Journal of Critical Care
Volume 24, Issue 3 , Pages 347-361 , September 2009

Predicting clinical physiology: A Markov chain model of heart rate recovery after spontaneous breathing trials in mechanically ventilated patients

  • Yan Lu, PhD

      Affiliations

    • Department of Physics and Astronomy, Rice University, Houston, TX 77005, USA
    • These authors contributed equally to the work.
    • ,
  • Anton Burykin, PhD

      Affiliations

    • Department of Surgery, Washington University, Saint Louis, MO 63110, USA
    • These authors contributed equally to the work.
    • ,
  • Michael W. Deem, PhD

      Affiliations

    • Department of Physics and Astronomy, Rice University, Houston, TX 77005, USA
    • ,
  • Timothy G. Buchman, PhD, MD

      Affiliations

    • Department of Surgery, Washington University, Saint Louis, MO 63110, USA
    • Corresponding Author InformationCorresponding author.

References 

  1. Shephard R. Exercise physiology. Philadelphia: BC Decker Inc.; 1987;
  2. Pierpont GL, Voth EJ. Heart rate recovery from exercise as an index of both parasympathetic and sympathetic activity. FASEB J. 2002;16(5):A1142
  3. Imai K, Sato H, Hori M, Kusuoka H, Ozaki H, Yokoyama H, et al. Vagally mediated heart rate recovery after exercise is accelerated in athletes but blunted in patients with chronic heart failure. J Am Coll Cardiol. 1994;24(6):1529–1535
  4. Buchheit M, Papelier Y, Laursen PB, Ahmaidi S. Noninvasive assessment of cardiac parasympathetic function: postexercise heart rate recovery or heart rate variability?. Am J Physiol Heart Circ Physiol. 2007;293(1):H8–H10
  5. Kannankeril PJ, Goldberger JJ. Parasympathetic effects on cardiac electrophysiology during exercise and recovery. Am J Physiol Heart Circ Physiol. 2002;282(6):H2091–H2098
  6. Goldberger JJ, Le FK, Lahiri M, Kannankeril PJ, Ng J, Kadish AH. Assessment of parasympathetic reactivation after exercise. Am J Physiol Heart Circ Physiol. 2006;290(6):H2446–H2452
  7. Lauer M, Froelicher ES, Williams M, Kligfield P. Exercise testing in asymptomatic adults: a statement for professionals from the American Heart Association Council on Clinical Cardiology, Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention. Circulation. 2005;112(5):771–776
  8. Shetler K, Marcus R, Froelicher VF, Vora S, Kalisetti D, Prakash M, et al. Heart rate recovery: validation and methodologic issues. J Am Coll Cardiol,. 2001;38(7):1980–1987
  9. Morise AP. Heart rate recovery: predictor of risk today and target of therapy tomorrow?. Circulation. 2004;110(18):2778–2780
  10. Smith LL, Kukielka M, Billman GE. Heart rate recovery after exercise: a predictor of ventricular fibrillation susceptibility after myocardial infarction. Am J Physiol Heart Circ Physiol. 2005;288(4):H1763–H1769
  11. Seshadri N, Gildea TR, McCarthy K, Pothier C, Kavuru MS, Lauer MS. Association of an abnormal exercise heart rate recovery with pulmonary function abnormalities. Chest. 2004;125(4):1286–1291
  12. Cole CR, Foody JM, Blackstone EH, Lauer MS. Heart rate recovery after submaximal exercise testing as a predictor of mortality in a cardiovascularly healthy cohort. Ann Intern Med. 2000;132(7):552–555
  13. Nishime EO, Cole CR, Blackstone EH, Pashkow FJ, Lauer MS. Heart rate recovery and treadmill exercise score as predictors of mortality in patients referred for exercise ECG. JAMA. 2000;284(11):1392–1398
  14. Gorelik DD, Hadley D, Myers J, Froelicher V. Is there a better way to predict death using heart rate recovery?. Clin Cardiol. 2006;29(9):399–404
  15. Javorka M, Zila I, Balharek T, Javorka K. On- and off-responses of heart rate to exercise - relations to heart rate variability. Clin Physiol Funct Imaging. 2003;23(1):1–8
  16. Billman GE. Heart rate response to onset of exercise: evidence for enhanced cardiac sympathetic activity in animals susceptible to ventricular fibrillation. Am J Physiol Heart Circ Physiol. 2006;291(1):H429–H435
  17. Ricardo DR, de Almeida MB, Franklin BA, Araujo CGS. Initial and final exercise heart rate transients: influence of gender, aerobic fitness, and clinical status. Chest. 2005;127(1):318–327
  18. Leeper NJ, Dewey FE, Ashley EA, Sandri M, Tan SY, Hadley D, et al. Prognostic value of heart rate increase at onset of exercise testing. Circulation. 2007;115(4):468–474
  19. Javorka M, Zila I, Balharek T, Javorka K. Heart rate recovery after exercise: relations to heart rate variability and complexity. Braz J Med Biol Res. 2002;35(8):991–1000
  20. Camm AJ, Malik M, Bigger JT, Breithardt G, Cerutti S, Cohen RJ, et al. Heart rate variability—standards of measurement, physiological interpretation, and clinical use. Circulation. 1996;93(5):1043–1065
  21. Castiglioni P. Evaluation of heart rhythm variability by heart rate or heart period: differences, pitfalls and help from logarithms. Med Biol Eng Comput. 1995;33(3):323–330
  22. Niklasson U, Wiklund U, Bjerle P, Olofsson BO. Heart-rate variation: what are we measuring?. Clin Physiol. 1993;13(1):71–79
  23. Pierpont GL, Voth EJ. Assessing autonomic function by analysis of heart rate recovery from exercise in healthy subjects. Am J Cardiol. 2004;94(1):64–68
  24. Kubo R. The fluctuation-dissipation theorem. Rep Prog Phys. 1966;29(1):255–284
  25. Chandler D. In: Introduction to modern statistical mechanics. New York: Oxford University Press; 1987;[xiii, 274 p]
  26. Norris JR. Markov chains. Cambridge, UK: Cambridge University Press; 1998;
  27. Pinsky MR. Breathing as exercise: the cardiovascular response to weaning from mechanical ventilation. Intensive Care Med. 2000;26(9):1164–1166
  28. Shen H-N, Lin L-Y, Chen K-Y, Kuo P-H, Yu C-J, Wu H-D, et al. Changes of heart rate variability during ventilator weaning. Chest. 2003;123(4):1222–1228
  29. Robertson TE, Mann HJ, Hyzy R, Rogers A, Douglas I, Waxman AB, et al. Multicenter implementation of a consensus-developed, evidence-based, spontaneous breathing trial protocol. Crit Care Med. 2008;36(10):2753–2762
  30. Burykin A, Buchman TG. Cardiorespiratory dynamics during transitions between mechanical and spontaneous ventilation in intensive care. Complexity. 2008;13(6):40–59
  31. Niskanen JP, Tarvainen MP, Ranta-Aho PO, Karjalainen PA. Software for advanced HRV analysis. Comput Methods Programs Biomed. 2004;76(1):73–81
  32. Hanggi P, Thomas H. Stochastic processes: time evolution, symmetries and linear response. Phys Rep. 1982;88(4):207–319
  33. Otzenberger H, Gronfier C, Simon C, Charloux A, Ehrhart J, Piquard F, et al. Dynamic heart rate variability: a tool for exploring sympathovagal balance continuously during sleep in men. Am J Physiol Heart Circ Physiol. 1998;44(3):H946–H950
  34. Kamen PW, Tonkin AM. Application of the Poincare plot to heart-rate-variability—a new measure of functional status in heart-failure. Aust N Z J Med. 1995;25(1):18–26
  35. Brennan M, Palaniswami M, Kamen P. Do existing measures of Poincare plot geometry reflect nonlinear features of heart rate variability?. IEEE Trans Biomed Eng. 2001;48(11):1342–1347
  36. Kirchgässner G, Wolters J. Introduction to modern time series analysis. Berlin: Springer; 2007;[ix, 274 p]
  37. Costa MD, Peng CK, Goldberger AL. Multiscale analysis of heart rate dynamics: entropy and time irreversibility measures. Cardiovasc Eng. 2008;
  38. Savin WM, Haskell WL, Schroeder JS, Stinson EB. Cardiorespiratory responses of cardiac transplant patients to graded, symptom-limited exercise. Circulation. 1980;62(1):55–60
  39. West BJ, Deering W. Fractal physiology for physicists—levy statistics. Phys Rep. 1994;246(1-2):2–100
  40. Lipsitz LA, Goldberger AL. Loss of complexity and aging—potential applications of fractals and chaos theory to senescence. JAMA. 1992;267(13):1806–1809
  41. Kaplan DT, Furman MI, Pincus SM, Ryan SM, Lipsitz LA, Goldberger AL. Aging and the complexity of cardiovascular dynamics. Biophys J. 1991;59(4):945–949
  42. Pincus SM. Greater signal regularity may indicate increased system isolation. Math Biosci. 1994;122(2):161–181
  43. Godin PJ, Buchman TG. Uncoupling of biological oscillators: a complementary hypothesis concerning the pathogenesis of multiple organ dysfunction syndrome. Crit Care Med. 1996;24(7):1107–1116
  44. Godin PJ, Fleisher LA, Eidsath A, Vandivier RW, Preas HL, Banks SM, et al. Experimental human endotoxemia increases cardiac regularity: results from a prospective, randomized, crossover trial. Crit Care Med. 1996;24(7):1117–1124
  45. Clifford JO, Buchman TG. Sedation modulates recognition of novel stimuli and adaptation to regular stimuli in critically ill adults. Crit Care Med. 2002;30(3):609–616
  46. Yulmetyev R, Hanggi P, Gafarov F. Stochastic dynamics of time correlation in complex systems with discrete time. Phys Rev E. 2000;62(5):6178–6194
  47. Yulmetyev R, Hanggi P, Gafarov F. Quantification of heart rate variability by discrete nonstationary non-Markov stochastic processes. Phys Review E. 2002;65(4):046107–046115
  48. Yulmetyev RM, Demin SA, Panischev OY, Hanggi P. Age-related alterations of relaxation processes and non-Markov effects in stochastic dynamics of R-R intervals variability from human ECGs. Physica A. 2005;353:336–352
  49. Arai Y, Saul JP, Albrecht P, Hartley LH, Lilly LS, Cohen RJ, et al. Modulation of cardiac autonomic activity during and immediately after exercise. Am J Physiol Heart Circ Physiol. 1989;256(1):H132–H141
  50. Martinez A, Seymour C, Nam M. Minute ventilation recovery time: a predictor of extubation outcome. Chest. 2003;123(4):1214–1221
  51. Seymour CW, Christie JD, Fuchs BD. Minute ventilation recovery time measured using a new, more practical methodology predicts extubation outcome. Crit Care Med. 2005;33(12):A113
  52. Seymour CW, Halpern S, Christie JD, Gallop R, Fuchs BD. Minute ventilation recovery time measured using a new, simplified methodology predicts extubation outcome. J Intensive Care Med. 2008;23(1):52–60
  53. Kampen NGV. Stochastic processes in physics and chemistry. Rev. and enl. ed. North-Holland: North-Holland personal library; 1992;[xiv, 465 p]
  54. Marciano F, Migaux ML, Acanfora D, Furgi G, Rengo F. In: Quantification of Poincare maps for the evaluation of heart rate variability. Computers in Cardiology 1994 Proceedings. Computers in Cardiology, Inc; 1994;p. 577–580
  55. Thuraisingham RA. Enhancing Poincare plot information via sampling rates. Appl Math Comput. 2007;186(2):1374–1378

☆ This work was generously supported by grants from the James S. McDonnell Foundation (220020070), DARPA (49533-LS-DRP and HR0011-05-1-0057), and the Barnes-Jewish Hospital Foundation.

PII: S0883-9441(09)00067-7

doi: 10.1016/j.jcrc.2009.01.014

Journal of Critical Care
Volume 24, Issue 3 , Pages 347-361 , September 2009

Article Tools

* Image Usage & Resolution