Akbaş Kübra, Hosseinalizadeh Mohammad, Petrillo Kelsi, Rufin Alexandria Jean L, La Placa Tana, Russo Mark, Toosizadeh Nima
Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers University, Newark, New Jersey, USA,
Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers University, Newark, New Jersey, USA.
Gerontology. 2025 Jul 31:1-13. doi: 10.1159/000546649.
Cardiac autonomic dysfunction reduces the cardiac system's ability to respond to stressors and is prevalent in aging and diseases, especially cardiovascular diseases like aortic stenosis (AS). Heart rate variability (HRV) is a common measure for evaluating parasympathetic activity and cardiac autonomic function; similarly, heart rate (HR) changes during exercise are utilized in determining cardiac health. However, directly measuring HR parameters from an electrocardiogram (ECG) is difficult due to motion artifacts during exercise.
This study aimed to develop a method that assesses HR metrics while minimizing motion artifacts, using an upper-extremity function (UEF) test. We determined the effect of aging and AS on resting-state HR measures, while quantifying the relationship between HRV and HR dynamics. Seventy participants, including 21 young controls (age = 21.8 ± 3.2 years), 12 aging/older controls (age = 69.8 ± 4.0 years), and 37 aging/older adults with AS (age = 74.3 ± 10.4 years), performed a baseline rest followed by the UEF test consisting of 20 s of rapid elbow flexion-extension with the right arm; HR was measured using ECG from the left side of the chest. HRV outcomes included sample entropy (SampEn), root mean square of successive differences between heartbeats (RMSSD), percentage of successive NN intervals with differences of more than 25 ms (pNN25), and a Poincaré plot. HR dynamics were percentage HR increase during the UEF test and percentage HR decrease during post-task recovery.
All resting-state HR measures, except SampEn, as well as HR increase and decrease due to UEF, were significantly lower in the aging/older adult control and AS groups compared to the young control group (p < 0.0072, effect size = 1.964 ± 0.399 for HRV and 1.534 ± 0.256 for HR dynamics). No significant differences were observed in HRV outcomes between the aging/older adult control and AS groups (p > 0.0706, effect size = 0.192 ± 0.082); however, HR decrease was significantly different between the two aging adult groups (p = 0.0440, effect size = 0.569). Across all groups, all HRV parameters correlated significantly with both HR dynamics measures (R2 = 0.233-0.463, p < 0.0001).
Findings suggest that, compared to AS, aging has a more pronounced impact on HRV and HR dynamics. Further, HR dynamics, evaluated through a short physical test, may provide a potential measure of cardiac autonomic dysfunction, which is promising for future clinical applications.
心脏自主神经功能障碍会降低心脏系统对应激源的反应能力，在衰老和疾病中普遍存在，尤其是在诸如主动脉瓣狭窄（AS）等心血管疾病中。心率变异性（HRV）是评估副交感神经活动和心脏自主神经功能的常用指标；同样，运动期间的心率（HR）变化也用于确定心脏健康状况。然而，由于运动期间的运动伪影，直接从心电图（ECG）测量HR参数很困难。
本研究旨在开发一种在最小化运动伪影的同时评估HR指标的方法，采用上肢功能（UEF）测试。我们确定了衰老和AS对静息状态HR测量的影响，同时量化了HRV与HR动态之间的关系。70名参与者，包括21名年轻对照组（年龄 = 21.8 ± 3.2岁）、12名衰老/老年对照组（年龄 = 69.8 ± 4.0岁）和37名患有AS的衰老/老年人（年龄 = 74.3 ± 10.4岁），先进行基线休息，然后进行UEF测试，测试包括用右臂进行20秒的快速肘部屈伸；使用胸部左侧的ECG测量HR。HRV结果包括样本熵（SampEn）、心跳间连续差值的均方根（RMSSD）、连续NN间期差值超过25毫秒的百分比（pNN25）以及庞加莱图。HR动态指标为UEF测试期间的HR增加百分比和任务后恢复期间的HR降低百分比。
与年轻对照组相比，衰老/老年对照组和AS组的所有静息状态HR测量值（除SampEn外）以及UEF引起的HR增加和降低均显著更低（p < 0.0072，HRV的效应大小 = 1.964 ± 0.399，HR动态的效应大小 = 1.534 ± 0.256）。衰老/老年对照组和AS组之间的HRV结果未观察到显著差异（p > 0.0706，效应大小 = 0.192 ± 0.082）；然而，两个老年组之间的HR降低存在显著差异（p = 0.0440，效应大小 = 0.569）。在所有组中，所有HRV参数与两种HR动态指标均显著相关（R2 = 0.233 - 0.463，p < 0.0001）。
研究结果表明，与AS相比，衰老对HRV和HR动态的影响更为显著。此外，通过简短的体能测试评估的HR动态指标可能提供一种心脏自主神经功能障碍的潜在测量方法，这在未来临床应用中具有前景。
