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Biomedical subjects

A Malliani

Publications and source records attributed to A Malliani.

At least 55 records · Page 3Linked to original sources
PubMed1997

Individual recognition by heart rate variability of two different autonomic profiles related to posture.

BACKGROUND: Power spectrum analysis of heart rate variability (HRV) can estimate the state of sympathovagal balance modulating sinus node activity. In view of the large distribution of spectral variables, a recognition of well-defined physiological conditions has never been attempted on an individual basis. METHODS AND RESULTS: We considered 10 spectral variables extracted from short segments (200 to 500 cardiac cycles) of 350 ECG tracings recorded in normal subjects in both supine and upright positions (700 patterns). The tracings were first ordered consecutively and subsequently assigned alternatively to a training or to a test set (each consisting of 175 cases, providing 350 patterns considered to be independent). A forecasting linear method estimated a normalized activation index (ranging from -1 for supine to +1 for upright) that concentrated the information derived from spectral variables and that identified, in the test set, individual by individual, approximately 84% of corresponding body postures. CONCLUSIONS: The combined use of spectral methodology and forecasting analysis has revealed an information content embedded, per se, in a short series of RR intervals capable of recognizing, individual by individual, two different autonomic profiles related to posture.

Adolescent↗
PubMed1997

Instant power spectrum analysis of heart rate variability during orthostatic tilt using a time-/frequency-domain method.

BACKGROUND: Spectral analysis of heart rate (HR) variability (HRV) requires, as a rule, some level of stationarity and, as a result, is inadequate to quantify biological transients. A time-/frequency-domain method (TF) was developed to obtain an instant spectral power (SP) of HRV during tilt. METHODS AND RESULTS: HR was recorded by Holter monitoring in volunteers and analyzed with a TF, the smoothed pseudo-Wigner-Ville transformation (SPWVT), with the table inclination randomly set or continuously increased while the table rotated in head-up position. (1) The SPWVT assesses, beat by beat, the instant center frequency (ICF) of the SP. ICF correlates better with instant HR than the ratio of low- (LF) to high-frequency (HF) oscillations. The transient effect of tilt is better characterized as a shift of SP toward lower frequencies than by changes in amplitudes. (2) The method evidences variations of HR from one second to another. During the passage to head-up position, the vagal withdrawal and the sympathetic activation occur nearly simultaneously, as indicated by the instant changes in both LF and HF amplitudes and ICF. (3) The averaged results of the SPWVT give results similar to those previously obtained with autoregressive algorithms. CONCLUSIONS: The SPWVT is a new tool to explore HR transitions such as periods before episodes of arrhythmias on a time scale of one beat and allows quantification of an instant frequency index (ICF) that closely reflects the instantaneous relationship between sympathetic and vagal modulations.

Adult↗
PubMed1997

Relationship between spectral components of cardiovascular variabilities and direct measures of muscle sympathetic nerve activity in humans.

BACKGROUND: Spectral analysis of RR interval and systolic arterial pressure variabilities may provide indirect markers of the balance between sympathetic and vagal cardiovascular control. METHODS AND RESULTS: We examined the relationship between power spectral measurements of variabilities in RR interval, systolic arterial pressure, and muscle sympathetic nerve activity (MSNA) obtained by microneurography over a range of blood pressures. In eight healthy human volunteers, MSNA, RR interval, intra-arterial pressure, and respiration were measured during blood pressure reductions induced by nitroprusside and during blood pressure increases induced by phenylephrine. Both low-frequency (LF; 0.10 +/- 0.01 Hz) and high-frequency (HF; 0.23 +/- 0.01 Hz) components were detected in MSNA variability. Increasing levels of MSNA were associated with a shift of the spectral power toward its LF component. Decreasing levels of MSNA were associated with a shift of MSNA spectral power toward the HF component. Over the range of pressure changes, the LF component of MSNA variability was positively and tightly correlated with LF components of RR interval (in normalized units; P < 10(-6)) and of systolic arterial pressure variability (both in millimeters of mercury squared and normalized units; P < 5 x 10(-5) and P < 5 x 10(-6), respectively). The HF component of MSNA variability was positively and tightly correlated with the HF component (in normalized units) of RR-interval variability (P < 3 x 10(-4)) and of systolic arterial pressure variability (P < .01). CONCLUSIONS: During sympathetic activation in normal humans, there is a predominance in the LF oscillation of blood pressure, RR interval, and sympathetic nerve activity. During sympathetic inhibition, the HF component of cardiovascular variability predominates. This relationship is best seen when power spectral components are normalized for total power. Synchronous changes in the LF and HF rhythms of both RR interval and MSNA during different levels of sympathetic drive are suggestive of common central mechanisms governing both parasympathetic and sympathetic cardiovascular modulation.

Blood Pressure↗
PubMed1997

Maintained autonomic responses to moderate exercise in hypertensive patients treated with lacidipine.

OBJECTIVE: Excessive adrenergic responses have been reported in hypertensive patients treated with short-acting dihydropiridine calcium channel antagonists that might worsen cardiovascular risk. In this study we addressed whether lacidipine, a long-acting dihydropiridine, increases the sympathetic excitation produced by moderate dynamic exercise. DESIGN: Because of the wide changes in autonomic drive during everyday life, the possible influence of antihypertensive regimens should be assessed not only at rest but also during spontaneous, behaviourally induced alterations of sympathovagal balance. This study was designed to test whether treatment with lacidipine might alter the autonomic response to supine moderate dynamic exercise. METHODS: We studied 16 moderate hypertensive patients (arterial pressure 151/102 mmHg) at rest and during 30% of nominal maximum recumbent bicycle exercise. The low frequency spectral component of RR interval and of systolic variability (Finapres) furnished markers of sympathetic modulation of the sinoatrial node and of the vasculature, respectively. Studies were performed during placebo and active treatment (lacidipine 4 mg per day). RESULTS: Lacidipine treatment significantly reduces arterial pressure values at rest and during moderate dynamic exercise, without affecting RR interval and systolic arterial pressure variabilities, both at rest and during moderate exercise. CONCLUSIONS: In conclusion, spectral analysis of RR interval and systolic arterial pressure variabilities indicate that antihypertensive treatment with lacidipine is not associated to an excessive sympathetic drive during moderate exercise.

Administration, Oral↗
PubMed1997

Non-invasive assessment of the changes in static and oscillatory components of peripheral pressure/flow relationships produced by moderate exercise in humans.

OBJECTIVE: The generalized sympathetic activation induced by exercise is accompanied by an increase in heart rate, blood pressure and vascular resistance in non-exercising vascular beds. The aim of the present study was to test the feasibility of assessing, non-invasively, the static and oscillatory pressure/flow relationships of peripheral arteries and their continuous changes during dynamic exercise. DESIGN: We studied 44 healthy humans at rest, during moderate exercise (recumbent bicycle exercise) and recovery using a totally non-invasive approach. METHODS: Arterial pressure was measured using a plethysmographic device, and ipsilateral brachial artery flow and palmar skin microcirculation flow were assessed with continuous wave Doppler and laser Doppler, respectively. Continuous, long data segments (> 90 s) were acquired with a personal computer and used to determine the changes of pressure/flow relationships of peripheral arteries during dynamic exercise. A new simplified method utilizing a transfer function analysis extracted automatically unequivocal indexes of static and oscillatory properties of vascular system. RESULTS: Moderate exercise induced significant increases of the static (Zo) and oscillatory (Zc) components of peripheral pressure/flow relationships in both brachial artery and skin microcirculation beds. Both indexes returned to control values during early recovery. CONCLUSIONS: This simple, non-invasive approach was capable of assessing the changes of static and oscillatory vascular properties induced by dynamic exercise. This method could be applied for a better understanding of the vascular modifications that occur in other physiological or pathophysiological conditions also characterized by increases in sympathetic drive.

Adult↗
PubMed1997

Evidence of increased sympathetic vasomotor drive with shorter acting dihydropyridine calcium channel antagonists in human hypertension: a study using spectral analysis of RR interval and systolic arterial pressure variability.

We studied the effects of common antihypertensive regimens on autonomic cardiovascular control. We considered calcium channel antagonists (nicardipine twice a day and isradipine once a day, respectively) and also examined, as reference treatments, once-a-day atenolol and cilazapril. A noninvasive evaluation of autonomic cardiovascular profile was obtained with spectral analysis of RR interval and systolic arterial pressure variability. We studied moderate essential hypertensives before and after 2 weeks of treatment, both at rest and during active standing and mental arithmetic. All treatments reduced arterial pressure equally well; however, marked differences in spectral profiles were observed. The low-frequency spectral component of RR interval variability [in normalized units, marker of sympathetic modulation of the sinoatrial (SA) node] tended to be greater at rest and during stimuli (p < 0.001) in subjects treated with dihydropyridines. No differences at rest, but striking increases of the low-frequency component of systolic arterial pressure variability were observed in nicardipine-treated patients during both standardized excitatory stimuli, suggesting a marked increase in sympathetic vasomotor drive. As to reference treatments, patients treated with atenolol displayed the lowest values, and patients treated with cilazapril (for 4 weeks) provided intermediate values. In conclusion, shorter acting dihydropyridine calcium channel antagonists may induce an exaggerated increase in sympathetic vasomotor drive during standardized laboratory stressors.

Adrenergic beta-Antagonists↗
PubMed1997

Multivariate time-variant identification of cardiovascular variability signals: a beat-to-beat spectral parameter estimation in vasovagal syncope.

In this paper a bivariate, time-variant model able to continuously measure the mutual interactions between heart rate and systolic blood pressure variability signals is presented. A recursive identification of the model parameters makes it possible to estimate, on a beat-to-beat basis, spectral low-frequency (LF) and high-frequency (HF) power, (LF/HF ratio) and cross-spectral (coherence and phase relationships between spectral peaks) indexes during nonstationary events. These indexes can be helpful in: 1) physiological study of autonomic nervous system mechanisms of cardiovascular control and 2) quantification and clinical evaluation of the neural and mechanical links between the two signals. In addition, an estimate of baroreceptive activation (alpha-gain) is continuously extracted. Before applying the model to cardiovascular signals, the reliability of the estimated parameters was tested on simulated signals. Subsequently, the model was applied to investigating vasovagal syncope episodes, aiming at the assessment of autonomic nervous system status and autonomic role in the dynamic phenomena which lead to syncope. The proposed model, which provides noninvasive beat-to-beat evaluation of the autonomic events, may be useful in the description of the syncopal episodes and in the comprehension of the complex physiological mechanisms of syncope.

Algorithms↗
PubMed1997

Cyclosporine-induced hypertension: evidence for maintained baroreflex circulatory control.

BACKGROUND: The clinical use of cyclosporine as an immunosuppressive agent enhanced long-term survival in transplant recipients at the expense of a high incidence of induced hypertension. Altered neurovegetative (autonomic) cardiovascular control is suspected as a mechanism of this form of hypertension. METHODS: Spectral analysis of systolic arterial pressure and R-R interval variability (electrocardiographic recordings) were performed, and the index alpha of baroreflex gain was computed in four groups of subjects matched for age: 13 orthotopic heart transplant recipients; 13 solid organ transplant recipients; 13 patients with essential hypertension; and 18 control subjects with normal blood pressure. All but the control subjects were treated with similar dihydropyridine calcium entry blockers. Heart and solid organ transplant recipients also received cyclosporine. RESULTS: R-R variance was lowest in the heart transplant recipients. The spectral profile of R-R interval was suggestive of sympathetic predominance in the patients with hypertension, but not in the solid organ transplant recipients or the control subjects. Systolic blood pressure variability and low frequency component (a marker of sympathetic vasomotor modulation) were similar in the four groups. The index alpha was 1.8 +/- 2.2 in heart transplant recipients, 11.7 +/- 6.6 in solid organ transplant recipients, 7.3 +/- 3.6 in patients with hypertension, and 13.5 +/- 6.4 msec/mm Hg in control subjects (p = 0.0001). CONCLUSIONS: These data indicate that (1) cyclosporine-induced hypertension in heart transplant recipients is associated with a loss of baroreflex function as a result of cardiac denervation-related uncoupling; (2) compared with patients with hypertension, organ transplant recipients with hypertension demonstrated a maintained baroreflex function as indicated by a lack of reduction of the index alpha; (3) baroreflex heart rate control in dihydropyridine-treated cyclosporine-induced hypertension is well maintained.

Adult↗
PubMed1996

Effects of aging and of chronic obstructive pulmonary disease on RR interval variability.

Clinical and experimental investigations suggest that spectral analysis of RR interval variability might be employed to assess changes in autonomic regulation of the SA node occurring in various chronic, cardiac or respiratory conditions. We studied three groups of subjects: young healthy, older healthy, and old patients with chronic obstructive pulmonary disease (COPD), considering RR interval and breathing, i.e. tidal volume, variability in the frequency domain (AR algorithms), in order to obtain markers of the sympathetic and vagal modulation of the SA node [by way, respectively, of the low (LF) and high frequency (HF) spectral components]. The gain of the relationship between tidal volume and heart period variation (index beta) was also examined. COPD patients demonstrated a reduced resting RR variance with maintained spectral power distribution; upon tilting they did not manifest the usual increase of LF (and attendant decrease of HF) component. Additionally, we observed that the index beta at rest was significantly reduced in older as opposed to younger subjects. This index was also reduced by tilt, in both groups. In patients the index beta was reduced as compared to the group of similar age and younger subjects, and did not diminish further with tilt. This study indicates that in patients with COPD, sympathetic excitatory modulation of the SA node is depressed. Furthermore, the index beta, which provides an assessment of the gain of respiratory modulation of RR interval variability is significantly reduced in patients, as compared to healthy subjects of similar age. These abnormalities of autonomic control, may represent a functional correlation of the hyperinflated state present in this clinical condition which can be assessed non-invasively with spectral analysis of RR interval and respiration.

Adult↗
PubMed1996

Linear and nonlinear dynamics of heart rate variability after acute myocardial infarction with normal and reduced left ventricular ejection fraction.

We analyzed heart rate variability (HRV) in 2 groups of patients after acute myocardial infarction with normal and reduced ejection fraction (EF) by considering both the power of the 2 major harmonic components at low and high frequency and 2 indexes of nonlinear dynamics, namely the 1/f slope and the correlation dimension D2. HRV of patients with a reduced EF was characterized by a diminished RR variance as well as a different distribution of the residual power in all frequency ranges, with lower values of the low-frequency component expressed in both absolute and normalized units, and of the low- to high-frequency ratio. In these patients we also observed a steeper slope of the negative regression line between power and frequency in the very low frequency range. The presence of a smaller fractal dimension was suggested by a lower D2. Thus, in patients after acute myocardial infarction with a reduced EF, the reduction in HRV is associated with a different distribution of the residual power in the entire frequency range, which suggests a diminished responsiveness of sinus node to neural modulatory inputs.

Case-Control Studies↗
PubMed1996

Heart rate variability in the early hours of an acute myocardial infarction.

The occurrence of an autonomic disturbance early in acute myocardial infarction (AMI) has been reported: signs of sympathetic activation were mainly observed in relation to an anterior localization, whereas signs of vagal overactivity were more frequent in inferior wall AMI. Information is limited in relation to the persistence of these alterations during the early hours of AMI. We studied 33 patients with an AMI within 188 +/- 16 minutes from the onset of symptoms and 1 week after hospital admission. From a 20-minute Holter recording, we computed with autoregressive methodology, time and frequency domain indexes of heart rate variability. At admission, patients with an anterior wall AMI exhibited a smaller RR variance (593 +/- 121 ms2) than did those with an inferior wall AMI (1,122 +/- 191 ms2). In both groups the spectral profile was characterized by a predominant (73 +/- 4 and 61 +/- 4 normalized units) low frequency and by a small (13 +/- 2 and 22 +/- 3 normalized units) high-frequency component, indicating the presence of a sympathetic excitation and of a diminished vagal modulation. Although signs of sympathetic activation were more evident in patients with anterior wall AMI, no evidence of a vagal hyperactivity was observed in patients with inferior wall AMI. In the latter group, we noticed 1 week after the acute event an increase in the low-frequency component, which reached the values observed in patients with anterior wall AMI. Thrombolysis did not affect heart rate variability parameters. Thus, this study suggests the presence of an autonomic disturbance characterized by signs of sympathetic excitation and of a reduced vagal modulation, which was more evident in patients with an anterior localization early after AMI.

Electrocardiography, Ambulatory↗
PubMed1996

Presence of vasomotor and respiratory rhythms in the discharge of single medullary neurons involved in the regulation of cardiovascular system.

We analyzed the discharges of 77 single neurons located in the rostral ventrolateral medulla (RVLM, n = 25), caudal ventrolateral medulla (CVLM, n = 18), lateral tegmental field (LTF, n = 19) and caudal raphe nuclei (n = 15). These recordings were made from 36 vagotomized and sinoaortic denervated cats that were either decerebrate (n = 27) or anesthetized with urethane (n = 9) and from 3 decerebrate cats with intact sinoartic and vagal nerves. These neurons were classified as sympathetic-related (n = 61) if spike triggered averaging showed that their naturally occurring discharges were correlated to either the cardiac related (2-6 Hz) or a faster (10 Hz) oscillation in inferior cardiac sympathetic nerve discharge. Neurons were classified as sympathetic-unrelated (n = 16) if they lacked these characteristics. We used autoregressive spectral techniques to detect additional slower oscillations hidden in the variability of neuronal discharge and possibly correlated to the oscillations of systolic arterial pressure (SAP). This analysis revealed the existence of a low frequency (LF) oscillation (0.12 +/- 0.02 Hz) in the discharges of 36 sympathetic-related and 9 sympathetic-unrelated neurons. In relation to 35 neurons in 21 animals there was also an LF component in SAP variability. In 29 instances the LF neuronal discharges and SAP variabilities were significantly correlated. In addition, there was a high frequency (HF) oscillation (0.34 +/- 0.06 Hz) in the discharges of 59 medullary neurons. In 56 cases the HF in neuronal discharge variability cohered to that in SAP variability. These data are the first to demonstrate the existence of an LF component in the discharges of individual medullary neurons, at least some of which were likely to be involved in the regulation of the cardiovascular system. Since these oscillations were evident in cats with section of sinoaortic and vagal nerves, they likely reflect central rhythmogenic properties.

Animals↗
PubMed1996

Classification of coupling patterns among spontaneous rhythms and ventilation in the sympathetic discharge of decerebrate cats.

The spontaneous low- and high-frequency rhythms in the sympathetic discharge of decerebrate artificially ventilated cats are affected by external ventilation. Two graphical methods (i.e. the space-time separation plot and the frequency tracking locus) are used to classify the non-linear interactions. The observed behaviours in the sympathetic discharge consist of phase-locked periodic dynamics (at various frequency ratios with ventilation), quasiperiodic and aperiodic patterns. They depend on the experimental condition. In control condition the sympathetic discharge appears more frequently locked to each ventilatory cycle (1:1 dynamics). However, some cases of quasiperiodic dynamics are found. A sympathetic activation stimulus, such as inferior vena cava occlusion, is able to synchronize slow rhythms in the sympathetic discharge to a subharmonic of ventilation. During a sympathetic inhibition stimulus, such as aortic constriction, 1:1 dynamics is detected but the amplitude of the sympathetic responses can be modulated by unlocked slow rhythms. Moreover some cases of aperiodic dynamics are observed. Vagotomy reduces the 1:1 coupling between sympathetic outflow and ventilation. Vagotomy plus spinalisation disrupts periodic dynamics in the sympathetic discharge so that irregular and complex patterns are found.

Animals↗