Computational modeling for the quantitative assessment of cardiac autonomic response to orthostatic stress

Objective.The autonomic nervous system (ANS) plays a critical role in regulating not only cardiac functions but also various other physiological processes, such as respiratory rate, digestion, and metabolic activities. The ANS is divided into the sympathetic and parasympathetic nervous systems, each of which has distinct but complementary roles in maintaining homeostasis across multiple organ systems in response to internal and external stimuli. Early detection of ANS dysfunctions, such as imbalances between the sympathetic and parasympathetic branches or impairments in the autonomic regulation of bodily functions, is crucial for preventing or slowing the progression of cardiovascular diseases. These dysfunctions can manifest as irregularities in heart rate, blood pressure regulation, and other autonomic responses essential for maintaining cardiovascular health. Traditional methods for analyzing ANS activity, such as heart rate variability (HRV) analysis and muscle sympathetic nerve activity recording, have been in use for several decades. Despite their long history, these techniques face challenges such as poor temporal resolution, invasiveness, and insufficient sensitivity to individual physiological variations, which limit their effectiveness in personalized health assessments.Approach.This study aims to introduce the open-loop Mathematical Model of Autonomic Regulation of the Cardiac System under Supine-to-stand Maneuver (MMARCS) to overcome the limitations of existing ANS analysis methods. The MMARCS model is designed to offer a balance between physiological fidelity and simplicity, focusing on the ANS cardiac control subsystems' input-output curve. The MMARCS model simplifies the complex internal dynamics of ANS cardiac control by emphasizing input-output relationships and utilizing sensitivity analysis and parameter subset selection to increase model specificity and eliminate redundant parameters. This approach aims to enhance the model's capacity for personalized health assessments.Main results.The application of the MMARCS model revealed significant differences in ANS regulation between healthy (14 females and 19 males, age: 42 ± 18) and diabetic subjects (8 females and 6 males, age: 47 ± 14). Parameters indicated heightened sympathetic activity and diminished parasympathetic response in diabetic subjects compared to healthy subjects (p < 0.05). Additionally, the data suggested a more sensitive and potentially more reactive sympathetic response among diabetic subjects (p < 0.05), characterized by increased responsiveness and intensity of the sympathetic nervous system to stimuli, i.e. fluctuations in blood pressure, leading to more pronounced changes in heart rate, these phenomena can be directly reflected by gain parameters and time response parameters of the model.Significance.The MMARCS model represents an innovative computational approach for quantifying ANS functionality. This model guarantees the accuracy of physiological modeling while reducing mathematical complexity, offering an easy-to-implement and widely applicable tool for clinical measurements of cardiovascular health, disease progression monitoring, and home health monitoring through wearable technology.