 30 min moderate-intensity walk. Statistical comparison was performed using three-way analyses of variance (p < 0.05 significant). Time domain HRV parameters during and following mental challenge in the yoga group were significantly higher compared to the controls regardless of the trimester (F = 7.22, p = 0.009 for SDNN and F = 9.57, p = 0.003 for RMSSD, respectively). We observed no significant differences in the yoga group vs. the controls in terms of ln(LF/HF) and synchronization indices. Regular prenatal yoga practice was associated with a significantly reduced sympathetic response to mental challenge and quicker recovery after acute psychological stress. These effects persisted throughout pregnancy with regular practice.

Hemodialysis Efficiency Predictor in End-Stage Kidney Disease Using Real-Time Heart Rate Variability.

Autonomic dysfunction as a long-term complication may occur in end-stage kidney disease (ESKD) patients and can be diagnosed using heart rate variability (HRV) analyzed from electrocardiogram (ECG) recordings. There is limited data about HRV using real-time ECG to predict hemodialysis (HD) efficiency in patients with ESKD who are routinely doing HD in the real world. A total of 50 patients (62.1 ± 10.7 years) with ESKD underwent continuous real-time ECG monitoring (237.4 ± 15.3 min) during HD for HRV using remote monitoring system. Their electrolyte levels were checked before and after HD. We compared HRV according to electrolyte levels. During the monitor, we checked the ECG and electrolyte levels simultaneously a total of 2374 times for all of the patients. Both time and frequency domain HRV were higher when the patients had lower K+ level (<0.5 mEq/L) and P+ level change (<2 mEq/L) before and after HD as compared to those with a higher K+ level (≥0.5 mEq/L) and P+ level change (≥2 mEq/L). Additionally, patients with lower K+ and P+ level change groups had higher incidences of arrhythmic events including atrial/ventricular premature complexes, despite no difference of mean heart rate (p < 0.001). Higher HRV was independently associated with a poorly controlled K+ and P+ level during HD in patients with ESKD. This is consistently evidenced by the independent association between higher HRV, K+ and P+ levels in real time, suggesting that low electrolyte changes before and after HD alone may cause cardiac autonomic dysfunction.

Prediction models for lymph node metastasis in cervical cancer based on preoperative heart rate variability.

The occurrence of lymph node metastasis (LNM) is one of the critical factors in determining the staging, treatment and prognosis of cervical cancer (CC). Heart rate variability (HRV) is associated with LNM in patients with CC. The purpose of this study was to validate the feasibility of machine learning (ML) models constructed with preoperative HRV as a feature of CC patients in predicting CC LNM. A total of 292 patients with pathologically confirmed CC admitted to the Department of Gynecological Oncology of the First Affiliated Hospital of Bengbu Medical University from November 2020 to September 2023 were included in the study. The patient' preoperative 5-min electrocardiogram data were collected, and HRV time-domain, frequency-domain and non-linear analyses were subsequently performed, and six ML models were constructed based on 32 parameters. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity. Among the 6 ML models, the random forest (RF) model showed the best predictive performance, as specified by the following metrics on the test set: AUC (0.852), accuracy (0.744), sensitivity (0.783), and specificity (0.785). The RF model built with preoperative HRV parameters showed superior performance in CC LNM prediction, but multicenter studies with larger datasets are needed to validate our findings, and the physiopathological mechanisms between HRV and CC LNM need to be further explored.

Changepoint Detection in Heart Rate Variability Indices in Older Patients Without Cancer at End of Life Using Ballistocardiography Signals: Preliminary Retrospective Study.

In an aging society such as Japan, where the number of older people continues to increase, providing in-hospital end-of-life care for all deaths, and end-of-life care outside of hospitals, such as at home or in nursing homes, will be difficult. In end-of-life care, monitoring patients is important to understand their condition and predict survival time; this information gives family members and caregivers time to prepare for the end of life. However, with no clear indicators, health care providers must subjectively decide if an older patient is in the end-of-life stage, considering factors such as condition changes and decreased food intake. This complicates decisions for family members, especially during home-based care. The purpose of this preliminary retrospective study was to determine whether and how changes in heart rate variability (HRV) indices estimated from ballistocardiography (BCG) occur before the date of death in terminally ill older patients, and ultimately to predict the date of death from the changepoint. This retrospective pilot study assessed the medical records of 15 older patients admitted to a special nursing home between August 2019 and December 2021. Patient characteristics and time-domain HRV indices such as the average normal-to-normal (ANN) interval, SD of the normal-to-normal (SDNN) interval, and root mean square of successive differences (RMSSD) from at least 2 months before the date of death were collected. Overall trends of indices were examined by drawing a restricted cubic spline curve. A repeated measures ANOVA was performed to evaluate changes in the indices over the observation period. To explore more detailed changes in HRV, a piecewise regression analysis was conducted to estimate the changepoint of HRV indices. The 15 patients included 8 men and 7 women with a median age of 93 (IQR 91-96) years. The cubic spline curve showed a gradual decline of indices from approximately 30 days before the patients' deaths. The repeated measures ANOVA showed that when compared with 8 weeks before death, the ratio of the geometric mean of ANN (0.90, 95% CI 0.84-0.98; P=.005) and RMSSD (0.83, 95% CI 0.70-0.99; P=.03) began to decrease 3 weeks before death. The piecewise regression analysis estimated the changepoints for ANN, SDNN, and RMSSD at -34.5 (95% CI -42.5 to -26.5; P<.001), -33.0 (95% CI -40.9 to -25.1; P<.001), and -35.0 (95% CI -42.3 to -27.7; P<.001) days, respectively, before death. This preliminary study identified the changepoint of HRV indices before death in older patients at end of life. Although few data were examined, our findings indicated that HRV indices from BCG can be useful for monitoring and predicting survival time in older patients at end of life. The study and results suggest the potential for more objective and accurate prognostic tools in predicting end-of-life outcomes.

Heart Rate Variability as a Predictor of +Gz Tolerance During the High-G Selective Test.

INTRODUCTION: Preselection of pilot candidates in the military is critical and determines the quality of subsequent selection. The Aero Medical Institute in Belgrade uses the following centrifuge endpoints: peripheral vision loss, heart rate above 180 bpm, cardiac arrhythmias, and G-induced loss of consciousness to assess relaxed +Gz tolerance. The aim of this study was to evaluate heart rate variability (HRV) associated with cardiovascular adaptability to different types of stress as a predictor of +Gz tolerance.METHODS: Thirty-six candidates were exposed to centrifuge runs, consisting of the following +Gz-acceleration phases: a 2-G plateau followed by an increase to 5.5 G, a decrease to 2 G, and ending with a plateau. Time-domain HRV indices were calculated for candidates, for a 60-s 2-G plateau, and for the entire test. The correlation was made between the groups that did (Group 1) and did not meet the criteria (Group 2).RESULTS: The results show significantly lower values in all time domain HRV indices, namely standard deviation of the normal-to-normal interval (SDNN) and root mean square of successive differences, in Group 2. Mean SDNN values were 45.98 ± 24.80 ms (2-G plateau) and 109.99 ± 39.64 ms (entire test) in Group 1, while the SDNN were 22.99 ± 12.04 ms and 69.70 ± 33.45 ms in Group 2. Root mean square of successive differences was higher in Group 1 for the 2-G plateau and for the entire test.DISCUSSION: The results suggest that HRV is positively correlated with +Gz-tolerance and can be used as an additional selection tool for military aircrew.Bacevic N, Ninkovic M, Drvendzija M, Vidakovic J, Bacevic M, Stepanic P. Heart rate variability as a predictor of +Gz tolerance during the high-G selective test. Aerosp Med Hum Perform. 2024; 95(2):93-100.

Effects of three-week intake of Matcha green tea powder on heart rate variability metrics

Introduction: Compared to other green teas, higher intake of multiple phytochemicals is achieved with Matcha green tea consumption. Green tea consumption is known to have metabolic effects but is also consumed for supposed calming effects. The aim of the present study was to examine the effects of encapsulated Matcha green tea on heart rate variability metrics during supine rest, as well as on physiological and metabolic responses during both supine rest and moderate-intensity exercise. Methods: Healthy females (n=8, age: 22±3 yrs, body mass: 68±11 kg, height: 162±5 cm) volunteered. The study employed a placebo-controlled, randomised cross-over design. Time-domain heart rate variability metrics during supine rest (n=5) and physiological and metabolic responses using indirect calorimetry techniques during supine rest and 60-min of moderate-intensity (~ 4-METs) treadmill walking (speed: 4.4±0.5 km·h-1) were measured following 3 weeks of 3 g·day-1 of Matcha green tea or placebo. Results: During supine rest with Matcha green tea, all participants had lower heart rates by 13±7% (P=0.01, d= -1.45), higher mean beat-to-beat RR intervals by 16±9% (P=0.03, d=1.25), higher SDNN by 44±32% (P=0.01, d=0.76) and higher pNN50 by 139±139% (P&lt;0.01, d=1.28). Matcha green tea had no effects on the physiological and metabolic responses during supine rest and moderate-intensity treadmill walking (e.g. respiratory exchange ratio, placebo: 0.78±0.04; Matcha: 0.78±0.03, P=0.87). Fat oxidation during supine rest was correlated (r=0.75, P&lt;0.01) with the moderate-intensity walking induced fat oxidation. Conclusions: In young adult healthy females, Matcha green tea beneficially effects heart rate variability metrics during supine rest indicating an alteration in parasympathetic nervous activity and therefore suggestive of a relaxing effect. Matcha green tea did not change the metabolic responses during supine rest and exercise possibly due to the low respiratory exchange ratio in the female cohort. Future work should address the effectiveness of Matcha green tea during conditions of psychological stress.Keywords: Matcha green tea, heart rate variability, rest, walking, substrate oxidation

Mood Disorder Severity and Subtype Classification Using Multimodal Deep Neural Network Models.

The subtype diagnosis and severity classification of mood disorder have been made through the judgment of verified assistance tools and psychiatrists. Recently, however, many studies have been conducted using biomarker data collected from subjects to assist in diagnosis, and most studies use heart rate variability (HRV) data collected to understand the balance of the autonomic nervous system on statistical analysis methods to perform classification through statistical analysis. In this research, three mood disorder severity or subtype classification algorithms are presented through multimodal analysis of data on the collected heart-related data variables and hidden features from the variables of time and frequency domain of HRV. Comparing the classification performance of the statistical analysis widely used in existing major depressive disorder (MDD), anxiety disorder (AD), and bipolar disorder (BD) classification studies and the multimodality deep neural network analysis newly proposed in this study, it was confirmed that the severity or subtype classification accuracy performance of each disease improved by 0.118, 0.231, and 0.125 on average. Through the study, it was confirmed that deep learning analysis of biomarker data such as HRV can be applied as a primary identification and diagnosis aid for mental diseases, and that it can help to objectively diagnose psychiatrists in that it can confirm not only the diagnosed disease but also the current mood status.

Essential Fatty Acid Associated with Heart Rate Variability in Highly Trained Male Cross-Country Skiers: A Pilot Study

Polyunsaturated fatty acid (PUFA) metabolites play important roles in the modulation of vascular tone, heart rate variability (HRV), and cardiovascular diseases. This study was undertaken to examine the relationship between HRV and the plasma levels of essential acids. Methods: Highly trained cross-country skiers participated in the study (n = 19). Time-domain and frequency-domain HRV analyses were performed. The plasma levels of fatty acids were determined using gas–liquid chromatography. Results: Plasma eicosapentaenoic acid and docosahexaenoic acid were found to be negatively correlated with resting heart rate (HR) (p = 0.026). The plasma levels of alpha-linolenic acid (ALA) were positively associated with the relative value of high-frequency power (rs = 0.465, p = 0.045) and negatively correlated with the sympathovagal balance ratio (rs = −0.493, p = 0.032) and the absolute and relative values of low-frequency power (rs = −0.490, p = 0.028). The plasma levels of arachidonic acid (ARA) were positively associated with the relative value of high-frequency power (rs = 0.59, p = 0.006) and negatively correlated with the sympathovagal balance ratio (rs = −0.54, p = 0.017) and the relative values of low-frequency power (rs = −0.52, p = 0.022). No correlation was found between n6/n3 and HRV parameters except for HR and pNN50. Conclusions: n-3 PUFAs and ARA play an important role in the autonomic regulation of heart rate in highly trained skiers. Athletes with substantial deficiencies in plasma ALA and excess levels of ARA had increased sympathetic and decreased parasympathetic activity.

Time-domain heart rate dynamics in the prognosis of progressive atherosclerosis

Background and aimThe regular uptake of a high-fat diet (HFD) with changing lifestyle causes atherosclerosis leading to cardiovascular diseases and autonomic dysfunction. Therefore, the current study aimed to investigate the correlation of autonomic activity to lipid and atherosclerosis markers. Further, the study proposes a support vector machine (SVM) based model in the prediction of atherosclerosis severity. Methods and resultsThe Lead-II electrocardiogram and blood markers were measured from both the control and the experiment subjects each week for nine consecutive weeks. The time-domain heart rate variability (HRV) parameters were derived, and the significance level was tested using a one-way Analysis of Variance. The correlation analysis was performed to determine the relation between autonomic parameters and lipid and atherosclerosis markers. The statistically significant time-domain values were used as features of the SVM. The observed results demonstrated the reduced time domain HRV parameters with the increase in lipid and atherosclerosis index markers with the progressive atherosclerosis severity. The correlation analysis revealed a negative association between time-domain HRV parameters with lipid and atherosclerosis parameters. The percentage accuracy increases from 86.58% to 98.71% with the increase in atherosclerosis severity with regular consumption of HFD. ConclusionsAtherosclerosis causes autonomic dysfunction with reduced HRV. The negative correlation between autonomic parameters and lipid profile and atherosclerosis indexes marker revealed the potential role of vagal activity in the prognosis of atherosclerosis progression. The support vector machine presented a respectable accuracy in the prediction of atherosclerosis severity from the control group.

Unveiling the acute neurophysiological responses to strength training: An exploratory study on novices performing weightlifting bouts with different motor learning models.

Currently, there is limited evidence regarding various neurophysiological responses to strength exercise and the influence of the adopted practice schedule. This study aimed to assess the acute systemic effects of snatch training bouts, employing different motor learning models, on skill efficiency, electric brain activity (EEG), heart rate variability (HRV), and perceived exertion as well as mental demand in novices. In a within-subject design, sixteen highly active males (mean age: 23.13 ± 2.09 years) randomly performed snatch learning bouts consisting of 36 trials using repetitive learning (RL), contextual interference (blocked, CIb; and serial, CIs), and differential learning (DL) models. Spontaneous resting EEG and HRV activities were recorded at PRE and POST training bouts while measuring heart rate. Perceived exertion and mental demand were assessed immediately after, and barbell kinematics were recorded during three power snatch trials performed following the POST measurement. The results showed increases in alpha, beta, and gamma frequencies from pre- to post-training bouts in the majority of the tested brain regions (p values ranging from < 0.0001 to 0.02). The CIb model exhibited increased frequencies in more regions. Resting time domain HRV parameters were altered following the snatch bouts, with increased HR (p < 0.001) and decreased RR interval (p < 0.001), SDNN, and RMSSD (p values ranging from < 0.0001 to 0.02). DL showed more pronounced pulse-related changes (p = 0.01). Significant changes in HRV frequency domain parameters were observed, with a significant increase in LFn (p = 0.03) and a decrease in HFn (p = 0.001) registered only in the DL model. Elevated HR zones (> HR zone 3) were more dominant in the DL model during the snatch bouts (effect size = 0.5). Similarly, the DL model tended to exhibit higher perceived physical (effect size = 0.5) and mental exertions (effect size = 0.6). Despite the highest psycho-physiological response, the DL group showed one of the fewest significant EEG changes. There was no significant advantage of one learning model over the other in terms of technical efficiency. These findings offer preliminary support for the acute neurophysiological benefits of coordination-strength-based exercise in novices, particularly when employing a DL model. The advantages of combining EEG and HRV measurements for comprehensive monitoring and understanding of potential adaptations are also highlighted. However, further studies encompassing a broader range of coordination-strength-based exercises are warranted to corroborate these observations.