Nonlinear heart rate variability biomarkers for gastric cancer severity: A pilot study

Shi, Bo; Wang, Lili; Yan, Chang; Chen, Deli; Liu, Mulin; Li, Peng

doi:10.1038/s41598-019-50358-y

Cited by 28 publications

(20 citation statements)

References 52 publications

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“…Due to the occurrence of HRA in the majority of the healthy human population, it has been postulated that the cardiovascular response to external body conditions or illnesses may manifest as a modification in the asymmetry in human heart beat variability. Research has shown that conditions that can affect HRV and its asymmetry are, among others, gastric cancer, mental stress, controlled breathing, or walking (Wang et al, 2013(Wang et al, , 2018Parvaneh et al, 2015;Shi et al, 2019). Naturally, changes in body position affect HRA particularly when it has rapid course.…”

Section: Introductionmentioning

confidence: 99%

Heart Rate Asymmetry Analysis During Head-Up Tilt Test in Healthy Men

et al. 2021

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The purpose of this study is to assess the cardiovascular system response to orthostatic stress in a group of 133 healthy men using heart rate asymmetry (HRA) methods. HRA is a feature of variability in human heart rate which is dependent upon external and internal body conditions. The initial phases of head-up tilt test (HUTT), namely, supine and tilt, were chosen as the external body affecting factors. Various calculation methods of HRA, such as Porta’s index (PI), Guzik’s index (GI), and its variance based components, were used to assess the heart rate variability (HRV) and its asymmetry. We compared 5-min ECG recordings from both supine and tilt phases of HUT test. Short-term HRA was observed in 54.1% of men in supine phase and 65.4% of men in tilt phase. The study revealed significant increase of GI (from 0.50 to 0.52, p < 0.001) in the tilt phase as well as significant changes in HRV descriptors between HUTT phases. Our results showed that the variability of human heart rate and its asymmetry are sensitive to orthostatic stress. The study of short-term HRA is a potential additional tool to increase sensitivity in conditions where HUTT is a diagnostic tool, such as vasovagal syncope.

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Section: Introductionmentioning

confidence: 99%

Heart Rate Asymmetry Analysis During Head-Up Tilt Test in Healthy Men

et al. 2021

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“…Most of the patients with gastric cancer in our study had increased heart rates directly proportional to the plasma levels of free metanephrine and normetanephrine. Shi et al recently reported that the severity of gastric cancer in diagnosed patients can also be predicted by perturbations in the nonlinear dynamic patterns of heart rate variability (HRV) [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Assessment of Epinephrine and Norepinephrine in Gastric Carcinoma

Mehedințeanu

Sfredel

Stovicek

et al. 2021

IJMS

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The aim of our study was to assess the sympathetic nervous system’s involvement in the evolution of gastric carcinoma in patients by analyzing the mediators of this system (epinephrine and norepinephrine), as well as by analyzing the histological expression of the norepinephrine transporter (NET). We conducted an observational study including 91 patients diagnosed with gastric carcinoma and an additional 200 patients without cancer between November 2017 and October 2018. We set the primary endpoint as mortality from any cause in the first two years after enrolment in the study. The patients were monitored by a 24-h Holter electrocardiogram (ECG) to assess sympathetic or parasympathetic predominance. Blood was also collected from the patients to measure plasma free metanephrine (Meta) and normetanephrine (N-Meta), and tumor histological samples were collected for the analysis of NET expression. All of this was performed prior to the application of any antineoplastic therapy. Each patient was monitored for two years. We found higher heart rates in patients with gastric carcinoma than those without cancer. Regarding Meta and N-Meta, elevated levels were recorded in the patients with gastric carcinoma, correlating with the degree of tumor differentiation and other negative prognostic factors such as tumor invasion, lymph node metastasis, and distant metastases. Elevated Meta and N-Meta was also associated with a poor survival rate. All these data suggest that the predominance of the sympathetic nervous system’s activity predicts increased gastric carcinoma severity.

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“…Concurrently, newer, more robust and flexible nonlinear measures are emerging, 39,40 and some have been applied in a range of healthcare settings; [41][42][43][44][45][46][47] the challenge will be to efficiently test and incorporate these tools in the myriad of data collected in the intensive care setting.…”

Section: Limitationsmentioning

confidence: 99%

Signal Information Prediction of Mortality Identifies Unique Patient Subsets after Severe Traumatic Brain Injury: A Decision-Tree Analysis Approach

Gao

Smielewski

et al. 2020

Journal of Neurotrauma

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Nonlinear physiological signal features that reveal information content and causal flow have recently been shown to be predictors of mortality after severe traumatic brain injury (TBI). The extent to which these features interact together, and with traditional measures to describe patients in a clinically meaningful way remains unclear. In this study, we incorporated basic demographics (age and initial Glasgow coma scale, GCS) with linear and nonlinear signal information based features-approximate entropy (ApEn), and multivariate conditional Granger causality (GC) to evaluate their relative contributions to mortality using cardio-cerebral monitoring data from 171 severe TBI patients admitted to a single neurocritical care center over a ten-year period. Beyond linear modelling, we employed a decision tree analysis approach to define a predictive hierarchy of features. We found ApEn (p = 0.009) and GC (p = 0.004) based features to be independent predictors of mortality at a time when mean intracranial pressure (ICP) was not. Our combined model with both signal information-based features performed the strongest (area under curve = 0.86 vs 0.77 for linear features only). Although low "intracranial" complexity (ApEn-ICP) out-ranked both age and GCS as crucial drivers of mortality (fivefold increase in mortality where ApEn-ICP < 1.56, 36.2% vs. 7.8%), decision tree analysis revealed clear subsets of patient populations using all three predictors. Patients with lower ApEn-ICP and aged > 60 died, whereas those with higher ApEn-ICP and GCS ³ 5 all survived. Yet, even with low initial intracranial complexity, as long as patients maintained robust GC and "extracranial" complexity (ApEn of mean arterial pressure), they all survived. Incorporating traditional linear and novel, nonlinear signal information features, particularly in a framework such as decision trees, may provide better insight into the 'health' status. However, caution is required when interpreting these results in a clinical setting prior to external validation.

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Nonlinear heart rate variability biomarkers for gastric cancer severity: A pilot study

Cited by 28 publications

References 52 publications

Heart Rate Asymmetry Analysis During Head-Up Tilt Test in Healthy Men

Heart Rate Asymmetry Analysis During Head-Up Tilt Test in Healthy Men

Assessment of Epinephrine and Norepinephrine in Gastric Carcinoma

Signal Information Prediction of Mortality Identifies Unique Patient Subsets after Severe Traumatic Brain Injury: A Decision-Tree Analysis Approach

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