Effect of nortriptyline and paroxetine on measures of chaos of heart rate time series in patients with panic disorder

Tricyclic antidepressants have notable cardiac side effects, and this issue has become important due to the recent reports of increased cardiovascular mortality in patients with depression and anxiety. Several previous studies indicate that serotonin reuptake inhibitors (SRIs) do not appear to have such adverse effects. Apart from the effects of these drugs on routine 12-lead ECG, the effects on beat-to-beat heart rate (HR) and QT interval time series provide more information on the side effects related to cardiac autonomic function. In this study, we evaluated the effects of two antidepressants, nortriptyline (n = 13), a tricyclic, and paroxetine (n = 16), an SRI inhibitor, on HR variability in patients with panic disorder, using a measure of chaos, the largest Lyapunov exponent (LLE) using pre- and posttreatment HR time series. Our results show that nortriptyline is associated with a decrease in LLE of high frequency (HF: 0.15-0.5 Hz) filtered series, which is most likely due to its anticholinergic effect, while paroxetine had no such effect. Paroxetine significantly decreased sympathovagal ratios as measured by a decrease in LLE of LF/HF. These results suggest that paroxetine appears to be safer in regards to cardiovascular effects compared to nortriptyline in this group of patients. (C) 2003 Elsevier Inc. All rights reserved.

Multiple Spectral Peak Tracking for Heart Rate Monitoring from Photoplethysmography Signal During Intensive Physical Exercise

We propose a multiple initialization based spectral peak tracking (MISPT) technique for heart rate monitoring from photoplethysmography (PPG) signal. MISPT is applied on the PPG signal after removing the motion artifact using an adaptive noise cancellation filter. MISPT yields several estimates of the heart rate trajectory from the spectrogram of the denoised PPG signal which are finally combined using a novel measure called trajectory strength. Multiple initializations help in correcting erroneous heart rate trajectories unlike the typical SPT which uses only single initialization. Experiments on the PPG data from 12 subjects recorded during intensive physical exercise show that the MISPT based heart rate monitoring indeed yields a better heart rate estimate compared to the SPT with single initialization. On the 12 datasets MISPT results in an average absolute error of 1.11 BPM which is lower than 1.28 BPM obtained by the state-of-the-art online heart rate monitoring algorithm.

Number of Players and Relative Pitch Area per Player: Comparing Their Influence on Heart Rate and Physical Demands in Under-12 and Under-13 Football Players

The aim of the present study is to analyse the influence of different large-sided games (LSGs) on the physical and physiological variables in under-12s (U12) and -13s (U13) soccer players. The effects of the combination of different number of players per team, 7, 9, and 11 (P7, P9, and P11, respectively) with three relative pitch areas, 100, 200, and 300 m(2) (A100, A200, and A300, respectively), were analysed in this study. The variables analysed were: 1) global indicator such as total distance (TD); work:rest ratio (W:R); player-load (PL) and maximal speed (V-max); 2) heart rate (HR) mean and time spent in different intensity zones of HR (<75%, 75-84%, 84-90% and >90%), and; 3) five absolute (<8, 8-13, 13-16 and >16 Km h(-1)) and three relative speed categories (<40%, 40-60% and >60% V-max). The results support the theory that a change in format (player number and pitch dimensions) affects no similarly in the two players categories. Although it can seem that U13 players are more demanded in this kind of LSG, when the work load is assessed from a relative point of view, great pitch dimensions and/or high number of player per team are involved in the training task to the U12 players. The results of this study could alert to the coaches to avoid some types of LSGs for the U12 players such as:P11 played in A100, A200 or A300, P9 played in A200 or A300 and P7 played in A300 due to that U13>U12 in several physical and physiological variables (W:R, time spent in 84-90% HRmax, distance in 8-13 and 13-16 Km h(-1) and time spent in 40-60% V-max). These results may help youth soccer coaches to plan the progressive introduction of LSGs so that task demands are adapted to the physiological and physical development of participants.

Recovery of linear and nonlinear heart rate dynamics after coronary artery bypass grafting surgery

Background: Conventional coronary artery bypass grafting (C-CABG) and off-pump CABG (OPCAB) surgery may produce different patients' outcomes, including the extent of cardiac autonomic (CA) imbalance. the beneficial effects of an exercise-based inpatient programme on heart rate variability (HRV) for C-CABG patients have already been demonstrated by our group. However, there are no studies about the impact of a cardiac rehabilitation (CR) on HRV behaviour after OPCAB. the aim of this study is to compare the influence of both operative techniques on HRV pattern following CR in the postoperative (PO) period.Methods: Cardiac autonomic function was evaluated by HRV indices pre- and post-CR in patients undergoing C-CABG (n = 15) and OPCAB (n = 13). All patients participated in a short-term(approximately 5 days) supervised CR programme of early mobilization, consisting of progressive exercises, from active-assistive movements at PO day 1 to climbing flights of stairs at PO day 5.Results: Both groups demonstrated a reduction in HRV following surgery. the CR programme promoted improvements in HRV indices at discharge for both groups. the OPCAB group presented with higher HRV values at discharge, compared to the C-CABG group, indicating a better recovery of CA function.Conclusion: Our data suggest that patients submitted to OPCAB and an inpatient CR programme present with greater improvement in CA function compared to C-CABG.

Focused attention, heart rate deceleration, and cognitive development in preterm and full-term infants

The majority of children who are born very preterm escape major impairment, yet more subtle cognitive and attention problems are very common in this population. Previous research has linked infant focused attention during exploratory play to later cognition in children born full-term and preterm. Infant focused attention can be indexed by sustained decreases in heart rate (HR). However there are no preterm studies that have jointly examined infant behavioral attention and concurrent HR response during exploratory play in relation to developing cognition. We recruited preterm infants free from neonatal conditions associated with major adverse outcomes, and further excluded infants with developmental delay (Bayley Mental Development Index [MDI?

Cortisol, behavior, and heart rate reactivity to immunization pain at 4 months corrected age in infants born very preterm

Pain response may be altered in infants born very preterm owing to repeated exposure to procedures in the neonatal intensive care unit. Findings have been inconsistent in studies of behavioral and cardiac responses to brief pain in preterm versus full-term infants following neonatal intensive care unit discharge. To our knowledge, cortisol reactivity to pain has not been compared in preterm and full-term infants. We examined pain reactivity to immunization in preterm and full-term infants.

Low Complexity Spectral Analysis of Heart-Rate-Variability through a Wavelet based FFT

In this paper, a low complexity system for spectral analysis of heart rate variability (HRV) is presented. The main idea of the proposed approach is the implementation of the Fast-Lomb periodogram that is a ubiquitous tool in spectral analysis, using a wavelet based Fast Fourier transform. Interestingly we show that the proposed approach enables the classification of processed data into more and less significant based on their contribution to output quality. Based on such a classification a percentage of less-significant data is being pruned leading to a significant reduction of algorithmic complexity with minimal quality degradation. Indeed, our results indicate that the proposed system can achieve up-to 45% reduction in number of computations with only 4.9% average error in the output quality compared to a conventional FFT based HRV system.

A quality-scalable and energy-efficient approach for spectral analysis of heart rate variability

Today there is a growing interest in the integration of health monitoring applications in portable devices necessitating the development of methods that improve the energy efficiency of such systems. In this paper, we present a systematic approach that enables energy-quality trade-offs in spectral analysis systems for bio-signals, which are useful in monitoring various health conditions as those associated with the heart-rate. To enable such trade-offs, the processed signals are expressed initially in a basis in which significant components that carry most of the relevant information can be easily distinguished from the parts that influence the output to a lesser extent. Such a classification allows the pruning of operations associated with the less significant signal components leading to power savings with minor quality loss since only less useful parts are pruned under the given requirements. To exploit the attributes of the modified spectral analysis system, thresholding rules are determined and adopted at design- and run-time, allowing the static or dynamic pruning of less-useful operations based on the accuracy and energy requirements. The proposed algorithm is implemented on a typical sensor node simulator and results show up-to 82% energy savings when static pruning is combined with voltage and frequency scaling, compared to the conventional algorithm in which such trade-offs were not available. In addition, experiments with numerous cardiac samples of various patients show that such energy savings come with a 4.9% average accuracy loss, which does not affect the system detection capability of sinus-arrhythmia which was used as a test case. 

Respiratory and non-respiratory sinus arrhythmia: implications for heart rate variability

The quantity of blood arriving at the left side of the heart oscillates throughout the breathing cycle due to the mechanics of breathing. Neurally regulated fluctuations in the length of the heart period act to dampen oscillations of the left ventricular stroke volume entering the aorta. We have reported that stroke volume oscillations but not spectral frequency variability stroke volume measures can be used to estimate the breathing frequency. This study investigated with the same recordings whether heart period oscillations or spectral heart rate variability measures could function as estimators of breathing frequency. Continuous 270 s cardiovascular recordings were obtained from 22 healthy adult volunteers in the supine and upright postures. Breathing was recorded simultaneously. Breathing frequency and heart period oscillation frequency were calculated manually, while heart rate variability spectral maximums were obtained using heart rate variability software. These estimates were compared to the breathing frequency using the Bland–Altman agreement procedure. Estimates were required to be \±10% (95% levels of agreement). The 95% levels of agreement measures for the heart period oscillation frequency (supine: -27.7 to 52.0%, upright: -37.8 to 45.9%) and the heart rate variability spectral maximum estimates (supine: -48.7 to 26.5% and -56.4 to 62.7%, upright: -37.8 to 39.3%) exceeded 10%. Multiple heart period oscillations were observed to occur during breathing cycles. Both respiratory and non-respiratory sinus arrhythmia was observed amongst healthy adults. This observation at least partly explains why heart period parameters and heart rate variability parameters are not reliable estimators of breathing frequency. In determining the validity of spectral heart rate variability measurements we suggest that it is the position of the spectral peaks and not the breathing