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Dynamic Response of Heart Rate Variability to Active Standing in Aortic Valve Disease: Insights from Recurrence
Itayetzin Beurini Cruz-Vega1,2, Nydia Ávila-Vanzzini3, Gertrudis Hortensia González-Gómez4
1Department of Molecular Biology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico.
Insights
Aortic valve disease (AVD) alters heart rate variability (HRV) dynamics. Nonlinear analysis reveals increased determinism and trapping times in AVD patients, indicating a rigidifying autonomic control related to disease severity.
Area of Science:
- Cardiology
- Biomedical Engineering
- Physiology
Background:
- Aortic valve disease (AVD) involves inflammation, lipid infiltration, and calcification.
- AVD is linked to altered linear heart rate variability (HRV) indices, suggesting sympathetic predominance and impaired autonomic control.
Purpose of the Study:
- To investigate HRV dynamics in AVD patients using nonlinear methods, specifically recurrence quantification analysis (RQA).
Main Methods:
- A cross-sectional study included 127 subjects: healthy valve (HV), aortic valve sclerosis (AVSc), and aortic valve stenosis (AVS).
- Five-minute ECG recordings were obtained in supine and standing positions.
- RQA indices were calculated using the Cross Recurrence Plot Toolbox.
Main Results:
- Aortic valve stenosis (AVS) patients showed higher determinism and trapping time compared to AVSc and HV groups in the supine position.
- Determinism and laminarity progressively increased from HV to AVS.
- The change in nonlinear HRV indices between supine and standing positions decreased with increasing AVD severity, being lowest in AVS.
Conclusions:
- RQA analysis of HRV in AVD patients demonstrates a rigidifying dynamic with increased determinism and prolonged trapping times in fewer states, correlating with AVD severity.
- These findings support the potential implementation of RQA methods in medical software and devices for AVD assessment.
Introduction:
Aortic valve disease (AVD) is an inflammatory, lipid infiltration and calcification disease that has been associated with changes in the conventional linear heart rate variability (HRV) indices showing a marked shift towards sympathetic predominance and a deterioration of the autonomic control.
Objective:
To explore the HRV dynamics in AVD patients through nonlinear methods by recurrence quantification analysis (RQA).
Methods:
In total, 127 subjects participated in a cross-sectional study categorized into three groups: healthy valve (HV), aortic valve sclerosis (AVSc), and aortic valve stenosis (AVS), as determined by echocardiographic assessment. HRV data were collected from five-minute ECG recordings at both a supine position and active standing. RQA indices were calculated using the Cross Recurrence Plot Toolbox.
Results:
In the supine position, patients with AVS exhibited larger determinism and trapping time than those with AVSc and HV. The analysis of these differences revealed that determinism and laminarity increased progressively from HV to AVS. In the same way, the magnitude of change (Δ) between positions decreased and presented the lowest values in AVS in most of the nonlinear indices.
Conclusion:
RQA indices of HRV in AVD patients indicate a rigidizing dynamic characterized by larger determinism and extended trapping times in fewer system states in relation to the severity of AVD. These findings establish a precedent for future perspective assessments for the implementation of these methods in medical software or devices.
