The Role of Heart Rate Variability in Risk Stratification for Adverse Postoperative Cardiac Events

Laitio, Timo; Jalonen, J.; Kuusela, Tom; Scheinin, Harry

doi:10.1213/01.ane.0000287654.49358.3a

Cited by 78 publications

(64 citation statements)

References 132 publications

(167 reference statements)

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“…This high frequency (HF) component is mediated almost solely by the parasympathetic nervous activity. 6,23 Another apparent component of HRV is the low frequency (LF) component ranging from 0.04 to 0.15 Hz. The LF component is mediated by both sympathetic and parasympathetic nervous activities 6 and is substantially affected by baroreflex activity.…”

Section: Introductionmentioning

confidence: 99%

Heart Rate Variability Dynamics During Low-Dose Propofol and Dexmedetomidine Anesthesia

et al. 2012

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Heart rate variability (HRV) has been observed to decrease during anesthesia, but changes in HRV during loss and recovery of consciousness have not been studied in detail. In this study, HRV dynamics during low-dose propofol (N = 10) and dexmedetomidine (N = 9) anesthesia were estimated by using time-varying methods. Standard time-domain and frequency-domain measures of HRV were included in the analysis. Frequency-domain parameters like low frequency (LF) and high frequency (HF) component powers were extracted from time-varying spectrum estimates obtained with a Kalman smoother algorithm. The Kalman smoother is a parametric spectrum estimation approach based on time-varying autoregressive (AR) modeling. Prior to loss of consciousness, an increase in HF component power indicating increase in vagal control of heart rate (HR) was observed for both anesthetics. The relative increase of vagal control over sympathetic control of HR was overall larger for dexmedetomidine which is in line with the known sympatholytic effect of this anesthetic. Even though the inter-individual variability in the HRV parameters was substantial, the results suggest the usefulness of HRV analysis in monitoring dexmedetomidine anesthesia.

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Section: Introductionmentioning

confidence: 99%

Heart Rate Variability Dynamics During Low-Dose Propofol and Dexmedetomidine Anesthesia

et al. 2012

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“…15,21 Recently, decrease in TP of HRV has been observed to be associated with sudden cardiac death and cardiac morbidities. 8,9,35,36 Thus, decreased HRV in FDR of diabetics patients makes them vulnerable to adverse CV events. Further, BHR was signifi cantly high in these subjects (Table 1).…”

Section: Discussionmentioning

confidence: 99%

Decreased Baroreceptor Refl ex Sensitivity in First-degree Relatives of Type 2 Diabetics is Linked to Sympathovagal Imbalance and Cardiovascular Risks

Pal¹,

Pal²,

Nanda³

et al. 2014

J. Cardiovasc. Dis. Res.

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Background: Though decreased baroreceptor refl ex sensitivity (BRS) promotes cardiovascular (CV) morbidity and CV risks are reported in the fi rst-degree relatives (FDR) of Type 2 diabetics, the pathophysiological mechanisms contributing to CV risks in these subjects are not yet elucidated. Methods and Results: Body mass index (BMI), CV parameters such as heart rate (HR), blood pressure (BP), rate-pressure product (RPP), stroke volume (SV), left-ventricular ejection time (LVET), cardiac output, total peripheral resistance (TPR) and BRS, spectral-indices of heart rate variability (HRV), autonomic function tests (AFT) and fasting blood glucose (FBG) were measured and analyzed in subjects of the study group (FDR of Type 2 diabetics, n = 79) and control group (subjects with no family history of diabetes, n = 115). BMI, HR, BP, RPP, SV, LVET, cardiac output, TPR, low-frequency to the high-frequency ratio (ratio of LF-HF power of HRV) and FBG were increased (P < 0.0001), and BRS was decreased (P < 0.0001) in the study group compared to the control group. AFT and HRV parameters demonstrated sympathovagal imbalance (SVI) in the study group, which was due to concomitant sympathetic activation and vagal inhibition. There was a signifi cant correlation of BRS with BMI, CV parameters and LF-HF ratio, a sensitive marker of SVI. Multiple-regression analysis demonstrated independent contribution LF-HF ratio and hypertension status to BRS in the study group. Bivariate-logistic regression revealed signifi cant prediction (odds ratio: 2.15; confi dence interval: 1.1112-6.856, P = 0.008) of BRS to increased RPP, the marker of CV risk, in the study group. Conclusion: Decreased BRS in FDR of Type 2 diabetics predisposes them to CV dysfunction. BRS is linked to SVI and CV risks in these high-risk subjects.

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“…Concerning the post-operative period, it is known, in adults, the correlation between ANS dysfunction and life-threatening complications after surgery [19][20][21]. The effect of anesthetics per se also affects ANS function.…”

Section: Introductionmentioning

confidence: 99%

Heart Rate Variability in Children Submitted to Surgery

Silva¹,

Pinheiro²,

Almeida³

2016

J Anesth Clin Res

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Objective: Heart Rate Variability (HRV) is known to reflect the sympathetic/parasympathetic interaction on several physiological and pathological conditions such as the cardiac activity responsiveness to physiological and environmental stimuli. Therefore, it has been widely used to assess nervous autonomic fluctuations and their influence on sinus node. Studies on children have demonstrated the correlation between HRV and different parameters like age, gender, physical activity and autonomic diseases whereas little evidence exists of the effects of surgery and residual anesthesic drugs on HRV. The aim of this study was to define the possible role of minor surgery in HRV in healthy children.Design: Observational prospective cohort study.Setting: Pediatric Surgery Department of a tertiary, university-affiliated hospital.Patients: 47 healthy children who were scheduled for elective minor surgery.Measurements and Main Results: HRV measurements of 10 to 15 minutes were obtained before and after surgery, using a Holter recorder and the BioSigBrowser ® software. Results showed significant differences in HRV time domain indices before and after surgery in younger patients and in frequency domain in the older ones. They also demonstrated decreased HRV indices until one hour after being submitted to surgery in both time domain and LF parameters, reflecting a parasympathetic withdrawal and sympathetic predominance. Differences were also found when analyzing other variables such as anesthetic drugs. Conclusion:This study demonstrated that surgery has impact on Autonomic Nervous System function in healthy children but, independently of anesthetic drugs, type of surgery, age and existence of pain 60 minutes after surgery no difference in HRV measures was found and autonomic homeostasis was re-established. However, further investigation in this area is required in order to a better support of the role of HRV monitoring on early prognosis prediction and risk stratification in the surgical context.

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The Role of Heart Rate Variability in Risk Stratification for Adverse Postoperative Cardiac Events

Cited by 78 publications

References 132 publications

Heart Rate Variability Dynamics During Low-Dose Propofol and Dexmedetomidine Anesthesia

Heart Rate Variability Dynamics During Low-Dose Propofol and Dexmedetomidine Anesthesia

Decreased Baroreceptor Refl ex Sensitivity in First-degree Relatives of Type 2 Diabetics is Linked to Sympathovagal Imbalance and Cardiovascular Risks

Heart Rate Variability in Children Submitted to Surgery

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