Complex nonlinear autonomic nervous system modulation link cardiac autonomic neuropathy and peripheral vascular disease (original) (raw)
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The 5th 2012 Biomedical Engineering International Conference, 2012
Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia associated with an increased risk of left atrial thrombosis as well as ischemic stroke. In this study, we have evaluated the characteristics of paroxysmal AF (PAF) and persistent AF using sample entropy (SampEn), a new biosignal parameter for determining degree of AF signal complexity in atrial activities extracted from surface ECG, including heart rate variability (HRV) to test the hypothesis that increased atrial signal irregularity in AF patients relates to cardiac autonomic dysfunction compared with control subjects. Methods: PAF patients with normal sinus rhythm (n = 12), persistent AF patients (n = 11), and control subjects (patient controls; n = 8, and healthy controls; n = 13) were recruited. The ECG recordings (sampling rate of 1000 Hz, 5-minute long) were performed, then standard short-term HRV and SampEn were analyzed by software algorithms. Results: SampEn values from lead V1 in patients with persistent AF were significantly higher than those in healthy controls (0.14±0.02 vs. 0.10±0.04). Although there was no SampEn difference between PAF patients and the other three groups, the PAF SampEn was in between persistent AF and control values. For HRV analysis, low-frequency to highfrequency (LF/HF) power ratio in both PAF and persistent AF patients were significantly decreased compared to healthy controls (0.75±0.52 and 0.44±0.09 vs. 1.56±0.77, respectively). Conclusion: There was an impairment of cardiac autonomic function in both PAF (with normal sinus rhythm) and persistent AF patients consistent with an increased atrial signal irregularity.
Abstract—Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia associated with an increased risk of left atrial thrombosis as well as ischemic stroke. In this study, we have evaluated the characteristics of paroxysmal AF (PAF) and persistent AF using sample entropy (SampEn), a new biosignal parameter for determining degree of AF signal complexity in atrial activities extracted from surface ECG, including heart rate variability (HRV) to test the hypothesis that increased atrial signal irregularity in AF patients relates to cardiac autonomic dysfunction compared with control subjects. Methods: PAF patients with normal sinus rhythm (n = 12), persistent AF patients (n = 11), and control subjects (patient controls; n = 8, and healthy controls; n = 13) were recruited. The ECG recordings (sampling rate of 1000 Hz, 5-minute long) were performed, then standard short-term HRV and SampEn were analyzed by software algorithms. Results: SampEn values from lead V1 in patient...
Atypical Cardiac Autonomic Neuropathy Identified with Entropy Measures
Cardiology and Angiology: An International Journal, 2015
Aims: To identify Cardiac Autonomic Neuropathy (CAN) from a range of measures extracted from Heart Rate Variability (HRV), including higher moments of RR intervals and a spectrum of entropy measures of RR intervals. Study Design: Analysis of HRV measured from participants at a diabetes screening clinic. Groups were compared using t-tests to identify variables that provide separation between groups.
2015
In this work we compare three multiscale measures for their ability to discriminate between participants having cardiac autonomic neuropathy (CAN) and aged controls. CAN is a disease that involves nerve damage leading to an abnormal control of heart rate, so one would expect disease progression to manifest in changes to heart rate variability (HRV). We applied multiscale entropy (MSE), multi fractal detrended fluctuation analysis (MFDFA), and Renyi entropy (RE) to recorded datasets of RR intervals. The latter measure provided the best separation (lowest p-value in Mann-Whitney tests) between classes of participants having CAN, early CAN or no CAN (controls). This comparison suggests the efficacy of RE as a measure for diagnosis of CAN and its progression, when compared to the other multiscale measures.
2009
This study presents the usefulness of tone-entropy (T-E) analysis of heart rate variability (HRV) using short term ECG recordings (~20 minutes) for screening the degree of severity (mild, definite and severe) of cardiac autonomic neuropathy (CAN). Tone reflects sympathovagal balance whose validity has been already examined on typical physiological cases. Entropy which is the autonomic regularity activity was evaluated though Shannon entropy of HRV. Both indexes were defined on a distribution of successive variations of heart periods. The results showed that the tone was high and the entropy was low in the definite group compared with the early and normal group. When the result was plotted in twodimensional T-E space, it revealed a curve-linear relation between the tone and entropy. The findings could form the basis of a cheap and non-invasive test for screening CAN in patients with or without diabetes.
2010
Background: Diabetic patients are at the risk of cardiac autonomic neuropathy (CAN) and arterial stiffness. This study aimed to investigate the association of heart rate variability (HRV) as an index for CAN and pulse wave velocity (PWV) as an index for arterial stiffness. Methods: Uncomplicated diabetes type-2 patients who had no apparent history of cardiovascular condition underwent HRV and PWV measurements and the results were compared with the control group consisting of non-diabetic peers. Also, the findings were adjusted for the cardiovascular risk factors and other confounding factors. Results: A total of 64 diabetic patients (age= 52.08±8.50 years; males=33 [51.6%]) were compared with 57 controls (age= 48.74±6.18 years; males=25 [43.9%]) in this study. Hypertension, dyslipidemia, and thereby systolic blood pressure and statin use were significantly more frequent in the diabetic group, while the serum levels of cholesterol, HDL-C and LDL-C were significantly higher in the controls. Pulse wave was significantly increased in the diabetic patients (p<0.001). Main HRV parameters were significantly lower in diabetics than in controls. After adjustment for the confounders, PWV and HRV remained significantly different between the groups (p=0.01 and p=0.004, respectively). Multiple logistic regression of the association between pulse wave velocity and HRV index was independently significant both in diabetics and controls. Conclusions: There exists a significant relationship between heart rate variability and arterial stiffness as a measure for atherosclerosis in diabetic patients, although the role of the confounding factors is noteworthy.
Entropy, 2015
In this work we compare three multiscale measures for their ability to discriminate between participants having cardiac autonomic neuropathy (CAN) and aged controls. CAN is a disease that involves nerve damage leading to an abnormal control of heart rate, so one would expect disease progression to manifest in changes to heart rate variability (HRV). We applied multiscale entropy (MSE), multi fractal detrended fluctuation analysis (MFDFA), and Renyi entropy (RE) to recorded datasets of RR intervals. The latter measure provided the best separation (lowest p-value in Mann-Whitney tests) between classes of participants having CAN, early CAN or no CAN (controls). This comparison suggests the efficacy of RE as a measure for diagnosis of CAN and its progression, when compared to the other multiscale measures.
Renyi entropy in identification of cardiac autonomic neuropathy in diabetes
2012
Heart rate variability (HRV) has been conventionally analyzed with time- and frequency-domain methods. More recent nonlinear analysis has shown an increased sensitivity for identifying risk of future morbidity and mortality in diverse patient groups. Included in the domain of nonlinear analysis are the multiscale entropy measures. The Renyi entropy is such a measure. It is calculated by considering the probability of sequences of values occurring in the HRV data. An exponent α of the probability can be varied to provide a spectrum of measures. In this work we applied the multiscale Renyi entropy for identification of cardiac autonomic neuropathy (CAN) in diabetes patients. Fifteen participants were identified with CAN (dCAN) using the five-test Ewing battery and 26 were control (nCAN). The multiscale Renyi entropy was measured from -5<;α<;+5. The best result was obtained with α=5, where the mean value for patients with CAN was 0.98 with standard deviation of 0.01, compared wit...
Using Renyi entropy to detect early cardiac autonomic neuropathy
Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference, 2013
Cardiac Autonomic Neuropathy (CAN) is a disease that involves nerve damage leading to abnormal control of heart rate. CAN affects the correct operation of the heart and in turn leads to associated arrhythmias and heart attack. An open question is to what extent this condition is detectable by the measurement of Heart Rate Variability (HRV). An even more desirable option is to detect CAN in its early, preclinical stage, to improve treatment and outcomes. In previous work we have shown a difference in the Renyi spectrum between participants identified with well-defined CAN and controls. In this work we applied the multi-scale Renyi entropy for identification of early CAN in diabetes patients. Results suggest that Renyi entropy derived from a 20 minute, Lead-II ECG recording, forms a useful contribution to the detection of CAN even in the early stages of the disease. The positive α parameters (1 ≤ α ≤ 5) associated with the Renyi distribution indicated a significant difference (p < ...
QT Variability Index Changes With Severity of Cardiovascular Autonomic Neuropathy
IEEE Transactions on Information Technology in Biomedicine, 2000
Cardiovascular autonomic neuropathy (CAN) has been frequently postulated to increase susceptibility to ventricular arrhythmias and sudden cardiac death in diabetic patients. The relation between the progression of CAN in diabetes and ventricular repolarization remains to be fully described. Therefore, this study examined QT interval variability and heart rate interbeat variability to identify any alterations of cardiac repolarization in diabetic patients in relation to severity of CAN. Seventy control participants without (CAN−) and 74 patients with CAN (CAN+) were enrolled in this study. Among 74 CAN+ patients, 62 are early CAN+ (eCAN+), and 12 are definite CAN+ (dCAN+) according to autonomic nervous system function tests as described by Ewing. The results showed that the QT variability index (QTVI) was significantly (p < 0.05) higher and positive in the dCAN+ (0.51 ± 1.32) group than in the eCAN+ (−0.39 ± 0.91) and CAN− (−0.54 ± 0.72) groups. The QT variability to heart-rate variability ratio provides a measure of the balance between QT and heart interbeat variability. QTVI was more sensitive in identifying disease progression at all stages. Our study supports the hypothesis that QTVI could be used as a clinical test to identify early CAN and as a marker of CAN progression in diabetic patients and may help physicians in determining the best therapeutic strategy for these patients.