Trend extraction in functional data of R and T waves amplitudes of exercise electrocardiogram

The R and T waves amplitudes of the electrocardiogram recorded during the exercise test undergo strong modifications in response to stress. We analyze the time series of these amplitudes in a group of normal subjects in the framework of functional data, performing reduction of dimensionality, smoothing and principal component analysis. These methods show that the R and T amplitudes have opposite responses to stress, consisting respectively in a bump and a dip at the early recovery stage. We test these features computing a confidence band for the trend of the population mean and analyzing the zero crossing of its derivative. Our findings support the existence of a relationship between R and T wave amplitudes and respectively diastolic and systolic ventricular volumes

Retinal micro-vascular and aortic macro-vascular changes in postmenopausal women with primary hyperparathyroidism

Aim of the study was to evaluate the micro and macro-vascular changes in patients with primary hyperparathyroidism (PHPT) compared to controls. 30 postmenopausal PHPT women (15 hypertensive and 15 normotensive) and 30 normotensive controls underwent biochemical evaluation of mineral metabolism and measurements of arterial stiffness by 24 hour ambulatory blood pressure monitoring. Retinal microcirculation was imaged by a Retinal Vessel Analyzer. PHPT patients also underwent bone mineral density measurements and kidney ultrasound. PHPT patients had higher mean calcium and parathyroid hormone values compared to controls. Evaluating macro-vascular compartment, we found higher values of 24 hours-systolic, diastolic blood pressure, aortic pulse wave velocity (aPWV) and aortic augmentation index (Aix) in hypertensive PHPT, but not in normotensive PHPT compared to controls. The eye examination showed narrowing arterial and venular diameters of retinal vessels in both hypertensive and normotensive PHPT compared to controls. In hypertensive PHPT, 24 hours systolic blood pressure was associated only with parathyroid hormone (PTH) levels (beta = 0.36, p = 0.04). aPWV was associated with retinal diameter (beta = −0.69, p = 0.003), but not with PTH. Retinal artery diameter was associated with PTH (beta = −0.6, p = 0.008). In the normotensive PHPT, only PTH was associated with retinal artery diameter (beta = −0.60, p = 0.01) and aortic AIx (beta = 0.65, p = 0.02). In conclusion, we found macro-vascular impairment in PHPT and that micro-vascular impairment is negatively associated with PTH, regardless of hypertension in PHPT

Diagnosing silent cardiac dysautonomia via ambulatory blood pressure monitoring: early diagnosis shown by the lack of heart rate circadian rhythm in type 1 diabetes mellitus

Introduction. Diabetes mellitus (DM) can be complicated by an involvement of Neurovegetative System (NVS), conventionally and non-invasively diagnosed by the means of Ewing's test and Heart Rate Variability (HRV) analysis. It is well known that the NVS is physiologically responsible, via biological clocks, for the regulation of Circadian Rhythms (CR) characterizing the majority of biological functions. Therefore, this study is aimed at investigating the CR of Heart Rate (HR) and Blood Pressure (BP) in DM, postulating that the diagnosis of Silent Cardiac Dysautonomia (SCD) could be facilitated by detecting anomalous rhythmometric changes, including the worse one, i.e., the lose of a CR. Materials and Methods. The study has been performed on 30 clinically healthy subjects (CHS), 10 patients with DM1 and 30 patients with DM2, who underwent an ambulatory BP monitoring (ABPM) collecting data equidistantly every 30 minutes, under standardized conditions of lifestyle. The group specific monitored values of systolic (S), diastolic (D) BP, as well as HR have been analyzed via: 1. a conventional analysis of their intradiem variability; 2. a chronobiometric analysis (Cosinor method) of their CR. Results. The conventional analysis disclosed that in CHS, DM1 and DM2, both the HR and BP show an intradiem variability that is significant (p<0.001). The chronobiological analysis showed that in CHS and DM2, both the HR and BP show a significant CR (p<0.001), viceversa in DM1 HR is characterized by a non significant CR (p=0.124), notwithstanding that the SBP and DBP maintain a significant CR (p<0.001). Conclusions. The disappearance of HR CR in DM1 reveals the involvement of neurovegetative biological clock that selectively controls the HR CR, as it is demonstrated by the pathophysiological finding of an internal desynchronization between the HR and BP CR. The selective lose of HR CR in DM1 leads to conclude that the ABPM, along with its Cosinor analysis, might be a practical, repeatable, low cost, low risk technique for diagnosing the SCD, at least in DM1. Clin Ter 2010; 161(1):e1-e1

Modeling trend and time-varying variance of heart beat RR intervals during stress test

The heart beat RR intervals extracted from the electrocardiogram recorded during the stress test show a non stationary profile consisting of a decreasing trend during the exercise phase, an increasing trend during the recovery and a global minimum (acme). In addition this time series exhibits a time-varying variance. We decompose the series into a deterministic trend and random fluctuation. The trend is obtained as an exponential fit of the data; the fluctuation is modeled as a mean reverting process driven by the trend, in which the random innovation has a time-varying variance. Data analysis, performed on ambulatory recorded electrocardiograms of 10 healthy subjects, shows that the model describes correctly the data series on a scale of at least 300 beats. © 2011 World Scientific Publishing Company

Analysis of extrema of heartbeat time series in exercise test.

The heartbeat time series of the electrocardiogram recorded during exercise test clearly reflects the physiological control mechanism of the autonomic nervous system on heart rate. This series shows both decreasing and increasing trends and variability of the variance. We analyse the series of intervals between two consecutive extrema, i.e. the durations of accelerations or decelerations of heart rate. We compute the distribution of the length of these intervals and their mean in a model of stationary independent variables, where they are independent of the variables' distribution. We use the mean length as discriminant statistics to compare stress and recovery phases. Data analysis performed over the heartbeat series of 14 healthy subjects shows significant difference between stress and recovery

Trend extraction in functional data of amplitudes of R and T waves in exercise electrocardiogram

The amplitudes of R and T waves of the electrocardiogram recorded during the exercise test show both large inter- and intra-individual variability in response to stress. We analyze a dataset of 65 normal subjects undergoing ambulatory test. We model the dataset of R and T series in the framework of functional data, assuming that the individual series are realizations of a non stationary process, centered at the population trend. We test the time variability of this trend computing a simultaneous confidence band and the zero crossing of its derivative. The analysis shows that the amplitudes of the R and T waves have opposite responses to stress, consisting respectively in a bump and a dip at the early recovery stage. Our findings support the existence of a relationship between R and T wave amplitudes and respectively diastolic and systolic ventricular volumes

Variability of RR intervals and QRS complex area during exercise stress test

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