Relation of Various Parameters Used to Estimate Cardiac Vagal Activity and Validity of pNN50 in Anesthetized Humans

Jae Ho Lee; In Young Huh; Jae Min Lee; Hyung Kwan Lee; Il Sang Han; Ho Jun Kang

doi:10.7180/kmj.2018.33.3.369

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Lee, Huh, Lee, Lee, Han, and Kang: Relation of Various Parameters Used to Estimate Cardiac Vagal Activity and Validity of pNN50 in Anesthetized Humans

Original Article

Kosin Medical Journal 2018;33(3):369-379.

Published online: 19 January 2018

DOI: https://doi.org/10.7180/kmj.2018.33.3.369

Relation of Various Parameters Used to Estimate Cardiac Vagal Activity and Validity of pNN50 in Anesthetized Humans

Jae Ho Lee, In Young Huh, Jae Min Lee, Hyung Kwan Lee, Il Sang Han, Ho Jun Kang

Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, College of Medicine, Ulsan University, Ulsan, Korea

Corresponding Author: In Young Huh, Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, 877, Bangeojin sunhwan do-ro, Dong-gu, Ulsan 44033, Korea Tel: +82-52-250-7248 Fax: +82-52-250-7249 E-mail: huhiy@naver.com

Received 21 November 20172 February 2018 Accepted 5 February 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

Analysis of heart rate variability (HRV) has been used as a measure of cardiac autonomic function. According to the pNN50 statistic, the percentage of differences between successive normal RR intervals (RRI) that exceed 50 ms, has been known to reflect cardiac vagal modulation. Relatively little is known about the validity of pNN50 during general anesthesia (GA). Therefore, we evaluated the correlation of pNN50 with other variables such as HF, RMSSD, SD1 of HRV reflecting the vagal tone, and examined the validity of pNN50 in anesthetized patients. Methods: We assessed changes in RRI, pNN50, root mean square of successive differences of RRI (RMSSD), high frequency (HF) and standard deviation 1 (SD1) of Poincaré plots after GA using sevoflurane anesthesia. We also calculated the probability distributions for the family of pNNx statistics (x: 2-50 ms).

Results

All HRV variables were significantly decreased during GA. HF power was not correlated with pNN50 during GA (r = 0.096, P = 0.392). Less than pNN47 was shown to have a correlation with other variables.

Conclusions

These data suggest that pNN50 can not reflect the level of vagal tone during GA.

Keywords: General anesthesia, Heart rate variability, pNN50, Vagal tone

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Fig. 1.

Mean pNNx distributions. During general anesthesia, pNNx is significantly lower than before general anesthesia state and nearly zero at greater than 30 ms. pNNx; proportion of successive RR intervals differences > 2 - 50 ms in relation to total RR intervals (x = 2 - 50 ms).

Fig. 2.

Correlations between RMSSD, pNN50, SD1 and LnHF. The effect of general anesthesia. Ln RMSSD and Ln SD1 are significantly correlated with Ln HF at before and after general anesthesia state. Note that pNN50 is not correlated with Ln HF during general anesthesia. Ln HF (ms2): natural logarithmic transformed of high frequency power of heart rate variability, Ln RMSSD (ms): natural logarithmic transformed of root mean square of successive differences of RR intervals, pNN50 (%): proportion of successive RR intervals differences > 50 ms in relation to the total RR intervals, Ln SD1 (ms): natural logarithmic transformed of standard deviation 1 from the Poincaré analysis.

Fig. 3.

Correlations of Ln RMSSD (A), LnHF (B), and Ln SD1 (C) for pNNx. pNN values greater than 47 ms are not correlated with other three parameters. Ln RMSSD (ms): natural logarithmic transformed of root mean square of successive differences of RR intervals, LnHF (ms2): natural logarithmic transformed high frequency power of heart rate variability, Ln SD1 (ms); natural logarithmic transformed of standard deviation 1 from the Poincaré analysis, NNx (ms): successive RR intervals differences > x ms (x = 2 - 50 ms).

Table 1.

Demographic Data


ASA score (1/2)	80 (48/32)
Age (yr)	45.7 ± 11.9
Sex (M/F)	80 (50/30)
Body weight (kg)	74.2 ± 30.5
Height (cm)	158.9 ± 28.9
Values are mean ± SD or n	number of patients.

Table 2.

Descriptive Statistics of Indices Derived from Heart Rate Variability

Variables	Before GA	After GA
Time-domain
RRI, ms	846.1 ± 135.8	818.8 ± 155.4
pNN50, %	11.42 ± 16.49	0.00 ± 0.03
Ln RMSSD, ms	3.18 ± 0.63	1.65 ± 0.54
Frequency-domain
Ln LF, ms₂	9.13 ± 0.89	5.01 ± 1.22
Ln LF, ms₂	8.14 ± 1.26	4.82 ± 1.24
nuLF, (nu)	0.71 ± 0.15	0.54 ± 0.21*
nuLF, (nu)	0.29 ± 0.15	0.46 ± 0.21*
LF/HF ratio	3.32 ± 2.18	1.97 ± 2.22
Nonlinear method	(Poincaré plot)
Ln SD1(ms)	2.82 ± 0.62	1.31 ± 0.56

Values are mean ± SD. GA: general anesthesia, RRI: RR intervals, pNN50: proportion of successive RRI differences > 50 ms in relation to the total RRI, Ln RMSSD: natural logarithmic-transformed of root mean square of successive differences of RRI, Ln LF: natural logarithmic-transformed of low frequency, Ln HF: natural logarithmic-transformed of high frequency, nuLF: normalized unit of low frequency, nuHF: normalized unit of high frequency, LF/HF ratio: ratio between low frequency and high frequency, Ln SD1: natural logarithmic-transformed of standard deviation 1 from the Poincaré plots analysis. * P < 0.05, † P < 0.001 versus before state.

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