Evidence map›Paper›PMID 30212552›Full record

Trial reportPloS one2018

Alterations in heart rate variability in patients with peripheral arterial disease requiring surgical revascularization have limited association with postoperative major adverse cardiovascular and cerebrovascular events.

Karri T Utriainen, Juhani K Airaksinen, Olli J Polo, Harry Scheinin, Ruut M Laitio, Kari A Leino, Tero J Vahlberg, Tom A Kuusela, Timo T Laitio

Open access · goldAbstract readClinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in PloS one, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 2 pooled it
1.9field-weighted citation impact, top 13% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 2 syntheses or guidelines pooled it, 16 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Article
  5. Article
  6. Review
  7. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 2 institutions in 1 country.

Karri T UtriainenDivision of Medicine, Turku University Hospital, Turku, Finland.ORCID 0000-0001-8998-0161
Juhani K AiraksinenHeart Centre, Turku University Hospital and University of Turku, Turku, Finland.
Olli J PoloSleep Research Centre, University of Turku, Turku, Finland.
Harry ScheininDivision of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland.
Ruut M LaitioDivision of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland.
Kari A LeinoDivision of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland.
Tero J VahlbergDepartment of Biostatistics, University of Turku, Turku, Finland.
Tom A KuuselaDepartment of Physics and Astronomy, University of Turku, Turku, Finland.
Timo T LaitioDivision of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland.
University of Turku · FITurku University Hospital · FI

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveObstructive sleep apnea (OSA) is common in peripheral arterial disease (PAD) and associates with high mortality after surgery. Since abnormal heart rate variability (HRV) is predictive of postoperative complications, we investigated the relations of HRV with PAD, OSA and major adverse cardiovascular and cerebrovascular events (MACCE). MATERIALS AND

methodsSeventy-five patients (67±9 years) scheduled for sub-inguinal revascularization and 15 controls (63±6 years) underwent polysomnography and HRV analyses. OSA with an apnea-hypopnea index (AHI) ≥20/hour was considered significant. HRV was measured during wakefulness, S2, S3-4 and rapid eye movement (REM) sleep with time and frequency domain methods including beat-to-beat variability, low frequency (LF) and high frequency (HF) power, and detrended fluctuation analysis (DFA). MACCE was defined as cardiac death, myocardial infarction, coronary revascularization, hospitalized angina pectoris and stroke.

resultsThirty-six patients (48%) had AHI≥20/hour. During follow-up (median 52 months), 22 patients (29%) suffered a MACCE. Compared to controls, fractal correlation of HRV (scaling exponent alpha 1 measured with DFA) was weaker during S2 and evening wakefulness in all subgroups (+/-AHI≥20/hour, +/-MACCE) but only in patients with AHI≥20/hour during morning wakefulness. The LF/HF ratio was lower in all subgroups during S2 but only in patients with AHI ≥20/hour during evening or morning wake. In the covariance analysis adjusted for age, body mass index, coronary artery disease and PAD duration, the alpha 1 during morning wakefulness remained significantly lower in patients with AHI≥20/hour than in those without (1.12 vs. 1.45; p = 0.03). Decreased HF during REM (p = 0.04) and S3-4 sleep (p = 0.03) were predictive of MACCE. In analyses with all sleep stages combined, mean heart rate as well as very low frequency, LF, HF and total power were associated with OSA of mild-to-moderate severity (AHI 10-20/hour).

conclusionsHRV is altered in patients with PAD. These alterations have a limited association with OSA and MACCE.

Indexed as

Cerebrovascular DisordersHeart RatePeripheral Arterial DiseasePolysomnographySleep Apnea, ObstructiveAgedFemaleFollow-Up StudiesHumansMaleMiddle AgedPostoperative ComplicationsVascular Surgical Procedures

Identifiers

PMID30212552
PMCPMC6136721
OpenAlexW2891041905

What OpenQuestion holds

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LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.