Transient suppression of heart rate complexity in concussed athletes

Fountaine, Michael F. La; Heffernan, Kevin S.; Gossett, James D.; Bauman, William A.; Meersman, Ronald E. De

doi:10.1016/j.autneu.2009.03.001

Cited by 71 publications

(72 citation statements)

References 16 publications

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“…49 Autonomic tests may be effective in identifying concussion or PCS. La Fountaine et al 27,28 showed that 2 measures of cardiac vagal modulation, the QT interval variability index at rest and HR complexity during isometric hand-grip exercise, were altered within 48 hours of head injury, resolved within 1 week, and remained at control levels 2 weeks later, consistent with vagal dysfunction early after concussion. In a controlled study of HRV in university athletes who were judged to be clinically recovered from concussion (a mean of 95 days postinjury), Abaji et al 50 found that during the isometric hand-grip exercise, but not at rest, athletes with a history of concussion had less HF power and a greater LF : HF ratio than age-and teammatched controls with no history of concussion.…”

Section: The Physiology Of Concussionmentioning

confidence: 92%

“…43 Heart-rate variability has been used to quantify autonomic dysfunction across a broad spectrum of TBI severity, including concussion. 33,44,45 Autonomic dysfunction after TBI is believed to represent some degree of uncoupling between the brain autonomic centers and the cardiovascular system, 44 can be precipitated by different types of exercise in patients after concussion, 28,33 and improves as patients recover from severe TBI 46 or from concussion. 28 One group, for example, showed that concussed athletes who reported recent symptom resolution had abnormal HRV 33 and elevated heart rates (HRs) 34 during steady-state exercise (but not at rest) versus healthy controls, which is consistent with increased SNS activation during exercise after concussion.…”

Section: The Physiology Of Concussionmentioning

confidence: 99%

“…Concussion affects the autonomic nervous system (ANS) 27,28 and the control of both cerebral blood flow (CBF) [29][30][31][32] and cardiac rhythm. 33,34 The primary ANS control center may be damaged in concussion, particularly if a rotational force was applied to the upper cervical spine, 35 as supported by results from a diffusion tensor imaging study 36 that showed changes to brainstem white matter neurons after concussion.…”

Section: The Physiology Of Concussionmentioning

confidence: 99%

See 2 more Smart Citations

A Physiological Approach to Prolonged Recovery From Sport-Related Concussion

Leddy¹,

Baker²,

Haider

et al. 2017

Journal of Athletic Training

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Management of the athlete with postconcussion syndrome (PCS) is challenging because of the nonspecificity of PCS symptoms. Ongoing symptoms reflect prolonged concussion pathophysiology or conditions such as migraine headaches, depression or anxiety, chronic pain, cervical injury, visual dysfunction, vestibular dysfunction, or some combination of these. In this paper, we focus on the physiological signs of concussion to help narrow the differential diagnosis of PCS in athletes. The physiological effects of exercise on concussion are especially important for athletes. Some athletes with PCS have exercise intolerance that may result from altered control of cerebral blood flow. Systematic evaluation of exercise tolerance combined with a physical examination of the neurologic, visual, cervical, and vestibular systems can in many cases identify one or more treatable postconcussion disorders.

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Section: The Physiology Of Concussionmentioning

confidence: 92%

Section: The Physiology Of Concussionmentioning

confidence: 99%

Section: The Physiology Of Concussionmentioning

confidence: 99%

See 1 more Smart Citation

A Physiological Approach to Prolonged Recovery From Sport-Related Concussion

Leddy¹,

Baker²,

Haider

et al. 2017

Journal of Athletic Training

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“…In another article, there was shorter interbeat interval after concussion but a time course was not profiled 62. One study showed decreased complexity of heart rate during isometric hand grip testing on the second day after injury 63. In one article, there was decreased stroke volume (as estimated by SysSlope) on days 2 and 7 after injury 64…”

Section: Heart Ratementioning

confidence: 99%

What is the physiological time to recovery after concussion? A systematic review

Kamins¹,

et al. 2017

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Modalities of measuring physiological change after SRC were categorised into the following: functional MRI, diffusion tensor imaging, magnetic resonance spectroscopy, cerebral blood flow, electrophysiology, heart rate, exercise, fluid biomarkers and transcranial magnetic stimulation. Due to differences in modalities, time course, study design and outcomes, it is not possible to define a single 'physiological time window' for SRC recovery. Multiple studies suggest physiological dysfunction may outlast current clinical measures of recovery, supporting a buffer zone of gradually increasing activity before full contact risk. Future studies need to use generalisable populations, longitudinal designs following to physiological and clinical recovery and careful correlation of neurobiological modalities with clinical measures.

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“…Thus, evidence of exaggerated sympathetic control of heart rate from HRV variables in concussed athletes, although probable, remains debatable and may be more easily described with low-intensity provocations such as an isometric hand grip test, during which heart rate responses are lower than in an exercise assessment. 5 From a clinical perspective, the immediate application of our findings is limited, because standard electrocardiographic technology is not equipped to perform the QTVI algorithm. This observation is preliminary and must be replicated on a larger scale before a definitive conclusion about or association between QTVI and concussion can be made.…”

Section: Discussionmentioning

confidence: 99%

Increased QT Interval Variability in 3 Recently Concussed Athletes: An Exploratory Observation

Fountaine

Gossett

Meersman

et al. 2011

Journal of Athletic Training

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Context:The QT interval variability index (QTVI) is a noninvasive measure of beat-to-beat fluctuations of the QT interval as seen from a single electrocardiographic lead. It represents the relationship between the respective variabilities of the QT and R-R intervals. Recently, the QTVI was demonstrated to be an index of vagal cardiac autonomic modulation in resting conditions.Objective: To determine whether QTVI varied in athletes at 48 hours, 1 week, and 2 weeks after a concussive head injury.Design: Case series. Setting: Testing facility. Patients or Other Participants:Three athletes with recent concussions and 3 uninjured athletes with similar demographic factors.Main Outcome Measure(s): Continuous 3-lead electrocardiograms were obtained in a seated, resting position over 2 successive weeks. Separate, unpaired t tests were performed to determine whether group-visit differences were present in the QTVI at 48 hours, 1 week, or 2 weeks.Results: No demographic differences were present between groups. At 48 hours, the QTVI was greater in the concussion group than in the matched controls. At weeks 1 and 2, the QTVI in the concussion group was lower than at 48 hours and not different from that of the control group. Conclusions:Vagal cardiac autonomic modulation, as quantified by the QTVI, appeared to be negatively affected in concussed athletes within 48 hours of injury, resolved within 1 week, and remained at control group levels 2 weeks later. Serial assessments of QTVI may be of clinical utility in identifying suspected cases of acute concussion and may provide helpful information for determining when an athlete can return to play safely.Key Words: autonomic nervous system, heart, cardiovascular system, return to play Key Points• The QT interval variability index was higher at rest in concussed participants than in the control group.• This resting change suggests that vagal cardioautonomic modulation was impaired in recently concussed participants.• The QT interval variability index change resolved within 1 week of injury.B y definition, a sport concussion is a complex pathophysiologic process affecting the brain that is induced by traumatic biomechanical forces. l The nature of the brain injury results in a number of short-term and, in some cases, long-term symptoms. The primary assessment and management of concussion has included comprehensive evaluations designed to identify symptoms from the cognitive, vestibular, and somatic realms; these evaluations are often used in the subsequent determination of playing status. 2 To date, the respective assessment techniques have routinely demonstrated efficacy across multiple groups of athletes.An underexplored area that may have utility in the identification of acute concussion injury is assessment of cardiovascular autonomic function. Linear and nonlinear computations of heart rate variability (HRV), a measure of the autonomically mediated periodicity in a mean heart rate,3 have demonstrated transient, abnormal autonomic responses to exercise or lowintensity provocati...

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Transient suppression of heart rate complexity in concussed athletes

Cited by 71 publications

References 16 publications

A Physiological Approach to Prolonged Recovery From Sport-Related Concussion

A Physiological Approach to Prolonged Recovery From Sport-Related Concussion

What is the physiological time to recovery after concussion? A systematic review

Increased QT Interval Variability in 3 Recently Concussed Athletes: An Exploratory Observation

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