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Special Issue "Cardiovascular Time Series in the Preclinical and Clinical Settings"

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: 20 March 2024 | Viewed by 7559

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Special Issue Editors

Prof. Dr. Gianfranco Parati

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1. Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
2. IRCCS, Istituto Auxologico Italiano, Department of Cardiology San Luca Hospital, Milan, Italy
Interests: cardiovascular risk, arterial hypertension, blood pressure measurement and monitoring, blood pressure variability, autonomic neural cardiovascualr regulation, heart failure, children and adolescents, cardiovascular effects of high altitude exposure, sleep apnea; arterial stiffness, pulmonary circulation
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Prof. Dr. Przemyslaw Guzik

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1. Department of Cardiology - Intensive Therapy, Poznan University of Medical Sciences, Poznan, Poland
2. University Centre for Sports and Medical Studies, Poznan University of Medical Sciences, Poznan, Poland
Interests: heart rate variability, heart rate asymmetry, blood pressure variability, baroreflex function, continuous blood pressure and hemodynamics, echocardiography, arrhythmias, cardiopulmonary exercise test, sports cardiology, cardiovascular time series

Prof. Dr. Paolo Castiglioni

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IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy
Interests: complexity in biosignals; physiological time series; fractals in medicine; cardiovascular modeling; physiology in extreme environments; rehabilitation medicine
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The cardiovascular system is dynamic, and its functions change over time. Heart rate, pressure waveforms and transit times, hemodynamic (e.g., stroke volume, vascular resistance), atrioventricular conduction, QT interval, myocardial oxygen consumption, and muscle or brain oxygenation are examples of vital signals originating from or transferred by the heart and the vascular system.

The cardiovascular time series describing the dynamics of these signals can be defined at every heartbeat or breath or on equally spaced points in time sampled over periods of seconds, hours, days, weeks, or visits. Various mathematical methods are applied to analyze such time series, from simple indexes of dispersion such as standard deviation or counting statistics to more sophisticated approaches such as spectral, nonlinear, and complexity-based analyses. Methods of heart rate and blood pressure variability, baroreflex sensitivity, arterial stiffness, central and peripheral blood pressure, and hemodynamics provide useful information in many clinical areas, including intensive care, cardiology, internal medicine, and sports.

Cardiovascular time series have been explored in patients with hypertension, diabetes, heart failure, shock, sepsis, myocardial infarction, or ischaemic stroke, as well as in athletes in relation to their exercise capacity and sports discipline. Some derived parameters have diagnostic value, and others are used for risk prediction, monitoring the progress of the disease, and the effects of therapies or exercise training.

This Special Issue aims to collect submissions on advances in the monitoring and analysis of cardiovascular time series focusing only on human studies with clear physiological or clinical interpretation. Manuscripts challenging the current knowledge with novel findings are also cordially invited.

Only the following submissions are encouraged: original prospective studies and retrospective analyses, meta-analyses, reviews, and critical appraisals. Neither case nor a series of case studies will be further processed.

Clinicians are the primary readers of the Journal of Clinical Medicine. Therefore, the authors should avoid complex mathematical argumentation and modeling. However, some advanced statistical and analytical methodology (e.g., machine learning or artificial intelligence) may be necessary to provide meaningful clinical or physiological information. Such submissions are also invited to this Special Issue.

Prof. Dr. Gianfranco Parati
Prof. Dr. Przemyslaw Guzik
Prof. Dr. Paolo Castiglioni
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

cardiovascular time series
cardiopulmonary exercise test
sports cardiology
echocardiography
arrhythmias
heart rate variability
heart rate asymmetry
blood pressure variability

Published Papers (8 papers)

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Open AccessArticle

Midday Dipping and Circadian Blood Pressure Patterns in Acute Ischemic Stroke

Nikolaos Kakaletsis

George Ntaios

Haralampos Milionis

Anastasia Karagiannaki

and

J. Clin. Med. 2023, 12(14), 4816; https://doi.org/10.3390/jcm12144816 - 21 Jul 2023

Viewed by 342

Abstract

The purpose of this study was to investigate the alterations in blood pressure (BP) during midday and the changes in circadian BP patterns in the acute phase of ischemic stroke (AIS) with the severity of stroke and their predictive role outcomes within 3 months. A total of 228 AIS patients (a prospective multicenter follow-up study) underwent 24 h ambulatory blood pressure monitoring (ABPM). Mean BP parameters during the day (7:00–22:59), the midday (13:00–16:59), and the night (23:00–6:59), and midday and nocturnal dipping were calculated. Midday SBP dippers had less severe stroke, lower incidence of hypertension and SBP/DBP on admission, lower levels of serum glucose and WBCs, and delayed initiation of ABPM compared to risers. There was a reverse relation between midday SBP dipping and both nocturnal dipping and stroke severity. The “double dippers” (midday and nocturnal dipping) had the least severe stroke, the lowest SBP/DBP on admission, the lowest heart rate from ABPM, and a lower risk of an unfavorable outcome, while the “double risers” had the opposite results, by an approximately five-fold risk of death/disability at 3 months. These findings indicate different circadian BP patterns during the acute phase of AIS, which could be considered a marker of stroke severity and prognosis. Full article

(This article belongs to the Special Issue Cardiovascular Time Series in the Preclinical and Clinical Settings)

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Open AccessArticle

Dependence of the Atrioventricular Conduction Time on the Conduction through the Atrioventricular Node and His–Purkinje System

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J. Clin. Med. 2023, 12(4), 1330; https://doi.org/10.3390/jcm12041330 - 07 Feb 2023

Viewed by 863

Abstract

The electrical depolarization of the heart passes through various structures of the cardiac conduction system, which modify its conduction to different extents. In this study, we investigated the relationship between the atrioventricular conduction time (AV interval) and its contributors, the atrioventricular node (AVN) and the His–Purkinje system (HPS), as represented by the AH and HV intervals, respectively. We also compared sex differences in these intervals and their relations. Resting intracardiac tracings lasting 5 min were obtained from 64 patients (33 women) during an invasive electrophysiological study. The aforementioned intervals were measured for all consecutive beats. The mean AH interval was 85.9 ms, HV 43.7 ms, and AV 129.6 ms. Men had longer AH (80.0 vs. 65.9 ms), HV (38.4 vs. 35.3 ms), and AV intervals (124.7 vs. 108.5 ms) than women. The AV intervals were linearly correlated with AH intervals in all patients (r² = 0.65). No significant correlation was found between AV and HV intervals in all patients (r² = 0.05). There were no sex differences in these associations. Our results suggest that the atrioventricular conduction time depends mainly on the conduction through the AVN and less on the HPS. These relations are similar in both sexes, although men had longer conduction times through the AVN, HPS, and total atrioventricular conduction time. Full article

(This article belongs to the Special Issue Cardiovascular Time Series in the Preclinical and Clinical Settings)

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Open AccessArticle

Investigating the Ischaemic Phase of Skin NADH Fluorescence Dynamics in Recently Diagnosed Primary Hypertension: A Time Series Analysis

Regina Pawlak-Chomicka

and

J. Clin. Med. 2023, 12(4), 1247; https://doi.org/10.3390/jcm12041247 - 04 Feb 2023

Viewed by 654

Abstract

The reduced form of nicotinamide adenine dinucleotide (NADH) is crucial in cellular metabolism. During hypoxia, NADH accumulation results from anaerobic cytoplasmic glycolysis and impaired mitochondrial function. This study aimed to compare the dynamic changes in the 460-nm forearm skin fluorescence, which reflects cellular NADH content, during transient ischaemia between healthy individuals and patients with newly diagnosed, untreated essential hypertension (HA). Sixteen healthy volunteers and sixty-five patients with HA underwent non-invasive measurement of forearm skin NADH content using the Flow Mediated Skin Fluorescence (FMSF) method at rest and during a 100-s transient ischaemia induced by inflation of the brachial cuff. The fluorescent signal was sampled at 25 Hz. All samples were normalised to the end of the ischaemic phase, which is the most stable phase of the whole recording. Slope values of 1 s linear regressions were determined for every 25-sample neighbouring set. The 1-s slopes in the early phase of skin ischaemia, indicating quicker hypoxia-induced NADH accumulation in skin, were significantly higher in patients with HA than in healthy individuals. These findings suggest that some protecting mechanisms postponing the early consequences of early cellular hypoxia and premature NADH accumulation during skin ischaemia are impaired in patients with untreated HA. Further studies are needed to investigate this phenomenon. Full article

(This article belongs to the Special Issue Cardiovascular Time Series in the Preclinical and Clinical Settings)

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Open AccessArticle

Heart Rate Asymmetry, Its Compensation, and Heart Rate Variability in Healthy Adults during 48-h Holter ECG Recordings

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J. Clin. Med. 2023, 12(3), 1219; https://doi.org/10.3390/jcm12031219 - 03 Feb 2023

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Abstract

Heart rate asymmetry (HRA) reflects different contributions of heart rate (HR) decelerations and accelerations to heart rate variability (HRV). In this study, we examined various properties of HRA, including its compensation and HRV, in 48-h electrocardiogram (ECG) recordings in healthy adults. Furthermore, we compared sex differences in parameters used to quantify HRA and HRV. Variance-based and relative HRA and HRV parameters were computed for Holter ECG recordings lasting up to 48 h in 101 healthy volunteers. The median age of the subjects was 39 years, with 47 of them being men. The prevalence of all forms of HRA was statistically different from randomness (p < 0.0001). Specifically, HR decelerations contributed >50% (C1d) to short-term HRA in 98.02% of subjects, while HR decelerations contributed <50% to long-term HRA in 89.11% of recordings and to total HRA in 88.12% of recordings. Additionally, decelerations accounted for <50% of all changing heartbeats (Porta’s index) in 74.26% of subjects, and HRA compensation was present in 88.12% of volunteers. Our findings suggest that various HRA features are present in most healthy adults. While men had more pronounced HRA expression, the prevalence of short-, long-term, and total HRA and its compensation was similar in both sexes. For HRV, values of variance-based indices were higher in men than in women, but no differences were found for relative measures. In conclusion, our study references HRA and HRV for longer ECG recordings of up to 48 h, which have become increasingly important in clinical ECG monitoring. The findings can help understand and compare the characteristics of HRA and HRV in patients with different diseases. Full article

(This article belongs to the Special Issue Cardiovascular Time Series in the Preclinical and Clinical Settings)

Open AccessArticle

Heart Rate Asymmetry in Healthy Children

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J. Clin. Med. 2023, 12(3), 1194; https://doi.org/10.3390/jcm12031194 - 02 Feb 2023

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Abstract

Heart rate asymmetry (HRA) is a physiological phenomenon characterized by an unequal contribution of heart rate decelerations and accelerations to different heart rate variability (HRV) features. While HRA has been demonstrated in adults’ ECGs of different duration, a similar investigation in healthy children has not been conducted. This study investigated the variance- and number-based HRA features in 96 healthy children (50 girls and 46 boys, aged 3–18 years) using 24-h ECGs. Additionally, we studied sex differences in HRA. To quantify HRA, variance-based and relative contributions of heart rate decelerations to short-term (C1d), long-term (C2d), and total (CTd) HRV, and the number of all heartbeats (Nd) were computed. Heart rate decelerations contributed more to C1d, but less to C2d and CTd, and were less frequent than heart rate accelerations. Short-term HRA was better expressed in boys. The majority of children (93.7%) had short-term HRA, 88.5% had long-term HRA, 88.5% had total HRA, and 99.0% had more accelerations than decelerations. No sex differences were observed for the rate of various HRA features. Heart rate asymmetry is a common phenomenon in healthy children, as observed in 24-h ECGs. Our findings can be used as reference data for future clinical studies on HRA in children. Full article

(This article belongs to the Special Issue Cardiovascular Time Series in the Preclinical and Clinical Settings)

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Open AccessArticle

A New Approach to Detecting Atrial Fibrillation Using Count Statistics of Relative Changes between Consecutive RR Intervals

Szymon Buś

Konrad Jędrzejewski

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Przemysław Guzik

J. Clin. Med. 2023, 12(2), 687; https://doi.org/10.3390/jcm12020687 - 15 Jan 2023

Viewed by 987

Abstract

Background: The ratio of the difference between neighboring RR intervals to the length of the preceding RR interval (x%) represents the relative change in the duration between two cardiac cycles. We investigated the diagnostic properties of the percentage of relative RR interval differences equal to or greater than x% (pRRx%) with x% in a range between 0.25% and 25% for the distinction of atrial fibrillation (AF) from sinus rhythm (SR). Methods: We used 1-min ECG segments with RR intervals with either AF (32,141 segments) or SR (32,769 segments) from the publicly available Physionet Long-Term Atrial Fibrillation Database (LTAFDB). The properties of pRRx% for different x% were analyzed using the statistical procedures and metrics commonly used to characterize diagnostic methods. Results: The distributions of pRRx% for AF and SR differ significantly over the whole studied range of x% from 0.25% to 25%, with particularly outstanding diagnostic properties for the x% range of 1.5% to 6%. However, pRR3.25% outperformed other pRRx%. Firstly, it had one of the highest and closest to perfect areas under the curve (0.971). For pRR3.25%, the optimal threshold for distinction AF from SR was set at 75.32%. Then, the accuracy was 95.44%, sensitivity was 97.16%, specificity was 93.76%, the positive predictive value was 93.85%, the negative predictive value was 97.11%, and the diagnostic odds ratio was 514. The excellent diagnostic properties of pRR3.25% were confirmed in the publicly available MIT–BIH Atrial Fibrillation Database. In a direct comparison, pRR3.25% outperformed the diagnostic properties of pRR31 (the percentage of successive RR intervals differing by at least 31 ms), i.e., so far, the best single parameter differentiating AF from SR. Conclusions: A family of pRRx% parameters has excellent diagnostic properties for AF detection in a range of x% between 1.5% and 6%. However, pRR3.25% outperforms other pRRx% parameters and pRR31 (until now, probably the most robust single heart rate variability parameter for AF diagnosis). The exquisite pRRx% diagnostic properties for AF and its simple computation make it well-suited for AF detection in modern ECG technologies (mobile/wearable devices, biopatches) in long-term monitoring. The diagnostic properties of pRRx% deserve further exploration in other databases with AF. Full article

(This article belongs to the Special Issue Cardiovascular Time Series in the Preclinical and Clinical Settings)

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Open AccessArticle

Changes in Maternal Heart Rate and Autonomic Regulation following the Antenatal Administration of Corticosteroids: A Secondary Analysis

Maretha Bester

Rohan Joshi

Joyce H. A. M. van Dooren

Massimo Mischi

Rik Vullings

and

Judith O. E. H. van Laar

J. Clin. Med. 2023, 12(2), 588; https://doi.org/10.3390/jcm12020588 - 11 Jan 2023

Viewed by 1258

Abstract

While the effect of antenatally administered corticosteroids on fetal heart rate (HR) and heart rate variability (HRV) is well established, little information is available on how these drugs affect maternal physiology. In this secondary analysis of a prospective, observational cohort study, we quantify how corticosteroids affect maternal HR and HRV, which serve as a proxy measure for autonomic regulation. Abdominal ECG measurements were recorded before and in the five days following the administration of betamethasone—a corticosteroid commonly used for fetal maturation—in 46 women with singleton pregnancies. Maternal HR and HRV were determined from these recordings and compared between these days. HRV was assessed with time- and frequency-domain features, as well as non-linear and complexity features. In the 24 h after betamethasone administration, maternal HR was significantly increased (p < 0.01) by approximately 10 beats per minute, while HRV features linked to parasympathetic activity and HR complexity were significantly decreased (p < 0.01 and p < 0.001, respectively). Within four days after the initial administration of betamethasone, HR decreases and HRV features increase again, indicating a diminishing effect of betamethasone a few days after administration. We conclude that betamethasone administration results in changes in maternal HR and HRV, despite the heterogeneity of the studied population. Therefore, its recent administration should be considered when evaluating these cardiovascular metrics. Full article

(This article belongs to the Special Issue Cardiovascular Time Series in the Preclinical and Clinical Settings)

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Differences in Heart Rate Variability and Baroreflex Sensitivity between Male and Female Athletes

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J. Clin. Med. 2023, 12(12), 3916; https://doi.org/10.3390/jcm12123916 - 08 Jun 2023

Viewed by 835

Abstract

Heart rate variability (HRV), systolic blood pressure variability (BPV), and spontaneous baroreflex sensitivity (BRS) are indirect and approximate measures of autonomic regulation of the cardiovascular system. Studies have shown differences in HRV and BRS between males and females; however, no study has observed differences in BPV, HRV, or BRS between male and female athletes. One hundred males (age 21.2 ± 2.1 y; BMI 27.4 ± 4.5 kg/m²) and sixty-five females (age: 19.7 ± 1.6 y; BMI 22.7 ± 2.2 kg/m²) were assessed during the pre-season baseline. We collected resting beat-to-beat blood pressure and R-R intervals using finger photoplethysmography and a 3-lead electrocardiogram, respectively. Participants underwent a controlled slow breathing protocol (six breaths/minute: 5 s inhale, 5 s exhale) for 5 min. Spectral and linear analysis was conducted on blood pressure and ECG data. Regression curves were fitted to the blood pressure and R-R signals, with the slopes providing the BRS parameters. Male athletes had significantly (p < 0.05) lower mean heart rate, RR interval SD2/SD1, HRV % low-frequency, and higher BP high-frequency power during controlled respiration. No differences were found in any BRS parameters. HRV and BPV responses to a slow breathing protocol differed between male and female athletes; however, BRS responses did not. Full article

(This article belongs to the Special Issue Cardiovascular Time Series in the Preclinical and Clinical Settings)

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