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Biomedical subjects

M Pagani

Publications and source records attributed to M Pagani.

At least 163 records · Page 9Linked to original sources
PubMed1988

Spectral analysis of heart rate variability in the assessment of autonomic diabetic neuropathy.

We studied heart rate variability in 49 uncomplicated diabetics (27 with insulin therapy; 22 with oral hypoglycemic agents) and in 40 age-matched controls. An automatic autoregressive algorithm was used to compute the power spectral density (PSD) of beat by beat RR variability derived from the surface ECG. The PSD contains two major components (a low frequency approximately 0.1 Hz (LF) and a high frequency, respiratory linked, approximately 0.25 Hz (HF] that provide, respectively, quantitative markers of sympathetic and vagal modulatory activities and of their balance. As compared to controls, in diabetics, besides a reduced RR variance at rest (2722 +/- 300 and 1436 +/- 241 ms2, respectively), we observed during passive tilt an altered response of spectral indices of sympathetic activation and vagal withdrawal, suggestive of a complex modification in the neural control activities. In addition, we compared this approach to the commonly used clinical tests score, and observed that the latter provides overall results similar to those obtained with spectral changes induced by tilt (r = 0.42; P less than 0.01). Of potential clinical importance is that the data obtained with spectral analysis appear more thoroughly quantifiable and do not require the active collaboration of the patients.

Adolescent↗
PubMed1988

Sympathetic predominance in essential hypertension: a study employing spectral analysis of heart rate variability.

In this study on 91 subjects we tested the hypothesis of an enhanced sympathetic activity in uncomplicated essential hypertension employing spectral analysis of heart rate variability. With this technique the tonic sympathetic and vagal activities and their changes are respectively assessed by the power of approximately 0.1 Hz (low frequency, LF) and approximately 0.25 Hz (respiratory linked, high frequency, HF) components of the spectrum of the beat by beat variability of RR interval. When comparing the 40 subjects with diastolic blood pressure consistently greater than 95 mmHg (hypertensives, Ht), with 35 age-matched controls (diastolic arterial pressure less than 90 mmHg, Nt), we observed that LF was greater and HF smaller in Ht as compared to Nt, thus suggesting an enhanced sympathetic activity and a reduce vagal activity in Ht. Additionally, passive tilt, which in Nt enhances LF [delta = 26 +/- 2 normalized units (nu)] and reduces HF (delta = -22 +/- 2, nu), produced smaller (P less than 0.05) changes in Ht (delta LF = 6.3 +/- 2.7 and delta HF = -7.5 +/- 2.3 nu). Furthermore, the values of LF at rest and the altered effects of tilt on LF and HF were significantly correlated with the degree of the hypertensive state. Chronic beta-adrenergic blockade (atenolol 100 mg once daily for 2 weeks, n = 13) reduced heart rate and blood pressure (from 162/103 to 136/88 mmHg) together with a significant diminution of LF and an increase of HF. Thus, spectral analysis of RR variability appears to be a convenient non-invasive technique to follow the progressive alterations in sympatho-vagal balance present in essential hypertension.

Adult↗
PubMed1988

Changes in autonomic regulation induced by physical training in mild hypertension.

The adaptive effects of physical training on cardiovascular control mechanisms were studied in 11 subjects with mild hypertension. In these subjects we assessed the gain of the heart period-systolic arterial pressure relationship in the unfit and the fit state by using 1) an open loop approach, whereby the gain is expressed by the slope of the regression of heart period as a function of systolic arterial pressure, during a phenylephrine-induced pressure rise and 2) a closed loop approach with proper simplification, whereby the gain is expressed by the index alpha, obtained through simultaneous spectral analysis of the spontaneous variabilities of heart period and systolic arterial pressure. Both methods indicated that training significantly increased the gain of the relationship between heart period and systolic arterial pressure at rest and reduced arterial pressure and increased heart period significantly. This gain was drastically reduced during bicycle exercise both in the unfit and fit state. In a second group of normotensive (n = 7; systolic pressure, 133 +/- 3 mm Hg) and hypertensive (n = 7; systolic pressure, 180 +/- 10 mm Hg) subjects undergoing 24-hour diagnostic continuous electrocardiographic and high fidelity arterial pressure monitoring, the index alpha was significantly reduced in the hypertensive group at rest. Furthermore, when analyzed continuously over the entire 24-hour period, this index underwent minute-to-minute changes with lower values during the day and higher values during the night. We propose the index alpha as a quantitative indicator of the changes in the gain of baroreceptor mechanisms occurring with physical training in mild hypertension and during a 24-hour period in ambulatory subjects.

Adult↗
PubMed1988

Automatic assessment of the interaction between respiration and heart rate variability signal.

The present paper introduces an original method of processing heart rate variability (HRV) and respiration signals as detected respectively through chest electrodes and thoracic belt in dogs under different experimental conditions. Signals are processed as time series synchronous with the occurrence of QRS complexes on ECG signal and auto and cross spectra are accordingly calculated. Two particular bands appear mainly of interest on the spectrum of HRV signal: one in correspondence with the respiration rate and another one at a lower frequency value. Values of power at these frequency bands together with coherence and phase between HRV signal and respiration complete the parameters which try to quantify a few aspects of the complex dynamic relationships between the original signals. In particular, controlled respiration in dogs was studied through the connection with an automatic ventilator, as well as the effects of drugs which interact with the neural regulatory systems (i.e. sympathetic and parasympathetic nervous system). Gain and phase relationships between heart rate variability and respiration, obtained with spectral analysis, could be used to provide a better understanding of the neural control mechanisms linking heart rate and respiration in various experimental conditions. The method described in this study is to be used both in physiological and clinical research.

Animals↗
PubMed1987

Heart rate variability as an index of sympathovagal interaction after acute myocardial infarction.

By analysis of spectral components of heart rate variability, sympathovagal interaction was assessed in patients after acute myocardial infarction (AMI). At 2 weeks after AMI (n = 70), the low-frequency component was significantly greater (69 +/- 2 vs 53 +/- 3 normalized units [NU], p less than 0.05) and the high-frequency component was significantly smaller (17 +/- 1 vs 35 +/- 3 NU) than in 26 age-matched control subjects. This difference was likely to reflect an alteration of sympathovagal regulatory outflows with a predominance of sympathetic activity. At 6 (n = 33) and 12 (n = 29) months after AMI, a progressive decrease in the low- (62 +/- 2 and 54 +/- 3 NU) and an increase in the high-frequency (23 +/- 2 and 30 +/- 2 NU) spectral components was observed, which suggested a normalization of sympathovagal interaction. An increase in sympathetic efferent activity induced by tilt did not further modify the low-frequency spectral component (78 +/- 3 vs 74 +/- 3 NU) in a subgroup of 24 patients at 2 weeks after AMI. Instead, 1 year after AMI, this maneuver was accompanied by an increase in the low-frequency component (77 +/- 3 vs 53 +/- 3 NU, p less than 0.05) of a magnitude similar to the one observed in control subjects (78 +/- 3 vs 53 +/- 3 NU). These data indicate that the sympathetic predominance that is detectable 2 weeks after AMI is followed by recovery of vagal tone and a normalization of sympathovagal interaction, not only during resting conditions, but also in response to a sympathetic stimulus.

Adult↗
PubMed1987

Heart rate variability signal processing: a quantitative approach as an aid to diagnosis in cardiovascular pathologies.

The heart rate variability (HRV) signal carries important information about the systems controlling heat rate and blood pressure, mainly elicited by autonomic nervous system (sympathetic and parasympathetic) controls. The present paper illustrates methods of HRV signal processing by using autoregressive (AR) modeling and power spectral density estimate. The information enhanced in this way seems to be particularly sensitive in discriminating various cardiovascular pathologies (hypertension, myocardial infarction, diabetic neuropathy, etc.). This method provides a simple non-invasive analysis, based on the processing of spontaneous oscillations in heart rate. Particular emphasis is directed to the algorithms used and to their direct application by using proper computerized techniques: only a few paradigmatical examples will be illustrated as preliminary results.

Cardiovascular Diseases↗
PubMed1987

Effects of verapamil, nifedipine, and dilazep on left ventricular relaxation in the conscious dog.

The cardiac systolic and diastolic effects of the two major calcium blockers, verapamil and nifedipine, were studied and compared with those produced by dilazep, a relatively new vasodilator with calcium blocking properties, in conscious instrumented dogs to avoid the complications of anaesthesia and recent surgery. Mean arterial pressure was reduced by nifedipine and dilazep but not by verapamil, whereas peak left ventricular pressure was reduced only by dilazep and verapamil. Consistent tachycardia occurred, the rate being highest with nifedipine and lowest with dilazep. Left ventricular dP/dt was unaffected by dilazep, reduced by verapamil, and increased by nifedipine; this increase was no longer observed after beta adrenergic blockade. Ventricular relaxation was assessed by calculating the time relaxation constant, tau. Verapamil increased tau significantly only after beta adrenergic blockade, whereas nifedipine and dilazep reduced it both before and after beta adrenergic blockade. These data suggest that reflex beta adrenergic mechanisms may modulate the effects of calcium blockade on both systolic and diastolic performance.

Animals↗
PubMed1986

Spectral and cross-spectral analysis of heart rate and arterial blood pressure variability signals.

A parametric method for autoregressive (AR) auto- and cross-spectral analysis is presented for the contemporaneous processing of heart rate and arterial blood pressure variability signals. In particular, the introduced bivariate spectral analysis (phase and coherence spectra) provides quantitative and objective means which are useful to measure the role played by the neural controlling systems (sympathetic and parasympathetic systems) on the cardiovascular signals under different pathophysiological conditions. Algorithmic aspects, connected to the way of processing discrete numerical series synchronized to single cardiac beats, are particularly stressed. Important applications are foreseen both in physiological studies and in clinical practice as an aid to the detection of various relevant cardiovascular pathologies such as hypertension and diabetes.

Blood Pressure↗
PubMed1986

Continuous recording of direct high fidelity arterial pressure and electrocardiogram in ambulant patients.

A system providing high quality direct arterial blood pressure recordings and electrocardiograms in ambulatory patients was devised using a modified commercially available Holter type magnetic tape recorder together with a microminiature Millar (3F) tip transducer. This system did not require a perfusion line and solved the major drawbacks of other available systems. Pressure and electrocardiographic data were fed directly from the playback unit into a minicomputer for automatic beat to beat waveform analysis. Thus the blood pressure and RR interval variability signals could be simultaneously analysed with autoregressive modelling techniques to provide a quantitative estimate of sympathovagal balance in ambulant patients. The system was reliable, simple, and safe to use.

Ambulatory Care↗
PubMed1986

Power spectral analysis of heart rate and arterial pressure variabilities as a marker of sympatho-vagal interaction in man and conscious dog.

In 57 normal subjects (age 20-60 years), we analyzed the spontaneous beat-to-beat oscillation in R-R interval during control recumbent position, 90 degrees upright tilt, controlled respiration (n = 16) and acute (n = 10) and chronic (n = 12) beta-adrenergic receptor blockade. Automatic computer analysis provided the autoregressive power spectral density, as well as the number and relative power of the individual components. The power spectral density of R-R interval variability contained two major components in power, a high frequency at approximately 0.25 Hz and a low frequency at approximately 0.1 Hz, with a normalized low frequency:high frequency ratio of 3.6 +/- 0.7. With tilt, the low-frequency component became largely predominant (90 +/- 1%) with a low frequency:high frequency ratio of 21 +/- 4. Acute beta-adrenergic receptor blockade (0.2 mg/kg IV propranolol) increased variance at rest and markedly blunted the increase in low frequency and low frequency:high frequency ratio induced by tilt. Chronic beta-adrenergic receptor blockade (0.6 mg/kg p.o. propranolol, t.i.d.), in addition, reduced low frequency and increased high frequency at rest, while limiting the low frequency:high frequency ratio increase produced by tilt. Controlled respiration produced at rest a marked increase in the high-frequency component, with a reduction of the low-frequency component and of the low frequency:high frequency ratio (0.7 +/- 0.1); during tilt, the increase in the low frequency:high frequency ratio (8.3 +/- 1.6) was significantly smaller. In seven additional subjects in whom direct high-fidelity arterial pressure was recorded, simultaneous R-R interval and arterial pressure variabilities were examined at rest and during tilt. Also, the power spectral density of arterial pressure variability contained two major components, with a relative low frequency:high frequency ratio at rest of 2.8 +/- 0.7, which became 17 +/- 5 with tilt. These power spectral density components were numerically similar to those observed in R-R variability. Thus, invasive and noninvasive studies provided similar results. More direct information on the role of cardiac sympathetic nerves on R-R and arterial pressure variabilities was derived from a group of experiments in conscious dogs before and after bilateral stellectomy. Under control conditions, high frequency was predominant and low frequency was very small or absent, owing to a predominant vagal tone. During a 9% decrease in arterial pressure obtained with IV nitroglycerin, there was a marked increase in low frequency, as a result of reflex sympathetic activation.(ABSTRACT TRUNCATED AT 400 WORDS)

Adrenergic beta-Antagonists↗
PubMed1986

Variability analysis of fetal heart rate signals as obtained from abdominal electrocardiographic recordings.

The present paper introduces an original method of digital signal processing for an automatic analysis of non-invasive abdominal ECG recordings on pregnant women starting from the 25th week of gestation. The procedure has been implemented on a DEC-VAX 750 digital computer at the Department of Electrical Engineering, Polytechnic of Milano and the signals are recorded at the Department of Obstetrics and Gynecology "L. Mangiagalli", University of Milano, Italy. The experimental results presented in here are still preliminary as only few cases have been considered up to now (about 20) and the goal of the paper is mainly focused on the algorithmic aspects of the whole procedure implemented in the computer and on the approach of heart rate variability (HRV) signal analysis both in the mother and in the fetus. Abdominal ECG lead processing is illustrated starting from the step of maternal (M) and fetal (F) QRS recognitions through linear digital filtering (derivative and low-pass FIR filter, Weber-Cappellini window) and weighted averaging techniques synchronized with maternal QRS's. Figure 1 a shows the original abdominal lead; figure 1 b the filtered signal for MQRS recognitions; figure 2 a the template of maternal cardiac cycle as obtained after the averaging operation synchronized with the instants of MQRS occurrence. The subtraction of the template results in the abdominal lead shown in figure 1 c in which the contribution of MECG is practically entirely reduced even in the case of MQRS and FQRS overlapping.(ABSTRACT TRUNCATED AT 250 WORDS)

Electrocardiography↗
PubMed1986

Neural control of vasomotor tone of large coronary arteries.

In man, the occurrence of constrictions of large coronary arteries accompanied by transient myocardial ischemia is now well established. However, the role of neural factors involved in such coronary artery spasms is still a matter of conjecture. A consistent reduction (9 +/- 2%) of the diameter of the large coronary arteries can be obtained in the conscious dog with alpha-adrenergic receptor stimulation with methoxamine in spite of the concomitant pressor rise (65 +/- 5%). Smaller reductions in coronary diameter can be obtained with electrical efferent sympathetic stimulation in anesthetized dogs. The diameter of a conduit artery such as the aorta can be reduced (5%) by reflex increases in sympathetic efferent activity: therefore it is not unlikely that similar neural influences might be exerted on the coronary tree as well. In normal life, stressful situations, such as emotion or exercise, will be accompanied by a drastic increase in sympathetic drive to the heart, together with a marked increase in coronary flow. The latter will induce an endothelial mediated vasodilation; however the net effect on coronary size of these two potentially opposite mechanisms is as yet unexplored. In the laboratory, intracoronary bradykinin and regional myocardial ischemia initiate a reflex increase in sympathetic activity to the heart; in the clinics acute myocardial ischemia can be accompanied by signs of sympathetic overactivity. The extent to which such increases in sympathetic activity, could play a role in the control of coronary tone and hence in the pathophysiology of coronary artery disease, is still under investigation.

Animals↗