Heart rate variability and ischaemia in patients with coronary heart disease and stable angina pectoris Influence of drug therapy and prognostic value

Weber, Frank; Schneider, Hartmut; Arnim, Th. v.; Urbaszek, W

doi:10.1053/euhj.1998.1272

Cited by 35 publications

(23 citation statements)

References 46 publications

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“…The activity of the autonomic nervous system is reflected in the heart rate variability (HRV) [6][7][8]. Several authors have demonstrated depressed long-term HRV in patients with underlying cardiovascular disease [9][10][11] and HRV has proved to be highly predictive for cardiovascular morbidity and mortality in these patients [12][13][14]. Recently, short-term HRV analysis (5 min) has been shown to be a reliable tool to predict hypotension after spinal anaesthesia [15,16].…”

Section: Discussionmentioning

confidence: 99%

Does heart rate variability predict hypotension and bradycardia after induction of general anaesthesia in high risk cardiovascular patients?*

et al. 2008

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SummaryThis study investigated whether heart rate variability predicts haemodynamic events in high risk patients, defined as Revised Cardiac Risk Index score = 3, scheduled for general anaesthesia. Fifty patients underwent baseline measurement of heart rate variability and were then assigned according to haemodynamic events (hypotension or bradycardia) after standardised induction of anaesthesia into 'stable' (n = 39) and 'unstable' patients (n = 11). Unstable patients had significantly lower baseline total power. Total power < 500 ms 2 .Hz )1 was associated with high sensitivity and specificity for the prediction of hypotension or bradycardia. Prospectively, 29 patients with total power < 500 ms 2 .Hz )1 were compared with 21 patients with total power > 500 ms 2 .Hz )1 . Differences were found in the lowest mean arterial pressure and heart rate after induction of anaesthesia. We conclude that the pre-operative total power of heart rate variability in high risk patients may indicate the occurrence of haemodynamic events with high sensitivity and specificity. Heart rate variability may be a suitable tool to identify patients at high risk of a haemodynamic event and may be used to indicate need for intensive monitoring and, perhaps, prophylactic treatment. Patients with underlying cardiovascular disease are at high risk of peri-operative cardiovascular events and death [1,2]. Adverse events during anaesthesia and surgery may increase the risk further in this patient population. Specifically, following induction of general anaesthesia, hypotension and bradycardia are often observed and may lead to insufficient organ perfusion and ischaemic events [3][4][5]. Haemodynamic parameters are controlled, to some extent, by the autonomic nervous system. The activity of the autonomic nervous system is reflected in the heart rate variability (HRV) [6][7][8]. Several authors have demonstrated depressed long-term HRV in patients with underlying cardiovascular disease [9][10][11] and HRV has proved to be highly predictive for cardiovascular morbidity and mortality in these patients [12][13][14]. Recently, short-term HRV analysis (5 min) has been shown to be a reliable tool to predict hypotension after spinal anaesthesia [15,16]. The low to high frequency ratio (LF ⁄ HF) was demonstrated to be a highly sensitive parameter to predict hypotension [17] and LF ⁄ HF-guided prophylactic therapy was able to prevent hypotension [18]. Only preliminary data have been published on the incidence of hypotension or bradycardia after induction of general anaesthesia in patients with underlying autonomic dysfunction [19,20]. A retrospective subgroup analysis of a small number of patients with diabetes demonstrated that pre-operative depression of sympathetic and parasympathetic activity was correlated with a significantly greater incidence of hypotension after induction of anaesthesia. However, these results were not confirmed prospectively.This study was designed to investigate the predictive power of HRV in patients with underlying cardiovascu...

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Section: Discussionmentioning

confidence: 99%

Does heart rate variability predict hypotension and bradycardia after induction of general anaesthesia in high risk cardiovascular patients?*

et al. 2008

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“…Changes of neural heart modulation occur in several systemic diseases, such as diabetes (2)(3)(4)(5), hypertension (6), heart failure (7,8), and coronary heart disease (9,10). In such situations, HRV analysis can be used to monitor long-term changes of cardiac regulation by the autonomic nervous system.…”

Section: Introductionmentioning

confidence: 99%

Reproducibility of heart rate variability parameters measured in healthy subjects at rest and after a postural change maneuver

Dantas

Gonçalves

Silva

et al. 2010

Braz J Med Biol Res

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0.6) were obtained in the orthostatic position. Bland-Altman plots revealed that most values were inside the agreement limits, indicating concordance between measures. Only SDNN and NNv in the supine position were not reproducible. Our results showed reproducibility of HRV parameters when recorded in the same individual with a short time between two exams. The increased sympathetic activity occurring in the orthostatic position probably facilitates reproducibility of the HRV indexes.]]>

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“…22 The TIBBS group also revealed that bisoprolol had an effect that was prognostically favorable. 23 These results indicate that modulation of sympathovagal balance is one of the favorable effects of b-blockade. Because different b-blockers may exert different effects, these b-blocking effects should be compared with one another in future studies.…”

Section: Discussionmentioning

confidence: 92%

A critical role of sympathetic nerve regulation for the treatment of impaired daily rhythm in hypertensive Dahl rats

et al. 2010

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There is a deep relationship between impaired circadian rhythm and hypertension. However, the detailed mechanisms between the daily sleep-wake rhythm and cardiovascular disorders have not yet been elucidated. To clarify the mechanism, we examined salt-sensitive Dahl rats that were fed normal chow (n¼10), high-salt chow (n¼10) and high-salt chow with bisoprolol (n¼10). Simultaneous electroencephalogram, electromyogram and locomotor activity were examined to analyze the sleep-wake state. We also examined heart rate, blood pressure and echocardiographic findings to verify the presence of hypertension. Hypertension with impaired ventricular contraction was observed in the rats with high-salt-chow consumption whereas normal-chow rats did not show these disorders. Although rats with the normal diet showed a standard daily rhythm with normal rapid eye movement (REM) sleep duration and locomotor activity, the high-salt-diet group exhibited an impaired daily rhythm with suppressed REM sleep and significant abnormal locomotor activity. Bisoprolol significantly improved the daily sleep-wake rhythm and locomotor activity. We showed that an impaired daily rhythm was closely related to the development of hypertension. Keywords: b-blocker; daily rhythm; locomotor activity INTRODUCTION It is well known that there is a deep relationship between sleep disorders and cardiovascular diseases such as hypertension and congestive heart failure (CHF). The fact that patients with advanced CHF induced by hypertension frequently suffer from central breathing disorders 1 suggests that CHF is causally related to alterations in the central control of breathing, resulting in Cheyne-Stokes respiration during sleep. 2 Disorders in the central control of breathing are a key factor in altered daily sleep-wake rhythm and are also an independent predictor for premature death. 3,4 Although it is known that cardiovascular diseases are closely related to circadian rhythm, 5 the relationship among changes in circadian rhythm, sleep disorders and cardiovascular diseases has not yet been elucidated.It has been reported that long-term treatment with b-receptorblocking substances (b-blockers) improves hypertension and CHF. bBlockers also reduce the inappropriate increase of ventilation during exercise and alleviate central breathing disorders during wakefulness. 6,7 These positive effects result in improved exercise capacity and slower progression of underlying hypertension and CHF. However, little is known about the effects of b-blocker treatment on sleep

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Heart rate variability and ischaemia in patients with coronary heart disease and stable angina pectoris Influence of drug therapy and prognostic value

Cited by 35 publications

References 46 publications

Does heart rate variability predict hypotension and bradycardia after induction of general anaesthesia in high risk cardiovascular patients?*

Does heart rate variability predict hypotension and bradycardia after induction of general anaesthesia in high risk cardiovascular patients?*

Reproducibility of heart rate variability parameters measured in healthy subjects at rest and after a postural change maneuver

A critical role of sympathetic nerve regulation for the treatment of impaired daily rhythm in hypertensive Dahl rats

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