Heart Rate Variability in Individuals With Duchenne Muscular Dystrophy

February 1, 2021 updated by: Talita Dias da Silva, University of Sao Paulo

Characterization of Heart Rate Variability in Individuals With Duchenne Muscular Dystrophy - Influence of Corticosteroids and Betablockers

A cross-sectional study was carried out, in which 40 boys, aged 11 to 18 years, were evaluated. The recruitment of groups was carried out at the neuromuscular disease outpatient clinic of the Federal University of São Paulo (UNIFESP). The recruited individuals were divided into 4 groups, namely: DMD that used deflazacort (DMD-D); DMD that used Prednisone/Prednisolone (DMD-P); DMD Control with no corticoid use (DMD-C) and Controls with typical development (CTD). The protocol was applied during the evaluation that was carried out at outpatient follow-up visits.

To assess the functionality of each patient, the Vignos scales were used to characterize the sample and the Motor Function Measure (MFM) for association with HRV indices.

All heart rate records were performed using a cardiofrequencymeter (V800, Polar). After placing the brace and monitor, the individuals were placed in the supine position and remained at rest spontaneously breathing for 25 minutes. For HRV analysis, indexes obtained by linear methods, in the domain of time and frequency, and non-linear methods were used.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

A cross-sectional study was carried out, in which 40 boys, aged 11 to 18 years, were evaluated. The recruitment of groups was carried out at the neuromuscular disease outpatient clinic of the Federal University of São Paulo (UNIFESP). The recruited individuals were divided into 4 groups, namely: DMD that used deflazacort (DMD-D) with n=11; DMD that used Prednisone/Prednisolone (DMD-P), with n=9; DMD Control with no corticoid use (DMD-C), and n=10 and Controls with typical development (CTD) with n=10. The protocol was applied during the evaluation that was carried out at outpatient follow-up visits. Anthropometry was analyzed in 4 groups and functionality was assessed in 3 groups with DMD. To assess the functionality of each patient, the Vignos scales were used to characterize the sample and the Motor Function Measure (MFM) for association with HRV indices.

Initially, the resting ECG was analyzed to verify the existence of sinus rhythm and to exclude individuals with arrhythmias and blocks. The measurements at rest were performed immediately before and after the HRV assessment, including systolic (SBP) and diastolic (DBP), heart rate (HR), Respiratory Rate (RF - blood pressure) to ensure that at the beginning and at the end of the collection FR remains between 9 - 24rpm, in the range of 0.15 - 0.40Hz) and partial oxygen saturation (SO2). Heart rate was recorded by the cardiofrequency meter (RS800CX, Polar). And the partial oxygen saturation by means of a digital oximeter (DX2010, Dixtal) connected to the participant's index finger or hallux, through a sensor of age-appropriate size, in room air. Hemoglobin saturation by oxygen was recorded after the first minute of stabilization, as the value that remains most constant during the second minute.

All heart rate records were performed using a cardiofrequencymeter (V800, Polar). After placing the brace and monitor, the individuals were placed in the supine position and remained at rest spontaneously breathing for 25 minutes. For HRV analysis, indexes obtained by linear methods, in the domain of time and frequency, and non-linear methods were used.

In the time domain, for linear analyses, each normal RR interval (sinus beats) was verified during a certain time interval and, using statistical and non-linear methods, the translating indexes of fluctuations in the duration of the cardiac cycles were calculated. With this, the indices expressed in ms were obtained: SDNN (Standard deviation of the normal RR intervals recorded in a time interval); rMSSD (square root of the mean of the square of the differences between adjacent normal RR intervals in a time interval).

In the frequency domain, the spectral power density is more used, mainly when treating individuals in resting conditions. This analysis divides HRV into fundamental oscillatory components, which were used the main: High Frequency normalized unite (HFnu) component and Low Frequency normalized unite (LFnu) component. O algoritmo utilizado para a análise espectral foi a transformada rápida de Fourier - FFT (janela de 256 s com 50% de overlap).

Among the nonlinear methods used for HRV analysis, we can mention the Detrended Fluctuations Analysis (DFA), Visual Recurrence Analysis (VRA) and symbolic analysis (SA), the three of which were verified in this study.

DFA is used to quantify the fractal property of RR interval time series, being used to detect possible abnormalities present in a subject, based on α coefficients. For this, short memory parameters α1, which corresponds to a period of 4 to 11 beats, and long memory α2, which corresponds to the period from 64 to 1024 beats, were used.

The VRA is used to study the time dependence of a series, that is, in the study of stationarity35. The recurrence graph makes it possible to visualize the behavior of trajectories in the phase space and, in addition, to show the times in which a state of a dynamic system is repeated, besides these factors can be confirmed regarding the quantitative analysis of this, wich presents such indices: Mean, SD, PerRec, PerDet, PerLam, TrapTim, Ratio.

The evaluation of the symbolic analysis is based on the quantification of the information carried in a time series, in the transformation of the previously selected iRRs into integers from zero to six, from which sequences of 3 symbols (symbolic patterns) are constructed. For this, all possible patterns will be grouped according to the number and type of variations between the symbols, shown subsequently. The patterns were (1) patterns, without variation (0V), three identical symbols; (2) patterns with a variation (1V), that is, two subsequent symbols that are the same and a different one; (3) patterns with two similar variations (2LV) that is, the three symbols form a ramp; (4) patterns with two different variations (2ULV), that is, the three symbols form a peak or a valley.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Observational

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
40

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

11 years to 18 years (ADULT, CHILD)

Accepts Healthy Volunteers

Yes

Genders Eligible for Study

Male

Sampling Method

Non-Probability Sample

Study Population

30 boys with Duchenne Muscular Dystrophy and 10 typically developing boys aged 11 to 18 years.

Description

Inclusion Criteria:

  • Individuals diagnosed with DMD confirmed by molecular method and / or by protein expression of skeletal muscle.
  • Individuals undergoing clinical follow-up at the outpatient clinic for neuromuscular diseases at the Federal University of São Paulo (UNIFESP)
  • Individuals who had authorization from their parents or guardians to participate in the study

Exclusion Criteria:

  • Patients with cardiac arrhythmias.
  • Patients with atrioventricular block.
  • Patients with congenital anomalies such as congenital heart defects, pulmonary deformity.
  • Patients using drugs that interfere with ANS, such as antiarrhythmic agents and drugs for the treatment of diabetes mellitus, such as insulin.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort

Group / Cohort

A group or subgroup of participants in an observational study that is assessed for biomedical or health outcomes.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Duchenne Muscular Dystrophy group with Deflazacort
Individuals Duchenne Muscular Dystrophy, with age 11 to 18 years which make use of deflazacort.
Behavioral: Duchenne Muscular Dystrophy group with Deflazacort
Subjects with duchenne muscular dystrophy undergoing drug therapy with Deflazacort
Duchenne Muscular Dystrophy group with Prednisone/Predisolone
Individuals Duchenne Muscular Dystrophy, with age 11 to 18 years which make use of Prednisone/Predinisolone.
Behavioral: Duchenne Muscular Dystrophy group with Prednisone/Predisolone
Subjects with duchenne muscular dystrophy undergoing drug therapy with Prednisona/Predinisolone
Duchenne Muscular Dystrophy group without Corticosteroids therapy
Individuals Duchenne Muscular Dystrophy, with age 11 to 18 years which don't use of corticosteroids.
Behavioral: Duchenne Muscular Dystrophy group without Corticosteroids therapy
Control group with duchenne muscular dystrophy without the use of corticosteroid drug therapy.
Control Group Typically Developing
Individuals with typical development age 11 to 18 years which don't use of corticosteroids.
Behavioral: Control Group Typically Developing
Control group with tipical development.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Heart Rate Variability in adolescents with Duchenne Muscular Dystrophy undergoing therapy with corticosteroids
Time Frame: One day
Heart rate variability indices at rest in adolescents with duchenne muscular dystrophy will be analyzed, which will be divided into the following groups: Under the use of Deflazacort, Predinisone / Predinisolone and without the use of corticosteroids, in addition to the analysis of a control group with typical development.
One day

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
University of Sao Paulo

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (ACTUAL)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
March 1, 2013

Primary Completion (ACTUAL)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
September 1, 2014

Study Completion (ACTUAL)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
February 1, 2015

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
February 1, 2021

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
February 1, 2021

First Posted (ACTUAL)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
February 5, 2021

Study Record Updates

Last Update Posted (ACTUAL)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
February 5, 2021

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
February 1, 2021

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
February 1, 2021

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • 09942913.4.0000.5505

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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