Cardiac repolarization and autonomic regulation during short-term cold exposure in hypertensive men: an experimental study

Heidi Hintsala, Tuomas V Kenttä, Mikko Tulppo, Antti Kiviniemi, Heikki V Huikuri, Matti Mäntysaari, Sirkka Keinänen-Kiukaannemi, Risto Bloigu, Karl-Heinz Herzig, Riitta Antikainen, Hannu Rintamäki, Jouni J K Jaakkola, Tiina M Ikäheimo, Heidi Hintsala, Tuomas V Kenttä, Mikko Tulppo, Antti Kiviniemi, Heikki V Huikuri, Matti Mäntysaari, Sirkka Keinänen-Kiukaannemi, Risto Bloigu, Karl-Heinz Herzig, Riitta Antikainen, Hannu Rintamäki, Jouni J K Jaakkola, Tiina M Ikäheimo

Abstract

Objectives: The aim of our study was to assess the effect of short-term cold exposure, typical in subarctic climate, on cardiac electrical function among untreated middle-aged hypertensive men.

Methods: We conducted a population-based recruitment of 51 hypertensive men and a control group of 32 men without hypertension (age 55-65 years) who underwent whole-body cold exposure (15 min exposure to temperature -10°C, wind 3 m/s, winter clothes). Conduction times and amplitudes, vectorcardiography, arrhythmias, and heart rate variability (autonomic nervous function) were assessed.

Results: Short-term cold exposure increased T-peak to T-end interval from 67 to 72 ms (p<0.001) and 71 to 75 ms (p<0.001) and T-wave amplitude from 0.12 to 0.14 mV (p<0.001) and from 0.17 to 0.21 mV (p<0.001), while QTc interval was shortened from 408 to 398 ms (p<0.001) and from 410 to 401 ms (p<0.001) among hypertensive men and controls, respectively. Cold exposure increased both low (from 390 to 630 ms2 (p<0.001) and 380 to 700 ms2 (p<0.001), respectively) and high frequency heart rate variability (from 90 to 190 ms2 (p<0.001) and 150 to 300 ms2 (p<0.001), respectively), while low-to-high frequency-ratio was reduced. In addition, the frequency of ventricular ectopic beats increased slightly during cold exposure. The cold induced changes were similar between untreated hypertensive men and controls.

Conclusions: Short-term cold exposure with moderate facial and mild whole body cooling resulted in prolongation of T-peak to T-end interval and higher T-wave amplitude while QTc interval was shortened. These changes of ventricular repolarization may have resulted from altered cardiac autonomic regulation and were unaffected by untreated hypertension.

Trial registration: ClinicalTrials.gov NCT02007031.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. The recruitment procedure.
Figure 1. The recruitment procedure.
BP, blood pressure. a Four subjects excluded for the usage of BP medication and one for inadequate data quality.b One subject excluded for the usage of BP medication and two did not perform cold exposure for safety reasons.
Figure 2. ECG changes during cold exposure.
Figure 2. ECG changes during cold exposure.
T-peak to T-end interval in lead II (A), T-wave amplitude in lead V5 (B), QTc in lead V5 (C), and HR (D) of hypertensive men (N = 51) and controls (N = 32) before (baseline), during, and after (recovery) cold exposure. Values represent means and standard error of the means.
Figure 3. Example ECG presenting changes in…
Figure 3. Example ECG presenting changes in cardiac repolarization.
Figure presents a median ECG from 10 consecutive beats as an example of changes in T-wave in lead II before (baseline), during, and after (recovery) cold exposure. Cold exposure increased T-peak to T-end interval and T-wave amplitude.

References

    1. The Eurowinter Group (1997) Cold exposure and winter mortality from ischaemic heart disease, cerebrovascular disease, respiratory disease, and all causes in warm and cold regions of Europe. The Eurowinter Group. Lancet 349: 1341–1346.
    1. Fares A (2013) Winter cardiovascular diseases phenomenon. N Am J Med Sci 5: 266–279.
    1. Manfredini R, Manfredini F, Boari B, Bergami E, Mari E, et al. (2009) Seasonal and weekly patterns of hospital admissions for nonfatal and fatal myocardial infarction. Am J Emerg Med 27: 1097–1103.
    1. Mehta RH, Manfredini R, Hassan F, Sechtem U, Bossone E, et al. (2002) International Registry of Acute Aortic Dissection (IRAD) Investigators (2002) Chronobiological patterns of acute aortic dissection. Circulation 106: 1110–1115.
    1. Gallerani M, Boari B, Manfredini F, Manfredini R (2011) Seasonal variation in heart failure hospitalization. Clin Cardiol 34: 389–394.
    1. Palm F, Dos Santos M, Urbanek C, Greulich M, Zimmer K, et al. (2013) Stroke seasonality associations with subtype, etiology and laboratory results in the ludwigshafen stroke study (LuSSt). Eur J Epidemiol 28: 373–381.
    1. Anand K, Aryana A, Cloutier D, Hee T, Esterbrooks D, et al. (2007) Circadian, daily, and seasonal distributions of ventricular tachyarrhythmias in patients with implantable cardioverter-defibrillators. Am J Cardiol 100: 1134–1138.
    1. Page RL, Zipes DP, Powell JL, Luceri RM, Gold MR, et al. (2004) Seasonal variation of mortality in the antiarrhythmics versus implantable defibrillators (AVID) study registry. Heart Rhythm 1: 435–440.
    1. Leppäluoto J, Pääkkönen T, Korhonen I, Hassi J (2005) Pituitary and autonomic responses to cold exposures in man. Acta Physiol Scand 184: 255–264.
    1. Vaseghi M, Shivkumar K (2008) The role of the autonomic nervous system in sudden cardiac death. Prog Cardiovasc Dis 50: 404–419.
    1. Khurana RK, Wu R (2006) The cold face test: A non-baroreflex mediated test of cardiac vagal function. Clin Auton Res 16: 202–207.
    1. Shattock MJ, Tipton MJ (2012) ‘Autonomic conflict’: A different way to die during cold water immersion? J Physiol (Lond) 590: 3219–3230.
    1. Tulppo MP, Kiviniemi AM, Hautala AJ, Kallio M, Seppänen T, et al. (2005) Physiological background of the loss of fractal heart rate dynamics. Circulation 112: 314–319.
    1. Aslam AF, Aslam AK, Vasavada BC, Khan IA (2006) Hypothermia: Evaluation, electrocardiographic manifestations, and management. Am J Med 119: 297–301.
    1. De Souza D, Riera AR, Bombig MT, Francisco YA, Brollo L, et al. (2007) Electrocardiographic changes by accidental hypothermia in an urban and a tropical region. J Electrocardiol 40: 47–52.
    1. Backman C, Linderholm H (1991) Reaction of patients with effort angina to cold exposure during exercise. Arctic Med Res Suppl: 526–528.
    1. Schmid JP, Morger C, Noveanu M, Binder RK, Anderegg M, et al. (2009) Haemodynamic and arrhythmic effects of moderately cold (22 degrees C) water immersion and swimming in patients with stable coronary artery disease and heart failure. Eur J Heart Fail 11: 903–909.
    1. Sanchez-Gonzalez MA, Figueroa A (2013) Cold exposure attenuates post exercise cardiovagal reactivation and sympathetic withdrawal. Auton Neurosci 176: 95–97.
    1. Parati G, Esler M (2012) The human sympathetic nervous system: Its relevance in hypertension and heart failure. Eur Heart J 33: 1058–1066.
    1. Manolis AJ, Rosei EA, Coca A, Cifkova R, Erdine SE, et al. (2012) Hypertension and atrial fibrillation: Diagnostic approach, prevention and treatment. position paper of the working group ‘hypertension arrhythmias and thrombosis’ of the european society of hypertension. J Hypertens 30: 239–252.
    1. Hintsala H, Kandelberg A, Herzig KH, Rintamäki H, Mäntysaari M, et al. (2014) Central aortic blood pressure of hypertensive men during short-term cold exposure. Am J Hypertens 27 (5) 656–664.
    1. Komulainen S, Tähtinen T, Rintamäki H, Virokannas H, Keinänen-Kiukaanniemi S (2000) Blood pressure responses to whole-body cold exposure: Effect of carvedilol. Eur J Clin Pharmacol 56: 637–642.
    1. Barnett AG, Sans S, Salomaa V, Kuulasmaa K, Dobson AJ, et al. (2007) The effect of temperature on systolic blood pressure. Blood Press Monit 12: 195–203.
    1. Parati G, Stergiou GS, Asmar R, Bilo G, de Leeuw P, et al. (2008) European society of hypertension guidelines for blood pressure monitoring at home: A summary report of the second international consensus conference on home blood pressure monitoring. J Hypertens 26: 1505–1526.
    1. ISO 9920 (2007) Ergonomics of the thermal environment - estimation of thermal insulation and water vapour resistance of a clothing ensemble.
    1. Karjalainen J, Viitasalo M, Mänttäri M, Manninen V (1994) Relation between QT intervals and heart rates from 40 to 120 beats/min in rest electrocardiograms of men and a simple method to adjust QT interval values. J Am Coll Cardiol 23: 1547–1553.
    1. Daskalov IK, Christov II (1999) Electrocardiogram signal preprocessing for automatic detection of QRS boundaries. Med Eng Phys 21: 37–44.
    1. Edenbrandt L, Pahlm O (1988) Vectorcardiogram synthesized from a 12-lead ECG: Superiority of the inverse dower matrix. J Electrocardiol 21: 361–367.
    1. Pardey J, Jouravleva S (2004) The next-generation holter revolution: From “analyse, edit, print” to “analyse, print”. Computers in cardiology 31: 373–376.
    1. Huikuri HV, Valkama JO, Airaksinen KE, Seppänen T, Kessler KM, et al. (1993) Frequency domain measures of heart rate variability before the onset of nonsustained and sustained ventricular tachycardia in patients with coronary artery disease. Circulation 87: 1220–1228.
    1. ISO 10551 (1995) Ergonomics of the thermal environment - assessment of the influence of the thermal environment using subjective judgement scales.
    1. Bernardo D, Murray A (2000) Explaining the T-wave shape in the ECG. Nature 403: 40.
    1. Mattu A, Brady WJ, Perron AD (2002) Electrocardiographic manifestations of hypothermia. Am J Emerg Med 20: 314–326.
    1. Wierzba T, Musial P, Cwikalowska H (2011) Variable profile of individual heart rate responses to cold water immersion apnea in healthy late adolescent men. - Georgian Med News 196–197: 28–38.
    1. Sundaram S, Carnethon M, Polito K, Kadish AH, Goldberger JJ (2008) Autonomic effects on QT-RR interval dynamics after exercise. Am J Physiol Heart Circ Physiol 294: H490–H497.
    1. Vaseghi M, Yamakawa K, Sinha A, So E, Zhou W, et al. (2013) Modulation of regional dispersion of repolarization and T-peak to T-end interval by right and left stellate ganglia. - Am J Physiol Heart Circ Physiol 305 (7) H1020–H1030.
    1. Kralios FA, Martin L, Burgess MJ, Millar K (1975) Local ventricular repolarization changes due to sympathetic nerve-branch stimulation. Am J Physiol 228: 1621–1626.
    1. Conrath CE, Opthof T (2006) Ventricular repolarization: An overview of (patho)physiology, sympathetic effects and genetic aspects. Prog Biophys Mol Biol 92: 269–307.
    1. Arai K, Nakagawa Y, Iwata T, Horiguchi H, Murata K (2013) Relationships between QT interval and heart rate variability at rest and the covariates in healthy young adults. Auton Neurosci 173: 53–57.
    1. Tulppo MP, Kiviniemi AM, Hautala AJ, Kallio M, Seppänen T, et al. (2011) Sympatho-vagal interaction in the recovery phase of exercise. Clin Physiol Funct Imaging 31: 272–281.
    1. Chen PS, Tan AY (2007) Autonomic nerve activity and atrial fibrillation. Heart Rhythm 4: S61–S64.
    1. Grassi G (2010) Sympathetic neural activity in hypertension and related diseases. Am J Hypertens 23: 1052–1060.
    1. Murphy BP, Stanton T, Dunn FG (2009) Hypertension and myocardial ischemia. Med Clin North Am 93: 681–695.
    1. Wu JS, Lu FH, Yang YC, Lin TS, Chen JJ, et al. (2008) Epidemiological study on the effect of pre-hypertension and family history of hypertension on cardiac autonomic function. J Am Coll Cardiol 51: 1896–1901.
    1. Dilaveris P, Gialafos E, Poloniecki J, Hnatkova K, Richter D, et al. (2000) Changes of the T-wave amplitude and angle: An early marker of altered ventricular repolarization in hypertension. Clin Cardiol 23: 600–606.
    1. Andersen MP, Xue JQ, Graff C, Kanters JK, Toft E, et al. (2008) New descriptors of T-wave morphology are independent of heart rate. J Electrocardiol 41: 557–561.
    1. Kenttä T, Karsikas M, Kiviniemi A, Tulppo M, Seppänen T, et al. (2010) Dynamics and rate-dependence of the spatial angle between ventricular depolarization and repolarization wave fronts during exercise ECG. Ann Noninvasive Electrocardiol 15: 264–275.
    1. Mäkinen TM, Raatikka VP, Rytkönen M, Jokelainen J, Rintamäki H, et al. (2006) Factors affecting outdoor exposure in winter: Population-based study. Int J Biometeorol 51: 27–36.

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