Saving the brain one heartbeat at a time

Frasch, Martin G.

doi:10.1113/jp275776

Cited by 20 publications

(30 citation statements)

References 6 publications

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“…Finally, Van Laar et al found a rise in LF and a decrease in HF HRV in the last 30 minutes of labor when pH was <7.05 at birth . However, commonly used HRV analysis methods have significant interindividual variability and require post‐treatment, which precludes their use in current practice …”

Section: Discussionmentioning

confidence: 99%

Parasympathetic nervous system response to acidosis: Evaluation in an experimental fetal sheep model

Ghesquière

Jonckheere

Drumez

et al. 2019

Acta Obstet Gynecol Scand

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| INTRODUC TI ONThe occurrence of decreased maternal-fetal gas exchange during labor may lead to fetal acidosis, which can be responsible for severe neonatal complications including a risk of cerebral palsy. It is recognized that about 10% of cases of cerebral palsy are caused by peripartum asphyxia. 1 Recent guidelines highlighted the importance of knowledge of fetal physiology to improve the interpretation of fetal heart rate (FHR) changes during labor. 2 However, changes in FHR are an imperfect reflection of fetal adaptation to hypoxia.Abbreviations: ANS, autonomic nervous system; FHR, fetal heart rate; FSI, fetal stress index; HF, high-frequency; HRV, heart rate variability; LF, low-frequency; MAP, mean arterial pressure; UCO, umbilical cord occlusion. 1 EA 4489 -Perinatal Environment and Health, Abstract Introduction: Heart rate variability and fetal heart rate decelerations are impacted by parasympathetic function and reflect acid-base status. Our team developed a new heart rate variability index, the fetal stress index (FSI), which has lower interindividual variability and higher sensitivity for detecting fluctuations in parasympathetic nervous system activity. The aim of this study was to explore the ability of the FSI to predict fetal acidosis in a fetal sheep model. Material and methods: Repeated 1-minute total umbilical cord occlusions (UCOs)were performed every 2.5 minutes over 3 hours to generate fetal acidosis mimicking that which occurs during labor and contractions. Fetal hemodynamic parameters, blood gas, the FSI and the magnitude (from the beginning to the nadir) of the fetal heart rate deceleration were recorded at regular intervals. The data were analyzed over three time intervals because of variation in the duration of the experiments: period A (first 12 UCOs), period B (middle 12 UCOs) and period C (last 12 UCOs). Results:Nine experiments were performed. Acidosis was progressive with a significant difference between the pH, lactate levels and base deficit values for the three periods of occlusion (P < 0.05). Both FSI and the magnitude of fetal heart rate decelerations gradually increased during the UCOs and both differed significantly between periods A and C (P = 0.0008 for FSI and P = 0.003 for deceleration). Conclusion:This experimental protocol allowed the development of progressive acidosis in a good model of the physiology of labor. Parasympathetic nervous system activity increased during acidosis and could be measured using our index, the FSI, and the magnitude of fetal heart rate decelerations. K E Y W O R D Sacidosis, fetal heart rate, fetal sheep, fetal stress index, parasympathetic nervous system

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Section: Discussionmentioning

confidence: 99%

Parasympathetic nervous system response to acidosis: Evaluation in an experimental fetal sheep model

Ghesquière

Jonckheere

Drumez

et al. 2019

Acta Obstet Gynecol Scand

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“…Our present work highlights the difficulty in summarizing fHRV changes as being more/less complex or suppressed/increased variability. (Frasch, 2018) The various HRV measures characterize different, sometimes conflicting, aspects of the signal and the dynamics of the underlying system. It is for this reason that we introduced the terms "HRV code" and "vagus code".…”

Section: Discussionmentioning

confidence: 99%

Vagal contributions to fetal heart rate variability: an omics approach

et al. 2019

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Fetal heart rate variability (fHRV) is an important indicator of health and disease, yet its physiological origins, neural contributions in particular, are not well understood. We aimed to develop novel experimental and data analytical approaches to identify fHRV measures reflecting the vagus nerve contributions to fHRV. In near-term ovine fetuses, a comprehensive set of 46 fHRV measures was computed from fetal pre-cordial electrocardiogram recorded during surgery and 72 hours later without (n=24) and with intra-surgical bilateral cervical vagotomy (n=15). The fetal heart rate did not change due to vagotomy. We identify fHRV measures specific to the vagal modulation of fHRV: Multiscale time irreversibility asymmetry index (AsymI), Detrended fluctuation analysis (DFA) α 1 , Kullback-Leibler permutation entropy (KLPE) and Scale dependent Lyapunov exponent slope (SDLE α). We provide a systematic delineation of vagal contributions to fHRV across signal-analytical domains which should be relevant for the emerging field of bioelectronic medicine and the deciphering of the "vagus code". Our findings also have clinical significance for in utero monitoring of fetal health during surgery. Key points• Fetal surgery causes a complex pattern of changes in heart rate variability measures with overall reduction of complexity or variability • At 72 hours after surgery, many of the HRV measures recover and this recovery is delayed by an intrasurgical cervical bilateral vagotomy • We identify HRV pattern representing complete vagal withdrawal that can be understood as part of "HRV code", rather than any single HRV measure • We identify HRV biomarkers of recovery from fetal surgery and discuss the effect of anticholinergic medication on this recovery al. , 2011;Sassi et al. , 2015) While some of these techniques capture properties of time series' variability that are correlated, most offer a unique aspect of variability by characterizing different mathematical properties of the signals. They include measures characterizing the statistical properties (e.g., standard deviation, root mean square of successive differences of R-R intervals of electrocardiogram (ECG), RMSSD), the informational complexity (e.g., entropy measures), the pattern of variations across time scales (i.e., time-invariant features such as fractal measures, power law exponents) or the energy contained in the signal (e.g., spectral measures). Researchers generally agree that a plurality of techniques offers the most complete evaluation. (Goldberger, 1996;Goldberger et al. , 2002) An important underlying assumption about studying biological variability is that it has predictive properties about physiological systems from which it emerges. Hence, variability properties are a form of biological code, taking place on different scales in space and time. While the time component can be taken literally, the space component can represent different organs and regions of the body contributing to the properties of a variability pattern in question. The space component can also...

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“…We invite the interested reader to explore this study and test the identified measurable d) The HRV code has been proposed as an overarching concept incorporating the various multi-scale contributions of inter-organ communication reflected in HRV. [8,46,47] We suggest that an understanding of the impact on CPS of chronic fetal hypoxia or infection during pregnancy should be sought within the integrative framework of the HRV code; e) Could we use mathematical modeling to derive predictions for HRV properties, likely to work as iHRV biomarkers in the human clinical setting? Mathematical models exist for CPS and fetal cardiovascular responses to labor, for example.…”

Section: ) Can the Impact Of Fetal Hypoxia Or Infection On Cps Be Camentioning

confidence: 99%

“…[6] The analysis of fetal heart rate variability (HRV) has been the mainstay of noninvasive fetal health monitoring for decades, yet its utility to identify endangered fetuses has remained limited. [7,8] In this review, we will discuss how the CPS provides the subcellular, cellular and multicellular substrate for the emergence of an intrinsic fetal HRV (iHRV). We hope that expanding research into the iHRV as a proxy to fetal cardiac health will not only help in the diagnosis of fetuses at risk in adverse pregnancy, but that it will also inspire future studies into this aspect of cardiac cellular development and its significance for the early detection of cardiac diseases in later life.…”

Section: Introductionmentioning

confidence: 99%

Impact of Chronic Fetal Hypoxia and Inflammation on Cardiac Pacemaker Cell Development

Frasch

Giussani

2020

Cells

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Chronic fetal hypoxia and infection are examples of adverse conditions during complicated pregnancy, which impact cardiac myogenesis and increase the lifetime risk of heart disease.However, the effects that chronic hypoxic or inflammatory environments exert on cardiac pacemaker cells are poorly understood. Here, we review the current evidence and novel avenues of bench-to-bed research in this field of perinatal cardiogenesis as well as its translational significance for early detection of future risk for cardiovascular disease.

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Saving the brain one heartbeat at a time

Cited by 20 publications

References 6 publications

Parasympathetic nervous system response to acidosis: Evaluation in an experimental fetal sheep model

Parasympathetic nervous system response to acidosis: Evaluation in an experimental fetal sheep model

Vagal contributions to fetal heart rate variability: an omics approach

Impact of Chronic Fetal Hypoxia and Inflammation on Cardiac Pacemaker Cell Development

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