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Loss of fractal heart rate dynamics in depressive hemodialysis patients.
Psychosom Med. 2008 Feb; 70(2):177-85.PM

Abstract

OBJECTIVE

To assess the relationship between depression, reduced heart rate (HR) variability, and altered HR dynamics among patients with end-stage renal disease who are receiving hemodialysis (HD) therapy.

METHODS

We analyzed the 24-hour electrocardiograms of 119 outpatients receiving chronic HD. HR variability was quantified with the standard deviation of normal-to-normal R-R intervals, the triangular index, and the powers of the high- (HF), low- (LF), very-low (VLF), and ultra-low frequency (ULF) components. Nonlinear HR dynamics was assessed with the short-term (alpha(1)) and long-term (alpha(2)) scaling exponents of the detrended fluctuation analysis and approximate entropy. The depression level was assessed using the Beck Depression Inventory, Second Edition (BDI-II). HR variability and dynamics measurements were compared by gender, diabetes, and depression with adjustment for age and serum albumin concentration.

RESULTS

Most indices of HR variability and dynamics were negatively correlated with age, serum albumin concentration, depression score, and were lower in women and patients with diabetes. The alpha(2) was inversely associated with these variables. Depressed men had significantly lower HF, LF, VLF, and marginally lower ULF than nondepressed persons after adjustment for diabetes and other covariates; no difference in depression was observed in women. The alpha(2) showed marginally significant difference in depression independent from gender and diabetes.

CONCLUSIONS

Among the patients who received HD, depression is associated with reduced HR variability and loss of fractal HR dynamics. However, the influence of depression on HR variability may vary by gender and physiological backgrounds. Further prospective studies are necessary to confirm their association with poor prognosis.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Kojima M
Department of Health Promotion and Preventive Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan. masayok@med.nagoya-cu.ac.jp
Hayano J
No affiliation info available
Fukuta H
No affiliation info available
Sakata S
No affiliation info available
Mukai S
No affiliation info available
Ohte N
No affiliation info available
Seno H
No affiliation info available
Toriyama T
No affiliation info available
Kawahara H
No affiliation info available
Furukawa TA
No affiliation info available
Tokudome S
No affiliation info available

MeSH

Age FactorsAnalysis of VarianceAutonomic Nervous SystemComorbidityDepressive DisorderDiabetes MellitusElectrocardiography, AmbulatoryFemaleFractalsHeart RateHumansJapanKidney Failure, ChronicLinear ModelsMaleMiddle AgedModels, CardiovascularNonlinear DynamicsRenal DialysisRisk FactorsSerum AlbuminSex Factors

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18256338

Citation

Kojima, Masayo, et al. "Loss of Fractal Heart Rate Dynamics in Depressive Hemodialysis Patients." Psychosomatic Medicine, vol. 70, no. 2, 2008, pp. 177-85.
Kojima M, Hayano J, Fukuta H, et al. Loss of fractal heart rate dynamics in depressive hemodialysis patients. Psychosom Med. 2008;70(2):177-85.
Kojima, M., Hayano, J., Fukuta, H., Sakata, S., Mukai, S., Ohte, N., Seno, H., Toriyama, T., Kawahara, H., Furukawa, T. A., & Tokudome, S. (2008). Loss of fractal heart rate dynamics in depressive hemodialysis patients. Psychosomatic Medicine, 70(2), 177-85. https://doi.org/10.1097/PSY.0b013e31816477a1
Kojima M, et al. Loss of Fractal Heart Rate Dynamics in Depressive Hemodialysis Patients. Psychosom Med. 2008;70(2):177-85. PubMed PMID: 18256338.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Loss of fractal heart rate dynamics in depressive hemodialysis patients. AU - Kojima,Masayo, AU - Hayano,Junichiro, AU - Fukuta,Hidekatsu, AU - Sakata,Seiichiro, AU - Mukai,Seiji, AU - Ohte,Nobuyuki, AU - Seno,Hachiro, AU - Toriyama,Takanobu, AU - Kawahara,Hirohisa, AU - Furukawa,Toshiaki A, AU - Tokudome,Shinkan, Y1 - 2008/02/06/ PY - 2008/2/8/pubmed PY - 2008/4/30/medline PY - 2008/2/8/entrez SP - 177 EP - 85 JF - Psychosomatic medicine JO - Psychosom Med VL - 70 IS - 2 N2 - OBJECTIVE: To assess the relationship between depression, reduced heart rate (HR) variability, and altered HR dynamics among patients with end-stage renal disease who are receiving hemodialysis (HD) therapy. METHODS: We analyzed the 24-hour electrocardiograms of 119 outpatients receiving chronic HD. HR variability was quantified with the standard deviation of normal-to-normal R-R intervals, the triangular index, and the powers of the high- (HF), low- (LF), very-low (VLF), and ultra-low frequency (ULF) components. Nonlinear HR dynamics was assessed with the short-term (alpha(1)) and long-term (alpha(2)) scaling exponents of the detrended fluctuation analysis and approximate entropy. The depression level was assessed using the Beck Depression Inventory, Second Edition (BDI-II). HR variability and dynamics measurements were compared by gender, diabetes, and depression with adjustment for age and serum albumin concentration. RESULTS: Most indices of HR variability and dynamics were negatively correlated with age, serum albumin concentration, depression score, and were lower in women and patients with diabetes. The alpha(2) was inversely associated with these variables. Depressed men had significantly lower HF, LF, VLF, and marginally lower ULF than nondepressed persons after adjustment for diabetes and other covariates; no difference in depression was observed in women. The alpha(2) showed marginally significant difference in depression independent from gender and diabetes. CONCLUSIONS: Among the patients who received HD, depression is associated with reduced HR variability and loss of fractal HR dynamics. However, the influence of depression on HR variability may vary by gender and physiological backgrounds. Further prospective studies are necessary to confirm their association with poor prognosis. SN - 1534-7796 UR - https://www.unboundmedicine.com/medline/citation/18256338/Loss_of_fractal_heart_rate_dynamics_in_depressive_hemodialysis_patients_ DB - PRIME DP - Unbound Medicine ER -