Original ArticleThe Impact of Remote Ischaemic Conditioning on Beat-to-Beat Heart Rate Variability Circadian Rhythm in Healthy Adults
Introduction
Remote ischaemic conditioning (RIC) is an intervention in which small doses of reversible episodes of ischaemia and reperfusion are applied in distant tissues or organs, recruiting protective pathways and rendering remote tissues and organs resistant to ischaemia/reperfusion injury [1,2], a process first demonstrated by Murry et al. in 1986 [3]. Since then, RIC has been studied extensively. According to the available evidence, RIC exerts a potentially protective effect to multiple tissues or organs of human body at the same time, such as the heart [4,5], brain [6,7], kidney [8], lung [9], and liver [10], by activating neurogenic pathways, humoral factors, and the immune system [11]. However, the exact mechanisms of RIC are still not fully understood.
Heart rate (HR) variability (HRV) is defined as HR oscillation in relation to the mean value [12]. Many physiological and pathological processes may lead to HRV changes, such as mental or physical stress, cardiac or non-cardiac diseases, and pharmacological or invasive treatments [13]. It has been widely demonstrated that the frequency and time domain of cardiovascular rhythmicity, such as HRV, can be used to assess the state of sympathetic and parasympathetic balance [14]. Remote ischaemic conditioning regulates neuronal signal transduction to protect vital organs. Several studies have demonstrated the regulation of RIC on HRV [[15], [16], [17], [18]]; however, the RIC procedures and results are very heterogeneous, and how long the regulation exist remains unknown.
The main objective of this study was to assess the impact of RIC on HRV circadian rhythm to explore whether RIC can influence the autonomic nervous system (ANS) and how long its impact lasts. In order to avoid any confounding factors caused by the physiological circadian rhythm, we conducted a self-controlled interventional study on 4 consecutive days (control day and RIC day). The changes of time–domain indices, frequency domain parameters, and non-linear values of HRV were measured in healthy adults at seven time points (baseline and 1, 3, 6, 9, 12, and 24 hours after RIC) by beat-to-beat monitoring.
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Participants
Fifty (50) healthy Asian adults, both males and females (age range 18–70 years) were recruited between January and July 2017. Before inclusion, each participant was subjected to a comprehensive physical examination by a physician, in order to exclude potential diseases. The exclusion criteria were (1) any infectious disease in the past month; (2) any history of chronic diseases (including hypertension, diabetes mellitus, generalised anxiety disorder, depression, insomnia, and chronic heart
Subject Characteristics
Fifty (50) healthy adult volunteers (mean age 34.54±12.01 years, 22 men [44%], all Asian) were enrolled in this study. The clinical characteristics of the participants are shown in Table 2.
RIC and HRV Circadian Rhythm
Heart rate variability circadian rhythms are presented as different time points during the daytime in Figure 2. A summary of the repeated measurements for the different parameters of HRV across the intervention (RIC) and time points is displayed in Table 3. Comparison of parameters that were significant in
Discussion
In the present study, we showed that HRV, an indication of autonomic nerve activity, was altered by RIC, which was validated in two time windows; specifically, the SDNN and SD2 increased starting within 1 hour but no more than 3 hours after RIC. The SD2 then increased for a second time at 12 hours after RIC.
To the best of our knowledge, this study is the first to evaluate the impact of RIC on HRV circadian rhythm and how long that impact will last. Several previous studies have investigated the
Conclusion
Our results suggest that RIC increases the SD2 components of HRV 1 hour and 12 hours later, indicating that ANS activity changes induced by RIC exists in both early and delayed protective windows, which may indicate some of the underlying mechanisms by which RIC offers protection. As decreased HRV has been identified to be associated with a high risk of cardiovascular death, as a therapeutic target, RIC may favourably influence the prognosis of cardiovascular diseases by ameliorating autonomic
Funding Sources
This project was supported by the National Key R&D Program of China (2016YFC1301600), JLUSTIRT (2017TD-12) and Jilin Provincial Key Laboratory (20190901005JC) to Yi Yang.
Conflicts of Interest
There are no conflicts of interest to disclose.
Author Contributions
All authors provided critical review, edits and approval of the final manuscript. Z-NG and YY devised the study design and supervised study procedures. YQ, JL, P-DZ, X-LY, and SQ conducted the experiments, analysed data, and provided results. PZ provided significant statistical support.
References (45)
- et al.
Remote ischemic conditioning
J Am Coll Cardiol
(2015) - et al.
Remote ischemic conditioning reduces myocardial infarct size and edema in patients with ST-segment elevation myocardial infarction
JACC Cardiovasc Interv
(2015) - et al.
Remote ischemic conditioning for kidney protection: a meta-analysis
J Crit Care
(2016) - et al.
Reduced parasympathetic tone in newly diagnosed essential hypertension
Indian Heart J
(2016) - et al.
Heart rate variability
Handb Clin Neurol
(2013) - et al.
Heart rate variability explored in the frequency domain: a tool to investigate the link between heart and behavior
Neurosci Biobehav Rev
(2009) - et al.
Effects of remote ischaemic conditioning on heart rate variability and cardiac function in patients with mild ischaemic heart failure
Heart Lung Circ
(2018) - et al.
Neuro-autonomic changes induced by remote ischemic preconditioning (RIPC) in healthy young adults: implications for stress
Neurobiol Stress
(2019) - et al.
A new method of assessing cardiac autonomic function and its comparison with spectral analysis and coefficient of variation of R-R interval
J Auton Nerv Syst
(1997) - et al.
Protective effect of ischemic preconditioning on ischemia/reperfusion-induced acute kidney injury through sympathetic nervous system in rats
Eur J Pharmacol
(2013)
Progressive impairment of autonomic control of heart rate in patients with multiple sclerosis
Arch Med Res
Circadian rhythm and variability of heart rate in Duchenne-type progressive muscular dystrophy
Am J Cardiol
Remote ischaemic conditioning – a new paradigm of self-protection in the brain
Nat Rev Neurol
Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium
Circulation
Remote ischemic conditioning improves coronary microcirculation in healthy subjects and patients with heart failure
Drug Des Devel Ther
High prestroke physical activity is associated with reduced infarct growth in acute ischemic stroke patients treated with intravenous tPA and randomized to remote ischemic perconditioning
Cerebrovasc Dis
Remote ischemic conditioning for acute ischemic stroke: dawn in the darkness
Rev Neurosci
Limb remote ischemic preconditioning for intestinal and pulmonary protection during elective open infrarenal abdominal aortic aneurysm repair: a randomized controlled trial
Anesthesiology
Effect of remote ischaemic preconditioning on liver injury in patients undergoing major hepatectomy for colorectal liver metastasis: a pilot randomised controlled feasibility trial
World J Surg
Biological networks in ischemic tolerance – rethinking the approach to clinical conditioning
Transl Stroke Res
Autonomic nervous system response to remote ischemic conditioning: heart rate variability assessment
BMC Cardiovasc Disord
The impact of remote ischemic preconditioning on arterial stiffness and heart rate variability in patients with angina pectoris
J Clin Med
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