Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-15T09:20:04.182Z Has data issue: false hasContentIssue false
  • English
  • Français

The Deceleration Capacity - a New Measure of Heart Rate Variability Evaluated in Patients With Schizophrenia and Antipsychotic Treatment

Published online by Cambridge University Press:  14 September 2011

A. Birkhofer ,
J. Geissendoerfer ,
P. Alger ,
A. Mueller ,
M. Rentrop ,
T. Strubel ,
S. Leucht ,
H. Förstl ,
K.-J. Bär  and
G. Schmidt
A. Birkhofer*
Affiliation:
Technische Universität München, Klinik für Psychiatrie und Psychotherapie, Ismaninger Str 22, 81675München, Germany
J. Geissendoerfer
Affiliation:
Technische Universität München, Klinik für Psychiatrie und Psychotherapie, Ismaninger Str 22, 81675München, Germany
P. Alger
Affiliation:
Technische Universität München, Klinik für Psychiatrie und Psychotherapie, Ismaninger Str 22, 81675München, Germany
A. Mueller
Affiliation:
Department of Medicine and Centre of Non-linear Dynamic, Technische Universität, München, Germany
M. Rentrop
Affiliation:
Technische Universität München, Klinik für Psychiatrie und Psychotherapie, Ismaninger Str 22, 81675München, Germany
T. Strubel
Affiliation:
Technische Universität München, Klinik für Psychiatrie und Psychotherapie, Ismaninger Str 22, 81675München, Germany
S. Leucht
Affiliation:
Technische Universität München, Klinik für Psychiatrie und Psychotherapie, Ismaninger Str 22, 81675München, Germany
H. Förstl
Affiliation:
Technische Universität München, Klinik für Psychiatrie und Psychotherapie, Ismaninger Str 22, 81675München, Germany
K.-J. Bär
Affiliation:
Department of Psychiatry and Psychotherapy, Ruhr-Universität, Alexandrinenstr. 1, 44791Bochum, Germany
G. Schmidt
Affiliation:
Department of Medicine and Centre of Non-linear Dynamic, Technische Universität, München, Germany
*
⁎Corresponding author. Tel.: +49 89 4140 4220; fax: +49 89 4140 4987. E-mail address: [email protected] (A. Birkhofer).
Get access

Abstract

Background

Schizophrenia is associated with increased cardiac mortality. A disturbed autonomic modulation of heart rate (HR) has been described in patients with schizophrenia in whom antipsychotic medication may represent an additional cardiac risk. The novel measure deceleration capacity (DC) of heart rate predicts cardiac mortality in patients with cardiovascular illnesses. The aim of the present paper was to calculate DC in patients with schizophrenia and to compare this measure with established parameters of heart rate variability (HRV).

Methods

HRV and DC were calculated in 24-hour electrocardiogram (ECG) recordings of 20 unmedicated, 40 medicated patients with schizophrenia and 40 controls. As activity has a major influence on HRV, 4-hour periods of “sleep-” and “wake-” ECG were evaluated as additional parameters. Actigraphy was used to ensure comparable levels of activity in patients and controls.

Results

The DC as well as the other established HRV measures were not significantly different comparing unmedicated patients with schizophrenia to healthy controls. However, medicated patients showed a significant reduction of DC calculated from ECG recordings during 4 hour over night periods.

Conclusion

Calculation of DC might contribute to a better monitoring and identification of an increased risk of cardiac mortality in patients with schizophrenia undergoing antipsychotic treatment.

Keywords

SchizophreniaAntipsychoticDeceleration capacityHeart rate variabilityMortality riskPsychophysiologyCardiac mortality
Type
Original article
Information
European Psychiatry , Volume 28 , Issue 2 , February 2013 , pp. 81 - 86
Copyright
Copyright © Elsevier Masson SAS 2013

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Abbreviations: BDI, Beck Depression Inventory; BPRS, Brief Psychiatric Rating Scale; CGI, Clinical Global Impression Scale; DC, deceleration capacity; ESI, Eppendorf Schizophrenia Inventory; HRV, heart rate variability; PRSA, phase rectified signal averaging; RMSSD, square root of the mean squared differences of successive intervals; SDNN, standard deviation of normal to normal intervals; STAI, State-Trait-Anxiety Inventory.

References

Agelink, M.W., Malessa, R., Kamcili, E., Zeit, T., Lemmer, W., Bertling, R.et al.Cardiovascular autonomic reactivity in schizophrenics under neuroleptic treatment: a potential predictor of short-term outcome?. Neuropsychobiology 1998;381:19–24.CrossRefGoogle Scholar
Agelink, M.W., Majewski, T., Wurthmann, C., Lukas, K., Ullrich, H., Linka, T.et al.Effects of newer atypical antipsychotics on autonomic neurocardiac function: a comparison between amisulpride, olanzapine, sertindole, and clozapine. J Clin Psychopharmacol 2001;211:8–13.CrossRefGoogle Scholar
Agelink, M.W., Majewski, T.B., Andrich, J., Mueck-Weymann, M.Short-term effects of intravenous benzodiazepines on autonomic neurocardiac regulation in humans: a comparison between midazolam, diazepam, and lorazepam. Crit Care Med 2002;305:997–1006.CrossRefGoogle Scholar
Antelmi, I., de Paula, R.S., Shinzato, A.R., Peres, C.A., Mansur, A.J., Grupi, C.J.Influence of age, gender, body mass index, and functional capacity on heart rate variability in a cohort of subjects without heart disease. Am J Cardiol 2004;933:381–385.CrossRefGoogle Scholar
Appleby, L., Thomas, S., Ferrier, N., Lewis, G., Shaw, J., Amos, T.Sudden unexplained death in psychiatric in-patients. Br J Psychiatry 2000;176:405–406.CrossRefGoogle ScholarPubMed
Bar, K.J., Berger, S., Metzner, M., Boettger, M.K., Schulz, S., Ramachandraiah, C.T.et al.Autonomic dysfunction in unaffected first-degree relatives of patients suffering from schizophrenia. Schizophr Bull 2009;36:1050–1058.CrossRefGoogle ScholarPubMed
Bar, K.J., Letzsch, A., Jochum, T., Wagner, G., Greiner, W., Sauer, H.Loss of efferent vagal activity in acute schizophrenia. J Psychiatr Res 2005;395:519–527.CrossRefGoogle Scholar
Bar, K.J., Boettger, M.K., Schulz, S., Harzendorf, C., Agelink, M.W., Yeragani, V.K.et al.The interaction between pupil function and cardiovascular regulation in patients with acute schizophrenia. Clin Neurophysiol 2008;11910:2209–2213.CrossRefGoogle Scholar
Bar, K.J., Koschke, M., Berger, S., Schulz, S., Tancer, M., Voss, A.et al.Influence of olanzapine on QT variability and complexity measures of heart rate in patients with schizophrenia. J Clin Psychopharmacol 2008;286:694–698.CrossRefGoogle Scholar
Bar, K.J., Wernich, K., Boettger, S., Cordes, J., Boettger, M.K., Loffler, S.et al.Relationship between cardiovagal modulation and psychotic state in patients with paranoid schizophrenia. Psychiatry Res 2008;1571-3:255–257.CrossRefGoogle Scholar
Barthel, P., Schneider, R., Bauer, A., Ulm, K., Schmitt, C., Schomig, A.et al.Risk stratification after acute myocardial infarction by heart rate turbulence. Circulation 2003;10810:1221–1226.CrossRefGoogle Scholar
Barutcu, I., Esen, A.M., Kaya, D., Turkmen, M., Karakaya, O., Melek, M.et al.Cigarette smoking and heart rate variability: dynamic influence of parasympathetic and sympathetic maneuvers. Ann Noninvasive Electrocardiol 2005;103:324–329.CrossRefGoogle Scholar
Bauer, A., Kantelhardt, J.W., Barthel, P., Schneider, R., Makikallio, T., Ulm, K. et al. Deceleration capacity of heart rate as a predictor of mortality after myocardial infarction: cohort study. Lancet 2006;3679523:1674–1681.CrossRefGoogle Scholar
Bauer, A., Kantelhardt, J.W., Bunde, A., Barthel, P., Schneider, R., Malik, M.et al.Phase-rectified signal averaging detects quasi-periodicities in non-stationary data. Physica 2006;364:423–434.CrossRefGoogle Scholar
Bauer, A., Barthel, P., Schneider, R., Ulm, K., Muller, A., Joeinig, A.et al.Improved Stratification of Autonomic Regulation for risk prediction in post-infarction patients with preserved left ventricular function (ISAR-Risk). Eur Heart J 2009;305:576–583.CrossRefGoogle Scholar
Berger, R.D., Kasper, E.K., Baughman, K.L., Marban, E., Calkins, H., Tomaselli, G.F.et al.interval variability: novel evidence for repolarization lability in ischemic and non-ischemic dilated cardiomyopathy. Circulation 1997;965:1557–1565.CrossRefGoogle Scholar
Bigger, J.T. Jr., Fleiss, J.L., Steinman, R.C., Rolnitzky, L.M., Kleiger, R.E., Rottman, J.N.Frequency domain measures of heart period variability and mortality after myocardial infarction. Circulation 1992;851:164–171.CrossRefGoogle Scholar
Bigger, J.T., Fleiss, J.L., Rolnitzky, L.M., Steinman, R.C.The ability of several short-term measures of RR variability to predict mortality after myocardial infarction. Circulation 1993;883:927–934.CrossRefGoogle Scholar
Billman, G.E., Schwartz, P.J., Stone, H.L.Baroreceptor reflex control of heart rate: a predictor of sudden cardiac death. Circulation 1982;664:874–880.CrossRefGoogle Scholar
Birkhofer, A., Schmidt, G., Förstl, H.Relationships between mental and cardiac disorders. Fortschritte der Neurologie Psychiatrie 2005;72:1–15.Google Scholar
Birkhofer, A., Alger, P., Schmid, G., Forstl, H.The cardiovascular risk of schizophrenic patients. Neuropsychiatr 2007;214:261–266.Google Scholar
Boettger, S., Hoyer, D., Falkenhahn, K., Kaatz, M., Yeragani, V.K., Bar, K.J.Altered diurnal autonomic variation and reduced vagal information flow in acute schizophrenia. Clin Neurophysiol 2006;11712:2715–2722.CrossRefGoogle Scholar
Buchheit, M., Simon, C., Charloux, A., Doutreleau, S., Piquard, F., Brandenberger, G.et al.Heart rate variability and intensity of habitual physical activity in middle-aged persons. Is slow wave sleep an appropriate recording condition for heart rate variability analysis?. Med Sci Sports Exerc 2005;379:1530–1534.CrossRefGoogle Scholar
Curkendall, S.M., Mo, J., Glasser, D.B., Rose, S.M., Jones, J.K.Cardiovascular disease in patients with schizophrenia in Saskatchewan, Canada. J Clin Psychiatry 2004;655:715–720.CrossRefGoogle Scholar
Dobson, C.P., La Rovere, M.T., Pinna, G.D., Goldstein, R., Olsen, C., Bernardinangeli, M.et al.QT Variability Index on 24-hour Holter independently predicts mortality in patients with heart failure: analysis of GISSI-HF Trial Data. Heart Rhythm 2011;8:1237–1242.CrossRefGoogle Scholar
Enger, C., Weatherby, L., Reynolds, R.F., Glasser, D.B., Walker, A.M.Serious cardiovascular events and mortality among patients with schizophrenia. J Nerv Ment Dis 2004;1921:19–27.CrossRefGoogle Scholar
Gutin, B., Howe, C., Johnson, M.H., Humphries, M.C., Snieder, H., Barbeau, P.Heart rate variability in adolescents: relations to physical activity, fitness, and adiposity. Med Sci Sports Exerc 2005;3711:1856–1863.CrossRefGoogle Scholar
Hennekens, C.H., Hennekens, A.R., Hollar, D., Casey, D.E.Schizophrenia and increased risks of cardiovascular disease. Am Heart J 2005;1506:1115–1121.CrossRefGoogle Scholar
Ikawa, M., Tabuse, H., Ueno, S., Urano, T., Sekiya, M., Murakami, T.Effects of combination psychotropic drug treatment on heart rate variability in psychiatric patients. Psychiatry Clin Neurosci 2001;554:341–345.CrossRefGoogle Scholar
Ito, T., Inoue, Y., Sugihara, T., Yamada, H., Katayama, S., Kawahara, R.Autonomic function in the early stage of panic disorder: power spectral analysis of heart rate variability. Psychiatry Clin Neurosci 1999;536:667–672.CrossRefGoogle Scholar
Jindal, R.D., Keshavan, M.S., Eklund, K., Stevens, A., Montrose, D.M., Yeragani, V.K.Beat-to-beat heart rate and QT interval variability in first episode neuroleptic-naive psychosis. Schizophr Res 2009;1132–3:176–180.CrossRefGoogle Scholar
Jobert, M., Poiseau, E., Jahnig, P., Gaillard, P., Schulz, H.ECG activity in the sleep of insomniac patients under the influence of lormetazepam and zopiclone. Neuropsychobiology 1995;314:204–209.CrossRefGoogle Scholar
Kantelhardt, J.W., Bauer, A., Schumann, A.Y., Barthel, P., Schneider, R., Malik, M.et al.Phase-rectified signal averaging for the detection of quasi-periodicities and the prediction of cardiovascular risk. Chaos 2007;171:015112.CrossRefGoogle Scholar
Kim, J.H., Yi, S.H., Yoo, C.S., Yang, S.A., Yoon, S.C., Lee, K.Y.et al.Heart rate dynamics and their relationship to psychotic symptom severity in clozapine-treated schizophrenic subjects. Prog Neuropsychopharmacol Biol Psychiatry 2004;282:371–378.CrossRefGoogle Scholar
Kleiger, R.E., Miller, J.P., Bigger, J.T. Jr., Moss, A.J.Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol 1987;594:256–262.CrossRefGoogle Scholar
Koponen, H., Alaraisanen, A., Saari, K., Pelkonen, O., Huikuri, H., Raatikainen, M.J.et al.Psychiatry. 2008;625:342–345.Google Scholar
Kosky, N.A possible association between high normal and high dose olanzapine and prolongation of the PR interval. J Psychopharmacol 2002;162:181–182.CrossRefGoogle Scholar
Kreuz, J., Lickfett, L.M., Schwab, J.O.Modern noninvasive risk stratification in primary prevention of sudden cardiac death. J Interv Card Electrophysiol 2008;231:23–28.CrossRefGoogle Scholar
Low, P.A., Pfeifer, M.A.Standardization of clinical tests for practical and clinical trials. In: Low, P.A. editor. Clinical autonomic disorders. Boston: Little, Brown and Co; 1993. p. 294–305.Google Scholar
Lown, B., Verrier, R.L.Neural activity and ventricular fibrillation. N Engl J Med 1976;29421:1165–1170.Google Scholar
Malaspina, D., Dalack, G., Leitman, D., Corcoran, C., Amador, X.F., Yale, S.et al.Low heart rate variability is not caused by typical neuroleptics in schizophrenia patients. CNS Spectr 2002;71:53–57.CrossRefGoogle Scholar
Mann, K., Rossbach, W., Muller, M.J., Muller-Siecheneder, F., Ru, H., Dittmann, R.W.Heart rate variability during sleep in patients with schizophrenia treated with olanzapine. Int Clin Psychopharmacol 2004;196:325–330.CrossRefGoogle Scholar
Mass, R., Haasen, C., Borgart, E.J.Abnormal subjective experiences of schizophrenia: evaluation of the Eppendorf Schizophrenia Inventory. Psychiatry Res 2005;1352:91–101.CrossRefGoogle Scholar
Mujica-Parodi, L.R., Yeragani, V., Malaspina, D.Nonlinear complexity and spectral analyses of heart rate variability in medicated and unmedicated patients with schizophrenia. Neuropsychobiology 2005;511:10–15.CrossRefGoogle Scholar
Nolan, J., Batin, P.D., Andrews, R., Lindsay, S.J., Brooksby, P., Mullen, M.et al.Prospective study of heart rate variability and mortality in chronic heart failure: results of the United Kingdom heart failure evaluation and assessment of risk trial (UK-heart). Circulation 1998;9815:1510–1516.CrossRefGoogle Scholar
Norris, P.R., Anderson, S.M., Jenkins, J.M., Williams, A.E., Morris, J.A. Jr.Heart rate multiscale entropy at three hours predicts hospital mortality in 3,154 trauma patients. Shock 2008;301:17–22.CrossRefGoogle Scholar
Osby, U., Correia, N., Brandt, L., Ekbom, A., Sparen, P.Mortality and causes of death in schizophrenia in Stockholm County, Sweden. Schizophr Res 2000;451–2:21–28.CrossRefGoogle Scholar
Osterhues, H.H., Hanzel, S.R., Kochs, M., Hombach, V.Influence of physical activity on 24-hour measurements of heart rate variability in patients with coronary artery disease. Am J Cardiol 1997;8011:1434–1437.CrossRefGoogle Scholar
Peupelmann, J., Boettger, M.K., Ruhland, C., Berger, S., Ramachandraiah, C.T., Yeragani, V.K.et al.Cardio-respiratory coupling indicates suppression of vagal activity in acute schizophrenia. Schizophr Res 2009;112:153–157.CrossRefGoogle ScholarPubMed
Ray, W.A., Chung, C.P., Murray, K.T., Hall, K., Stein, C.M.Atypical antipsychotic drugs and the risk of sudden cardiac death. N Engl J Med 2009;3603:225–235.CrossRefGoogle Scholar
Rechlin, T., Beck, G., Weis, M., Kaschka, W.P.Correlation between plasma clozapine concentration and heart rate variability in schizophrenic patients. Psychopharmacology (Berl) 1998;1354:338–341.CrossRefGoogle Scholar
Ruschena, D., Mullen, P.E., Burgess, P., Cordner, S.M., Barry-Walsh, J., Drummer, O.H.et al.Sudden death in psychiatric patients. Br J Psychiatry 1998;172:331–336.CrossRefGoogle ScholarPubMed
Sakuragi, S., Sugiyama, Y.Effects of daily walking on subjective symptoms, mood and autonomic nervous function. J Physiol Anthropol 2006;254:281–289.CrossRefGoogle Scholar
Sato, N., Miyake, S., Akatsu, J., Kumashiro, M.Power spectral analysis of heart rate variability in healthy young women during the normal menstrual cycle. Psychosom Med 1995;574:331–335.CrossRefGoogle Scholar
Scalvini, S., Volterrani, M., Zanelli, E., Pagani, M., Mazzuero, G., Coats, A.J.et al.Is heart rate variability a reliable method to assess autonomic modulation in left ventricular dysfunction and heart failure? Assessment of autonomic modulation with heart rate variability Low heart rate variability and sudden cardiac death. Int J Cardiol 1998;671:9–17.CrossRefGoogle Scholar
Schumann, A.Y., Bartsch, R.P., Penzel, T., Ivanov, P.C., Kantelhardt, J.W.Aging effects on cardiac and respiratory dynamics in healthy subjects across sleep stages. Sleep 2010;337:943–955.CrossRefGoogle Scholar
Silke, B., Campbell, C., King, D.J.The potential cardiotoxicity of antipsychotic drugs as assessed by heart rate variability. J Psychopharmacol 2002;164:355–360.CrossRefGoogle Scholar
Skinner, J.E., Pratt, C.M., Vybiral, T.A reduction in the correlation dimension of heartbeat intervals precedes imminent ventricular fibrillation in human subjects. Am Heart J 1993;1253:731–743.CrossRefGoogle Scholar
Straus, S.M., Bleumink, G.S., Dieleman, J.P., van der, L.J., ’t Jong, G.W., Kingma, J.H.et al.Antipsychotics and the risk of sudden cardiac death. Arch Intern Med 2004;16412:1293–1297.CrossRefGoogle Scholar
Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology Heart rate variability: standards of measurement, physiological interpretation and clinical use. Circulation 1996;935:1043–1065.Google Scholar
Taylor, C.B., Youngblood, M.E., Catellier, D., Veith, R.C., Carney, R.M., Burg, M.M.et al.Effects of antidepressant medication on morbidity and mortality in depressed patients after myocardial infarction. Arch Gen Psychiatry 2005;627:792–798.CrossRefGoogle Scholar
Townsend, M.H., Baier, M.B., Becker, J.E., Ritchie, M.A.Blood pressure, heart rate, and anxiety in schizophrenia. Psychiatry Res 2007;1511–2:155–157.CrossRefGoogle Scholar
Valkonen-Korhonen, M., Tarvainen, M.P., Ranta-Aho, P., Karjalainen, P.A., Partanen, J., Karhu, J.et al.Heart rate variability in acute psychosis. Psychophysiology 2003;405:716–726.CrossRefGoogle Scholar
Vogel, L.R., Muskin, P.R., Collins, E.D., Sloan, R.P.Lorazepam reduces cardiac vagal modulation in normal subjects. J Clin Psychopharmacol 1996;166:449–453.CrossRefGoogle Scholar
Walker, A.M., Lanza, L.L., Arellano, F., Rothman, K.J.Mortality in current and former users of clozapine. Epidemiology 1997;86:671–677.CrossRefGoogle Scholar
Whitsel, E.A., Raghunathan, T.E., Pearce, R.M., Lin, D., Rautaharju, P.M., Lemaitre, R.et al.RR interval variation, the QT interval index and risk of primary cardiac arrest among patients without clinically recognized heart disease. Eur Heart J 2001;222:165–173.CrossRefGoogle Scholar
Williams, L.M., Das, P., Harris, A.W., Liddell, B.B., Brammer, M.J., Olivieri, G.et al.Dysregulation of arousal and amygdala-prefrontal systems in paranoid schizophrenia. Am J Psychiatry 2004;1613:480–489.CrossRefGoogle Scholar
Yen, Y.C., Lung, F.W., Chong, M.Y.Adverse effects of risperidone and haloperidol treatment in schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2004;282:285–290.CrossRefGoogle Scholar
Zahn, T.P., Rosenthal, D., Lawlor, W.G.Electrodermal and heart rate orienting reactions in chronic schizophrenia. J Psychiatr Res 1968;62:117–134.Google Scholar
Ziegler, D., Zentai, C., Perz, S., Rathmann, W., Haastert, B., Meisinger, C.et al.Selective contribution of diabetes and other cardiovascular risk factors to cardiac autonomic dysfunction in the general population Influence of age, gender, body mass index, and functional capacity on heart rate variability in a cohort of subjects without heart disease. Exp Clin Endocrinol Diabetes 2006;1144:153–159.CrossRefGoogle Scholar
Submit a response

Comments

No Comments have been published for this article.