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Separating arterial pressure increases and decreases in assessing cardiac baroreflex sensitivity via sequence and bivariate phase-rectified signal averaging techniques

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Abstract

Cardiac baroreflex (cBR) is activated by both arterial pressure (AP) increases and decreases. Sequence method, a widely utilized tool assessing cBR sensitivity (cBRS) from spontaneous heart period (HP) and systolic AP (SAP) variations, allows the separated computation of cBRS from positive and negative SAP variations. The recently proposed phase-rectified signal averaging (PRSA) method has the same feature but it has been applied so far solely to positive SAP variations. We adapted the PRSA method to compute cBRS over negative SAP variations and we compared the results with those derived from sequence method over two protocols: (i) graded head-up tilt (HUT) at 15, 30, 45, 60, and 75° in 19 healthy subjects and (ii) general anesthesia induction in 118 patients undergoing coronary artery bypass graft surgery. Regardless of the sign of SAP changes and method, cBRS moved toward 0 during HUT. Only sequence method detected the cBRS decrease after general anesthesia induction. In both protocols, the correlation between the PRSA-based cBRSs derived from positive and negative SAP changes was higher than that obtained from analogous sequence-based cBRSs and correlation between equivalent cBRSs derived from different methods might be absent. We conclude that the two methods are not interchangeable in assessing cBRS.

Graphical representation of the baroreflex sensitivity (BRS) estimation procedures carried out using sequence (SEQ) and phase-rectified signal averaging (PRSA) techniques over spontaneous fluctuations of heart period (HP) and systolic arterial pressure (SAP). BRSSEQ and BRSPRSA was separately computed over positive (+) and negative (−) SAP variations.

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Acknowledgements

The study was partially supported by the Italian Ministry of Health Grant GR-2013-02356272.

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Authors and Affiliations

  1. IRCCS Istituti Clinici Scientifici Maugeri, Istituto di Milano, Milan, Italy

    Beatrice De Maria & Laura Dalla Vecchia

  2. Department of Electronics Information and Bioengineering, Politecnico di Milano, Milan, Italy

    Beatrice De Maria & Sergio Cerutti

  3. Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy

    Vlasta Bari, Marco Ranucci, Valeria Pistuddi, Giovanni Ranuzzi & Alberto Porta

  4. Department of Physiotherapy, Federal University of São Carlos, São Carlos, SP, Brazil

    Anielle C. M. Takahashi & Aparecida M. Catai

  5. Department of Biomedical Sciences for Health, University of Milan, Via F. Fellini 4, San Donato Milanese, 20097, Milan, Italy

    Alberto Porta

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  1. Beatrice De Maria
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  10. Alberto Porta
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Correspondence to Alberto Porta.

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The study protocols were approved by the Ethics Review Committee of the L. Sacco Hospital, Milan, Italy, and IRCCS San Raffaele Hospital, Milan, Italy, conformed to the principles of the Declaration of Helsinki for medical research involving humans. All subjects provided written informed consent.

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De Maria, B., Bari, V., Ranucci, M. et al. Separating arterial pressure increases and decreases in assessing cardiac baroreflex sensitivity via sequence and bivariate phase-rectified signal averaging techniques. Med Biol Eng Comput 56, 1241–1252 (2018). https://doi.org/10.1007/s11517-017-1765-0

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  • DOI: https://doi.org/10.1007/s11517-017-1765-0

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