Vinicius Minatel

Effect of age on complexity and causality of the cardiovascular control: comparison between model-based and model-free approaches.

The proposed approach evaluates complexity of the cardiovascular control and causality among cardiovascular regulatory mechanisms from spontaneous variability of heart period (HP), systolic arterial pressure (SAP) and respiration (RESP). It relies on construction of a multivariate embedding space, optimization of the embedding dimension and a procedure allowing the selection of the components most suitable to form the multivariate embedding space. Moreover, it allows the comparison between linear model-based (MB) and nonlinear model-free (MF) techniques and between MF approaches exploiting local predictability (LP) and conditional entropy (CE). The framework was applied to study age-related modifications of complexity and causality in healthy humans in supine resting (REST) and during standing (STAND). We found that: 1) MF approaches are more efficient than the MB method when nonlinear components are present, while the reverse situation holds in presence of high dimensional embedding spaces; 2) the CE method is the least powerful in detecting age-related trends; 3) the association of HP complexity on age suggests an impairment of cardiac regulation and response to STAND; 4) the relation of SAP complexity on age indicates a gradual increase of sympathetic activity and a reduced responsiveness of vasomotor control to STAND; 5) the association from SAP to HP on age during STAND reveals a progressive inefficiency of baroreflex; 6) the reduced connection from HP to SAP with age might be linked to the progressive exploitation of Frank-Starling mechanism at REST and to the progressive increase of peripheral resistances during STAND; 7) at REST the diminished association from RESP to HP with age suggests a vagal withdrawal and a gradual uncoupling between respiratory activity and heart; 8) the weakened connection from RESP to SAP with age might be related to the progressive increase of left ventricular thickness and vascular stiffness and to the gradual decrease of respiratory sinus arrhythmia.

Effect of the Postural Challenge on the Dependence of the Cardiovascular Control Complexity on Age

Short-term complexity of heart period (HP) and systolic arterial pressure (SAP) was computed to detect age and gender influences over cardiovascular control in resting supine condition (REST) and during standing (STAND). Healthy subjects (n = 110, men = 55) were equally divided into five groups (21–30; 31–40; 41–50; 51–60; and 61–70 years of age). HP and SAP series were recorded for 15 min at REST and during STAND. A normalized complexity index (NCI) based on conditional entropy was assessed. At REST we found that both NCIHP and NCISAP decreased with age in the overall population, but only women were responsible for this trend. During STAND we observed that both NCIHP and NCISAP were unrelated to age in the overall population, even when divided by gender. When the variation of NCI in response to STAND (ΔNCI = NCI at REST-NCI during STAND) was computed individually, we found that ΔNCIHP progressively decreased with age in the overall population, and women were again responsible for this trend. Conversely, ΔNCISAP was unrelated to age and gender. This study stresses that the complexity of cardiovascular control and its ability to respond to stressors are more importantly lost with age in women than in men.

Assessing the evolution of redundancy/synergy of spontaneous variability regulation with age

OBJECTIVE We exploited a model-based Wiener-Granger causality method in the information domain for the evaluation of the transfer entropy (TE) and interaction TE (ITE), the latter taken as a measure of the net balance between redundancy and synergy, to describe the interactions between the spontaneous variability of heart period (HP) and systolic arterial pressure (SAP) and the effect of respiration (R) on both variables. APPROACH Cardiac control was typified via the genuine TE from SAP to HP, that from R to HP, and the ITE from SAP and R to HP, while vascular control was characterized via the genuine TE from HP to SAP, that from R to SAP, and the ITE from HP and R to SAP. The approach was applied to study age-related modifications of cardiac and vascular controls in a cohort of 100 healthy humans (age from 21 to 70 years, 54 males) recorded at supine rest (REST) and during active standing (STAND). A surrogate approach was exploited to test the significance of the computed quantities. MAIN RESULTS Trends of the genuine information transfer with age, already present in literature, were here confirmed. We originally found that: (i) at REST redundancy was predominant over synergy in both vascular and cardiac controls; (ii) the predominance of redundancy of the cardiac control was not affected by postural challenge, while STAND reduced redundancy of vascular control; (iii) the net redundancy of the cardiac control at REST gradually decreased with age, while that of vascular control remained stable; (iv) during STAND net redundancy of both cardiac and vascular controls was stable with age. SIGNIFICANCE The study confirms the relevance of computing genuine information transfer in cardiovascular control analysis and stresses the importance of evaluating the ITE to quantify the degree of redundancy of physiological mechanisms operating to maintain cardiovascular homeostasis.

Hemodynamic Responses to Blood Flow Restriction and Resistance Exercise to Muscular Failure

The aim of the present study was to compare hemodynamic responses between blood flow-restricted resistance exercise (BFR-RE), high-intensity resistance exercise (HI-RE) and low-intensity resistance exercise (LI-RE) performed to muscular failure. 12 men (age: 20±3 years; body mass: 73.5±9 kg; height: 174±6 cm) performed 4 sets of leg press exercises using BFR-RE (30% of 1-RM), HI-RE (80% of 1-RM) and LI-RE (30% of 1-RM) protocols. Systolic (SBP) and diastolic blood pressure (DBP), heart rate (HR), stroke volume (SV), cardiac output (CO) and total peripheral vascular resistance (TPR) were measured on a beat-to-beat continuous basis by a noninvasive photoplethysmographic arterial pressure device. The HI-RE and LI-RE showed higher values (P<0.05) in all of the sets than the BFR-RE for SBP, DBP, HR. Additionally, HI-RE showed higher SBP (4th set) and DBP (all sets) (P<0.05) values than the LI-RE. However, the SV, CO and TPR showed significantly greater values for LI-RE compared to HI-RE and BFR-RE (P<0.05). In conclusion, the results of this study indicate that the BFR-RE promotes a lower hemodynamic response compared to the HI-RE and LI-RE performed to muscular failure.

Avaliação da frequência cardíaca à medida de pressão expiratória máxima estática e à manobra de Valsalva em jovens saudáveis

BACKGROUND The measure of the maximal expiratory pressure (MEP) has some contraindications, as it is believed that the responses obtained in this measure are similar to the Valsalva maneuver (VM). OBJECTIVE The main purpose of this study was to evaluate the heart rate responses (HR) during the MEP and the VM measures in healthy young men into different postures aiming to identify whether and in which situation the MEP reproduces the responses obtained in the VM. Additionally we aim to estimate the workload realized during the maneuvers. METHOD Twelve healthy young men were evaluated, instructed and familiarized with the maneuvers. The VM was characterized by an expiratory effort (40 mmHg) against a manometer for 15 seconds. The MEP measure has been performed according to the American Thoracic Society. Both measures were performed at sitting and supine positions. ANOVA two-way with Holm-Sidak post-hoc test (p<0.05) was used to analyse the heart rate variation (∆HR); Valsalva index (VI); MEP index (MEPI), and the estimated workload of the maneuvers (Wtotal, Wisotime, Wtotal/∆HRtotal and Wisotime/∆HRisotime ). RESULTS The ∆HR during the maneuvers was not influenced by the supine and sitting positions. However, the ∆HR during the VM and VI were higher (supine: 47±9 bpm, 2.3±0.2; sitting: 41±10 bpm, 2.0±0.2, respectively) than ∆HR during the MEP and MEPI values (supine: 23±8 bpm, 1.5±0.2; sitting 24±8 bpm, 1.6±0.3, respectively) (p<0.001). The estimated workload of the maneuvers was statistically different (p<0.001) between the maneuvers, except to Wtotal/∆HR. CONCLUSIONS In the studied conditions the MEP does not reproduces the HR response observed in the VM in healthy young men.

Pressão expiratória positiva nas vias aéreas não reproduz as respostas de frequência cardíaca à manobra de Valsalva em homens jovens saudáveis

The expiratory positive airway pressure (EPAP) is a therapeutic resource that comprises an inspiration followed by expiration against resistance. During its application there were adjustments in the cardiovascular system, similar to those observed during the Valsalva maneuver (VM). The aim of this study was to analyze the heart rate (HR) response to VM and to different ways of EPAP application to identify if and in which condition this technique reproduces the HR response observed in the VM, in apparently healthy young men. Ten subjects (24±3 years, 25±3 kg/m2) performed randomly the VM and EPAP procedures on different days. The expiratory effort in VM was sustained for 15 s (oral pressure of 40 mmHg [53.4cm H2O]). Two EPAP techniques were employed (alone and therapeutic) against three pressure levels (10, 15 and 20 cmH2O), randomly applied. The maneuvers were repeated three times with five minutes interval. It was considered the greatest value of HR variation (DHR) for each maneuver analysis. Were used the Shapiro-Wilk test to analyze the data distribution and the ANOVA for repeated measures, with Fishers post-hoc, considering α<0.05. The DHR values observed in VM were higher (p<0.05) than those found in the different EPAP techniques, regardless the pressure level employee. The EPAP application, in these three level pressures, generates less cardiac overload and does not reproduce HR responses observed in the VM.

Effects of inspiratory muscle training on cardiovascular autonomic control: A systematic review

PURPOSE To carry out a systematic review to determine if inspiratory muscle training (IMT) promotes changes in cardiovascular autonomic responses in humans. METHODS The methodology followed the PRISMA statement for reporting systematic review analysis. MEDLINE, PEDro, SCOPUS and PubMed electronic databases were searched from the inception to March 2017. The quality assessment was performed using a PEDro scale. The articles were included if: (1) primary objective was related to the effects of IMT on the cardiovascular autonomic nervous system, and (2) randomized clinical trials and quasi-experimental studies. Exclusion criteria were reviews, short communications, letters, case studies, guidelines, theses, dissertations, qualitative studies, scientific conference abstracts, studies on animals, non-English language articles and articles addressing other breathing techniques. Outcomes evaluated were measures of cardiovascular autonomic control, represented by heart rate variability (HRV) and blood pressure variability (BPV) indexes. RESULTS The search identified 729 citations and a total of 6 studies were included. The results demonstrated that IMT performed at low intensities can chronically promote an increase in the parasympathetic modulation and/or reduction of sympathetic cardiac modulation in patients with diabetes, hypertension, chronic heart failure and gastroesophageal reflux, when assessed by HRV spectral analysis. However, there was no study which evaluated the effects of IMT on cardiovascular autonomic control assessed by BPV. CONCLUSIONS IMT can promote benefits for cardiac autonomic control, however the heterogeneity of populations associated with different protocols, few studies reported in the literature and the lack of randomized controlled trials make the effects of IMT on cardiovascular autonomic control inconclusive.

Circulatory and Ventilatory Power: Characterization in Patients with Coronary Artery Disease

Background Circulatory power (CP) and ventilatory power (VP) are indices that have been used for the clinical evaluation of patients with heart failure; however, no study has evaluated these indices in patients with coronary artery disease (CAD) without heart failure. Objective To characterize both indices in patients with CAD compared with healthy controls. Methods Eighty-seven men [CAD group = 42 subjects and healthy control group (CG) = 45 subjects] aged 40–65 years were included. Cardiopulmonary exercise testing was performed on a treadmill and the following parameters were measured: 1) peak oxygen consumption (VO2), 2) peak heart rate (HR), 3) peak blood pressure (BP), 4) peak rate-pressure product (peak systolic HR x peak BP), 5) peak oxygen pulse (peak VO2/peak HR), 6) oxygen uptake efficiency (OUES), 7) carbon dioxide production efficiency (minute ventilation/carbon dioxide production slope), 8) CP (peak VO2 x peak systolic BP) and 9) VP (peak systolic BP/carbon dioxide production efficiency). Results The CAD group had significantly lower values for peak VO2 (p < 0.001), peak HR (p < 0.001), peak systolic BP (p < 0.001), peak rate-pressure product (p < 0.001), peak oxygen pulse (p = 0.008), OUES (p < 0.001), CP (p < 0.001), and VP (p < 0.001) and significantly higher values for peak diastolic BP (p = 0.004) and carbon dioxide production efficiency (p < 0.001) compared with CG. Stepwise regression analysis showed that CP was influenced by group (R2 = 0.44, p < 0.001) and VP was influenced by both group and number of vessels with stenosis after treatment (interaction effects: R2 = 0.46, p < 0.001). Conclusion The indices CP and VP were lower in men with CAD than healthy controls.

Short-term complexity of cardiovascular oscillations in frailty syndrome

Frailty has been described as a clinical state of vulnerability to stress, consequence from decline of resilience and physiological reserves and progressive decline on ability of homeostasis maintenance. The aim of this study was to evaluate the complexity of R-R intervals (RR) in resting supine (REST) and standing (STAND) position in 3 groups: frail, pre-frail and non-frail. Eighty older people (60-94 years old) were divided into frail group (n = 6), pre-frail (n=36) and non-frail group (n=38). The RR series were recorded at REST and during STAND for 10 minutes in each position. Short sequences of RR were analyzed by conditional entropy (CE) and approximate entropy (ApEn). Position, group and interaction effects were evaluated by two-way repeated-measures ANOVA. CE indicated only position effect while ApEn showed only group effect. ApEn seems to be more suitable for assessing changes in the complexity in frailty syndrome.

Comparison between probabilistic and Wiener–Granger causality in assessing modifications of the cardiac baroreflex control with age

BACKGROUND Probabilistic causality (PC) is a framework for checking that the occurrence of a cause raises the probability of the effect by comparing the probability of the effect conditioned and unconditioned to the cause. Even though it is less frequently utilized with respect to the more traditional model-based Wiener-Granger causality (WGC) that is based on the predictability improvement of an effect resulting from the inclusion of the presumed cause in the multivariate linear regression model, PC has the advantage of being model-free. OBJECTIVE The aim of the study is to apply the PC framework to assess the evolution of cardiac baroreflex control with age from spontaneous fluctuations of heart period (HP) and systolic arterial pressure (SAP) and to compare it to the more common WGC approach. APPROACH We studied 100 healthy humans (54 males, age: 21-70 years, 20 subjects for each 10 years bin). HP and SAP were extracted on a beat-to-beat basis from 5 min recordings of electrocardiogram and plethysmographic arterial pressure at rest in supine position (REST) and during active standing (STAND) under spontaneous breathing. The WGC ratio (WGCR) was computed as the log ratio of the prediction error variance of the autoregressive model on HP to that on HP with exogenous SAP. The PC ratio (PCR) was computed as the probability of observing an HP ramp given an associated parallel SAP variation divided by the probability of observing an HP ramp. MAIN RESULTS The WGCR and PCR suggested the gradual impairment of cardiac baroreflex with age, especially during STAND. Moreover, they were significantly associated both at REST and during STAND but the degree of the PCR-WGCR association was weak. SIGNIFICANCE PC can be effectively exploited to assess modification of the cardiovascular control during senescence even though a limited agreement was observed with WGC.