Background: Postoperative atrial ﬁbrillation (AF) might be favored by cardiovascular control impairment. We hypothesize that cardiovascular regulation indexes derived from directional model-based analysis of the spontaneous ﬂuctuations of heart period (HP) and systolic arterial pressure (SAP) can identify subjects at risk to develop AF after coronary artery bypass graft (CABG) surgery. Methods: Beat-to-beat HP and SAP series were derived from electrocardiogram (ECG) and invasive arterial pressure recorded for 5 min just before CABG surgery in conscious condition. The group comprised subjects who did develop AF (AF, n = 37, 71 ± 8 years, 27 males) or did not (noAF, n = 92, 65 ± 10 years, 85 males). From HP and SAP variabilities we computed classical time-domain, spectral, cross-spectral and complexity indexes characterizing autonomic function and cardiac baroreﬂex control. Moreover, we performed model-based directional analysis assessing the gain and strength of the relations from SAP to HP along cardiac baroreﬂex feedback and from HP to SAP along the feedforward pathway while disambiguating the effect of respiration as estimated from respiratory-related ECG modulations. Results: Classical HP and SAP variability indexes and baroreﬂex sensitivity could not separate AF from noAF individuals. Causality markers, and more speciﬁcally, the strength of the dynamical interactions from SAP to HP and vice versa, could distinguish the two groups: indeed, AFs have a lower degree of association from SAP to HP and vice versa. Conclusions: An impairment of the feedforward and feedback arms of the HP-SAP closed loop relation predisposes subjects undergoing CABG surgery to develop postoperative AF. Perspectives: Competency in medical knowledge: Atrialﬁbrillation (AF) is a frequent complication after coronary artery bypass graft (CABG) surgery lengthening hospitalization duration and increasing healthcare system costs. Translational outlook 1: CABG patients who developed AF had a less preserved cardiovascular interactions due to less active physiological control mechanisms as resulting from the lower degree of dependence of systolic arterial pressure on heart period and vice versa before CABG surgery. Translational outlook 2: Cardiovascular control markers improve stratiﬁcation of the AF risk after CABG surgery above and beyond more traditional demographic and clinical indexes.
Model-based directional analysis of cardiovascular variability identifies patients developing atrial fibrillation after coronary artery bypass grafting / V. Bari, M. Ranucci, B. De Maria, B. Cairo, V. Pistuddi, A. Porta. - In: INTERNATIONAL JOURNAL OF CARDIOLOGY. - ISSN 0167-5273. - 258(2018 May), pp. 97-102.
|Titolo:||Model-based directional analysis of cardiovascular variability identifies patients developing atrial fibrillation after coronary artery bypass grafting|
PORTA, ALBERTO (Corresponding)
|Parole Chiave:||heart rate variability; arterial pressure; cardiac baroreflex; causality; autonomic nervous system; cardiovascular control|
|Settore Scientifico Disciplinare:||Settore ING-INF/06 - Bioingegneria Elettronica e Informatica|
|Data di pubblicazione:||mag-2018|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1016/j.ijcard.2018.01.071|
|Appare nelle tipologie:||01 - Articolo su periodico|