Kosin Med J.  2018 Dec;33(3):369-379. 10.7180/kmj.2018.33.3.369.

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

• Lee JH
• Huh IY
• Lee JM
• Lee HK
• Han IS
• Kang HJ

• KMID: 2442547
• DOI: http://doi.org/10.7180/kmj.2018.33.3.369

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.

Keyword

General anesthesia; Heart rate variability; pNN50; Vagal tone

MeSH Terms

Anesthesia
Anesthesia, General
Heart Rate
Humans*

Figure

• 

  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).

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  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.

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  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).

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