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Fractal scaling properties of heart rate dynamics and myocardial efficiency in dilated cardiomyopathy

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Abstract

Introduction

Since altered heart rate (HR) fluctuations provide prognostic information in heart failure, we examined the associations between HR dynamics, myocardial efficiency and perfusion, among patients with dilated cardiomyopathy.

Methods

Sixteen patients with dilated cardiomyopathy were enrolled. Patients received supervised strength and aerobic training for 5 months (n = 9) or standard care (n = 7). The short-term scaling exponent (α1) and frequency domain measures of HR behavior were assessed at baseline and after 5 months of intervention. The left ventricular (LV) function measured using echocardiography and oxidative metabolism measured using positron emission tomography (PET) and [11C]-acetate were used to estimate the myocardial efficiency.

Results

Short-term fractal exponent α1 correlated significantly with LV myocardial efficiency (r = 0.77, p = 0.002) at baseline. After the intervention period, the majority of patients showed improved myocardial efficiency and small or marked change in HR dynamics toward the natural fractal-like organization (α1 value close 1). Parallel change in fractal properties of HR and myocardial efficiency after intervention was observed in 78% of the patients. Intervention had no significant effect on any other HR fluctuation indices.

Conclusions

The present study suggests that short-term fractal scaling exponent α1, an important prognostic marker in heart failure, is related to LV myocardial efficiency.

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Abbreviations

DCM:

Dilated cardiomyopathy

LV:

Left ventricle

HR:

Heart rate

α1 :

Short-term scaling exponent

PET:

Positron emission tomography

[15O]-water:

Oxygen-15-labeled water

[11C]-acetate:

Carbon-11-labeled acetate

ROI:

Region of interest

Kmono :

[11C]-acetate clearance rate

References

  1. Kim IS, Izawa H, Sobue T, Ishihara H, Somura F, Nishizawa T, Nagata K, Iwase M, Yokota M (2002) Prognostic value of mechanical efficiency in ambulatory patients with idiopathic dilated cardiomyopathy in sinus rhythm. J Am Coll Cardiol 39:1264–1268

    Article  PubMed  Google Scholar 

  2. Karcz M, Chojnowska L, Zareba W, Ruzyllo W (2003) Prognostic significance of heart rate variability in dilated cardiomyopathy. Int J Cardiol 87:75–81

    Article  PubMed  Google Scholar 

  3. Ho K, Moody G, Peng CK, Mietus J, Larson M, Levy D, Goldberger AL (1997) Predicting survival in heart failure case and control subjects by use of fully automated methods for deriving nonlinear and conventional indices of heart rate dynamics. Circulation 96:842–848

    CAS  PubMed  Google Scholar 

  4. Huikuri HV, Mäkikallio T, Airaksinen KE, Mitrani R, Castellanos A, Myerburg RJ (1999) Measurement of heart rate variability: a clinical tool or a research toy? J Am Coll Cardiol 34:1878–1883

    Article  CAS  PubMed  Google Scholar 

  5. Knaapen P, Lubberink M (2008) Cardiac positron emission tomography: myocardial perfusion and metabolism in clinical practice. Clin Res Cardiol 97:791–796

    Article  PubMed  Google Scholar 

  6. Stolen KQ, Kemppainen J, Ukkonen H, Kalliokoski KK, Luotolahti M, Lehikoinen P, Hämäläinen H, Salo T, Airaksinen KE, Nuutila P, Knuuti J (2003) Exercise training improves biventricular oxidative metabolism and left ventricular efficiency in patients with dilated cardiomyopathy. J Am Coll Cardiol 41:460–467

    Article  CAS  PubMed  Google Scholar 

  7. Wu ZK, Vikman S, Laurikka J, Pehkonen E, Iivanainen E, Huikuri HV, Tarkka MR (2005) Nonlinear heart rate variability in CABG patients and the preconditioning effect. Eur J Cardiothorac Surg 28:109–113

    Article  CAS  PubMed  Google Scholar 

  8. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N (1986) Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 57:450–458

    Article  CAS  PubMed  Google Scholar 

  9. Pike VW, Eakins MN, Allan RM, Selwyn AP (1982) Preparation of [1–11C]-acetate: an agent for the study of myocardial metabolism by positron emission tomography. Int J Appl Radiat Isot 33:505–512

    Article  CAS  PubMed  Google Scholar 

  10. Alenius S, Ruotsalainen U (1997) Bayesian image reconstruction for emission tomography based on median root prior. Eur J Nucl Med 24:258–265

    CAS  PubMed  Google Scholar 

  11. Nekolla SG, Miethaner C, Nguyen N, Ziegler S, Schwaiger M (1998) Reproducibility of polar map generation and assessment of defect severity and extent assessment in myocardial perfusion imaging using positron emission tomography. Eur J Nucl Med 25:1313–1321

    Article  CAS  PubMed  Google Scholar 

  12. Bengel FM, Ueberfuhr P, Nekolla S, Ziegler S, Reichart B, Schwaiger M (1999) Oxidative metabolism of the transplanted human heart assessed by positron emission tomography using C-11 acetate. Am J Cardiol 83:1503–1505

    Article  CAS  PubMed  Google Scholar 

  13. Laine H, Raitakari OT, Niinikoski H, Pitkänen OP, Iida H, Viikari J et al (1998) Early impairment of coronary flow reserve in young men with borderline hypertension. J Am Coll Cardiol 32:147–153

    Article  CAS  PubMed  Google Scholar 

  14. Iida H, Takahashi A, Tamura Y, Ono Y, Lammertsma AA (1995) Myocardial blood flow: comparison of oxygen-15-water bolus injection, slow infusion and oxygen-15-carbon dioxide slow inhalation. J Nucl Med 36:78–85

    CAS  PubMed  Google Scholar 

  15. Iida H, Rhodes CG, de Silva R, Araujo LI, Bloomfield PM, Lammertsma AA, Jones T (1992) Use of the left ventricular time–activity curve as a noninvasive input function in dynamic oxygen-15-water positron emission tomography. J Nucl Med 33:1669–1677

    CAS  PubMed  Google Scholar 

  16. Simon T, Becker R, Voss F, Bikou O, Hauck M, Licka M, Katus HA, Bauer A (2008) Elevated B-type natrium peptide levels in patients with nonischemic cardiomyopathy predict occurrence of arrhythmic events. Clin Res Cardiol 97:306–309

    Article  CAS  PubMed  Google Scholar 

  17. Smilde TD, van Veldhuisen DJ, van den Berg MP (2009) Prognostic value of heart rate variability and ventricular arrhythmias during 13-year follow-up in patients with mild to moderate heart failure. Clin Res Cardiol 98:233–239

    Article  CAS  PubMed  Google Scholar 

  18. Goldberger AL (1996) Non-linear dynamics for clinicians: chaos theory, fractals, and complexity at the bedside. Lancet 347:1312–1314

    Article  CAS  PubMed  Google Scholar 

  19. Mäkikallio TH, Høber S, Køber L, Torp-Pedersen C, Peng CK, Goldberger AL, Huikuri HV (1999) Fractal analysis of heart rate dynamics as a predictor of mortality in patients with depressed left ventricular function after acute myocardial infarction: TRACE Investigators, TRAndolapril Cardiac Evaluation. Am J Cardiol 83:836–839

    Article  PubMed  Google Scholar 

  20. Mäkikallio TH, Huikuri HV, Hintze U, Videbaek J, Mitrani RD, Castellanos A, Myerburg RJ, Møller M, DIAMOND Study Group (Danish Investigations of Arrhythmia, Mortality ON Dofetilide) (2001) Fractal analysis and time- and frequency-domain measures of heart rate variability as predictors of mortality in patients with heart failure. Am J Cardiol 87:178–182

    Article  PubMed  Google Scholar 

  21. Mahon NG, Hedman AE, Pedula M, Gang Y, Savelieva I, Waktare JE, Malik MM, Huikuri HV, McKenna WJ (2002) Fractal correlation properties of R–R interval dynamics in asymptomatic relatives of patients with dilated cardiomyopathy. Eur J Heart Fail 4:151–158

    Article  PubMed  Google Scholar 

  22. Kaye DM, Lefkovits J, Jennings GL, Bergin P, Broughton A, Esler MD (1995) Adverse consequences of high sympathetic nervous activity in the failing human heart. J Am Coll Cardiol 26:1257–1263

    Article  CAS  PubMed  Google Scholar 

  23. Tulppo MP, Kiviniemi AM, Hautala AJ, Kallio M, Seppänen T, Mäkikallio TH, Huikuri HV (2005) Physiological background of the loss of fractal heart rate dynamics. Circulation 112:314–319

    Article  PubMed  Google Scholar 

  24. Tulppo MP, Mäkikallio TH, Seppänen T, Shoemaker K, Tutungi E, Hughson RL (2001) Effects of pharmacological adrenergic and vagal modulation on fractal heart rate dynamics. Clin Physiol 21:515–523

    Article  CAS  PubMed  Google Scholar 

  25. Bengel FM, Permanetter B, Ungerer M, Nekolla S, Schwaiger M (2000) Non-invasive estimation of myocardial efficiency using positron emission tomography and carbon-11 acetate-comparison between the normal and failing human heart. Eur J Nucl Med 27:319–326

    Article  CAS  PubMed  Google Scholar 

  26. Ukkonen H, Beanlands RS, Burwash IG, de Kemp RA, Nahmias C, Fallen E, Hill MR, Tang AS (2003) Effect of cardiac resynchronization on myocardial efficiency and regional oxidative metabolism. Circulation 107:28–31

    Article  CAS  PubMed  Google Scholar 

  27. Nelson GS, Berger RD, Fetics BJ, Talbot M, Spinelli JC, Hare JM, Kass DA (2000) Left ventricular or biventricular pacing improves cardiac function at diminished energy cost in patients with dilated cardiomyopathy and left bundle-branch block. Circulation 102:3053–3059

    CAS  PubMed  Google Scholar 

  28. Bradley DJ, Bradley EA, Baughman KL, Berger RD, Calkins H, Goodman SN, Kass DA, Powe NR (2003) Cardiac resynchronization and death from progressive heart failure: a meta-analysis of randomized controlled trials. JAMA 289:730–740

    Article  PubMed  Google Scholar 

  29. Cleland JGF, Daubert J-C, Erdmann E, Freemantle N, Gras D, Kappenberger L, Tavazzi L, Cardiac Resynchronization-Heart Failure (CARE-HF) Study Investigators (2005) Effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 352:1539–1549

    Article  CAS  PubMed  Google Scholar 

  30. Sundell J, Engblom E, Koistinen J, Ylitalo A, Naum A, Stolen KQ, Kalliokoski R, Nekolla SG, Airaksinen KE, Bax JJ, Knuuti J (2004) The effects of cardiac resynchronization therapy on left ventricular function, myocardial energetics, and metabolic reserve in patients with dilated cardiomyopathy and heart failure. J Am Coll Cardiol 43:1027–1033

    Article  PubMed  Google Scholar 

  31. Adamson PB, Kleckner KJ, VanHout WL, Srinivasan S, Abraham WT (2003) Cardiac resynchronization therapy improves heart rate variability in patients with symptomatic heart failure. Circulation 108:266–269

    Article  PubMed  Google Scholar 

  32. Lin JL, Chan HL, Du CC, Lin IN, Lai CW, Lin KT, Wu CP, Tseng YZ, Lien WP (1999) Long-term β-blocker therapy improves autonomic nervous regulation in advanced congestive heart failure: a longitudinal heart rate variability study. Am Heart J 137:658–665

    Article  CAS  PubMed  Google Scholar 

  33. Beanlands RSB, Nahmias C, Gordon E, Coates G, deKemp R, Firnau G, Fallen E (2000) The effects of beta1-blockade on oxidative metabolism and the metabolic cost of ventricular work in patients with left ventricular dysfunction. Circulation 102:2070–2075

    CAS  PubMed  Google Scholar 

  34. Gademan MG, Swenne CA, Verwey HF, van der Laarse A, Maan AC, van de Vooren H, van Pelt J, van Exel HJ, Lucas CM, Cleuren GV, Somer S, Schalij MJ, van der Wall EE (2007) Effect of exercise training on autonomic derangement and neurohumoral activation in chronic heart failure. J Card Fail 13:294–303

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank the staff of the Turku PET Centre for their excellent technical assistance. This study was financially supported by grants from the Finnish Foundation for Cardiovascular Research, Helsinki, Finland, and Turku University Hospital (EVO).

Conflict of interest statement

No conflict of interest.

Author information

Authors and Affiliations

  1. Department of Medicine, University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland

    Tiina Marjatta Salo, Jan Sundell & K. E. Juhani Airaksinen

  2. Turku PET Centre, University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland

    Juhani Knuuti, Jukka Kemppainen, Kira Stolen & Pirjo Nuutila

  3. Oulu University Hospital, Kajaanintie 50, 90029, Oulu, Finland

    Timo H. Mäkikallio & Heikki V. Huikuri

Authors
  1. Tiina Marjatta Salo
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  2. Jan Sundell
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  3. Juhani Knuuti
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  4. Jukka Kemppainen
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  5. Kira Stolen
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  7. Timo H. Mäkikallio
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  8. Heikki V. Huikuri
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  9. K. E. Juhani Airaksinen
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Correspondence to K. E. Juhani Airaksinen.

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Salo, T.M., Sundell, J., Knuuti, J. et al. Fractal scaling properties of heart rate dynamics and myocardial efficiency in dilated cardiomyopathy. Clin Res Cardiol 98, 725–730 (2009). https://doi.org/10.1007/s00392-009-0060-y

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  • DOI: https://doi.org/10.1007/s00392-009-0060-y

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