Use of heart rate variability analysis to determine the risk of cardiac ischaemia in high‐risk patients undergoing general anaesthesia

Heart rate variability (HRV) provides an excellent proxy for monitoring of autonomic function, but the clinical utility of such characterization has not been investigated. In a clinical setting, the baseline autonomic function can reflect ability to adapt to stressors such as anesthesia. No monitoring tool has yet been developed that is able to track changes in HRV in real time. This study is a proof-of-concept for a non-invasive, real-time monitoring model for autonomic function via continuous Poincaré quantification of HRV dynamics. Anonymized heart rate data of 18 healthy individuals (18–45 years) undergoing minor procedures and 18 healthy controls (21–35 years) were analyzed. Patients underwent propofol and fentanyl anesthesia, and controls were at rest. Continuous heart rate monitoring was carried out from before aesthetic induction to the end of the surgical procedure. HRV components (sympathetic and parasympathetic) were extracted and analyzed using Poincaré quantification, and a real-time assessment tool was developed. In the patient group, a significant decrease in the sympathetic and parasympathetic components of HRV was observed following anesthesia (SD1: p = 0.019; SD2: p = 0.00027). No corresponding change in HRV was observed in controls. HRV parameters were modelled into a real-time graph. Using the monitoring technique developed, autonomic changes could be successfully visualized in real-time. This could provide the basis for a novel, fast and non-invasive method of autonomic assessment that can be delivered at the point of care. Electronic supplementary material The online version of this article (10.1007/s10877-018-0206-4) contains supplementary material, which is available to authorized users.

Section: Discussionmentioning

confidence: 99%

Non-invasive real-time autonomic function characterization during surgery via continuous Poincaré quantification of heart rate variability

Ardissino

Nicolaou

Vizcaychipi

2018

“…In abdominal and vascular surgery, Hanss et al found higher rates of postOP myocardial ischemia on ECG and higher total creatine kinase and creatine kinase myocardial band (CK-MB) in patients with lower TP (p < 0.05) and higher LF on the day of surgery. Other frequency domain parameters were not associated with ischemia [ 56 ]. Similarly, May et al found that patients with HRV in the two upper tertiles of LF, HF, and rMSSD before arriving in the OR on the day of surgery had higher troponin T within the first postOP 48 h [ 57 ].…”

Section: Resultsmentioning

confidence: 99%

“…Two studies in abdominal and vascular surgery found that groups with lower TP had longer LOS in hospital. One measured on the day of surgery (p < 0.05) [ 56 ] and the other, one day before (p < 0.0001) [ 16 ]. However, differences in LOS were related to increased overall complications in one study [ 16 ], while causes were not reported in the other [ 56 ].…”

Section: Resultsmentioning

confidence: 99%

Preoperative heart rate variability as a predictor of perioperative outcomes: a systematic review without meta-analysis

Frandsen

Mehlsen

Foss

et al. 2022

Heart rate variability (HRV) is a predictor of mortality and morbidity after non-lethal cardiac ischemia, but the relation between preoperatively measured HRV and intra- and postoperative complications is sparsely studied and most recently reviewed in 2007. We, therefore, reviewed the literature regarding HRV as a predictor for intra- and postoperative complications and outcomes. We carried out a systematic review without meta-analysis. A PICO model was set up, and we searched PubMed, EMBASE, and CENTRAL. The screening was done by one author, but all authors performed detailed review of the included studies. We present data from studies on intraoperative and postoperative complications, which were too heterogeneous to warrant formal meta-analysis, and we provide a pragmatic review of HRV indices to facilitate understanding our findings. The review was registered in PROSPERO (CRD42021230641). We screened 2337 records for eligibility. 131 records went on to full-text assessment, 63 were included. In frequency analysis of HRV, low frequency to high frequency ratio could be a predictor for intraoperative hypotension in spinal anesthesia and lower total power could possibly predict intraoperative hypotension under general anesthesia. Detrended fluctuation analysis of HRV is a promising candidate for predicting postoperative atrial fibrillation. This updated review of the relation between preoperative HRV and surgical outcome suggests a clinically relevant role of HRV but calls for high quality studies due to methodological heterogeneity in the current literature. Areas for future research are suggested.

“…Additionally, there have been several studies demonstrating that anesthesia (both general and regional) alter heart rate variability [23][24][25][26][27][28]. Very few studies however have examined the relationship between pre-operative heart rate variability and post-operative outcome [29]. Our observations therefore add a new temporal dimension (the intraoperative period) to the previously published data indicating that markers of autonomic dysfunction may serve as clinically useful tools in the evaluation and management of the critically ill [30][31][32][33].…”

Section: Discussionmentioning

confidence: 99%

Low intraoperative heart rate volatility is associated with early postoperative mortality in general surgical patients: a retrospective case–control study

Mandel-Portnoy

Levin

Bansilal

et al. 2015

Heart rate volatility (HRVO) is hypothesized to be a physiological measure of sympathetic activity and is defined by the standard deviation (SD) of the heart rate (HR) in beats per minutes (BPM) over fixed time intervals. To investigate the relationship between low HRVO (SD < 0.5 BPM) during surgical procedures and mortality within 48 h post-procedure. We retrospectively reviewed all adult general surgical procedures performed at our center from January 1, 2003 through July 1, 2013 to identify patients who died within 48 h post-procedure. Demographic, heart rate, and mortality data were extracted from the electronic anesthesia record. Propensity score analysis was used to find matching controls based on age, gender, ASA score, anesthesia type, Charlson index, procedure type, emergency status, year, use of preoperative beta blocker, hypertension, diabetes, atrial fibrillation and heart failure. HRVO was calculated for each 5 min interval as the SD of all HR's within that interval. Negative binomial regression was then used to model the count of intervals with HRVO < 0.5 BPM for the duration of the surgery. During the 10 year study period, 283 patients died within 48 h of procedure finish. These patients were matched to 566 patients who did not die within 48 h after procedure. Patients who died had a 39 % increase in frequency of low HRVO episodes compared to patients who survived (RR 1.39, 95 % CI 1.13-1.72; p = 0.003). Low HRVO during surgical procedure is associated with increased mortality risk within 48 h after procedure. Strategies to identify HRVO early and modify it may lead to improvement in outcomes.