Relationship between combat-related traumatic injury and ultrashort term heart rate variability in a UK military cohort: findings from the ADVANCE study

Authors: Maqsood, R., Schofield, S., Bennett, A.N., Bull, A.M.J., Fear, N.T., Cullinan, P., Khattab, A. and Boos, C.J.

Journal: BMJ Military Health

eISSN: 2633-3775

ISSN: 2633-3767

DOI: 10.1136/military-2022-002316

Abstract:

Introduction: Combat-related traumatic injury (CRTI) has been linked to an increased cardiovascular disease (CVD) risk. The long-term impact of CRTI on heart rate variability (HRV) - a robust CVD risk marker - has not been explored. This study investigated the relationship between CRTI, the mechanism of injury and injury severity on HRV. Methods: This was an analysis of baseline data from the ArmeD SerVices TrAuma and RehabilitatioN OutComE (ADVANCE) prospective cohort study. The sample consisted of UK servicemen with CRTI sustained during deployment (Afghanistan, 2003-2014) and an uninjured comparison group who were frequency matched to the injured group based on age, rank, deployment period and role in theatre. Root mean square of successive differences (RMSSD) was measured as a measure of ultrashort term HRV via <16 s continuous recording of the femoral arterial pulse waveform signal (Vicorder). Other measures included injury severity (New Injury Severity Scores (NISS)) and injury mechanism. Results: Overall, 862 participants aged 33.9±5.4 years were included, of whom 428 (49.6%) were injured and 434 (50.3%) were uninjured. The mean time from injury/deployment to assessment was 7.91±2.05 years. The median (IQR) NISS for those injured was 12 (6-27) with blast being the predominant injury mechanism (76.8%). The median (IQR) RMSSD was significantly lower in the injured versus the uninjured (39.47 ms (27.77-59.77) vs 46.22 ms (31.14-67.84), p<0.001). Using multiple linear regression (adjusting for age, rank, ethnicity and time from injury), geometric mean ratio (GMR) was reported. CRTI was associated with a 13% lower RMSSD versus the uninjured group (GMR 0.87, 95% CI 0.80-0.94, p<0.001). A higher injury severity (NISS ≥25) (GMR 0.78, 95% CI 0.69-0.89, p<0.001) and blast injury (GMR 0.86, 95% CI 0.79-0.93, p<0.001) were also independently associated with lower RMSSD. Conclusion: These results suggest an inverse association between CRTI, higher severity and blast injury with HRV. Longitudinal studies and examination of potential mediating factors in this CRTI-HRV relationship are needed.

https://eprints.bournemouth.ac.uk/38401/

Source: Scopus

Relationship between combat-related traumatic injury and ultrashort term heart rate variability in a UK military cohort: findings from the ADVANCE study.

Authors: Maqsood, R., Schofield, S., Bennett, A.N., Bull, A.M., Fear, N.T., Cullinan, P., Khattab, A., Boos, C.J. and ADVANCE study

Journal: BMJ Mil Health

eISSN: 2633-3775

DOI: 10.1136/military-2022-002316

Abstract:

INTRODUCTION: Combat-related traumatic injury (CRTI) has been linked to an increased cardiovascular disease (CVD) risk. The long-term impact of CRTI on heart rate variability (HRV)-a robust CVD risk marker-has not been explored. This study investigated the relationship between CRTI, the mechanism of injury and injury severity on HRV. METHODS: This was an analysis of baseline data from the ArmeD SerVices TrAuma and RehabilitatioN OutComE (ADVANCE) prospective cohort study. The sample consisted of UK servicemen with CRTI sustained during deployment (Afghanistan, 2003-2014) and an uninjured comparison group who were frequency matched to the injured group based on age, rank, deployment period and role in theatre. Root mean square of successive differences (RMSSD) was measured as a measure of ultrashort term HRV via <16 s continuous recording of the femoral arterial pulse waveform signal (Vicorder). Other measures included injury severity (New Injury Severity Scores (NISS)) and injury mechanism. RESULTS: Overall, 862 participants aged 33.9±5.4 years were included, of whom 428 (49.6%) were injured and 434 (50.3%) were uninjured. The mean time from injury/deployment to assessment was 7.91±2.05 years. The median (IQR) NISS for those injured was 12 (6-27) with blast being the predominant injury mechanism (76.8%). The median (IQR) RMSSD was significantly lower in the injured versus the uninjured (39.47 ms (27.77-59.77) vs 46.22 ms (31.14-67.84), p<0.001). Using multiple linear regression (adjusting for age, rank, ethnicity and time from injury), geometric mean ratio (GMR) was reported. CRTI was associated with a 13% lower RMSSD versus the uninjured group (GMR 0.87, 95% CI 0.80-0.94, p<0.001). A higher injury severity (NISS ≥25) (GMR 0.78, 95% CI 0.69-0.89, p<0.001) and blast injury (GMR 0.86, 95% CI 0.79-0.93, p<0.001) were also independently associated with lower RMSSD. CONCLUSION: These results suggest an inverse association between CRTI, higher severity and blast injury with HRV. Longitudinal studies and examination of potential mediating factors in this CRTI-HRV relationship are needed.

https://eprints.bournemouth.ac.uk/38401/

Source: PubMed

Relationship between combat-related traumatic injury and ultrashort term heart rate variability in a UK military cohort: findings from the ADVANCE study

Authors: Maqsood, R., Schofield, S., Bennett, A.N., Bull, A.M.J., Fear, N.T., Cullinan, P., Khattab, A. and Boos, C.J.

Journal: BMJ MILITARY HEALTH

eISSN: 2633-3775

ISSN: 2633-3767

DOI: 10.1136/military-2022-002316

https://eprints.bournemouth.ac.uk/38401/

Source: Web of Science (Lite)

Relationship between combat-related traumatic injury and ultrashort term heart rate variability in a UK military cohort: findings from the ADVANCE study.

Authors: Maqsood, R., Schofield, S., Bennett, A.N., Bull, A.M., Fear, N.T., Cullinan, P., Khattab, A. and Boos, C.J.

Journal: BMJ Mil Health

Volume: 0

Pages: 1-6

Publisher: BMJ

DOI: 10.1136/military-2022-002316

Abstract:

Abstract Introduction Combat-related traumatic injury (CRTI) has been linked to an increased cardiovascular disease (CVD) risk. The long-term impact of CRTI on heart rate variability (HRV)—a robust CVD risk marker—has not been explored. This study investigated the relationship between CRTI, the mechanism of injury and injury severity on HRV.

Methods This was an analysis of baseline data from the ArmeD SerVices TrAuma and RehabilitatioN OutComE (ADVANCE) prospective cohort study. The sample consisted of UK servicemen with CRTI sustained during deployment (Afghanistan, 2003–2014) and an uninjured comparison group who were frequency matched to the injured group based on age, rank, deployment period and role in theatre. Root mean square of successive differences (RMSSD) was measured as a measure of ultrashort term HRV via <16 s continuous recording of the femoral arterial pulse waveform signal (Vicorder). Other measures included injury severity (New Injury Severity Scores (NISS)) and injury mechanism.

Results Overall, 862 participants aged 33.9±5.4 years were included, of whom 428 (49.6%) were injured and 434 (50.3%) were uninjured. The mean time from injury/deployment to assessment was 7.91±2.05 years. The median (IQR) NISS for those injured was 12 (6–27) with blast being the predominant injury mechanism (76.8%). The median (IQR) RMSSD was significantly lower in the injured versus the uninjured (39.47 ms (27.77–59.77) vs 46.22 ms (31.14–67.84), p<0.001). Using multiple linear regression (adjusting for age, rank, ethnicity and time from injury), geometric mean ratio (GMR) was reported. CRTI was associated with a 13% lower RMSSD versus the uninjured group (GMR 0.87, 95% CI 0.80–0.94, p<0.001). A higher injury severity (NISS ≥25) (GMR 0.78, 95% CI 0.69–0.89, p<0.001) and blast injury (GMR 0.86, 95% CI 0.79–0.93, p<0.001) were also independently associated with lower RMSSD.

Conclusion These results suggest an inverse association between CRTI, higher severity and blast injury with HRV. Longitudinal studies and examination of potential mediating factors in this CRTI-HRV relationship are needed.

https://eprints.bournemouth.ac.uk/38401/

http://creativecommons.org/licenses/by-nc/4.0/

Source: Manual

Relationship between combat-related traumatic injury and ultrashort term heart rate variability in a UK military cohort: findings from the ADVANCE study

Authors: Maqsood, R., Schofield, S., Bennett, A., Bull, A., Fear, N., Cullinan, P., Khattab, A. and Boos, C.

Journal: BMJ Military Health

https://eprints.bournemouth.ac.uk/38401/

Source: Manual

Relationship between combat-related traumatic injury and ultrashort term heart rate variability in a UK military cohort: findings from the ADVANCE study.

Authors: Maqsood, R., Schofield, S., Bennett, A.N., Bull, A.M., Fear, N.T., Cullinan, P., Khattab, A., Boos, C.J. and ADVANCE study

Journal: BMJ military health

Pages: e002316

eISSN: 2633-3775

ISSN: 2633-3767

DOI: 10.1136/military-2022-002316

Abstract:

Introduction

Combat-related traumatic injury (CRTI) has been linked to an increased cardiovascular disease (CVD) risk. The long-term impact of CRTI on heart rate variability (HRV)-a robust CVD risk marker-has not been explored. This study investigated the relationship between CRTI, the mechanism of injury and injury severity on HRV.

Methods

This was an analysis of baseline data from the ArmeD SerVices TrAuma and RehabilitatioN OutComE (ADVANCE) prospective cohort study. The sample consisted of UK servicemen with CRTI sustained during deployment (Afghanistan, 2003-2014) and an uninjured comparison group who were frequency matched to the injured group based on age, rank, deployment period and role in theatre. Root mean square of successive differences (RMSSD) was measured as a measure of ultrashort term HRV via <16 s continuous recording of the femoral arterial pulse waveform signal (Vicorder). Other measures included injury severity (New Injury Severity Scores (NISS)) and injury mechanism.

Results

Overall, 862 participants aged 33.9±5.4 years were included, of whom 428 (49.6%) were injured and 434 (50.3%) were uninjured. The mean time from injury/deployment to assessment was 7.91±2.05 years. The median (IQR) NISS for those injured was 12 (6-27) with blast being the predominant injury mechanism (76.8%). The median (IQR) RMSSD was significantly lower in the injured versus the uninjured (39.47 ms (27.77-59.77) vs 46.22 ms (31.14-67.84), p<0.001). Using multiple linear regression (adjusting for age, rank, ethnicity and time from injury), geometric mean ratio (GMR) was reported. CRTI was associated with a 13% lower RMSSD versus the uninjured group (GMR 0.87, 95% CI 0.80-0.94, p<0.001). A higher injury severity (NISS ≥25) (GMR 0.78, 95% CI 0.69-0.89, p<0.001) and blast injury (GMR 0.86, 95% CI 0.79-0.93, p<0.001) were also independently associated with lower RMSSD.

Conclusion

These results suggest an inverse association between CRTI, higher severity and blast injury with HRV. Longitudinal studies and examination of potential mediating factors in this CRTI-HRV relationship are needed.

https://eprints.bournemouth.ac.uk/38401/

Source: Europe PubMed Central

Relationship between combat-related traumatic injury and ultrashort term heart rate variability in a UK military cohort: findings from the ADVANCE study

Authors: Maqsood, R., Schofield, S., Bennett, A.N., Bull, A.M.J., Fear, N.T., Cullinan, P., Khattab, A.D. and Boos, C.J.

Journal: BMJ Military Health

Issue: Mar

Pages: 1-6

Abstract:

Introduction Combat-related traumatic injury (CRTI) has been linked to an increased cardiovascular disease (CVD) risk. The long-term impact of CRTI on heart rate variability (HRV)—a robust CVD risk marker—has not been explored. This study investigated the relationship between CRTI, the mechanism of injury and injury severity on HRV.

Methods This was an analysis of baseline data from the ArmeD SerVices TrAuma and RehabilitatioN OutComE (ADVANCE) prospective cohort study. The sample consisted of UK servicemen with CRTI sustained during deployment (Afghanistan, 2003–2014) and an uninjured comparison group who were frequency matched to the injured group based on age, rank, deployment period and role in theatre. Root mean square of successive differences (RMSSD) was measured as a measure of ultrashort term HRV via <16 s continuous recording of the femoral arterial pulse waveform signal (Vicorder). Other measures included injury severity (New Injury Severity Scores (NISS)) and injury mechanism.

Results Overall, 862 participants aged 33.9±5.4 years were included, of whom 428 (49.6%) were injured and 434 (50.3%) were uninjured. The mean time from injury/ deployment to assessment was 7.91±2.05 years. The median (IQR) NISS for those injured was 12 (6–27) with blast being the predominant injury mechanism (76.8%).

The median (IQR) RMSSD was significantly lower in the injured versus the uninjured (39.47 ms (27.77–59.77) vs 46.22 ms (31.14–67.84), p<0.001). Using multiple linear regression (adjusting for age, rank, ethnicity and time from injury), geometric mean ratio (GMR) was reported. CRTI was associated with a 13% lower RMSSD versus the uninjured group (GMR 0.87, 95% CI 0.80–0.94, p<0.001).

A higher injury severity (NISS ≥25) (GMR 0.78, 95% CI 0.69–0.89, p<0.001) and blast injury (GMR 0.86, 95% CI 0.79–0.93, p<0.001) were also independently associated with lower RMSSD.

Conclusion These results suggest an inverse association between CRTI, higher severity and blast injury with HRV.

Longitudinal studies and examination of potential mediating factors in this CRTI-HRV relationship are needed.

https://eprints.bournemouth.ac.uk/38401/

Source: BURO EPrints