Effect of Hyperventilation on Periodic Repolarization Dynamics

Schüttler, Dominik; Stülpnagel, Lukas von; Rizas, Konstantinos D.; Bauer, Axel; Brunner, Stefan; Hamm, Wolfgang

doi:10.3389/fphys.2020.542183

Cited by 10 publications

(14 citation statements)

References 27 publications

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“…This work investigates the performance of PRD, characterizing the oscillatory behavior of the T wave, for cardiac risk stratification in a population of CHF patients. Although PRD has been previously used in various contexts 19 , 27 , 30 – 34 , in this study, we computed PRD in a large CHF cohort to predict the risk of the two most common modes of death, namely SCD and PFD, both considering PRD on its own and in combination with other ECG-based indices.…”

Section: Discussionmentioning

confidence: 99%

Periodic repolarization dynamics as predictor of risk for sudden cardiac death in chronic heart failure patients

Palacios

Cygankiewicz

Luna

et al. 2021

Sci Rep

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The two most common modes of death among chronic heart failure (CHF) patients are sudden cardiac death (SCD) and pump failure death (PFD). Periodic repolarization dynamics (PRD) quantifies low-frequency oscillations in the T wave vector of the electrocardiogram (ECG) and has been postulated to reflect sympathetic modulation of ventricular repolarization. This study aims to evaluate the prognostic value of PRD to predict SCD and PFD in a population of CHF patients. 20-min high-resolution (1000 Hz) ECG recordings from 569 CHF patients were analyzed. Patients were divided into two groups, $$\hbox {PRD}^+$$ PRD + and $$\hbox {PRD}^-$$ PRD - , corresponding to PRD values above and below the optimum cutoff point of PRD in the study population. Univariate Cox regression analysis showed that SCD risk in the $$\hbox {PRD}^+$$ PRD + group was double the risk in the $$\hbox {PRD}^-$$ PRD - group [hazard ratio (95% CI) 2.001 (1.127–3.554), $$\hbox {p}<0.05$$ p < 0.05 ]. The combination of PRD with other Holter-based ECG indices, such as turbulence slope (TS) and index of average alternans (IAA), improved SCD prediction by identifying groups of patients at high SCD risk. PFD could be predicted by PRD only when combined with TS [hazard ratio 2.758 (1.572–4.838), $$\hbox {p}<0.001$$ p < 0.001 ]. In conclusion, the combination of PRD with IAA and TS can be used to stratify the risk for SCD and PFD, respectively, in CHF patients.

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Section: Discussionmentioning

confidence: 99%

Periodic repolarization dynamics as predictor of risk for sudden cardiac death in chronic heart failure patients

Palacios

Cygankiewicz

Luna

et al. 2021

Sci Rep

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“…For PRD to be more meaningful from a clinical point of view, its RRV-unrelated fraction could be analyzed, as it could more closely reflect ventricular repolarization instabilities occurring under excessive sympathetic activity that may increase susceptibility to ventricular arrhythmias and sudden cardiac death. Prior studies investigating PRD have assessed its modulation by HR by evaluating the response to physiological interventions, such as hyperventilation or incremental exercise, and have established the independence of dT and PRD with respect to HR and HRV by reporting a non-significant correlation [ 16 , 17 ]. Other studies have determined that PRD is not an epiphenomenon of HRV by proving that it presents small (25% in mean) changes following fixed atrial pacing to abolish HRV [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Specifically regarding PRD, clinical and experimental studies have so far provided evidence that it is enhanced by sympathetic activation, induced by either tilt table test or exercise, and suppressed by pharmacological β-adrenergic blockade [ 10 , 16 ]. PRD has been verified to occur independently of respiratory activity in volume-controlled ventilated swine [ 10 ] and in humans when comparing respiratory rates of 10 and 20/min with constant minute ventilation [ 17 ]. Moreover, PRD has been confirmed not to be an epiphenomenon of HR and HRV, as substantiated by the fact that fixed atrial pacing exerts modest effects on PRD despite fully abolishing HRV and despite varying HR at fixed values in a large range [ 10 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

ECG Ventricular Repolarization Dynamics during Exercise: Temporal Profile, Relation to Heart Rate Variability and Effects of Age and Physical Health

Hernández-Vicente

Hernando

Vicente-Rodríguez

et al. 2021

IJERPH

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Periodic repolarization dynamics (PRD) is a novel electrocardiographic marker of cardiac repolarization instability with powerful risk stratification capacity for total mortality and sudden cardiac death. Here, we use a time-frequency analysis approach to continuously quantify PRD at rest and during exercise, assess its dependence on heart rate variability (HRV) and characterize the effects of age (young adults/middle-aged adults/older adults), body mass index (non-overweight/overweight) and cardiorespiratory fitness level (fit/unfit). Sixty-six male volunteers performed an exercise test. RR and dT variabilities (RRV, dTV), as well as the fraction of dT variability unrelated to RR variability, were computed based on time-frequency representations. The instantaneous LF power of dT (PdTV), representing the same concept as PRD, and of its RRV-unrelated component (PdTVuRRV) were quantified. dT angle was found to mostly oscillate in the LF band. Overall, 50–70% of PdTV was linearly unrelated to RRV. The onset of exercise caused a sudden increase in PdTV and PdTVuRRV, which returned to pre-exercise levels during recovery. Clustering analysis identified a group of overweight and unfit individuals with significantly higher PdTV and PdTVuRRV values at rest than the rest of the population. Our findings shed new light on the temporal profile of PRD during exercise, its relationship to HRV and the differences in PRD between subjects according to phenotypic characteristics.

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“…PRD has been proven to be a highly sensitive parameter to monitor sympathetic nervous system on the level of ventricular myocardium [8,15]. Previous studies of our group with similar sample sizes showed robust statistical differences on PRD changes in response to triggers stimulating the sympathetic nervous system [10][11][12]. We thus assumed that our number of participants would be sufficient to see possible effects.…”

Section: Sample Sizementioning

confidence: 91%

“…It has proven its strong prognostic power in large trials of patients with ischemic and non-ischemic cardiomyopathy [8,9]. Several studies demonstrated its regulation among physiological states which are known to activate the sympathetic nervous system [10][11][12]. However, the effect of caffeine consumption on PRD levels and on cardiac repolarization instability, is still insufficiently explored.…”

Section: Introductionmentioning

confidence: 99%

Impact of energy drink versus coffee consumption on periodic repolarization dynamics: an interventional study

et al. 2022

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Purpose Caffeinated beverages are consumed daily throughout the world. Caffeine consumption has been linked to dysfunction of the autonomic nervous system. However, the exact effects are still insufficiently understood. Methods Sixteen healthy individuals were included in the present non-randomized cross-over interventional study. All study subjects consumed a commercial energy drink (containing 240 mg caffeine), and in a second independent session coffee (containing 240 mg caffeine). High-resolution digital ECGs in Frank-lead configuration were recorded at baseline before consumption, and 45 min after consumption of the respective beverage. Using customized software, we assessed ECG-based biomarker periodic repolarization dynamics (PRD), which mirrors the effect of efferent cardiac sympathetic activity on the ventricular myocardium. Results The consumption of energy drinks resulted in an increase in PRD levels (3.64 vs. 5.85 deg2; p < 0.001). In contrast, coffee consumption did not alter PRD levels (3.47 vs 3.16 deg2, p = 0.63). The heart rates remained unchanged both after coffee and after energy drink consumption. Spearman analysis showed no significant correlation between PRD changes and heart rate changes (R = 0.34, p = 0.31 for coffee, R = 0.31, p = 0.24 for energy drink). Conclusion Our data suggests that sympathetic activation after consumption of caffeinated beverages is independent from caffeine and might be mediated by other substances. Trial Number: NCT04886869, 13 May 2021, retrospectively registered

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Effect of Hyperventilation on Periodic Repolarization Dynamics

Cited by 10 publications

References 27 publications

Periodic repolarization dynamics as predictor of risk for sudden cardiac death in chronic heart failure patients

Periodic repolarization dynamics as predictor of risk for sudden cardiac death in chronic heart failure patients

ECG Ventricular Repolarization Dynamics during Exercise: Temporal Profile, Relation to Heart Rate Variability and Effects of Age and Physical Health

Impact of energy drink versus coffee consumption on periodic repolarization dynamics: an interventional study

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