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Recurrence quantitative analysis of heart rate variability during intradialytic hypotension

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Abstract

Recurrence quantitative analysis (RQA) of heart rate variability (HRV) is helpful for the non-invasive study of the regulation of the cardiovascular system by the autonomic nervous system. HRV monitoring during hemodialysis (HD) sessions of end-stage renal disease patients reflects a sympathetic hyperactivity that has been proposed as an early marker of intradialytic hypotension (IDH). However, neither intradialytic HRV analysis nor episodes of IDH have been explored from the RQA perspective. We studied the HRV dynamics with linear and RQA indices during intradialytic recordings (N = 38) in which 39.5% of patients presented IDH. Patients with IDH showed a restricted HRV during the whole HD compared to patients with stable blood pressure (p < 0.05). Although the RQA results during HD were heterogeneous, laminarity and the recurrence time of the second type revealed a constricted behavior around the onset of the IDH episodes. RQA analysis complemented the linear HRV measure to reveal a characteristic behavior immediately before and after the IDH episode. We also explored a framework for IDH prediction with a linear HRV index, the standard deviation of the differences between adjacent heartbeats intervals, which was associated in the early moments of HD with the development of IDH throughout HD sessions (sensitivity 80%, specificity 82.6%). The observed differences between groups may be of clinical utility for an early identification of patients prone to IDH.

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Data availability Statement

Data will be made available on reasonable request to the corresponding author.

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Acknowledgements

Martín Calderón-Juárez received a Ph.D. scholarship by CONACYT.

Author information

Authors and Affiliations

  1. Plan de Estudios Combinados en Medicina, Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico

    Martín Calderón-Juárez

  2. Department of Electromechanical Instrumentation, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico

    Martín Calderón-Juárez & Claudia Lerma

  3. Department of Physics, Faculty of Sciences, Universidad Nacional Autónoma de México, Mexico City, Mexico

    Gertrudis Hortensia González Gómez

  4. Department of Electrical Engineering, Universidad Autónoma Metropolitana Unidad Iztapalapa, Mexico City, Mexico

    Juan C. Echeverría

  5. Department of Nephrology, Hospital General Dr. Miguel Silva, Michoacán, México

    Jesús Arellano-Martínez, Víctor Hugo Gómez-Suárez & Israel David Campos-González

Authors
  1. Martín Calderón-Juárez
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  2. Gertrudis Hortensia González Gómez
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  3. Juan C. Echeverría
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  4. Jesús Arellano-Martínez
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  5. Víctor Hugo Gómez-Suárez
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  6. Israel David Campos-González
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  7. Claudia Lerma
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Contributions

MC-J, GHGG, JCE, JA-M, VHG-S, DIC-G and CL: conceptualization and methodology. MC-J, GHGG, JCE, JA-M, VHG-S, DIC-G and CL: writing—original draft preparation. MC-J and CL: software and formal analysis. MC-J: data gathering. MC-J, GHGG, JCE, JA-M, VHG-S, DIC-G and CL: writing—review and editing. All authors have read and agreed to the submitted version of the manuscript.

Corresponding author

Correspondence to Claudia Lerma.

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Conflict of interest

All authors declare no conflict of interests.

Ethics approval

The studies involving human participants were reviewed and approved by the Research and Ethics Committee of the Hospital General Dr. Miguel Silva (protocol number 573/01/21) and the Instituto Nacional de Cardiología Ignacio Chávez (protocol number 21–1236). All patients provided their written informed consent to participate in this study.

Additional information

Trends in Recurrence Analysis of Dynamical Systems. Guest editors: Norbert Marwan, Charles Webber Jr., Andrzej Rysak.

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Calderón-Juárez, M., González Gómez, G.H., Echeverría, J.C. et al. Recurrence quantitative analysis of heart rate variability during intradialytic hypotension. Eur. Phys. J. Spec. Top. 232, 111–121 (2023). https://doi.org/10.1140/epjs/s11734-022-00688-2

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