Very high frequency oscillations in the heart rate and blood pressure of heart transplant patients

Article

Abstract

The authors studied the recently reported very high frequency (VHF) peaks in the heart rate (HR) and blood pressure (BP) power spectra of heart transplant (HT) patients. These VHF peaks appear at frequencies much higher than the respiratory frequency, in addition to the typical low-frequency and high-frequency peaks. Twenty-five recordings obtained from 13 male HT patients (0.5–65 months following surgery) were compared with recordings from 14 normal male subjects. The ECG, continuous BP and respiration were recorded during 45 min of supine rest. Eight recordings from HT patients were excluded owing to arrhythmias. Spectral analysis was performed on all other recordings. VHF peaks were found in the spectra of both BP and HR in nine recordings obtained from six HT patients. In some cases, the power in the VHF peaks was markedly higher than that of the high-frequency peak. No VHF peaks were observed in eight recordings obtained from four HT patients or in recording from any of the normal subjects. No correlation was found between the incidence of VHF peaks and time after transplant. It was proved that the VHF peaks were not artifactual, and their significance within the framework of the theory of communication systems is discussed. The presence of those peaks was attributed to vagal denervation.

Keywords

Cardiac transplantation Heart rate variability Blood pressure variability Spectral analysis Higher-order harmonics 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Akselrod, S., Gordon, D., Ubel, F. A., Shannon, D. C., Berger, A. C., andCohen, R. J. (1981): ‘Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat-to-beat cardiovascular control’,Science,213, pp. 220–222Google Scholar
  2. Akselrod, S., Gordon, D., Madwed, J. B., Snidman, N. C., Shannon, D. C., andCohen, R. J. (1985): ‘Hemodynamic regulation: investigation by spectral analysis’,Am. J. Physiol.,249, pp. H867-H875Google Scholar
  3. Akselrod, S. (1995): ‘Components of heart rate variability: basic studies’ inMalik, M., andCamm, A. J. (Eds.): ‘Heart rate variability’ (Futura Publishing, Armonk NY, 1995), pp. 147–164Google Scholar
  4. Berger, R. D., Akselrod, S., Gordon, D., andCohen, R. J. (1986): ‘An efficient algorithm for spectral analysis of heart rate variability’,IEEE Trans. Biomed. Eng.,33, pp. 900–904Google Scholar
  5. Bernardi, L., Keller, F., Sanders, M., Reddy, P. S., Griffith, B., Meno, F., andPinsky, M. R. (1989): ‘Respiratory sinus arrhythmia in the denervated human heart’,J. Appl. Physiol.,67, pp. 1447–1455Google Scholar
  6. Bernardi, L., Salvucci, F., Suardi, R., Solda, P. L., Calciati, A., Perlini, S., Falcone, C., andRicciardi, L. (1990): ‘Evidence for an intrinsic mechanism regulating heart rate variability in the transplanted and the intact heart during submaximal dynamic exercise?’,Cardiovasc. Res.,24, pp. 969–981Google Scholar
  7. Bernardi, L., Valle, F., Leuzzi, S., Rinaldi, M., Marchesi, E., Falcone, C., Martinelli, L., Vigano, M., Finardi, G., andRadaelli, A. (1994): ‘Non-respiratory components of heart rate variability in heart transplant recipients: evidence of autonomic reinnervation?’,Clin. Sci.,86, pp. 537–545Google Scholar
  8. Bernardi, L., Valenti, C., Wdowczyck-Szulc, J., Frey, A. W., Rinaldi, M., Spadacini, G., Passino, C., Martinelli, L., Vigano, M., andFinardi, G. (1998): ‘Influence of type of surgery on the occurrence of parasympathetic reinnervation after cardiac transplantation’,Circulation,97, pp. 1368–1374Google Scholar
  9. Camm, A. J., Malik, M., Bigger, J., Breithardt, G., Cerutti, S., Cohen, R., Coumel, P., Fallen, E., Kennedy, H., Kleiger, R., Lombardi, F., Malliani, A., Moss, A., Rottman, J., Schmidt, G., Schwartz, P., andSinger, D. (1996): ‘Heart rate variability: standards of measurements, physiological interpretation, and clinical use’,Circulation,93, pp. 1043–1065Google Scholar
  10. Constant, I., Girard, A., Le Bidois, J., Villain, E., Laude, D., andElghozi, J. L. (1995): ‘Spectral analysis of systolic blood pressure and heart rate after heart transplantation in children’,Clin. Sci.,88, pp. 95–102Google Scholar
  11. D'Azoo, J. J., andHoupis, C. H. (1995): ‘Linear control system analysis and design’, (McGraw-Hill, Singapore, 1995)Google Scholar
  12. DeBoer, R. W., Karemaker, J. M., andStrackee, J. (1984): ‘Comparing spectra of a series of point events particularly for heart rate variability data’,IEEE Trans. Biomed. Eng.,31, pp. 384–387Google Scholar
  13. Di Rienzo, M., Mancia, G., Parati, G., Pedotti, A., andZanchetti, A. (1993): ‘Blood pressure and heart rate variability’ (IOS Press, Amsterdam, 1993)Google Scholar
  14. Di Rienzo, M., Parati, G., Castiglioni, P., Tordi, R., Mancia, G., andPedotti, A. (2001): ‘Baroreflex effectiveness index: an additional measure of baroreflex control of heart rate in daily life’,Am. J. Physiol. Regulat. Integr. Comp. Physiol.,280, pp. R744-R751Google Scholar
  15. Goldberger, J. J., Challapalli, S., Tung, R., Parker, M. A., andKadish, A. H. (2001): ‘Relationship of heart rate variability to parasympathetic effect’,Circulation,103, pp. 1977–1983Google Scholar
  16. Gordon, D., Herrera, V. L., McAlpine, L., Cohen, R. J., Akselrod, S., Lang, P., andNorwood, W. I. (1988): ‘Heart-rate spectral analysis: a noninvasive probe of cardiovascular regulation in critically ill children with heart disease’,Pediatr. Cardiol.,9, pp. 69–77CrossRefGoogle Scholar
  17. Hedman, A. E., Tahvanainen, K. U., Hartikainen, J. E., andHakumaki, M. O. (1995): ‘Effect of sympathetic modulation and sympatho-vagal interaction on heart rate variability in anaesthetized dogs’,Acta Physiol. Scand.,155, pp. 205–214Google Scholar
  18. Hirsch, J. A., andBishop, B. (1981): ‘Respiratory sinus arrhythmia in humans: how breathing pattern modulates heart rate’,Am. J. Physiol.,241, pp. H620-H629Google Scholar
  19. Keselbrener, L., andAkselrod, S. (1995): ‘Artefacts in standard and time-dependent spectral analysis of arterial blood pressure signals obtained by Finapres: importance and correction’,Clin. Auton. Res.,5, pp. 295–301CrossRefGoogle Scholar
  20. Kitney, R. I. (1987): ‘Beat-by-beat interrelationships between heart rate, blood pressure, and respiration’ inKitney, R. I., andRompelman, O. (Eds): ‘The beat-by-beat investigation of cardiovascular function: measurement, analysis, and applications’ (Clarendon Press, Oxford, UK, 1987), pp. 146–178Google Scholar
  21. Malliani, A. (2000): ‘Principles of cardiovascular neural regulation in health and disease’ (Kluwer Academic, Boston, 2000)Google Scholar
  22. Mateo, J., andLaguna, P. (2000): ‘Improved heart rate variability signal analysis from the beat occurrence times according to the IPFM model’,IEEE Trans. Biomed. Eng.,47, pp. 985–996CrossRefGoogle Scholar
  23. Mukkamala, R., andCohen, R. J. (2001): ‘A forward model-based validation of cardiovascular system identification’,Am. J. Physiol. Heart Circ. Physiol.,281, pp. H2714-H2730Google Scholar
  24. Oppenheim, A. V., andSchafer, R. W. (1989): ‘Discrete-time signal processing’ (Prentice-Hall, Englewood Cliffs, NJ, 1989)Google Scholar
  25. Perlini, S., Solda, P. L., Piepoli, M., Sala-Gallini, G., Calciati, A., Finardi, G., andBernardi, L. (1995): ‘Determinants of respiratory sinus arrhythmia in the vagotomized rabbit’,Am. J. Physiol.,269, pp. H909-H915Google Scholar
  26. Saul, J. P., Kaplan, D. T., andKitney, R. J. (1988): ‘Nonlinear interactions between respiration and heart rate: classical physiology or entrained nonlinear oscillators’,Comput. Cardiol.,15, pp. 299–302Google Scholar
  27. Saul, J. P., Berger, R. D., Albrecht, P., Stein, S. P., Chen, M. H., andCohen, R. J. (1991): ‘Transfer function analysis of the circulation: unique insights into cardiovascular regulation’,Am. J. Physiol.,261, pp. H1231-H1245Google Scholar
  28. Saul, J. P., andBernardi, L. (1995): ‘Heart rate variability after cardiac transplantation’ inMalik, M., andCamm, A. J. (Eds): ‘Heart rate variability’ (Futura Publishing, NY, 1995), pp. 479–494Google Scholar
  29. Taylor, J. A., Myers, C. W., Halliwill, J. R., Seidel, H., andEckberg, D. L. (2001): ‘Sympathetic restraint of respiratory sinus arrhythmia: implications for vagal-cardiac tone assessment in humans’,Am. J. Physiol. Heart Circ. Physiol.,280, pp. H2804-H2814Google Scholar
  30. Toledo, E., Pinhas, I., Aravot, D., andAkselrod, S. (2000): ‘Evolution of compensatory cardiovascular control mechanisms in heart transplant subjects’,Comput. Cardiol.,27, pp. 1–4Google Scholar
  31. Toledo, E., Pinhas, I., Aravot, D., andAkselrod, S. (2001a): ‘Bispectrum and bicoherence for the investigation of very high frequency peaks in heart rate variability’,Comput. Cardiol.,28, pp. 667–670Google Scholar
  32. Toledo, E., Pinhas, I., Aravot, D., andAkselrod, S. (2001b): ‘Heart transplantation-spectral and bispectral analysis’. 2002 Conf. Proc. of 23rd Annual Int. Conf. IEEE Eng. Med. Biol. Soc.,1, pp. 515–518Google Scholar
  33. Toledo, E., Pinhas, I., Almog, Y., Aravot, D., andAkselrod, S. (2002): ‘Functional restitution of cardiac control in heart transplant patients’,Am. J. Physiol. Regulat. Integr. Comp. Physiol.,282, pp. R900-R908Google Scholar
  34. Toledo, E., Gurevitz, O., Hod, H., Eldar, M., andAkselrod, S. (2003): ‘Wavelet analysis of instantaneous heart rate: a study of autonomic control during thrombolysis’,Am. J. Physiol. Regulat. Integr. Comp. Physiol.,284, pp. R1079-R1091Google Scholar
  35. Vanoli, E., La Rovere, M. T., Mortara, A., andSchwartz, P. J. (1994): ‘Methods for iassessment of vagal reflexes’ inLevy, M. N. andSchwartz, P. J. (Eds): ‘Vagal control of the heart: experimental basis and clinical implications’ (Futura Publishing, Armonk, NY, 1994), pp. 455–480Google Scholar
  36. Wiklund, U. (2001): ‘Modelling and analysis of heart rate variability signals: wavelets and autoregresive methods in clinical environments’. PhD dissertation, Umea University, SwedenGoogle Scholar
  37. Witte, H., Zwiener, U., Rother, M., andGlaser, S. (1988): ‘Evidence of a previously undescribed form of respiratory sinus arrhythmia (RSA)—the physiological manifestation of ‘cardiac aliasing”,Pflugers Arch.,412, pp. 442–444CrossRefGoogle Scholar
  38. Zwiener, U., Luthke, B., Bauer, R., Richter, A., Hoyer, D., andWagner, H. (1994): ‘Forms of physiological aliasing within the heart rate fluctuations by higher frequent respiratory movements’,J. Physiol. Pharmacol.,45, pp. 563–572Google Scholar
  39. Zwiener, U., Luthke, B., Bauer, R., Hoyer, D., Richter, A., andWagner, H. (1995): ‘Heart rate fluctuations of lower frequencies than the respiratory rhythm but caused by it’,Pflugers Arch.,429, pp. 455–461CrossRefGoogle Scholar

Copyright information

© IFMBE 2003

Authors and Affiliations

  1. 1.Abramson Center for Medical Physics, Sackler Faculty of Exact SciencesTel Aviv UniversityTel AvivIsrael
  2. 2.Heart-Lung Transplant UnitRabin Medical CenterPetach TikvaIsrael

Personalised recommendations