Brno 2013
NONINVASIVE METHODS
IN CARDIOLOGY
2013
Masaryk University · Faculty of Medicine · Brno · Czech Republic
Edited by: Kenner T., Cornélissen G., Siegelová J., Dobšák P.
Brno 2013
NONINVASIVE METHODS
IN CARDIOLOGY
2013
Masaryk University · Faculty of Medicine · Brno · Czech Republic
Edited by: Kenner T., Cornélissen G., Siegelová J., Dobšák P.
Under the auspices of
Ing. Miloš Zeman, CSc., President of the Czech Republic
Ing. Zdeněk Škromach, Vice-President of the Senate of the Czech Republic
doc. PhDr. Mikuláš Bek, Ph.D., Rector of Masaryk University Brno
prof. MUDr. Jiří Mayer, CSc., Dean of Faculty of Medicine, Masaryk University Brno
Reviewed by: prof. MUDr. Zdeněk Placheta, DrSc.
© 2013 Masarykova univerzita
ISBN 978-80-210-6534-5
CONTENTS
CONGRESSES ON NONINVASIVE METHODS IN CARDIOLOGY�������������������������������������������������5
PROF. MUDR. B. FIŠER, CSC.,
MINISTER OF HEALTH OF THE CZECH REPUBLIC 2000–2002�������������������������������������������������6
Michal Pohanka
REMEMBERING PROFESSOR BOHUMIL FIŠER
(22 OCTOBER 1943 – 21 MARCH 2011)������������������������������������������������������������������������������������������9
Zdeněk Koudelka
SOME CONSIDERATIONS ABOUT THE TITLE “EVERY-DAY-PHYSIOLOGIST”
WHICH WAS INVENTED BY FRANZ HALBERG DURING A STAY IN BRNO����������������������������10
Thomas Kenner
IN HONOR OF BOHUMIL FISER: EDUCATOR, PHYSIOLOGIST, CHRONOBIOLOGIST,
ADMINISTRATOR, CZECH MINISTER OF HEALTH, AND EXECUTIVE BOARD
MEMBER OF THE WORLD HEALTH ORGANIZATION�������������������������������������������������������������� 14
Germaine Cornelissen, Jiri Dusek, Thomas Kenner, Brigitte Kenner,
Othild Schwartzkopff, Jarmila Siegelova
PROFESSOR BOHUMIL FIŠER, A SCIENTIST AND A TEACHER AT THE DEPARTMENT
OF PHYSIOLOGY, FACULTY OF MEDICINE, MASARYK UNIVERSITY, BRNO������������������������ 20
Nataša Honzíková, Marie Nováková
PROF. MUDR. B. FIŠER, CSC., *22 OCTOBER 1943 – †21 MARCH 2011:
INTERNATIONAL COOPERATION IN MEDICINE���������������������������������������������������������������������25
Jarmila Siegelová
PROF. FRANZ HALBERG, M.D., PH.D., DR. H. C. MULTI, 5 JULY 1919 – 9 JUNE 9 2013��������������55
Jarmila Siegelová
SOME REMARKS CONCERNING THE CHRONOBIOLOGY
OF EARLY HUMAN DEVELOPMENT�����������������������������������������������������������������������������������������59
Thomas Kenner
REMEMBERING A BELOVED TEACHER AND DEAR FRIEND, FRANZ HALBERG
(5 JULY 1919 – 9 JUNE 2013) IN APPRECIATION������������������������������������������������������������������������62
Germaine Cornelissen, Othild Schwartzkopff, Jiri Dusek, Jarmila Siegelova
DR OTHILD SCHWARTZKOPFF CHRONOBIOLOGIST, HALBERG CHRONOBIOLOGY
CENTER UNIVERSITY OF MINNESOTA, USA��������������������������������������������������������������������������68
Germaine Cornélissen
DECADAL AND MULTIDECADAL CYCLES IN THE CARDIOVASCULAR SYSTEM,
RELATING TO DIAGNOSIS AND TREATMENT?�����������������������������������������������������������������������69
Franz Halberg, Germaine Cornelissen, Othild Schwartzkopff, Prateek Kashigawala, Dewayne Hillman,
Robert B Sothern, George Katinas, Shiyu Hong, Jarmila Siegelova
SUNSPOT CYCLES DRIVE THE CARDIOVASCULAR SYSTEM IN A UNIFIED SCIENCE�����������79
Germaine Cornelissen, Prateek Kashigawala, Dewayne Hillman, Jarmila Siegelova, Franz Halberg
SEVEN-DAY AMBULATORY BLOOD PRESSURE MONITORING:
BLOOD PRESSURE VARIABILITY AT REST AND DURING EXERCISE�������������������������������������87
Siegelová J., Havelková A., Dušek J., Pohanka M., Dunklerová L., Dobšák P., Singh, R.B., Cornélissen G.,
ABOUT HALF-WEEKLY (CIRCASEMISEPTAN)RHYTHM
IN URINARY NEOSPORIN OF HEALTHY WOMAN: METHODOLOGIC MODEL������������������������96
Christian Schubert, Germaine Cornelissen, Franz Halberg
AN ATLAS OF CHRONOMES TO MAP BROAD TIME STRUCTURES��������������������������������������� 102
Germaine Cornelissen, Larry A Beaty, Jarmila Siegelova, Cathy Lee Gierke, Kuniaki Otsuka,
Yoshihiko Watanabe, Elena V Syutkina, Anatoly Masalov, Lyazzat Gumarova, Franz Halberg
APPLICATION OF CARDIO-ANKLE VASCULAR INDEX (CAVI)
IN CLINICAL AND EPIDEMIOLOGICAL STUDY����������������������������������������������������������������������117
Dobšák P., Frantisová M., Sochor O., Ráček V., Šrámková T., Pohanka M., Homolka P., Sosíková M.,
Dušek L., Wotke J., Siegelová J.
SEVEN DAY AMBULATORY BLOOD PRESSURE MONITORING
AND LEFT VENTRICULAR MASS INDEX IN PATIENTS AFTER INFARCTUS
OF MYOCARDIUM IN CARDIOVASCULAR REHABILITATION���������������������������������������������� 123
Jarmila Siegelová, Alena Havelková, Jiří Dušek, Pavel Vank, Michal Pohanka, Germaine Cornélissen,
Franz Halberg
THE DUSTY BOXES IN MY OFFICE AND SOME SURPRISING
ISTORICAL AND SCIENTIFIC OBSERVATIONS���������������������������������������������������������������������� 138
Thomas Kenner
REHABILITATION OF SPASTICITY IN PATIENTS WITH STROKE���������������������������������������� 142
Petr Konecny, Milan Elfmark, Katerina Belohlavkova, Karolina Rezkova, Robert Mikulik,
Jarmila Siegelova, Petr Dobsak
5
NONINVASIVE METHODS IN CARDIOLOGY 2013
CONGRESSES ON NONINVASIVE
METHODS IN CARDIOLOGY
After the Velvet revolution in 1989 we started international cooperation among University of Minnesota,
USA, Prof. Franz Halberg, Prof. Germaine Cornélissen, University of Graz, Austria, Prof. Thomas
Kenner, University of Paris, France, Prof. J.P. Martineaud and Masaryk University of Brno, Prof. Bohumil
Fišer, Dr. Jiří Dušek, Prof. Jarmila Siegelová. The cooperation was realized also by the meetings held two
times per year in Brno; the results from the common studies were published in the books Noninvasive
Methods in Cardiology 1994, 1996, 1999, 2002, 2003, 2004, 2007, 2008, 2009, 2010, 2011, 2012. The editors of
these books were Prof. Franz Halberg, Prof. Thomas Kenner, Prof. Bohumil Fišer, Prof. Jarmila Siegelová.
At the occasion of Noninvasive Methods in Cardiology 2013 we want to remember the people who are no
more with us.
Professor F. Halberg was presented by video transmission in Brno Workshop in May 3 to 4, 2013, and
presented for the last time his scientific work; he died on June 9, 2013.
Professor Bohumil Fišer died on March 21, 2011. That is why this book Noninvasive Methods in Cardiology
2013 is devoted to what would have been the 70th birthday of Professor Bohumil Fišer.
prof. MUDr. Jarmila Siegelová, DrSc.
Dept. of Physiotherapy and Rehabilitation
Faculty of Medicine, Masaryk University
Czech Republic
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NONINVASIVE METHODS IN CARDIOLOGY 2013
PROF. MUDR. B. FIŠER, CSC., MINISTER OF HEALTH
OF THE CZECH REPUBLIC 2000–2002
MICHAL POHANKA
Department of Physiotherapy, Masaryk University Brno
I am very pleased to remember Professor Bohumil Fišer, Minister of Health of the Czech Republic,
under whom I worked in the function of Deputy Minister.
Professor Bohumil Fišer performed this function very responsibly, with the strength of his whole personality.
After 11 years, Professor Fišer as Minister of Health is still highly valued and honored, as it is
proved by the following documents.
Fig. 1 Ing. Miloš Zeman, CSc., President of the Czech Republic
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NONINVASIVE METHODS IN CARDIOLOGY 2013
Fig. 2 The letter of Ing. Miloš Zeman, CSc., President of the Czech Republic
Ladies and gentlemen,
I am very glad that I can take patronage of the congress “Noninvasive Methods in Cardiology 2013”. This is also due
to the fact that this congress is devoted to what would have been the 70th birthday of Professor Bohumil Fišer, Minister of
Health in my government. I want to ask you to remember with me a kind man and a successful minister who successfully
fulfilled his life.
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NONINVASIVE METHODS IN CARDIOLOGY 2013
Fig. 3 Ing. Zdeněk Škromach, Vice-President of the Senate of the Czech Republic
Fig. 4 Professor Bohumil Fišer, Minister of Health of the Czech Republic in 2000
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NONINVASIVE METHODS IN CARDIOLOGY 2013
REMEMBERING PROFESSOR BOHUMIL FIŠER
(22 OCTOBER 1943 – 21 MARCH 2011)
ZDENĚK KOUDELKA
Department of Constitutional Law and Political Science, Masaryk University
I have a great respect for the memory of Bohumil Fišer. He was a person who reached a top as a scientist
and as a teacher. He was a very successful professor and the Head of the Department of Physiology in
the Medical faculty of the Masaryk University. He was a dedicated scientist, but he was also very interested
in politics. He was very probably influenced by his father – veterinarian in Brno, who was also very
active in the municipal council of the city of Brno in the Czechoslovak Republic. He had to leave his post
just during the German occupation of the Czech Republic, when he was replaced by a Nazi representative.
Professor Fišer become very active in the socialist party and was eventually chosen by then prime
minister Milos Zeman to become minister of Health in his Government (9 February 2000 – 12 July 2002 ).
To this day he is considered as the one of the most successful Health ministers. It is also proved by the fact,
that he stayed in this post for more then 2 years, which was a record at that time, broken just by Leoš Heger.
Bohumil Fišer was my political colleague and he was for me and many others a great political authority.
He was for me an example of an ideal politician and a public personality. To this day I admire his ability
to understand and exactly explain the merits of complicated political events.
According to my opinion it was very appropriate, that the first book of Jost Academy, Úvahy o poli-
tice (1) (Essays about Politics), included a paper by B. Fišer: “Politics from the view of a Scientist”. His text
shows his non traditional opinions on the political events from his position as a doctor of medicine and a
scientist. In his text he has shown a deep knowledge of the social sciences and his text is very readable as
he shows very interesting and new views on the historical political events. He has also successfully shown
the correlations between historical and present politics. He was not afraid to leave a path of political correctness
and has openly published his opinions on how to solve some very sensitive issues. One example
is his suggestion as how to solve the problems with the Roma minority. His vision was to do it through an
education of the Roma children in boarding schools of British type, which would also provide a material
support. He was also a big critic of corruption, but his opinions were realistic and he did not join the kind
of extreme criticism. This became some kind of mantra for some journalists resembling the communistic
mantra about the fight between the social classes. His text is available on the pages of the Repository of
Masaryk University (2).
He always viewed politics from the left side of the political spectrum, but he was never a populist. His
vision was to secure the well being by introducing the European standards on important issues for all citizens.
It is logical, that the most important issues were medical care and education.
When he died, the main speaker on his funeral was the current president of the Czech Republic
Mr. Miloš Zeman. He described professor Fišer very nicely and accurately and he also mentioned his nickname
“Bohoušek” (diminutive of Bohumil), which was used by his friends and supporters. This nickname
shows the love of the people who worked with him and who were his friends. It shows a good heart and
a the friendly personality of the man who was always ready to help to the others in need.
I am missing the company of Bohoušek, who was a great companion and lover of Moravian wine. My
memories of him will always be very nice.
REFERENCES
1.	 BOHUMIL FIŠER, ZDENĚK KOUDELKA: Úvahy o politice. Joštova akademie Brno: 2011, ISSN 978-80-
-904880-0-7.
2.	 https://is.muni.cz/repo/930534/cs
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NONINVASIVE METHODS IN CARDIOLOGY 2013
SOME CONSIDERATIONS ABOUT THE TITLE
“EVERY-DAY-PHYSIOLOGIST” WHICH WAS
INVENTED BY FRANZ HALBERG DURING A STAY
IN BRNO
THOMAS KENNER
Department of Physiology, Medical University in Graz, Austria
In connection with discussions about medical education and medical and physiological activities,
Franz Halberg coined the title “Every-day-physiologist” for the three of us: Prof. Bohumil Fiser, he himself
and me. The title includes a special consideration of the relation between physicans and patients.
I interpret the meaning of this friendly title that it describes our common attempt to use our research
and our activities and also our planning especially for the improvement of practical medicine. To treat
a patient, means to lead her or him from symptoms of disease and weakness to restoration of health and
strength. There are always scientific components: the diagnostic process and the therapy. The therapeutic
procedures and the training for the rehabilitation follow experience from research. And there are equally
important components of humanity.
On the way from Graz to Brno, we made a stop in Vienna and – among other ways – we visited an exhibition,
where I found a text which seems to me worthwhile to be presented here:
“What I feel is an art of balance of gravity and serenity, devoid of troubling and disturbing subject matter,
an art that could have soothing, calming influence on the mind, something like a good arm chair that provides
revelation from physical fatigue.”
This text was written in the year 1908 by the famous French painter HENRI MATISSE – and was presented
in the Viennese House “ALBERTINA” in an Exhibition, where pictures of Matisse and his friends
and followers were presented.
I had the impression, that this description of positive influencing and positive thinking is not only
applicable in connection with pictures and arts, but also describes vividly, how in a hospital a physician
should speak, act and behave in order to be perceived by a patient as somebody who is able to generate and
distribute balance, gravity and serenity. It is clearly necessary that the activity of a physician should be felt
and accepted as something positive and “as soothing, calming influence on the mind.”
Another text comes in my mind, a text, which is much older than Matisse’s text and life time, and in
addition has some relation to what we could even imagine to be activities in a modern hospital. It was written
by the monk St. Benedict around the year AD 400 as part Nr. 36 of his rules for the behavior of persons
in a monastery. This short text Nr. 36 describes the care for sick persons. It starts with the sentence: “The
care for the sick is more important than any other obligation… The sick have to accept the help gratefully… However
it is important to tolerate even overdoing patients.” In addition there are descriptions about necessary activities
like bathing, eating and drinking. The text ends with the remarkable sentence: “The Abbot (the chairman)
is responsible for any mistake, which the young make”.
We had often discussed with Prof. Bohumil Fiser current problems of medical schools. He was involved
in problems of organization and reform as physiology teacher, and also as minister of health. Of course he
was also informed about reform activities in Austria. An when I told him about major changes in Austria –
like the separation of former Medical Faculties in our Universities in order to become new Medical Universities
– it was relaxing to know that he listened and understood the problems.
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NONINVASIVE METHODS IN CARDIOLOGY 2013
ATTINGER’S MODEL
Ernst O. Attinger was chairman of the Division of Biomedical Engineering of the University of Virginia,
where I worked several years – he introduced a simple model of human systems, in order to describe
different possible strategies to react to problems. Despite the fact that goals of societies or groups are often
but vaguely defined, the difference between desire und actual achievements can be used as an indicator of
the state of health of the system. For this lack between the desired goal and the actual achievement he used
the name “goal-gap ratio”. This ratio is defined as the quotient of goal or desire and actual achievement. Attinger
(1) argues that a high goal-gap ratio – the achievement is markedly lower than the goal – may lead to
frustration. If this occurs, three alternative reactions are possible.
Attingers model is a feedback system, which is able to recognize the actual achievement and to compare
this achievement with the desired goal. As an index of missing quality the value of the so-called
goal-gap ratio indicates the necessity of reactions or at least modifications to actual loads. Considering the
estimated value of the goal-gap ratio, a decision about the further strategy of correction has to be found. As
mentioned above, three possible strategies can be chosen.
1.	 The first one leads through exhaustion to extinction.
2.	 The second passes through negative aggressive behavior and social unrest to socioeconomic and political
instability. A positive feedback raises the instability, and leads to a further increase of goal-gap
ratio and unrest.
3.	 The third choice is characterized by positive aggressive behavior that results in designing constructive
solutions of problems in order to decrease in the goal-gap ratio through negative feedback.
One problem, which Attinger did not mention is the additional source of problems: in case of marked
increase of bureaucracy any Improvement is markedly inhibited.
THE NEW AUSTRIAN LAW “UOG 2002”
As former rector of the Karl-Franzens-Univesity in Graz it seems to me interesting to present here
some related problems, which several years ago had discussed with the – at that time MINISTER OF
HEALTH Bohumil Fiser.
Before the new law with the title “UOG 2002” (UOG stands for “Universitäts Organisations-Gesetz”)
was introduced in Austria, the rector of a University was the chairman of the senate, and there was no additional
board.
The actual modification in Austrian Universities according to the new law “UOG 2002” modifies
these Universities into a business. The highest leadership is now manifold: 1. the rector, 2. the senate,
3. the chairman of the senate, 4. the university-board of external board-members, 5. the chairman of the
university-board.
Of course, a generation of quarrel between senate and university-board has high probability. Example:
in the University of Arts and Music in Graz, a quarrel blocked the election of a rector for more than one
year.
An additional change of matters by the new law was the separation of the former Medical Faculties and
the formation of Medical Universities.
In my opinion this separation is an amputation and I shortly report about The reaction to the
amputation.
In an interview in June 2006 the Rector of the new Medical University in Graz gave the following
answer to the question about the future of the Austrian Universities (2): “With the new University-law
(UOG 2002) the Universities received a far reaching autonomy which is now increasingly used. In industry
such a phase of reconstruction takes seven to eight years. We are now since two years in this phase and
perform today things the very first time…” Furthermore, he expressed his hope that within the next five
12
NONINVASIVE METHODS IN CARDIOLOGY 2013
years a stability will be reached so that an evaluation of the change will be possible. My comment to these
open words about the current troubles is as follows: It seems to me irresponsible to make a new law, which
creates serious problems for estimated eight years in an institution of health care, education and research,
where students are supposed to learn for 6 years.
In any case the “goal gap ration” was markedly increased. A tremendous growth of bureaucracy blocks
the “goal gap ration” at a high level.
THE NEW DIFFICULTIES
Through the UOG 2002 Austrian Universities received the right to act like industrial units. This is
in agreement with modern trend of neoliberalism. The rector received a marked increase of power and
competence. He is no more elected out of the professors or academic personnel of the University, but his
position is advertised officially and who ever thinks to be able to fulfill the demands can apply. The appointment
of the rector depends on the senate and the so called university board.
In addition, at the same time came the most painful addition to UG 2002: A reform of the employment
law regulating all matters concerning employment, position, duration of position, income, rights, retirement,
etc. This addition apparently, leads now to the most dangerous uncertainties for young scientists and
young professors.
Last but not least the law UG 2002 orders that the three “classical Universities” which so far contained
Medical Faculties (Vienna, Innsbruck and Graz) had to split off these Medical Faculties in order to generate
three new Medical Universities. This “amputation” took place on January 1 st 2004.
As mentioned above, with respect to the medical education each of the three Medical Universities
in Austria started to develop a specific new curriculum – different from the curriculum of the two other
Medical Universities. This led in all locations to massive changes.
In Graz the classical curriculum, which until recently was similar in all former countries of the Austrian
Monarchy was replaced by a so called module-system. This system is based on so called problem
based learning (PBL). Difficulties were arising for several reasons. The new system demands cooperation
of different specialities within each module. E.g., the anatomist, the physiologist, the chemist and the cardiologist
would talk about hypertension. This may sound interesting, however, the organization of the
increased number of lectures and lecturers became increasingly difficult. Since PBL has to be taught in
small groups the teaching load for professors and assistants from non-clinical and clinical specialities,
increased tremendously. For the students the loss of systematic teaching appears to be a major problem.
Besides all that, the wide application of so called “virtual teaching” through internet and consequently the
application of written multiple-choice examinations – in my opinion – are extremely problematic. Furthermore,
the Medical Universities had to introduce entrance examinations as a reaction to a decision of
the ­EU-high court in 2005. Until then all Austrians who bad passed the so called Matura (final examination
after 8 years Gymnasium) had free access to study medicine. The new situation permitted all persons
from EU-countries, especially many students from Germany, to study medicine – and also other specialities
– in Austria under the same conditions as Austrians.
SUMMARY
As retired Professor and former rector of the still complete Karl-Franzens-Unversity in Graz, it was always
valuable to discuss such recent difficult problems with the physiologist, the “every day physiologist”
and Minister Bohumil Fiser. At this point I just can express my thankfulness to my good friend.
It is most difficult to understand or even to explain the motivation of the new laws. So far, the negative
effects are in the foreground, in particular due to the marked increase of bureaucracy.
The University of Graz was founded in 1585. The Medical Faculty was introduced in 1863. In a book
which was published 1913 on the occasion of the celebration of the 50th
anniversary of the new Medical
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NONINVASIVE METHODS IN CARDIOLOGY 2013
­Faculty, the following sentences can be found: “In these days the University of Graz celebrates together
with the Medical Faculty an important anniversary, because only after the introduction of the Medical
Faculty the University has gained completeness and from this completeness the rank of a fully important
UNIVERSITAS LITERARUM. Until 1863 the University was only patchwork! In 1863 she became a completeness.”
141 years later this completeness was lost again. We are back to be patchwork.
Fig. 1 Professor B. Fišer and Professor T. Kenner in Masaryk University Brno in 2009
REFERENCES
1.	 Attinger E.O.: Global Systems Dynamics. S. Karger: Basel-Müchen-New York 1970
2.	 Kenner T: Physiological considerations about life cycles of universities. Wien Med Wochenschr. 157,
392–397 (2007)
3.	 Kenner T: Physiological considerations about a statement by Gaius Petronius. Acta Physiologica Hungarica,
94, 271–285 (2007)
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NONINVASIVE METHODS IN CARDIOLOGY 2013
IN HONOR OF BOHUMIL FISER: EDUCATOR,
PHYSIOLOGIST, CHRONOBIOLOGIST,
ADMINISTRATOR, CZECH MINISTER OF HEALTH,
AND EXECUTIVE BOARD MEMBER OF THE WORLD
HEALTH ORGANIZATION
GERMAINE CORNELISSEN1, JIRI DUSEK2, THOMAS KENNER3, BRIGITTE KENNER3,
OTHILD SCHWARTZKOPFF1, JARMILA SIEGELOVA4
1 Halberg Chronobiology Center, University of Minnesota, Minneapolis, MN, USA
2 Health Medical Center, South Moravia Region, Brno, Czech Republic
3 Department of Physiology, Medical University, Graz, Austria
4 Department of Physiotherapy and Rehabilitation, St. Anna Teaching Hospital, Brno, Czech Republic
Figure 1 Bohumil Fiser
Two and a half years have passed since Professor Bohumil Fiser’s untimely death. Yet, his achievements
are still fresh in our memory and continue to inspire all who were fortunate to know him. His extensive
bibliography illustrates the active scientific career of Bohumil (Figure 1). The innovations he brought to the
field led him to head the department of physiology at what used to be Purkinje – now Masaryk – University.
The Czech Republic could not have chosen a better person to serve as Minister of Health. The responsibilities
Bohumil shouldered expanded even further when he served on the executive board of the World
Health Organization.
Bohumil was also a gentleman, a kind man everyone would wish to have as a friend. And a friend he
was to us and to chronobiology. The Minnesota connection with Brno started in April 1990 when Franz
Halberg and I were invited by Professor Pavel Prikryl and Professor Jarmila Siegelova to participate at
an International Symposium on Hypertension they organized in Brno (1). This was the start of a long and
rewarding ongoing cooperation.
Vividly I remember my first encounter with Bohumil Fiser. On January 13, 1995, he, Jarmila Siegelova
and Jiri Dusek arrived in Minnesota. Franz Halberg was at the airport to greet them. They all came immediately
to my home where I had readied the new ambulatory blood pressure monitors from the A&D
Company (TM-2421) we had just received. These devices needed to be compared with those from the Colin
Medical Company (ABPM-630) we had previously used to be sure the data could be pooled and analyzed as
15
NONINVASIVE METHODS IN CARDIOLOGY 2013
longitudinal records. We all placed cuffs from each monitor on each arm and started a week-long session of
around-the-clock measurements (2).
Blood pressure monitoring had been one of Bohumil’s specialities already. He was there in Brno with
Jan Penaz as a young scientist-subject when the first continuous beat-to-beat blood pressure recorder on
the finger for automatic use was developed (3). To the study of short-term variations made possible by this
device (4, 5), Bohumil recognized the merit of monitoring blood pressure over much longer spans to obtain
a more accurate diagnosis of “hypertension”. He supported around-the-clock blood pressure monitoring
for 7 days at the outset in a consensus document he guided with Professor Thomas Kenner (6), in order to
account for the often encountered large day-to-day variability in circadian characteristics. The fact that
weeklong records allow a glimpse at the circaseptan variation (7) is a dividend that led to interesting new
results in relation to depression (8), as documented in our international project on the BIOsphere and the
COSmos (BIOCOS).
Figure 2 ROC curves of some VVDs. The percentage of morbid outcomes (such as a stroke) among subjects testing positive
(e.g., for CHAT or for MESOR-hypertension) is known as the sensitivity of the test (e.g., circadian amplitude or MESOR
of blood pressure). CHAT has a sensitivity of 28.2%, as compared to 92.3% for the case of MESOR-hypertension. The
specificity of a given test is the percentage of subjects with no adverse outcome among those testing negative. CHAT has
a specificity of 94.6%, as compared to 45.7% for the case of MESOR-hypertension. SBP & DBP: Systolic & Diastolic Blood
Pressure; PP: Pulse Pressure; HR-SD: Standard Deviation of Heart Rate; -M: MESOR; -A: Amplitude.
Bohumil was an advocate of the chronobiologic approach to blood pressure monitoring, recognizing
that in addition to an elevated blood pressure (MESOR-Hypertension; where MESOR stands for the
Midline Estimating Statistic Of Rhythm, or rhythm-adjusted mean value), alterations in the variability
of blood pressure and heart rate constitute Vascular Variability Disorders (VVDs) associated with an increased
cardiovascular disease risk in their own right (6). VVDs include an excessive circadian amplitude
of blood pressure (CHAT, brief for Circadian Hyper-Amplitude-Tension), an odd phase of the circadian
blood pressure rhythm but not that of heart rate (ecphasia), a circadian period deviating with statistical
significance from 24 hours (ecfrequentia), an excessive pulse pressure, a deficient heart rate variability,
and an excessive pulse-pressure product. Acceptable limits for the MESOR and for the circadian amplitude
and acrophase are specified by gender and age.
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NONINVASIVE METHODS IN CARDIOLOGY 2013
With calculations prompted and guided by Bohumil, the sensitivity and specificity of some of the VVDs
are illustrated in Figure 2. Corresponding efficiency coefficients are provided in Table 1. The efficiency coefficient
is the percentage of correct diagnoses in the light of outcomes. For CHAT it is 85.9%, as compared
to 51.9% for MESOR-hypertension. These values strongly suggest the merit of assessing the blood pressure
variability, notably the circadian amplitude of blood pressure, since the diagnosis of CHAT is not meant
to be used as a substitute, but rather as a complement to the diagnosis of MESOR-hypertension. Similar
results are obtained for a deficient heart rate variability, Table 1.
Table 1 ROC results of some VVDs
Sensitivity (%) Specificity (%) Positive PV Negative PV
Efficiency
Coefficient
SBP-M 92.3 45.7 20.5 97.5 51.9
PP 56.4 88.8 43.1 93.1 84.5
DBP-2A 28.2 94.6 44.0 89.7 85.9
HR-SD 25.6 95.7 47.6 89.5 86.5
Non-dipping
SBP 43.6 62.0 14.8 87.9 59.6
DBP 35.9 72.1 16.3 88.2 67.3
PV: Predicted Value.
That CHAT is a more specific marker of risk than MESOR-Hypertension is also apparent from Figure
3. The relative risk of having a cerebral ischemic event within 6 years from the monitoring among patients
with no target organ damage at the outset is 4.12 for MESOR-hypertensive patients as compared to MESORnormotensive
subjects. In other words, MESOR-hypertensive patients have a 312% increased risk of having
an adverse cerebral event within 6 years by comparison to MESOR-normotensive subjects. The 95%
confidence interval of the relative risk, represented by the height of the bar is barely above the horizontal
line at X1 corresponding to equal risk. By contrast, systolic and diastolic CHAT have a relative risk of 6.21
and 8.16, respectively, that is a risk numerically larger than the risk associated with a high blood pressure.
Moreover, their 95% confidence intervals are narrower and well above the equal risk line, in keeping with
the higher specificity of CHAT as compared to MESOR-Hypertension (Table 1 and Figure 2).
From Table 1, it can also be seen that VVDs have a higher efficiency coefficient than the day-night ratio
of systolic and diastolic blood pressure used for a classification in terms of “dipping”. This result is in
keeping with results from another outcome study using the left ventricular mass index (LVMI) as a proxy
outcome measure (9; cf. 10, 11). On data he collected in Brno with Jarmila Siegelova and Jiri Dusek, Bohumil
documented the problem of exclusive reliance upon a classification by dipping when a chronobiologic
approach to blood pressure was available, pointing to the merits of the latter and the shortcomings of the
former (12, 13).
As minister of health and executive board member of WHO, Bohumil Fiser provided data for the documentation
of an about-50-year cycle in stroke incidence (14), Figure 4. An about 50-year cycle also characterized
the incidence of stroke deaths in Minnesota for the span from 1950 to 1998 (15). Nonlinearly,
the period was estimated as 51.1 years with a 95% confidence interval spanning from 49.0 to 53.1 years.
An upward trend in the incidence of stroke deaths after 2000 was also observed in Slovakia (16), in Lund,
Sweden (17), and in Arkansas, USA (18). About 50-year cycles have also been detected in other variables,
such as anthropometric measurements at birth in Russia, natality and homicides in the USA, an index of
international wars, as well as the incidence of large earthquakes and tsunamis (19). Known to economists
as the Kondratiev cycle, this component deserves further scrutiny of the role of space weather and/or geomagnetism
in physiology (20).
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NONINVASIVE METHODS IN CARDIOLOGY 2013
In 2011, Franz wrote about Bohumil’s untimely death (2): “BIOCOS has lost a friend. It will be hard to
find a better one. But Bohumil will live on in the unified science that he helped create, transcending disciplinary
barriers.” As apparent at this meeting on Noninvasive Cardiology, very much indeed, Bohumil’s
legacy lives on.
Figure 3 Higher specificity of CHAT as compared to MESOR-Hypertension as markers of cardiovascular disease risk
Figure 4 Increase in stroke deaths after 1997 in the Czech Republic: part of an about 50-year cycle?
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NONINVASIVE METHODS IN CARDIOLOGY 2013
REFERENCES
1.	 Birkenhäger WH, Halberg F, Prikryl P. (Eds.) Proc. Int. Symp. on Hypertension, Brno, Czechoslovakia,
April 9–10, 1990. Brno: Masaryk University; 1990.
2.	 Halberg F, Cornelissen G, Kenner T, Dusek J, Kenner B, Schwartzkopff O, Siegelova J. Bohumil Fiser
(*22 October 1943 – †21 March 2011): chronobiologist, emeritus head of the physiology department at
Masaryk University (Brno, Czech Republic), Czech minister of health, and executive board member
of the World Health Organization: his legacies for health and personalized health care. World Heart J
2011; 3: 63–71.
3.	 Penaz J, Honzikova N, Fiser B. Spectral analysis of resting variability of some circulatory parameters
in man. Physiologia Bohemoslovaca 1978; 27(4): 349–357.
4.	 Fiser B, Honzikova N, Semrad B. Pressure wave cardiography; cardiac diagnosis by means of noninvasive
continuous blood pressure record. Physiological Research 1992; 41(1): 25–29.
5.	 Al-Kubati MA, Fiser B, Siegelova J. Baroreflex sensitivity during psychological stress. Physiological
Research 1997; 46(1): 27–33.
6.	 Halberg F, Cornelissen G, Otsuka K, Siegelova J, Fiser B, Dusek J, Homolka P, Sanchez de la Pena S,
Singh RB, BIOCOS project. Extended consensus on means and need to detect vascular variability disorders
(VVDs) and vascular variability syndromes (VVSs). World Heart J 2010; 2(4): 279–305.
7.	 Siegelova J, Cornelissen G, Fiser B, Dusek J, Homolka P, Masek M, Jancik J, Svacinova H, Halberg F.
Blood pressure and heart rate monitoring in humans: the circaseptan and circadian rhythms. Clinical
Autonomic Research 2003; 13: 60–61.
8.	 Otsuka K, Yamanaka G, Shinagawa M, Murakami S, Yamanaka T, Kawauchi K, Shibata K, Yano S,
Chiang CE, Singh RB, Cornelissen G, Halberg F. Chronomic “health watch” with 24-hour/7-day ambulatory
monitoring reveals a circaseptan rhythmicity of blood pressure in depressive citizens in a
community. Int J Cardiol 2004; 97 (Suppl 2): S12–S13.
9.	 Cornelissen G, Halberg F, Otsuka K, Singh RB, Chen CH. Chronobiology predicts actual and proxy outcomes
when dipping fails. Hypertension 2007; 49: 237–239. doi:10.1161/01.HYP.0000250392.51418.64.
PMCID: PMC2613012.
10.	 Cornelissen G, Halberg F, Otsuka K, Singh RB. Separate cardiovascular disease risks: circadian hyperamplitude-tension
(CHAT) and an elevated pulse pressure. World Heart J 2008; 1 (3): 223–232.
11.	 Gupta AK, Greenway FL, Cornelissen G, Pan W, Halberg F. Prediabetes is associated with abnormal circadian
blood pressure variability. J Human Hypertension 2008; 22: 627–633. doi:10:1038/jnh.2008.32.
PMCID PMC18480832.
12.	 Fiser B, Havelkova A, Siegelova J, Dusek J, Pohanka M, Cornelissen G, Halberg F. Night-to-day blood
pressure ratio during seven-day ambulatory blood pressure monitoring. In: Halberg F, Kenner T, Fiser
B, Siegelova J. (Eds.) Noninvasive Methods in Cardiology, September 16-17, 2010, Brno, Czech Republic.
Brno: Faculty of Medicine, Masaryk University. p. 128–132.
13.	 Siegelova J, Havelkova A, Fiser B, Dusek J, Pohanka M, Dunklerova L, Cornelissen G, Halberg F. Day
and night blood pressure variability during seven-day ambulatory blood pressure monitoring. In: Halberg
F, Kenner T, Fiser B, Siegelova J. (Eds.) Noninvasive Methods in Cardiology, September 16–17, 2010,
Brno, Czech Republic. Brno: Faculty of Medicine, Masaryk University. p. 133–138.
14.	 Fiser B, Cornelissen G, Siegelova J, Dusek J, Homolka P, Mazankova V, Halberg F. Increase in stroke
deaths after 1997 in the Czech Republic. MEFA 8th International Fair of Medical Technology and Pharmacy,
Brno, Czech Republic, 7–10 Nov 2000, abstract 4.
15.	 Cornelissen G, Halberg F, Breus T, Syutkina EV, Baevsky R, Weydahl A, Watanabe Y, Otsuka K, Siegelova
J, Fiser B, Bakken EE. Non-photic solar associations of heart rate variability and myocardial
infarction. J Atmos Solar-Terr Phys 2002; 64: 707–720.
16.	 Kovac M, Mikulecky M. Chronocosmobiology of cerebral stroke in South West Slovakia. Proceedings,
1st International Symposium, Workshop on Chronoastrobiology & Chronotherapy (Satellite Sympo-
19
NONINVASIVE METHODS IN CARDIOLOGY 2013
sium, 7th Annual Meeting, Japanese Society for Chronobiology), Kudan, Chiyodaku, Tokyo, 11 Nov
2000, p. 26.
17.	 Johansson B, Norrving B, Lindgren A, Increased stroke incidence in Lund-Orup, Sweden, between
1983 to 1985 and 1993 to 1995. Stroke 2000; 31: 481–486.
18.	 Halberg F, Cornelissen G, Otsuka K, Watanabe Y, Katinas GS, Burioka N, Delyukov A, Gorgo Y, Zhao
ZY, Weydahl A, Sothern RB, Siegelova J, Fiser B, Dusek J, Syutkina EV, Perfetto F, Tarquini R, Singh RB,
Rhees B, Lofstrom D, Lofstrom P, Johnson PWC, Schwartzkopff O. Cross-spectrally coherent 10:5-and
21-year biological and physical cycles, magnetic storms and myocardial infarctions. Neuroendocrinology
Letters 2000; 21: 233–258.
19.	 Cornelissen G, Wendt H, Halberg F. Earthquakes, features of the dynamics of the lithosphere, mirror
the heliosphere, as do physiopathologic aspects of the biosphere. In: Proceedings, Natural Cataclysms
and Global Problems of the Modern Civilization, Istanbul, 19–21 September 2011. London: SWB International
Publishing House; 2012. p. 288–293.
20.	Halberg F, Cornelissen G, Schwartzkopff O, Khalilov E, Khalilov T, Damirov F, Wang Z, Watanabe Y,
Otsuka K, Siegelova J, al-Abdulgader AA. Preventive cardiology concerns avoidance of personal and
societal health-related and natural cataclysms. In: Halberg F, Kenner T, Fiser B, Siegelova J. (Eds.) Noninvasive
Methods in Cardiology, October 17, 2011, Brno, Czech Republic. Brno: Faculty of Medicine,
Masaryk University. pp. 33–44.
Support: University of Minnesota Supercomputing Institute.
Correspondence:
Germaine Cornelissen, PhD
Professor, Integrative Biology and Physiology
Director, Halberg Chronobiology Center
University of Minnesota – MMC8609
420 Delaware Street SE
Minneapolis, MN 55455, USA
Tel: 612-624-6976
Fax: 612-624-9989
Email: corne001@umn.edu
Website: http://www.msi.umn.edu/~halberg/
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NONINVASIVE METHODS IN CARDIOLOGY 2013
PROFESSOR BOHUMIL FIŠER,
A SCIENTIST AND A TEACHER
AT THE DEPARTMENT OF PHYSIOLOGY,
FACULTY OF MEDICINE,
MASARYK UNIVERSITY, BRNO
NATAŠA HONZÍKOVÁ, MARIE NOVÁKOVÁ
Department of Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
Professor MUDr. Bohumil Fišer, CSc., a respected physiologist at Faculty of Medicine of Masaryk University,
died on March 21, 2011, at the age of 68 years.
Professor Fišer was born on October 22, 1943, in Brno. In 1966, he graduated from Faculty of Medicine,
J. E. Purkyně University in Brno. He had already some research experience by that time – he had worked at
Medical Physics Department and Physiology Department during his studies. He chose the Department of
Physiology of J. E. Purkyně University (later renamed Masaryk University) for his professional career and
devoted all his life to physiology. Despite insidious disease he worked at the department till his last days.
He devoted his life to physiology because he felt a possibility of joining his knowledge of mathematics
and his talent for an exact approach to the elucidation of physiological problems. He directed his colleagues
and students with his exact thinking and the ability to spread a joy at physiological investigation. As a scientist,
he was a very active one. Due to a broad spectrum of problems which Prof. Fišer studied, it is not
easy to make a brief summary of all research areas in which he worked; therefore, we would like to present
a survey of his publications which are documented at our department. He published 41 original articles in
journals with an impact factor, 273 original articles in other journals and books from symposia and 395
abstracts from congresses and conferences. Citations listed in Web of Science exceed 530. A list of papers
in journals with impact factor can be found in Appendix.
Out of this remarkable number of publications we would like to mention the most important results of
our collaboration at Department of Physiology. Namely, it is a paper from 1973 focused on cardiac function
in patients with atrial fibrillation, which was done in co-operation with prof. MUDr. Bořivoj Semrád, CSc.
Modelling of two hypotheses of the conduction of electrical activity in His bundle was used – a model of
a concealed conduction and a model of summation of atrial action potentials. The modelling clearly showed
a priority of a hypothesis of summation of action potentials. It is necessary to emphasize that at that time
modelling was rarely used in physiology.
Intheseventiesofthelastcenturyweapplied,undertheleadershipofourcommonteacherProf. Peňáz,
spectral analysis to the variability of a non-invasively continuously recorded blood pressure by an original
Peňázʼs device. Blood pressure variability was evaluated together with variations in blood flow, heart rate,
and respiration. This study involved analysis of interrelationship between variations in different circulatory
and respiratory parameters, and the individual characteristics and repeatability of the spectra. This
was the first spectral analysis of non-invasively recorded blood-pressure variations worldwide, and we
would like to mention that this pioneer study was performed at a time when there were no computers
available at the Faculty.
Our next key study on baroreflex sensitivity determination by the spectral method was done as early
as in 1992. BRS was analysed at different rates of respiration in the respiratory and 0.1 Hz ranges and, based
on these results, we decided to use a 0.1 Hz frequency range and a controlled breathing at a frequency of
0.33 Hz in further BRS studies.
Since then we have performed dozens of studies in this field. Out of those we would like to mention our
studies on risk stratification of patients after myocardial infarction, because they showed the importance
of non-invasively determined baroreflex sensitivity together with other risk factors known at that time.
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NONINVASIVE METHODS IN CARDIOLOGY 2013
The results of these studies were quickly accepted and included in an American study on the decision to
implant a cardioverter defibrillator after myocardial infarction (BAILEY JJ, HODGES M, CHURCH TR: Decision
to implant a cardioverter defibrillator after myocardial infarction: the role of ejection fraction v. other risk
factor markers. Med Decis Making 27: 151–160, 2007).
One of the important characteristics of Bohumil Fišer was his extraordinary ability to establish contacts
with experts from other institutions not only in Brno, but at international level. There is no space for
listing all studies done with various departments and thus only some of them will be mentioned.
Since ninetieths, Prof. Fišer collaborated on numerous projects. In collaborations with Prof. Jarmila
Siegelová and American department headed by Prof. F. Halberg and later by Prof. G. Cornelissen, he studied
for almost two decades circadian blood pressure variation. Together with Prof. Savin from France he
focused his attention on autoregulation of cerebral circulation studied by non-invasive methods.
In numerous animal experiments in the 70th and 80th of last century, mainly on isolated heart perfused
according to Langendorff and on isolated multicellular heart preparations, Professor Fišer studied
cardiac contractility. Many of these studies were done in collaboration with Department of Physiology in
Halle.
Formal professional life of Bohumil Fišer was affected by political circumstances. Although he defended
his theses already in 1977 and he was indisputably a research talent, his possibilities to collaborate with
departments abroad were restricted in 70th and 80th. He was awarded a degree of Associate Professor of
Normal Physiology only after political changes at the end of 20th century (1989). He became a Professor in
1995, after democratic changes in our country. V 1995, he took over Department of Physiology LF MU. He
headed it next 13 years.
Prof. Fišer loved to teach and the students perceived it. He belonged to those teachers who managed to
fill up any lecture hall. He knew how to comment with humour on every sort of information and relate it
to his life experience. The students knew that they would be instructed and entertained at the same time.
And this is the very component of his pedagogical success: information based on a story is scarcely forgotten.
Surely there are hundreds of doctors who feel to be his disciples.
Prof. Fišer was not a scientist closed in his laboratory. He actively participated in reconstruction of
academic community of Masaryk University as a member of Academic senate in the 90th. He was an active
organizer of Czech Physiological Society ČLS JEP, mainly between 1993 and 1998, when he was elected into
executive board of this society.
Bohumil Fišer’s personality was characterized with deep social feeling and need of affecting public
changes in hectic era at the end of 90th, when our society was transforming to democratic system. This fact
brought him to his membership in Labour Party and to the position of Minister of Health. Due to his work
in WHO (member of executive board in 2003–2006) he became internationally recognized personality.
Prof. Bohumil Fišer was an exceptionally humble person, with enormous ability to solve problems,
tolerant, with sense of humour. And due to these features he became a popular person worldwide.
Faculty of Medicine, Masaryk University in Brno lost in Professor MUDr. Bohumil Fišer, CSc., eminent
scientist, great teacher and a personality which markedly influenced the development of the faculty during
the last two decades.
REFERENCES
Bibliography of Professor Bohumil Fišer:
full papers in journals with impact factor:
◆◆ Al-Kubati, M., Al-Kubati, A. S., al’Absi, M., & Fišer, B. (2006). The short-term effect of water-pipe smoking
on the baroreflex control of heart rate in normotensives. Autonomic Neuroscience: Basic and Clinical,
126–127, 146–149.
◆◆ Al-Kubati, M. A. A., Fišer, B., & Siegelová, J. (1997). Baroreflex sensitivity during psychological stress.
Physiological Research, 46(1), 27–33.
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NONINVASIVE METHODS IN CARDIOLOGY 2013
◆◆ Bothová, P., Honzíková, N., Fišer, B., Závodná, E., Nováková, Z., Kalina, D., Honzíková, K., & Lábrová, R.
(2010). Comparison of baroreflex sensitivity determined by cross-spectral analysis at respiratory and
0.1 Hz frequencies in man. Physiological Research, 59(SUPPL.1), 103–111.
◆◆ Cornélissen, G., Delcourt, A., Toussaint, G., Otsuka, K., Watanabe, Y., Siegelova, J., Fiser, B., Dusek, J.,
Homolka, P., Singh, R. B., Kumar, A., Singh, R. K., Sanchez, S., Gonzales, c., Holley, D., Sundaram, B.,
Zhao, Z., Tomlinson, B., Fok, B., Zeman, M., Dulková, K., & Halberg, F. (2005). Opportunity of detecting
pre-hypertension: Worldwide data on blood pressure overswinging. Biomedicine and Pharmacotherapy,
59(SUPPL. 1), S152–S157.
◆◆ Cornelissen, G., Halberg, F., Breus, T., Syutkina, E.V., Baevsky, R., Weydahl, A., Watanabe, Y., Otsuka,
K., Siegelova, J., Fiser, B., & Bakken, E. E. (2002) Non-photic solar associations of heart rate variability
and myocardial infarction. Journal of atmospheric and solar-terrestrial physics, 64(5–6), 707–720.
◆◆ Dobšák, P., Nováková, M., Fišer, B., Siegelová, J., Balcárková, P., Špinarová, L., Vítovec, J., Minami, N.,
Nagasaka, M., Kohzuki, M., Yambe, T., Imachi, K., Nitta, S.I., Eicher, J. C., &Wolf, J. E. (2006). Electrical
stimulation of skeletal muscles: An alternative to aerobic exercise training in patients with chronic
heart failure? International Heart Journal, 47(3), 441–453.
◆◆ Dobšák, P., Nováková, M., Siegelová, J., Fišer, B., Vítovec, J., Nagasaka, M., Kohzuki, M., Yambe, T., Nitta,
S.I., Eicher, J. C., Wolf, J. E., & Imachi, K. (2006). Low-frequency electrical stimulation increases muscle
strength and improves blood supply in patients with chronic heart failure. Circulation Journal, 70(1),
75–82.
◆◆ Fiser, B., Honzíková, N., & Semrád, B. (1992). Pressure wave cardiography; cardiac diagnosis by means
of noninvasive continuous blood pressure record. Physiological Research / Academia Scientiarum Bohemoslovaca,
41(1), 25–29.
◆◆ Fiser, B., & Janik, P. (1982). Relaxation of the myocardium of the perfused and ischaemic rabbit heart.
Physiologia Bohemoslovaca, 31(5), 401–406.
◆◆ Fiser, B., & Janik, P. (1985). Effect of a low sodium medium, ouabain and noradrenaline on relaxation of
the myocardium of the perfused rabbit heart. Physiologia Bohemoslovaca, 34(1), 77–84.
◆◆ Halberg, F., Cornélissen, G., Schwartzkopff, O., Syutkina, E. V., Grigoriev, A. E., Mitish, M. D., Yatsyk,
G. V., Studenikin, M. Y., Gubin, D., Gubin, G., Siegelova, J., Fiser, B., Dusek, J., Homolka, P., Watanabe, Y.,
Otsuka, K., Perfetto, F., Tarquini, R., & Delmore, P. (1999). Spin-offs from blood pressure and heart rate
studies for health care and space research. In Vivo, 13(1), 67–76.
◆◆ Halberg, F., Cornélissen, G., Otsuka, K., Watanabe, Y., Katinas, G. S., Burioka, N., Delyukov, A., Gorgo,
Y., Zhao, Z., Weydahl, A., Sothern, R. B., Siegelova, J., Fiser, B., Dusek, J., Syutkina, E. V., Perfetto, F.,
Tarquini, R., Singh, R. B., Rhees, B., Lofstrom, D., Lofstrom, P., Johnson, P. W. C., & Schwartzkopff, O.
(2000). Cross-spectrally coherent ~10.5- and 21-year biological and physical cycles, magnetic storms and
myocardial infarctions. Neuroendocrinology Letters, 21(3), 233–258.
◆◆ Halberg, F., Cornélissen, G., Watanabe, Y., Otsuka, K., Fiser, B., Siegelova, J., Mazankova, V., Maggioni,
C., Sothern, R. B., Kalinas, G. S., Syutkina, E. V., Burioka, N., & Schwartzkopff, O. (2001). Near 10-year
and longer periods modulate circadians: Intersecting anti-aging and chronoastrobiological research.
Journals of Gerontology – Series A Biological Sciences and Medical Sciences, 56(5), M304–M324.
◆◆ Halberg, F., Cornélissen, G., Otsuka, K., Fiser, B., Mitsutake, G., Wendt, H. W., Johnson, P., Gigolashvili,
M., Breus, T., Sonkowsky, R., Chibisov, S. M., Kalinas, G., Siegelová, J., Dusek, J., Singh, R. B., Berri, B.
L., & Schwartzkopff, O. (2005). Incidence of sudden cardiac death, myocardial infarction and far- and
near-transyears. Biomedicine and Pharmacotherapy, 59(SUPPL. 1), S239–S261.
◆◆ Honzík, P., Křivan, L., Lokaj, P., Lábrová, R., Nováková, Z., Fišer, B., & Honzíková, N. (2010). Logit and
fuzzy models in data analysis: Estimation of risk in cardiac patients. Physiological Research, 59(SUPPL.1),
89–96.
◆◆ Honzíková, N., & Fišer, B. (2009). Baroreflex sensitivity and essential hypertension in adolescents.
Physiological Research, 58(5), 605–612.
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NONINVASIVE METHODS IN CARDIOLOGY 2013
◆◆ Honzikova, N., Fiser, B., & Semrad, B. (1973). Ventricular function in patients with atrial fibrillation.
A simulation model study with the aid of a computer. Cor et Vasa, 15(4), 257–264.
◆◆ Honzíková, N., Fiser, B., & Honzík, J. (1992). Noninvasive determination of baroreflex sensitivity in man
by means of spectral analysis. Physiological Research / Academia Scientiarum Bohemoslovaca, 41(1), 31–37.
◆◆ Honzikova, N., Fiser, B., Penaz, J., & Honzik, J. (1995). The relationship between spontaneous fluctuations
in diastolic pressure and in the rate of blood-pressure decrease during diastole. Homeostasis in
health and disease, 36(2–3), 160–164.
◆◆ Honzikova, N., Fiser, B., & Semrad, B. (2000). Critical value of baroreflex sensitivity determined by
spectral analysis in risk stratification after myocardial infarction. PACE – Pacing and Clinical Electrophysiology,
23(11 II), 1965–1967.
◆◆ Honzikova, N., Labrova, R., Fiser, B., Maderova, E., Novakova, Z., Zavodna, E., & Semrad, B. (2006).
Influence of age, body mass index, and blood pressure on the carotid intima-media thickness in normotensive
and hypertensive patients. Biomedizinische Technik, 51(4), 159–162.
◆◆ Honzíková, N., Nováková, Z., Závodná, E., Paděrová, J., Lokaj, P., Fišer, B., Balcárková, P., & Hrstková, H.
(2006). Baroreflex sensitivity in children, adolescents, and young adults with essential and white-coat
hypertension. Klinische Padiatrie, 218(4), 237–242.
◆◆ Honzikova, N., Penaz, J., & Fiser B. (1988). Power spectra of blood-pressure and heart-rate fluctuations
during mental load. Journal of interdisciplinary cycle research, 19(1), 75–79.
◆◆ Honzikova, N., Penaz, J., & Fiser, B. (1990). Individual features of circulatory power spectra in man.
European Journal of Applied Physiology and Occupational Physiology, 59(6), 430–434.
◆◆ Honzikova, N., Penaz, J., Fiser, B., & Honzik, J. (1995). The relationship between the spontaneous fluctuation
in circulation and dept and rate of respiration. Homeostasis in health and disease, 36(2–3), 165–169.
◆◆ Honzíková, N., Semrád, B., Fišer, B., & Lábrová, R. (2000). Baroreflex sensitivity determined by spectral
method and heart rate variability, and two-years mortality in patients after myocardial infarction.
Physiological Research, 49(6), 643–650.
◆◆ Javorka, M., Lazarova, Z., Tonhajzerova, I., Turianikova, Z., Honzikova, N., Fiser, B., Javorka, K., & Baumert,
M. (2011). Baroreflex analysis in diabetes mellitus: Linear and nonlinear approaches. Medical and
Biological Engineering and Computing, 49(3), 279–288.
◆◆ Jíra, M., Závodná, E., Honzíková, N., Nováková, Z., & Fišer, B. (2006). Baroreflex sensitivity as an individual
characteristic feature. Physiological Research, 55(3), 349–351.
◆◆ Jíra, M., Závodná, E., Honzíková, N., Nováková, Z., Vašků, A., Izakovičová Hollá, L., & Fišer, B. (2010).
Association of A1166C polymorphism in AT1 receptor gene with baroreflex sensitivity. Physiological Research,
59(4), 517–528.
◆◆ Jíra, M., Závodná, E., Nováková, Z., Fišer, B., & Honzíková, N. (2010). Reproducibility of blood pressure
and inter-beat interval variability in man. Physiological Research, 59(SUPPL.1), 113–121.
◆◆ Jíra, M., Závodná, E., Honzíková, N., Nováková, Z., Vašků, A., Hollá, L. I., & Fišer, B. (2011). Association
of eNOS gene polymorphisms T-786C and G894T with blood pressure variability in man. Physiological
Research, 60(1), 193–197.
◆◆ Krontorádová, K., Honzíková, N., Fišer, B., Nováková, Z., Závodná, E., Hrstková, H., & Honzík, P. (2008).
Overweight and decreased baroreflex sensitivity as independent risk factors for hypertension in children,
adolescents, and young adults. Physiological Research, 57(3), 385–391.
◆◆ Lábrová, R., Honzíková, N., Maděrová, E., Vysočanová, P., Nováková, Z., Závodná, E., Fišer, B., & Semrád,
B. (2005). Age-dependent relationship between the carotid intima-media thickness, baroreflex
sensitivity, and the inter-beat interval in normotensive and hypertensive subjects. Physiological Research,
54(6), 593–600.
◆◆ Nováková, Z., Balcárková, P., Honzíková, N., Fišer, B., Závodná, E., Hrstková, H., Krontorádová, K.,
& Šťastná, J. (2007). Arterial blood pressure and baroreflex sensitivity 1–18 years after completing anthracycline
therapy. Neoplasma, 54(2), 162–167.
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NONINVASIVE METHODS IN CARDIOLOGY 2013
◆◆ Nováková, Z., Štastná, J., Honzíková, K., Hrstková, H., Honzíková, N., Závodná, E., Fišer, B., & Honzík,
P. (2010). Anthracycline therapy and 24-hour blood-pressure profile in long-term survivors of childhood
cancer. Physiological Research, 59(SUPPL.1), 97–102.
◆◆ Penaz, J., Honzikova, N., & Fiser, B. (1978). Spectral analysis of resting variability of some circulatory
parameters in man. Physiologia Bohemoslovaca, 27(4), 349–357.
◆◆ Savin, E., Siegelova, J., Fiser, B., & Martineaud, J. (1996). Non-invasive determination of aortic compliance
in man. [Determination non invasive de la compliance aortique chez l’homme] Archives of Physiology
and Biochemistry, 104(3), 257–264.
◆◆ Siegelova, J., Fiser, B., Dusek, J., & Al-Kubati, M. (1995). Baroreflex sensitivity in patients with essential
hypertension: Role of enalapril. [BAROREFLEX-SENSITIVITATSMESSUNG BEI PATIENTEN MIT
ESSENTIELLER HYPERTONIE: EINFLUSS VON ENALAPRIL] Nieren- Und Hochdruckkrankheiten, 24(1),
20–22.
◆◆ Siegelova, J., & Fiser, B. (2011). Day-to-day variability of 24-h mean values of SBP and DBP in patients
monitored for 7 consecutive days. Journal of Hypertension, 29(4), 818–819.
◆◆ Weise, F., Fiser, B., & Honzikova, N. (1995). Cardiac baroreflex function during static muscular-contraction
assessed by finger arterial-pressure and pulse interval spectral-analysis. Homeostasis in health and
disease, 36(2–3), 170–176.
◆◆ Zavodna, E., Honzikova, N., Hrstkova, H., Novakova, Z., Moudr, J., Jira, M., & Fiser, B. (2006). Can we
detect the development of baroreflex sensitivity in humans between 11 and 20 years of age? Canadian
Journal of Physiology and Pharmacology, 84(12), 1275–1283.
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NONINVASIVE METHODS IN CARDIOLOGY 2013
PROF. MUDR. B. FIŠER, CSC.,
*22 OCTOBER 1943 – †21 MARCH 2011:
INTERNATIONAL COOPERATION IN MEDICINE
JARMILA SIEGELOVÁ
Department of Physiotherapy, Faculty of Medicine, Masaryk University, Brno
Prof. Bohumil Fišer was Head of the Department of Physiology, Faculty of Medicine, Masaryk University,
Brno 1995–2008, Minister of Health in the Czech Republic in 2000–2002, member of executive committee
of WHO 2003–2008. He was a highly respected scientist of worldwide renown in the field of normal
and pathological physiology and a successful organizer in health service.
During his studies at the Faculty of Medicine of Masaryk University (1960–1966) he had been working
in the Institute of Medical Physics until 1964. In 1964 he started to work, together with me, in the Department
of Physiology. The Department of Physiology in University of J. E. Purkyne (Masaryk University) was
very well known all over the world. The head of the department was prof. MUDr. Vladislav Kruta, DrSc.,
who cooperated with the physiologists from England, France, Netherlands, Switzerland and others. Some
of younger coworkers in his team became professors in the future.
Professor Kruta was sending his coworkers in the Dept. of Physiology abroad and saw in the international
cooperation the best means for international scientific work. Prof. MUDr. Jan Peňáz, CSc., was in
the Netherlands, prof. MUDr. Pavel Bravený, CSc., was in the USA, prof. MUDr. Miloš Kukleta, CSc., was
in France, prof. MUDr. Bořivoj Semrád, CSc., was in Germany, prof. MUDr. Bohumil Fišer, CSc., was in
the Netherlands, prof. MUDr. Jarmila Siegelová, DrSc., was in Germany, doc. MUDr. Josef Šumbera, CSc.,
was in Switzerland, assistant professor MUDr. Zdeněk Franz, CSc., was in France. The young colleagues
assistant professor MUDr. Pavel Buriánek, CSc., and assistant professor MUDr. Jaroslava Hlávková started
their work in Brno.
The important scientific events in 1969 were International Symposium of J. E. Purkyně in Prague and
in 1970 Congress “Association des Physiologistes” in Brno, both organized by Professor Kruta and his colleagues
from the Dept. of Physiology. This fruitful period influenced Professor Fišer in his own scientific
work, not only in publishing, but also in meeting experts and scientists and in discussions and dealing
with scientific questions.
Prof. MUDr. Vladislav Kruta, DrSc., 1908–1979, Head, Dept. of Physiology, 1953–1970
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NONINVASIVE METHODS IN CARDIOLOGY 2013
The first scientific and publication activities of Professor Fišer started in 1966 in cooperation with Professor
Jan Peňáz and were concentrated on frequency analysis of blood pressure oscillations in rabbits.
At that time Professor Peňáz developed noninvasive volume-clamp method of blood pressure measurement
on finger. The figure shows the first prototype of Peňáz equipment in 1966.
Professor MUDr. Jan Peňáz, CSc.
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NONINVASIVE METHODS IN CARDIOLOGY 2013
To compare the noninvasive measurement of blood pressure with the invasive measurement of blood
pressure in arteria brachialis, it was important to measure blood pressure continuously invasively and
noninvasively by beat by beat measurement simultaneously; the experiment is shown on the next figure.
The experiment was done by Prof. Semrád and Prof. Peňáz on the person of Professor Fišer.
Figure 1 Invasive and noninvasive measurement of blood pressure on the person of Professor Fišer
Professor Fišer and Professor Semrád performed the analysis of pulse pressure and pulse interval in
patients with atrial fibrillation, using various mathematical methods and method of Monte Carlo including
the heart rate rhythm regulation of heart contractility in man. The study of heart contractility in man
confirmed the findings of contractility regulation in isolated heart experiments discovered by Professor
Vladislav Kruta, Professor Pavel Bravený and others co-authors from the same physiological department.
His scientific work from the studies mentioned above was finished by CSc. thesis in 1978.
Figure 2 Professor Fišer, Professor Peňáz and Professor Siegelová in Brno, 2008,
at the occasion of 100th anniversary of the birthday of Professor Kruta
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NONINVASIVE METHODS IN CARDIOLOGY 2013
He also contributed to the first clinical measurement of cardiac output and first electrophysiological
examination of the human heart in St. Anna Teaching Hospital together with Professor Bořivoj Semrád,
Professor Karel Zeman and senior lecturer Josef Šumbera.
Professor Fišer presented the results of his scientific experiments concerning the interrelationships
between heart rate fluctuations and blood pressure fluctuations using autocorrelation functions and power
spectral densities on the XXVI. INTERNATIONAL CONGRESS OF PHYSIOLOGICAL SCIENCES in New
Delhi, India in 1974 and XXVIII. INTERNATIONAL CONGRESS OF PHYSIOLOGICAL SCIENCES in Budapest,
Hungary in 1980.
He had a possibility to meet the experts on cardiovascular physiology all over the word. He was able to
speak English, German and French and also to publish in all three languages.
International cooperation of Professor B. Fišer in science and research could be fully extended only
after the Velvet Revolution in 1989.
Figure 3 Czech-English Congress of Physiological Society in Prague
Figure 4 Discussion with Professor J. Widdicomb, M.D. (London) in Charles University, Prague
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NONINVASIVE METHODS IN CARDIOLOGY 2013
COOPERATION PARIS, FRANCE AND BRNO, MASARYK
UNIVERSITY
The cooperation with Professor Jean-Paul Martineaud (27 March 1931 – 29 November 2010), Medical
Faculty, Lariboisiére Hospital, University de Paris (France) was very intensively developed and common
hemodynamic studies were provided as a non-invasive measurement of aortic compliance and blood
flow regulation in cerebral arteries, both in healthy subjects and patients, and published in international
journals.
Figure 5 Prof. Fišer, Prof. Siegelová and Prof. Jean Paul Martineaud, M.D., Paris, France
(cooperation from 1976 to 2010) in Dept. of Physiology Brno
Figure 6 Experiments were done in Paris, Hopital Lariboisiere, Professor J.P. Martineaud,
his team and Brno team (Professor Fišer, Professor Siegelová)
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NONINVASIVE METHODS IN CARDIOLOGY 2013
Figure 7 Scheme of experiment
Figure 8 Measurement of middle cerebral artery (DOPLER) and blood pressure (FINAPRES OHMEDA)
Figure 9 Middle cerebral artery (MCA), and blood pressure (mmHg) during occlusure
and after cuff release (5 s and 5 s) for 1 subject
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NONINVASIVE METHODS IN CARDIOLOGY 2013
The study Blood Flow Control of extra and intracranial arterial vessels during moderate hypotension
was carried out in ten healthy subjects to precise characteristics of autoregulation in the cephalic circulation.
It consisted of measurements of blood velocities in middle cerebral artery (MCA), intracranial
branch of internal carotid artery, and in temporal superficial artery (TSA), extracranial branch of external
carotid, during a sudden and moderate fall (−9%) in arterial systemic pressure. In this situation, flow
velocities in MCA and TSA decreased abruptly, −16% and –30% respectively, during the first cardiac cycle.
The recovery was different in the branches of the common carotid artery: it was fast in MCA, beginning
with the second cardiac cycle and completed in five seconds; while it was longer in TSA, remaining low till
approximately the thirtieth second. It is suggested that myogenic autoregulation can be present in extracranial
as well as in intracranial arterial vessels and would be efficient in one minute roughly. In cerebral
arteries, however, other mechanisms developed and a faster recovery is probably explained by intervention
of the autonomic nervous system, perhaps via the baroreflex. Then autoregulation protects effectively
the cerebral blood flow in the case of a sudden hypotension.
Tab. 1 Middle cerebral artery (MCA), superficial artery (TSA) velocities (cm.s−1) and common carotid artery blood flow
(CCA) ml.min−1 and blood pressure (mmHg) at rest, during occlusure and after cuff release (1,5 and 10 s) for 10 subjects
(values are means ±SD, * = p < 0.05; comparison with rest value)
Rest Occluding
Cuff release
1s 5s 10s
MCA
cm.s−1
50.3
±11.6
50.1
±10.2
*
41.8
±11.6
49.3
±10.9
51.6
±10.5
TSA
cm.s−1
10.9
±2.5
10.6
±2.6
*
7.4
±2.5
*
8.2
±2.2
*
8.2
±2.4
CCA
ml.min−1
*
305.1
±23.4
299.1
±23.7
232.7
±33.2
281.5
±43.3
292.5
±29.6
Blood pressure
mm.Hg
101.4
±23.4
299.1
±9.9
*
89.8
±10.3
*
86.4
±10.0
*
90.5
±10.0
Heart rate
beats.min−1
87.0
±17.0
82.0
±14.0
88.0
±14.0
*
92.0
±12.0
86.0
±15.0
Figure 10 Prof. Fišer, Prof. Siegelová and Prof. Jean Paul Martineaud, M.D., in Prague
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NONINVASIVE METHODS IN CARDIOLOGY 2013
Figure 11 Prof. Siegelová, A. Siegelová, Prof. Fišer, and Prof. Jean Paul Martineaud, M.D., in Brno
SCIENTIFIC COOPERATION UNIVERSITY GRAZ – UNIVERSITY
BRNO
The international cooperation continued with Professor Thomas Kenner from the Department of Physiology
in University in Graz (Austria), where the original studies of heart rate variability, baroreflex sensitivity
and chronobiology were realized and included in the common international project of analysis of
cardiovascular control in physiology and pathophysiology.
Prof. Dr. Thomas Kenner, M.D., Dr. h.c. multi, was honored by Dr. h. c. Universität Jena, 1990, by Dr. h. c.
in Germany, Semmelweis University Budapest, 1998, by Dr. h. c. in Hungary, Masaryk University Brno in
the Czech Republic, 2000, by Doctor Honoris Causa Masaryk University, 2000.
The book E. Wetterer, Th. Kenner: Grundlagen der Dynamik des Arterienpulses Springer-Verlag, Berlin,
Heidelberg, New York 1968, is the fundamental scientific work which gave rise to Professor Fišer studies
about cardio-ankle vascular index, aortic compliance and pressure wave velocity as measures of arterial
stiffness.
Stiffness of large arteries has been related to cardiovascular mortality. It can be expressed by pressure
wave velocity (PWV), aortic compliance (C) and by the cardio-ankle vascular index (CAVI). C was measured
noninvasively in normotensive and hypertensive human subjects and in human cadavers’ aortas,
PWV and CAVI were calculated. Despite completely different experimental situation the results of both
analyses were similar. Also regression coefficients between C and blood pressure were similar in both
experimental conditions.
The mathematical approach consisted in calculating PWV and CAVI in a group of normotensive and
hypertensive subjects where the aortic compliance was non-invasively measured and comparing the
­results with published data obtained from isolated aortas of human cadavers.
The stiffness parameter beta is reported to be independent of blood pressure and is calculated as
BETA = ln(Ps / Pd) × D / dD
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NONINVASIVE METHODS IN CARDIOLOGY 2013
where Ps and Pd are respectively the systolic and diastolic blood pressure in mmHg. D is the diameter of
the blood vessel and dD is the change of D. D/dD can be replaced by 2 × V / dV where V is the volume of the
tube, the volume of aorta in our case.
BETA = ln(Ps / Pd) × 2 × V / dV
The relationship between volume elastic modulus V × dP / dV (index of the stiffness) and PWV is expressed
by the formula
PWV2 = (V × dP / dV) / ρ
where ρ is blood density. Aortic compliance is dV / dP. Thus
V / dV = ρ × PWV2 / dP
If we substitute equation (4) for equation (2) we obtain the stiffness parameter
BETA = CAVI = ln(Ps / Pd) × 2 × (ρ / dP) × PWV2
and volume measurement by ultrasound is superfluous. The last equation expresses the relationship between
CAVI and PWV. On the other hand, direct comparison of these parameters with compliance (dV / dP)
is not possible because the value V (aortic volume) is missing. We used in our comparison the estimates of
V from cadaver studies.
The cadaver study includes 27 aortas from the subjects 20 to 83 years old. The results are published in
Kenner Wetterer monograph.
Figure 12 Professor Fišer
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NONINVASIVE METHODS IN CARDIOLOGY 2013
The compliance data were obtained by noninvasive measurement from 8 healthy men 27 + 9 years
old (from 21 to 49 years) with 24-hour blood pressure 121 + 10 / 75 + 8 mmHg, from 10 not-treated hypertensive
men 48 + 8 years old (from 38 to 58 years) with 24-hour blood pressure values 147 + 12 / 88 + 9
mmHg and from 6 hypertensive patients treated with verapamil (slow release formula) 240 mg/24 h for
3 months. The mean age was 43 + 9 years (from 32 to 53). Twenty four-hour blood pressure values were
143 + 7 / 88 + 4 mmHg before the treatment and 131 + 4 / 80 + 4 mmHg at the time of compliance investigation.
The method and the results of compliance measurement are described elsewhere.
The results of the cadaver study are seen in Fig. 13. From the Figure it 1 it is clear that the slopes of
the curves (which correspond to the compliance dV / dP) are pressure-dependent. The parameters of the
best fitted polynomal curves are seen in the table. Together with compliance values at 80 mmHg (value of
diastolic pressure), the parameters of linear relationship between compliance and pressure and calculated
PWV at 90 mmHg (value of mean arterial pressure) and CAVI (which is not pressure-dependent). PWV
was calculated according to the equation. Because PWV is aortic pulse wave velocity which is different
from cardio-ankle pulse wave velocity, we calculated at first aortic beta according to the equation and then
we calculated CAVI using the regression equation CAVI = 7.5 + 0.15 × aortic BETA. For CAVI we assume
Ps / d = 120 / 80 mmHg.
Aorta, pressure-volume diagram
0
50
100
150
200
250
300
0 50 100 150 200 250
mmHg
ml
20-39 years
40-59 years
60-69 years
70-83 years
Figure 13 Pressure-volume diagram of cadavers’ aortas
The results of the analysis of our compliance data are seen in the next table. The compliance values
were non-invasively measured as well as coefficients A and B, which we used for calculation of compliance
at 80 mmHg. The volume V was not measured in our study and thus we used the values of V from cadavers’
aortas studies for the calculation of PWV estimate again for mean pressure of 90 mmHg. Calculation of
CAVI we performed identically as in cadavers’ aortas analysis.
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NONINVASIVE METHODS IN CARDIOLOGY 2013
Tab. 2 Cadavers’ aortas study
Ages (n)
years
a b c A B
dV/dp
(80mmHg)
ml/mmHg
PWV
m/s
BETA
aortic
CAVI
20–39 (8) 40.54 1.897 −0.0051 1.897 −0.0102 1.081 11.71 21.08 10.66
40–59 (9) 76.77 1.778 −0.0050 1.778 −0.0100 0.978 13.20 26.78 11.51
60–69 (5) 105.10 1.849 −0.0054 1.849 −0.0108 0.985 14.20 31.00 12.15
70–83 (6) 144.40 1.510 −0.0045 1.510 −0.0090 0.790 15.95 39.11 13.36
Legend: parameters a, b, c correspond to equation; volume = a + b* pressure +c* pressure2
; parameters A, B: compliance = A + B*
pressure; dV/dP (80mmHg): compliance at pressure 80 mmHg; PWV: pulse wave velocity; BETA: aortic stiffness; CAVI cardio-ankle
vascular index.
Tab. 3 Human noninvasive study
Group (n)
dV/dp
ml/mmHg
A B
dV/dp
(80mmHg)
ml/mmHg
PWV
m/s
BETA
aortic
CAVI
Normotensives (6) 1.18 ±0.25 2.328 0.0154 0.969 11.77 21.29 10.69
Hypertensives (10) 0.96 ±0.21 2.219 0.0144 0.923 13.37 27.48 11.62
Treated hypertensives (6) 0.90 ±0.11 1.843 0.0122 0.745 13.86 29.50 11.92
Legend: dV/dp (±SD): measured compliance. Other parameters as in Table 1.
Despite a completely different experimental situation the results of both analyses are similar. The
most interesting finding is similar regression coefficient B despite the fact that the smooth muscle cells in
cadavers’ aortas are dead.
Stiffness of large arteries has been related to cardiovascular mortality. It can be expressed by pressure
wave velocity (PWV), aortic compliance (C) and by the cardio-ankle vascular index (CAVI). C was
measured noninvasively in normotensive and hypertensive human subjects and in human cadavers’ aortas,
PWV and CAVI were calculated. Despite a completely different experimental situation the results of
both analyses were similar. Also regression coefficients between C and blood pressure were similar in both
experimental conditions.
Figure 14 Professor Fišer
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NONINVASIVE METHODS IN CARDIOLOGY 2013
Figure 15 Professor Siegelová, B. Kenner, Professor Fišer in University Graz in the scientific meeting
COOPERATION WITH UNIVERSITY OF MINNESOTA
The personality of chronobiologist Professor Franz Halberg, (5 July 1919 – 9 June 2013): M.D., Dr. h.c.
(Montpellier), Dr. h.c. (Ferrara), Dr. h.c., (Tyumen), Dr. h.c. (Brno), Dr. h.c. (L’Aquila), Dr. h.c. (People’s Friendship
University of Russia, Moscow), Professor of Laboratory Medicine and Pathology, Physiology, Biology,
Bioengineering and Oral medicine, Director, Halberg Chronobiology Center, University of Minnesota.
Cooperation with Profesor Fišer from University Brno and Brno team (Professor Siegelová, Dr. Dušek)
took place from 1988 to 2011. The common cooperation led to the nomination of Professor Franz Halberg as
Doctor Honoris Causa Masaryk University in 2000. He was a founder of chronobiology, proposed 24-hours
blood pressure measurement in 1948. Later he and his team from Halberg Chronobiology Center proposed
7-day blood pressure measurement in 1990.
Figure 16 Prof. Franz Halberg, M.D., Dr. h. c. multi, and prof. MUDr. Bohumil Fišer, CSc.,
in Brno during symposium Noninvasive methods in cardiology 2003
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NONINVASIVE METHODS IN CARDIOLOGY 2013
Figure 17 Professor Halberg, Dr. Souček, Professor Siegelová, B. Kenner,
Professor Kenner, Professor Fišer in Brno congress
Figure 18 Professor Fišer, Professor Halberg, Professor Honzíková and Professor Bravený in Brno 1996, Symposium
Cardiovascular Coordination in Health and Blood Pressure Disorders, dedicated to 70th Anniversary of Professor Peňáz
Figure 19 Professor Halberg, Professor Bravený, B. Kenner, Professor Kenner, Professor Siegelová, Professor Peňáz
and Professor Fišer in Brno 1996, Symposium Cardiovascular Coordination in Health and Blood Pressure Disorders,
dedicated to 70th Anniversary of Professor Peňáz
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NONINVASIVE METHODS IN CARDIOLOGY 2013
Cooperation with Professor Franz Halberg and with Professor Germaine Cornélissen, Halberg Chronobiology
Center of the University of Minnesota, USA started in 1988. The studies of circadian variability
of cardiovascular variables and baroreflex sensitivity were published in many papers as the result of this
common work.
In 1995 Professor Bohumil Fišer was invited as a distinguished scientist for a lecture to the Supercomputer
Institute of University of Minnesota (USA) and presented there the paper about the use of supercomputers
in prevention of stroke and cardiac death.
Brno congresses were organized as MEFA Congresses 1990–2006 every year and Noninvasive Methods
in Cardiology Eds. Halberg F., Kenner T., Fišer B., Siegelová J. in the years 1994, 1996, 1999, 2002, 2003,
2004, 2007, 2008, 2009, 2010, 2011.
Blood pressure control in man was the main task of the common chronobiological studies. The common
work showed that blood pressure measurement in doctor’s office is not reliable and sufficient for the
diagnosis of hypertension. The measurement of blood pressure using measurement of blood pressure beatto-beat
was described in further studies about baroreflex sensitivity, heart rate variability, blood pressure
variability. BIOCOS project showed that we need measurement of blood pressure for longer period of time,
not only 24 hours, but seven day ambulatory blood pressure monitoring.
Figure 20 Congress Noninvasive Methods in Cardiology1999, Brno, St. Anna Hospital
The BIOCOS project in 2006 in Brno discussed the circadian blood pressure variability, MESOR hypertension,
Circadian Hyperamplitude Tension, heart rate variability and the risk of further cardiovascular
diseases connected with circadian blood pressure changes and the discussion finally was integrated in
Consensus on means and need to detect vascular variability disorders and vascular variability syndrome.
The vascular variability disorders were also published in the paper devoted to Professor Fišer and his work
in the following figures.
Prof. Fišer untimely death notwithstanding, he will be with us in spirit in our efforts to change a
medicine based on a number of diagnoses to an objective assessment of many novel rhythms and other
variability alterations in cardiovascular parameters. Thereby, health care can change from one based on
sheer intuition and hard-to-define experience listing a number of diagnoses to an objective assessment of
many novel biological rhythms.
Prof. Bohumil Fišer was a physiologist, scientist and teacher par excellence. He was an extremely busy
and productive scientist and excellent organizer of physiological department.
We should never forget that the historical progress in science and medicine was achieved also due to
the work of Professor Bohumil Fišer.
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NONINVASIVE METHODS IN CARDIOLOGY 2013
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NONINVASIVE METHODS IN CARDIOLOGY 2013
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NONINVASIVE METHODS IN CARDIOLOGY 2013
REFERENCES
1.	 Proceedings of the 1st Int.Fair of med.Technology and Pharmacy. Brno: Eds T.Kenner, J.P.Martineaud,
P.Mayer, B.Semrád, J.Siegelová, B. Fišer. 1993.
2.	 Halberg F, Kenner T, Fiser B, Siegelova J (eds): Faculty of Medicine, Masaryk University, Brno (1996).
3.	 Halberg F, Kenner T, Fiser B, Siegelova J (eds): Chronobiology and non-invasive methods in cardiology.
Brno IDV PZ, MU, 1999. ISBN 80-7013-279-5. Faculty of Medicine, Masaryk University, Brno (1999).
4.	 Halberg F, Kenner T, Fiser B (eds): The importance of chronobiology in diagnosis and therapy of internal
diseases. Faculty of Medicine, Masaryk University, Brno (2002)
5.	 Halberg F, Kenner T, Siegelova J (eds): The importance of chronobiology in diagnosis and therapy of
internal diseases. Faculty of Medicine, Masaryk University, Brno (2003)
6.	 Cornelissen G, Kenner T, Fiser B, Siegelova J (eds): Chronobiology in medicine. Faculty of Medicine,
Masaryk University, Brno (2004)
7.	 Halberg F, Kenner T, Fiser B, Siegelova J (eds): Nonivasive methods in cardiology 2006. Faculty of Medicine,
Masaryk University, Brno (2006)
8.	 Halberg F, Kenner T, Fiser B, Siegelova J (eds): Nonivasive methods in cardiology 2007. Faculty of Medicine,
Masaryk University, Brno (2007)
9.	 Halberg F, Kenner T, Fiser B, Siegelova J (eds): Nonivasive methods in cardiology 2008 Faculty of Medicine,
Masaryk University, Brno (2008)
10.	 Halberg F, Kenner T, Fiser B, Siegelova J (eds): Nonivasive methods in cardiology 2009 Faculty of Medicine,
Masaryk University, Brno (2009)
11.	 Halberg F, Kenner T, Fiser B, Siegelova J (eds): Nonivasive methods in cardiology 2010; Faculty of Medicine,
Masaryk University, Brno (2010)
12.	 Prikryl P, Siegelova J, Cornélissen G, Dusek J, Dankova E, Fiser B, Vacha J, Ferrazzani S, Tocci A, Caruso
A, Rao G, Fink H, Halberg F, International Womb-to-Tomb Chronome Initiative Group: Chronotherapeutic
pilot on 6 persons may guide tests on thousands: Toward a circadian optimization of prophylactic
treatment with daily low-dose aspirin. University of Minnesota/Medtronic Chronobiology Seminar
Series, #3, December 1991, 4 pp. text, 4 figures.
13.	 Siegelova J., Fiser B., Dusek J., Cornélissen G., Halberg F. 24-Stunden-Baroreflex-Sensitivitätsmessung
bei normotonen Personen. Hochdruck 11: 101, 1991.
14.	 Siegelova J., Fiser B., Dusek J., Cornélissen G., Halberg F. Baroreflex sensitivity during 24 hours. Scripta
medica (Brno) 64: 186, 1991.
15.	 Fiser B., Siegelova J., Dusek J., Cornélissen G., Halberg F. Baroreflex heart rate sensitivity during 24
hours period evaluated by spectral analysis of blood pressure record. Scripta medica (Brno) 65: 315,
1992.
16.	 Fiser B., Siegelova J., Dusek J., Cornélissen G., Halberg F. Cosinor analysis of baroreceptor heart rate
sensitivity during 24-hour period. Arch. int. Physiol. Biochim. Biophys. 100: A87, 1992.
17.	 Fiser B., Siegelova J., Dusek J., Halberg F., Cornélissen G. Circadian variation of baroreflex heart rate
sensitivity in man. Abstract, IV International Symposium on Control of Heart Rhythm, Slovak Academy
of Sciences, Smolenice Castle, April 6–9, 1992, #11.
18.	 Fiser B., Siegelova J., Dusek J., Halberg F., Cornélissen G. Is the circadian variability of baroreflex dependent
upon sleep? Abstract, 6th Int. Cong. Psychophysiology, Charité, Berlin, Germany, Sept. 2–6,
1992, p. 63.
19.	 Siegelova J., Fiser B., Dusek J., Cornélissen G., Halberg F. Analysis of time parameters of respiratory
cycle during 24 hours. Arch. int. Physiol. Biochim. Biophys. 100: A130, 1992.
20.	Siegelova J., Fiser B., Dusek J., Cornélissen G., Halberg F. Conscious state and control of breathing:
power spectral density of respiratory and cardiovascular parameters. Abstract, 6th Int. Cong. Psychophysiology,
Charité, Berlin, Germany, Sept. 2–6, 1992, p. 219.
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NONINVASIVE METHODS IN CARDIOLOGY 2013
21.	 Siegelova J., Fiser B., Dusek J., Cornélissen G., Halberg F. Noninvasive determination of baroreflex
heart rate sensitivity in patients with mild hypertension during 24 hours. Abstracts, 14th Scientific
Meeting, International Society for Hypertension, Madrid, June 14–19, 1992, p. 326.
22.	Siegelova J., Fiser B., Dusek J., Cornélissen G., Halberg F. Spectral analysis of the timing of respiratory
cycle and cardiovascular parameters during 24 hours period. Abstract, 2nd High Tatras International
Health Symposium: Health Management, Organization, and Planning in Changing Eastern Europe,
Strbské Pleso, Czecho-Slovakia, October 16–18, 1992, p. 38.
23.	Siegelova J., Fiser B., Dusek J., Halberg F., Cornélissen G. Circadian variations of baroreflex heart rate
sensitivity in man. Physiological Research 41: 15 pp., 1992.
24.	Siegelova J., Fiser B., Dusek J., Halberg F., Cornélissen G. Control of respiratory cycle during 24-hour
period. Abstract, 13th Martin’s Days of Respiration, Martin, September 7–8, 1992, p. 16.
25.	Siegelova J., Fiser B., Dusek J., Semrád B., Halberg F., Cornélissen G. 24-hodinové monitorování
krevního tlaku u pacientu s esenciální hypertenzí. Abstract, XX. celostátní internistický kongres
s mezinárodní účastí Zlin, 1992, p. 64.
26.	Siegelova J., Fiser B., Dusek J., Semrád B., Mayer P., Sevela K., Halberg F., Cornélissen G. Circadian
variations of blood pressure in patients with essential and nephrogen hypertension. Scripta medica
(Brno) 65: 316, 1992.
27.	 Siegelova J., Fiser B., Sevela K., Dusek J., Mayer P., Halberg F., Cornélissen G. 24-hodinové monitorování
krevního tlaku u pacientů s nefrogenní hypertenzí léčených aceprilem. Abstract, XX. Celostátní
Internisticky kongres s mezinárodní účastí, Zlín, 1992, p. 65.
28.	Dusek J., Siegelova J., Fiser B., Al-Kubati M., Cornélissen G., Halberg F. Noninvasive determination of
baroreflex heart rate sensitivity in patients with essential hypertension during 24 hours. Abstract
173.38/P, IUPS Congress, Glasgow, 1993, p. 79.
29.	Fiser B., Siegelova J., Dusek J., Cornélissen G., Halberg F. Is the circadian variability of baroreflex dependent
upon sleep? Int. J. Psychophysiol. 14: 122, 1993.
30.	Fiser B., Siegelova J., Dusek J., Cornélissen G., Halberg F. Determination of heart rate-baroreflex sensitivity
in man by spectral analysis during 24-hour period. Scripta medica (Brno) 66: 11–14, 1993.
31.	 Fiser B., Siegelova J., Dusek J., Al-Kubati M., Cidl K., Semrád B., Cornélissen G., Halberg F. Determination
of baroreflex heart rate sensitivity in patients with essential hypertension during 24 hours using
vasodilatation method. Proceedings, 1st Int. Fair of Medical Technology and Pharmacy, Brno, Czech
Rep., November 3–6, 1993, Kenner T., Marineaud J.P., Mayer P., Semrád B., Siegelova J., Fiser B. eds.,
pp. 43–52.
32.	Siegelova J., Fiser B., Dusek J., Cornélissen G., Halberg F. Conscious state and control of breathing power
spectral density of respiratory and cardiovascular parameters. Int. J. Psychophysiol. 14: 149–150, 1993.
33.	Siegelova J., Fiser B., Dusek J., Mayer P., Semrad B., Halberg F., Cornélissen G. Cirkadianni variabilita
krevniho tlaku u pacientů v administrativě. “Človek a technika očima ergonoma”, Sbornik, Vysoká
škola zemědělská, Brno, 1993, pp. 30–37.
34.	Siegelova J, Fiser B, Dusek J, Semrád B, Cidl K, Sevela K, Halberg F, Cornélissen G. Blood pressure monitoring
in patients with essential hypertension during 24-hour. In: Kenner T, Marineaud JP, Mayer P,
Semrád B, Siegelova J, Fiser B, editors. Proceedings, 1st Int. Fair of Medical Technology and Pharmacy,
Brno, Czech Rep.; November 3–6, 1993. p. 53–59.
35.	Siegelova J., Fiser B., Dusek J., Semrád B., Cornélissen G., Halberg F. Baroreflex heart rate sensitivity
measurement in patients with essential hypertension (I WHO) during 24-hour period. Proceedings,
1st Int. Fair of Medical Technology and Pharmacy, Brno, Czech Rep., November 3–6, 1993, Kenner T.,
Marineaud J.P., Mayer P., Semrád B., Siegelova J., Fiser B. eds., pp. 36–39.
36.	Siegelova J., Fiser B., Dusek J., Mayer P., Halberg F., Cornélissen G. Circadian variation of baroreflex
heart rate sensitivity using non-invasive determination in healthy subjects. Proceedings, 1st Int. Fair
of Medical Technology and Pharmacy, Brno, Czech Rep., November 3-6, 1993, Kenner T., Marineaud
J.P., Mayer P., Semrád B., Siegelova J., Fiser B. eds., pp. 12–19.
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NONINVASIVE METHODS IN CARDIOLOGY 2013
37.	 Siegelova J., Fiser B., Dusek J., Semrad B., Halberg F., Cornélissen G. 24-hodinové monitorováni
krevního tlaku u pacientů s esencialní hypertenzí. Vnitr. Lek. 39: 183–190, 1993.
38.	Siegelova J, Fiser B, Dusek J, Sevela K, Halberg F, Cornélissen G. Circadian variability of blood pressure
in patients with essential hypertension and nephrogenous hypertension treated with enalapril.
Scripta medica (Brno) 1993; 66: 99–104.
39.	Siegelova J., Fiser B., Dusek J., Cornélissen G., Halberg F. Spectral analysis of the timing of respiratory
cycle and cardiovascular parameters during 24 hours period. 2nd High Tatras International Health
Symposium: Health Management, Organization, and Planning in Changing Eastern Europe, Strbske
Pleso, Czecho-Slovakia, October 16–18, 1992, New York, Bratislava, 1993, pp. 71–78.
40.	Cornélissen G, Bingham C, Siegelova J, Fiser B, Dusek J, Prikryl P, Sonkowsky RP, Halberg F. Cardiovascular
disease risk monitoring in the light of chronobioethics. Chronobiologia 1994; 21: 321–325.
41.	 Cornélissen G., Halberg F. Chronobiology of blood pressure: international cooperation with Dr. Jarmila
Siegelova, Dr. Jiri Dusek and Dr. Bohumil Fiser of Masaryk University. Scripta medica (Brno) 67 (S1):
7–8, 1994.
42.	Cornélissen G, Sothern RB, Wendt HW, Tarquini B, Antuñano M, Siegelova J, Fiser B, Dusek J, Prikryl
P, Halberg F. Statistical significance without biologic signification is not enough: illustrative example.
Chronobiologia 1994; 21: 315–320.
43.	Dusek J., Siegelova J., Fiser B., Cornélissen G., Halberg F. Chronobiology of blood pressure in waking
man under light mental load. Proc. Workshop, Chronobiology in Health and Disease – Control of Cardiovascular
and Respiratory Functions, Medical Faculty, Masaryk University, Brno, Czech Republic,
July 2–4, 1994, pp. 33–37.
44.	Halberg F, Bingham C, Siegelova J, Fiser B, Dusek J, Prikryl P, Sonkowsky RP, Cornélissen G. “Cancer
marker chronomes” assessed in the light of chronobioethics. Chronobiologia 1994; 21: 327–330.
45.	Siegelova J., Fiser B., Al-Kubati M., Dusek J., Cornélissen G., Halberg F. Airway resistance and cardiovascular
parameters during a 24-hour period. In: Proceedings, 3rd High Tatras International Health
Symposium, Preventive and Clinical Medicine in Changing Europe, Salat D., Badalik L., Krcmery V.
(eds.), Sympos, Tatranska Polianka, Slovak Republic, 1994, pp. 386–391.
46.	Siegelova J., Fiser B., Dusek J., Cornélissen G., Halberg F. Chronobiology of blood pressure in essential
hypertension. Proc. Workshop, Chronobiology in Health and Disease – Control of Cardiovascular and
Respiratory Functions, Medical Faculty, Masaryk University, Brno, Czech Republic, July 2–4, 1994, pp.
13–25.
47.	 Siegelova J., Fiser B., Dusek J., Cornélissen G., Halberg F. Cosinor analysis of 24-hour variations of respiratory
and cardiovascular values in awake healthy man. Abstract, XIV Martin’s Days of Respiration,
September 6–7, 1994, Martin, Slovakia, p. 6.
48.	Siegelova J., Fiser B., Dusek J., Halberg F., Cornélissen G. Cosinor analysis of blood pressure in patients
with essential and nephrogenous hypertension. Proc. International Workshop, Sun, Moon and Living
Matter, Mikulecky M. (ed.), Bratislava, Slovakia, June 29 – July 1, 1994. Slovak Medical Society,
Bratislava, 1994, pp. 116–121.
49.	Siegelova J., Fiser B., Dusek J., Halberg F., Cornélissen G. Působení bděleho stavu a lehké mentální
zátěže na cirkadianni variabilitu krevního tlaku u zdravých osob. Ceska Ergonomicka Spolecnost
uzemni organizace Brno a Katedra automobilu Vojenske akademie v Brne, Seminar: Cesty Rozvoje a
Uplatnovani Ergonomie a Bezpecnosti Prace v Podminkach Denni Praxe, 25 kvetna 1994, pp. 17–24. [In
Czech.]
50.	Dusek J., Siegelova J., Fiser B., Cornélissen G., Halberg F. Chronobiology of blood pressure in waking
man under light mental load. Scripta medica (Brno) 68: 62–63, 1995.
51.	 Dusek J., Siegelova J., Nekvasil R., Cornélissen G., Halberg F. Circaseptan rhythm in blood pessure and
heart rate in newborns. Abstract, MEFA ’95 Congress, Brno, Czech Republic, October 24–27, 1995, p. 10.
44
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52.	Dusek J., Siegelova J., Fiser B., Nekvasil R., Cornélissen G., Halberg F. Blood pressure variations in
newborns. Abstract #64, 1st Congress, Federation of European Physiological Societies, September 9-12,
1995, Maastricht, The Netherlands. Pflügers Archiv / Eur. J. Physiol. 430 (Suppl.): R24, 1995.
53.	Halberg F, Cornélissen G, Johnson D, Wrbsky P, Portela A, Beystrom B, Siegelova J, Fiser B, Dusek J,
Nekvasil R, Syutkina EV, Grigoriev AE, Abramian A, Mitish M, Yatsyk GV, Revilla M, Ardura J, Garcia
Alonso L, Bakken E, Delmore P, Maggioni C, Tarquini B, Mainardi G, Otsuka K, Watanabe Y, Kumagai
Y, Wakasugi K, Saito Yuzo, Tamura K. Chronobiologic environmental optimization starting with neonatal
care: opportunities for health and device industries. Handout, The Physical and Developmental
Environment of the High-Risk Infant, Orlando, Florida, January 19–21, 1995, 70 pp.
54.	Halberg F, Cornélissen G, Raab F, Schaffer E, Siegelova J, Fiser B, Dusek J, Prikryl P, Otsuka K. Automatic
physiologic 7-day monitoring and chronobiology. Jpn J Electrocardiol 1995; 15 (Suppl. 1): S-1-5–S-1-11.
55.	Halberg F, Cornélissen G, Siegelova J, Fiser B, Dusek J, Prikryl P, Otsuka K. Automatic physiology 7-day
monitoring and chronobiology. Policlinico (Chrono) 1995; 1 (2): 33–42.
56.	Siegelova J, Cornélissen G, Dusek J, Prikryl P, Fiser B, Dankova E, Tocci A, Ferrazzani S, Hermida R,
Bingham C, Hawkins D, Halberg F. Aspirin and the blood pressure and heart rate of healthy women.
Policlinico (Chrono) 1995; 1 (2): 43–49.
57.	 Siegelova J., Fiser B., Dusek J., Cornélissen G., Halberg F. Cosinor analysis of 24-hour blood pressure
profile in hypertensives before and after treatment with ACE-inhibitor enalapril. EuroRehab 4:
­203–206, 1995.
58.	Siegelova J., Fiser B., Dusek J., Cornélissen G., Halberg F. Chronobiology of blood pressure in essential
hypertension. Scripta medica (Brno) 68: 60–61, 1995.
59.	Cornélissen G, Halberg F, Johnson D, Gubin D, Gubin G, Otsuka K, Watanabe Y, Kumagai Y, Syutkin V,
Syutkina E, Grigoriev AE, Turti T, Mitish M, Siegelova J, Fiser B, Dusek J, Garcia Alonso L. Blood pressure
and heart rate chronomes, yardsticks of ontogeny and vascular disease risk. Keynote #114, 2nd
World Congress of Cellular and Molecular Biology, Ottawa, Canada, September 3–7, 1996. Cell Molec
Biol 1996; 42 (Suppl.): S83–S84.
60.	Cornélissen G., Siegelova J., Fiser B., Dusek J., Halberg F. Current limitations and promise of ambulatory
blood pressure monitoring. In: Proceedings, Cardiovascular Coordination in Health and Blood Pressure
Disorders, Medical Faculty, Masaryk University, Brno, Czech Republic, May 24, 1996, ­Halberg F.,
Kenner T., Fiser B., Siegelova J. eds., 1996, pp. 11–13.
61.	 Dusek J., Siegelova J., Al-Kubati M., Fiser B., Cornélissen G., Halberg F. Blood pressure variability during
24 h in patients with essential hypertension. Abstract, Aerosols in Diagnosis, Therapy, and Prophylaxis
& Cardio-Respiratory Relations, International Symposium, High Tatras, Sanatorium Helios,
Slovakia, May 14–17, 1996, p. 19.
62.	Fiser B., Siegelova J., Turti T., Syutkina E.V., Cornélissen G., Grigoriev A.E., Mitish M.D., Abramian
A.S., Dusek J., Nekvasil R., Al-Kubati M., Muchova L., Halberg F. Neonatal blood pressure and heart
rate rhythm: multiseptan over circadian prominence. Abstract, International Workshop and Teaching
Course: Spontaneous Motor Activity as a Diagnostic Tool, Karl-Franzens-Univ., Graz, Austria, September
11–18, 1996, p. 64.
63.	Fiser B, Siegelova J, Cornélissen G, Dusek J, Al-Kubati M, Watanabe Y, Halberg F. Chronometaanalysis
of blood pressure data from drug tests. Abstract, 2nd Int. Symp. of Chronobiology and Chronomedicine,
Shenyang, China, Sept. 28 – Oct. 2, 1996. p. 53–54.
64.	Halberg F, Cornélissen G, Gubin D, Gubin G, Fiser B, Dusek J, Al-Kubati M, Siegelova J. Circadiani, circaseptani,
circasemiseptanique in chronomis seclusorum, præmaturorum, seniumque: in honorem
Johannis Penazensis modo Mendeliano, Goedeliano, Keplerianoque. In: Halberg F, Kenner T, Fiser B,
Siegelova J, editors. Proceedings, Cardiovascular Coordination in Health and Blood Pressure Disorders,
Brno, Czech Republic: Medical Faculty, Masaryk University; May 24, 1996. p. 8–10.
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65.	Siegelova J, Dusek J, Fiser B, Nekvasil R, Muchova M, Cornélissen G, Halberg F. Circaseptan rhythm in
blood pressure and heart rate in newborns. Scripta medica (Brno) 1996; 67 (Suppl. 2): 63–70.
66.	Siegelova J., Fiser B., Dusek J., Al-Kubati M., Nekvasil R., Cornélissen G., Halberg F. Blood pressure
and heart rate coordination in newborn: circadian and circaseptan rhythms. Abstract, International
Workshop and Teaching Course: Spontaneous Motor Activity as a Diagnostic Tool, Karl-FranzensUniv.,
Graz, Austria, September 11–18, 1996, p. 63.
67.	 Siegelova J., Fiser B., Dusek J., Cornélissen G., Halberg F. Limitace ambulantního monitorování
krevního tlaku. In: XII. Pracovni Konference Arterialni Hypertenze a Prevence Kardiovaskulárních
Chorob, Abstrakta, Dum techniky Brno, 1996, p. 10.
68.	Siegelova J., Fiser B., Kadanka Z., Moran M., Dusek J., Al-Kubati M., Cornélissen G., Halberg F. Sleep
apnea syndrome and 24-h blood pressure. Electroenceph. Clin. Neurophysiol. 99: 393, 1996.
69.	Siegelova J, Moran M, Fiser B, Kadanka Z, Dusek J, Al-Kubati M, Cornélissen G, Halberg F. Blood pressure
monitoring in healthy subjects, in patients with sleep apnea syndrom[e] and in patients with essential
hypertension. Scripta medica (Brno) 1996; 67 (Suppl 2): 59–62. [In Czech.]
70.	Siegelova J, Cornélissen G, Halberg F, Fiser B, Dusek J, Al-Kubati M, Machat R, Kumagai Y, Watanabe
Y, Otsuka K. Self-starting cumulative sums for the individualized assessment of antihypertensive response
and optimization by timing. Keynote, 2nd Int. Symp. of Chronobiology and Chronomedicine,
Shenyang, China, Sept. 28 – Oct. 2, 1996. p. 48.
71.	 Siegelova J., Fiser B., Al-Kubati M., Dusek J., Cornélissen G., Halberg F. Baroreflex heart rate sensitivity
in hypertensives: the role of antihypertensive therapy. In: Proceedings, Cardiovascular Coordination
in Health and Blood Pressure Disorders, Medical Faculty, Masaryk University, Brno, Czech Republic,
May 24, 1996, Halberg F., Kenner T., Fiser B., Siegelova J. eds., 1996, pp. 18–34. [2221]
72.	 Siegelova J., Morán M., Fiser B., Kadanka Z., Dusek J., Al-Kubati M., Halberg F., Cornélissen G. Circadian
variations in blood pressure in patients with sleep apnea and essential hypertension. Abstract
PS 103, 23rd Congress, International Society of Internal Medicine, Manila, Philippines, February 1–6,
1996, p. 159. [2218]
73.	 Siegelova J., Morán M., Fiser B., Kadanka Z., Dusek J., Al-Kubati M., Halberg F., Cornélissen G. Circadian
variations in blood pressure in patients with sleep apnea and essential hypertension. Proceedings,
23rd Congress, International Society of Internal Medicine, Manila, Philippines, February 1–6, 1996,
Aquino A.V., Piedad F.F., Sulit Y.Q.M. (eds.), Monduzzi Editore, Bologna, 1996, pp. 273–276.
74.	 Turti T, Syutkina EV, Cornélissen G, Grigoriev AE, Mitish MD, Abramian AS, Siegelova J, Fiser B, Dusek
J, Al-Kubati M, Muchova L, Uhlir M, Halberg F. Multiseptan-over-circadian prominence of neonatal
blood pressure and heart rate in Moscow, Russia. Scripta medica (Brno) 1996; 67 (Suppl. 2): 85–92.
75.	 Baevsky RM, Petrov VM, Cornélissen G, Halberg F, Orth-Gomér K, Åkerstedt T, Otsuka K, Breus T, Siegelova
J, Dusek J, Fiser B. Meta-analyzed heart rate variability, exposure to geomagnetic storms, and
the risk of ischemic heart disease. Scripta medica (Brno) 1997; 70: 199–204.
76.	 Gubin D., Cornélissen G., Halberg F., Fiser B., Dusek J., Al-Kubati M., Siegelova J., Gubin G. Aging
is accompanied by increased variability and acircadian dessimination of blood pressure (BP) biorhythms.
Proc. XXXIII Int. Cong. International Union of Physiological Sciences, St. Petersburg, Russia,
June 30 – July 5, 1997, abstract P041.42.
77.	 Gubin D, Cornélissen G, Halberg F, Gubin GD, Turti T, Syutkina EV, Grigoriev AE, Mitish MD, Yatsyk
GV, Ikonomov O, Stoynev A, Madjirova N, Siegelova J, Fiser B, Dusek J. Half-weekly and weekly blood
pressure patterns in late human ontogeny. Scripta medica (Brno) 1997; 70: 207–216.
78.	Halberg F., Cornélissen G., Watanabe Y., Siegelova J., Fiser B., Dusek J., Al-Kubati M. Chronobiologic
concepts: tempora mutantur et nos mutamur in illis. Scripta medica (Brno) 70: 231–237, 1997.
79.	 Halberg F., Cornélissen G., Wendt H., Siegelova J., Dusek J., Fiser B. New trends in cosmobiophysics and
the need for a space weather report. Folia Mendeliana 31–32, Supplementum ad Acta Musei Moraviae,
Scientiae naturales LXXXI-II: 13–15,1996/1997 (© 1997).
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80.	Siegelova J., Cornélissen G., Dusek J., Fiser B., Watanabe Y., Otsuka K., Halberg F. Diagnosis and assessment
of treatment effects: a single 24-hour blood pressure (BP) monitoring (ABPM) profile. 5th
International Fair of Medical Technology and Pharmacy, MEFA Congress, Brno, Czech Republic, No-
vember 5–8, 1997, section 6 (Neinvazivni vysetrovaci metody v kardiologii), abstract 8.
81.	 Siegelova J., Fiser B., Dusek J., Cornélissen G., Halberg F. Circaseptan variability in blood pressure in
newborn. Abstract #314, International Congress on Chronobiology. Chronobiology int. 14 (Suppl. 1):
158, 1997.
82.	Siegelova J, Fiser B, Dusek J, Halberg F, Cornélissen G. 24-h blood pressure profile in essential hypertension
after verapamil, nitrendipine and enalapril treatment. Scripta medica (Brno) 1997; 70: 373–374.
83.	Siegelova J., Fiser J., Kadanka Z., Moran M., Dusek J., Cornélissen G., Halberg F. Syndrom spankove
apnoe a 24-hodinove monitorovani krevniho tlaku. Abstract, XIV konference o arterialni hypertenzi
& VI konference preventivni kardiologie, Plzen, 15.–17. rijna 1997, p. 43.
84.	Siegelova J., Kadanka Z., Moran M., Fiser B., Homolka P., Dobsak P., Dusek J., Cornélissen G., Halberg
F. 24-hour blood pressure profile in patients with sleep apnea syndrome: the effect of therapy. 5th International
Fair of Medical Technology and Pharmacy, MEFA Congress, Brno, Czech Republic, Novem-
ber 5–8, 1997, section 6 (Neinvazivni vysetrovaci metody v kardiologii), abstract 12.
85.	Syutkina EV, Cornélissen G, Grigoriev AE, Mitish MD, Turti T, Yatsyk GV, Pimenov K, Breus TK, Studenikin
MY, Siegelova J, Fiser B, Dusek J, Johnson D, Halberg F. Neonatal intensive care may consider
associations of cardiovascular rhythms with local magnetic disturbance. Scripta medica (Brno) 1997;
70: 217–226.
86.	Siegelova J, Cornélissen G, Dusek J, Fiser B, Watanabe Y, Otsuka K, Halberg F. Diagnosis and assessment
of treatment effects: a single 24-hour blood pressure monitoring profile. Scripta medica (Brno)
1998; 71: 209–214.
87.	Siegelova J., Fiser B., Dusek J., Cornélissen G., Halberg F. Circadian variability of rate pressure product
in hypertension with enalapril therapy. Abstract, Investigator-Initiated Satellite Symposium to 17th
Scientific Meeting, International Society of Hypertension: Renin-angiotensin-aldosterone system:
Where to block it?, Prague, Czech Republic, June 4, 1998, p. 6.
88.	Siegelova J., Fiser B., Dusek J., Dobsak P., Cornélissen G., Halberg F. Cirkadianni kolisani kardiovaskularnich
velicin. Abstract, Nove Trendy ve Funkcni Diagnostice a Rehabilitaci, Slavnosti Pracovni
Schuze, 75 Let, Brno 27. unora 1998, p. 12.
89.	Siegelova J., Fiser B., Dusek J., Placheta Z., Cornélissen G., Halberg F. Circadian variability of rate pressure
product in essential hypertension with enalapril therapy. Abstract 3, Neinvazivni metody v kardiovaskularnim
vyzkumu, 6th International Fair of Medical Technology and Pharmacy, MEFA Congress,
Brno, Czech Republic, November 3–4, 1998.
90.	Siegelova J., Kadanka Z., Moran M., Fiser B., Homolka P., Dobsak P., Dusek J., Cornélissen G., Halberg F.
24-h blood pressure profile in patients with sleep apnea syndrom: the effect of therapy. Scripta medica
(Brno) 71: 239–244, 1998.
91.	 SiegelovaJ.,FiserB.,DusekJ.,KadankaZ.,MoranM.,CornélissenG.,HalbergF.Sleepapneasyndrom[e]
and circadian blood pressure variability: the effect of CPAP therapy. Abstract, XVI Martin Days of Respiration
with international participation, Martin, Slovakia, September 16–17, 1998, p. 26.
92.	Halberg F, Cornélissen G, Schwartzkopff O, Syutkina EV, Grigoriev AE, Mitish MD, Yatsyk GV, Studenikin
MY, Gubin D, Gubin G, Siegelova J, Fiser B, Dusek J, Homolka P, Watanabe Y, Otsuka K, Perfetto F,
Tarquini R, Delmore P. Spin-offs from blood pressure and heart rate studies for health care and space
research (review). In vivo 1999; 13: 67–76.
93.	Fiser B, Cornélissen G, Siegelova J, Dusek J, Homolka P, Mazankova V, Halberg F. Increase in stroke
deaths after 1997 in the Czech Republic. MEFA 8th International Fair of Medical Technology and Pharmacy,
Brno, Czech Republic, 7–10 Nov 2000, abstract 4.
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94.	Halberg F, Cornélissen G, Otsuka K, Watanabe Y, Katinas GS, Burioka N, Delyukov A, Gorgo Y, Zhao
ZY, Weydahl A, Sothern RB, Siegelova J, Fiser B, Dusek J, Syutkina EV, Perfetto F, Tarquini R, Singh RB,
Rhees B, Lofstrom D, Lofstrom P, Johnson PWC, Schwartzkopff O, International BIOCOS Study Group.
Cross-spectrally coherent ~10.5- and 21-year biological and physical cycles, magnetic storms and myocardial
infarctions. Neuroendocrinol Lett 2000; 21: 233–258. [Invited presentation, NATO Advanced
Study Institute on Space Storms and Space Weather Hazards, Crete, Greece, June 19–29, 2000.]
95.	Halberg F, Cornélissen G, Sanchez de la Peña S, Schwartzkopff O, Wall DG, Kysylyczyn J, Sarkozy S,
Delmore P, Borer K, Otsuka K, Siegelova J, Homolka P, Dusek J, Fiser B. [Why and how to implement
7-day/24-hour blood pressure monitoring.] Addendum 1, Proceedings, 4th International Symposium of
Chronobiology and Chronomedicine, Yantai, China, Oct. 7–14, 2000, 37 pp. [Translated into Chinese.]
96.	Halberg F, Cornélissen G, Siegelova J, Fiser B, Dusek J, Otsuka K, Delyukov AA, Gorgo Y, Gubin DG, Gubin
GD, Schwartzkopff O. The Cosmos and CHAT, prompting blood pressure and heart rate monitoring
for Dérer’s week. Bratislavske lekarske listy 2000; 101: 260–271.
97.	 Siegelova J, Dusek J, Fiser B, Halberg F, Cornélissen G. Biological rhythms in medicine. J Oncol Pharm
Practice 2000; 6: 15–16 (www.nature.com/jopp).
98.	Siegelova J, Fiser B, Dusek J, Halberg F, Cornélissen G. Circadian variability of blood pressure. Abstract,
Stabilität und Oszillationen, 8. AKP-Tagung in Weiz bei Graz, 30. 9. 2000 – 3. 10. 2000, Tagung
der Gruppe der Angewandten, Klinischen und Pathologischen Physiologen der Deutschen Physiologischen
Gesellschaft gemeinsam mit der Österreichischen Physiologen Gesellschaft, 2000, p. 16.
99.	Siegelova J, Fiser B, Dusek J, Placheta Z, Cornélissen G, Halberg F. Circadian variability of rate-pressure
product in essential hypertension with enalapril therapy. Scripta medica (Brno) 2000; 73: 69–75.
100.	Siegelova J, Fiser B, Dusek J, Placheta J, Dobsak P, Svacinova H, Jancik J, Cornélissen G, Halberg F.
Baroreflex sensitivity in “essential hypertension” treated with trandolapril and diltiazem in combination.
Abstract 22.11, APS Conference, Baroreceptor and Cardiopulmonary Receptor Reflexes, Iowa
City, IA, August 23–27, 2000. The Physiologist 2000; 43: 283.
101.		 Siegelova J, Homolka P, Dusek J, Fiser B, Cornélissen G, Halberg F. Extracircadian-to-circadian variance
transpositions early and vice versa late in life in the human circulation. Proceedings, 1st International
Symposium, Workshop on Chronoastrobiology & Chronotherapy (Satellite Symposium, 7th
Annual Meeting, Japanese Society for Chronobiology), Kudan, Chiyodaku, Tokyo, 11 Nov 2000, pp.
58–60.
102.	 Nintcheu-Fata S, Cornélissen G, Katinas G, Halberg F, Fiser B, Siegelova J, Masek M, Dusek J. Software
for contour maps of moving least squares spectra. Abstract 15, MEFA 9th International Fair of Medical
Technology and Pharmacy, Brno, November 6–11, 2001.
103.	 Dusek J, Fiser B, Siegelova J, Cornélissen G, Svoboda L, Homolka P, Jancik J, Svacinova H, Mazankova
V, Schwartzkopff O, Halberg F. Vzestup incidence cevni mozkove prihody po r. 1997 v Ceske Republice.
Cor et Vasa 2002; 44: 18.
104.	 Fiser B, Cornélissen G, Siegelova J, Dusek J, Homolka P, Mazankova V, Halberg F. Increase in stroke
deaths after 1997 in the Czech Republic. Scripta medica (Brno) 2002; 75: 95–100.
105.	 Halberg F, Cornélissen G, Engebretson M, Fiser B, Siegelova J, Dusek J, Katinas G, Schwartzkopff O.
Dedicne biosfericke analogie nesvetelnych solarnich nebo galaktickych cyklu. Abstract, Clovek ve
svem pozemskem a kosmickem prostredi, Upice, 21–23 May 2002, pp. 30–31.
106.	 Halberg F, Cornélissen G, Otsuka K, Katinas GS, Schwartzkopff O, Halpin C, Mikulecky M, Revilla
M, Siegelova J, Homolka P, Dusek J, Fiser B, Singh RB. Chronomics* (*the study of time structures,
chronomes) detects altered vascular variabilities constituting risks greater than hypertension: with
an illustrative case report. In: Mitro P, Pella D, Rybar R, Valocik G, editors. Proceedings, 2nd Congress
on Cardiovascular Diseases, Kosice, Slovakia, 25–27 April 2002. Bologna: Monduzzi Editore; 2002. p.
223–258.
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107.		 Halberg F, Cornélissen G, Prikryl P, Katinas G, Dusek J, Homolka P, Karpisek Z, Sonkowsky RP,
Schwartzkopff O, Fiser B, Siegelova J, International BIOCOS Project Team. Chronomics complement
genomics in Brno. What Johann Gregor Mendel wished, Jarmilka Siegelova accomplished: Broadening
system times and transdisciplinary time horizons. In: Halberg F, Kenner T, Fiser B, editors.
Proceedings, Symposium: The Importance of Chronobiology in Diagnosing and Therapy of Internal
Diseases. Faculty of Medicine, Masaryk University, Brno, Czech Republic, January 10–13, 2002. Brno:
Masaryk University; 2002. p. 7–56.
108.	 Halberg F, Cornélissen G, Wall D, Otsuka K, Halberg J, Katinas G, Watanabe Y, Halhuber M, MüllerBohn
T, Delmore P, Siegelova J, Homolka P, Fiser B, Dusek J, Sanchez de la Peña S, Maggioni C, Delyukov
A, Gorgo Y, Gubin D, Carandente F, Schaffer E, Rhodus N, Borer K, Sonkowsky RP, Schwartzkopff
O. Engineering and governmental challenge: 7-day/24-hour chronobiologic blood pressure and heart
rate screening: Part I. Biomedical Instrumentation & Technology 2002; 36: 89–122.
109.	 Halberg F, Cornélissen G, Wall D, Otsuka K, Halberg J, Katinas G, Watanabe Y, Halhuber M, MüllerBohn
T, Delmore P, Siegelova J, Homolka P, Fiser B, Dusek J, Sanchez de la Peña S, Maggioni C, Delyukov
A, Gorgo Y, Gubin D, Carandente F, Schaffer E, Rhodus N, Borer K, Sonkowsky RP, Schwartzkopff
O. Engineering and governmental challenge: 7-day/24-hour chronobiologic blood pressure and heart
rate screening: Part II. Biomedical Instrumentation & Technology 2002; 36: 183–197.
110.	Cornélissen G, Halberg F, Bakken EE, Wang ZR, Tarquini R, Perfetto F, Laffi G, Maggioni C, Kumagai Y,
Prikryl P, Homolka P, Dusek J, Siegelova J, Fiser B. Can society afford not to follow a chronobiological
approach to blood pressure screening, diagnosis and treatment? In: Halberg F, Kenner T, Siegelova
J, editors. Proceedings, Symposium, Chronobiological Analysis in Pathophysiology of Cardiovascular
System. Brno: Masaryk University; 2003. p. 75–90. [Dedicated to the 60th Anniversary of Prof.
­Bohumil Fiser.]
111.		 Cornélissen G, Halberg F, Otsuka K, Shinagawa M, Kubo Y, Ohkawa S, Fiser B, Siegelova J, Dusek
J. Iatrogenic excessive blood pressure variability (CHAT): implications for chronotherapy. Scripta
medica (Brno) 2003; 76: 275–278.
112.		 Fiser B, Cornélissen G, Siegelova J, Dusek J, Mazankova V, Halberg F. Spektralni analyza padesatileteno
zazmamu mortality pro cevni Mozkovou prihodu v Ceske Republice. Abstract, XI. vyrocniho
sjezdu Ceske kardiologicke spolecnosti, 11–14 kvetna 2003, Brno. Cor et Vasa 2003; 4 (Suppl): 21.
113.		 Halberg F, Cornélissen G, Otsuka K, Maggioni C, Schwartzkopff G, Fiser B, Dusek J, Siegelova J. Chronomics:
the broad scope of monitoring chronomes. A review. Scripta medica (Brno) 2003; 76: 269–273.
114.		 Halberg F, Cornélissen G, Stoynev A, Ikonomov O, Katinas G, Sampson M, Wang ZR, Wan CM, Singh
RB, Otsuka K, Sothern RB, Sothern SB, Sothern MI, Syutkina EV, Masalov A, Perfetto F, Tarquini
R, Maggioni C, Kumagai Y, Siegelova J, Fiser B, Homolka P, Dusek J, Uezono K, Watanabe Y, Wu JY,
Sonkowsky R, Schwartzkopff O, Hellbrügge T, Spector NH, Baciu I, Hriscu M, Bakken E. Season’s Appreciations
2002 and 2003. Imaging in time: The transyear (longer-than-the-calendar year) and the
half-year. Neuroendocrinol Lett 2003; 24: 421–440.
115.		 Kelsey R, Cornélissen G, Kapfer D, Siegelova J, Masek M, Dusek J, Fiser B, Halberg F. Research in practice:
inferential statistical procedures applicable to the individual patient’s response to benetensive
treatment. Abstract #15, MEFA, Brno, Czech Republic, 04–07 Nov 2003. p. 20.
116.		 Nintcheu-Fata S, Cornélissen G, Katinas G, Halberg F, Fiser B, Siegelova J, Masek M, Dusek J. Software
for contour maps of moving least-squares spectra. Scripta medica (Brno) 2003; 76: 279–283.
117.		 Otsuka K, Cornélissen G, Halberg F, Fiser B, Siegelova J, Sosikova M, Dusek J, Jancik J. Assessment of
different administration schedules of sotalol by electrocardiography. Scripta medica (Brno) 2003; 76:
297–300.
118.		 Schwartzkopff O, Halberg F, Cornélissen G, Katinas G, Wang ZR, Kröz M, Hecht K, Tarquini R, Perfetto
F, Maggioni C, Siegelova J, Dusek J, Fiser B, Singh RB, Bakken E. Self-experimentation: dangerous
when first done by a few, now safe for everybody’s health? In: Halberg F, Kenner T, Siegelova J,
editors. Proceedings, Symposium, Chronobiological Analysis in Pathophysiology of Cardiovascular
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System. Brno: Masaryk University; 2003. p. 91–104. [Dedicated to the 60th Anniversary of Prof. Bohumil
Fiser.]
119.		 Schwartzkopff O, Katinas G, Singh RB, Sanchez de la Pena S, Zhao ZY, Uezono K, Prikryl P, Siegelo-
va J, Fiser B, Dusek J, Otsuka K, Cornélissen G, Halberg F. Self-surveillance and self-experimentation
(SSSE) for preventing vascular diseases needed to follow established successes of anesthesia and vaccine
development. Abstract #13, MEFA, Brno, Czech Republic, 04–07 Nov 2003. p. 18.
120.	 Siegelova J, Cornélissen G, Fiser B, Dusek J, Homolka P, Masek M, Jancik J, Svacinova H, Halberg F.
Blood pressure and heart rate monitoring in humans: the circaseptan and circadian rhythms. Abstract,
3rd International Workshop on The Human Circulation: Noninvasive Haemodynamic, Autonomic
and Vascular Monitoring, Graz, Austria, 9-11 May 2003. Clinical Autonomic Research 2003; 13:
60–61.
121.		 Siegelova J, Fiser B, Dusek J, Placheta Z, Vlcek J, Svoboda L, Pazdirek J, Cornélissen G, Halberg F. Chronotherapy:
rate-pressure produce in essential hypertension. In: Halberg F, Kenner T, Siegelova J, editors.
Proceedings, Symposium, Chronobiological Analysis in Pathophysiology of Cardiovascular System.
Brno: Masaryk University; 2003. p. 118–121. [Dedicated to the 60th Anniversary of Prof. Bohumil
Fiser.]
122.	 Sothern RB, Cornélissen G, Engel P, Fiser B, Siegelova J, Vlcek J, Dusek J, Halberg F. Chronomics: instrumentation
for monitoring of peak expiratory flow. Scripta medica (Brno) 2003; 76: 313–315.
123.	 Watanabe Y, Cornélissen G, Watanabe F, Siegelova J, Dusek J, Halberg F. The trans- (~1.3) year in the
blood pressure of a 10-year-old boy. Abstract 17, MEFA, Brno, Czech Republic, 04–07 Nov 2003. p. 22.
124.	 Cornélissen G, Palermo J, Carandente F, Siegelova J, Fiser B, Dusek J, Halberg F. Chronomics: chronome
of suicides in Minnesota (1968–2002). Abstract, Noninvasive methods in cardiology, 2. 11. 2004,
Congress MEFA, Brno, Czech Republic, 2.–4. 11. 2004, p. 8.
125.	 Crawford VLS, Cornélissen G, Fiser B, Dusek J, Siegelova J, Halberg F. Infrannual changes in the incidence
of myocardial infarctions and strokes in Northern Ireland. Abstract, Noninvasive methods in
cardiology, 2. 11. 2004, Congress MEFA, Brno, Czech Republic, 2.–4. 11. 2004, p. 9.
126.	 Dusek J, Siegelova J, Fiser B, Brazdova Z, Homolka P, Vank P, Forejt M, Hollan J, Cornélissen G, Halberg
F. Alterations of circadian rhythm in blood pressure by lack of dark: 24-h ambulatory blood-pressure
monitoring. Abstract, Noninvasive methods in cardiology, 2. 11. 2004, Congress MEFA, Brno, Czech
Republic, 2.–4. 11. 2004, p. 16.
127.		 Fiser B, Cornélissen G, Otsuka K, Chibisov S, Dusek J, Siegelova J, Halberg F. Blood pressure and heart
rate readings for solar science and health care. Abstract, 2nd International Conference, Pathophysiology
and Contemporary Medicine, Moscow, Russia, 22–24 April 2004. p. 472–473; and Science without
Borders, Transactions of the International Academy of Science H&E, 2003/2004; 1: 420–421.
128.	 Fiser B, Siegelova J, Dusek J, Moudr J, Cornélissen G, Halberg F. Assessment of high blood pressure
risk for stroke – chronobiological approach. Abstract, Noninvasive methods in cardiology, 2. 11. 2004,
Congress MEFA, Brno, Czech Republic, 2.–4. 11. 2004, p. 11.
129.	 Halberg F, Cornélissen G, Otsuka K, Siegelova J, Homolka P, Fiser B, Dusek J, Sanchez de la Pena S,
Schwartzkopff O, Singh RB. Home ambulatory blood pressure and heart rate monitoring in practice
and for science: transyears and magnetoperiodism vs. photoperiodism. Abstract S8–02, 3rd Int Congress
on Cardiovascular Disease, Taipei, Taiwan, 26–28 Nov 2004. Int J Cardiol 2004; 97 (Suppl 2): S12.
130.	 Halberg F, Cornélissen G, Panksepp J, Schwartzkopff O, Siegelova J, Fiser B, Dusek J. Near-transyears
in geophysics and autism. Abstract, Noninvasive methods in cardiology, 2. 11. 2004, Congress MEFA,
Brno, Czech Republic, 2.–4. 11. 2004, p. 7.
131.	Katinas GS, Chopra RK, Singh RB, Siegelova J, Fiser B, Dusek J, Cornélissen G, Halberg F. Design for
timing nutriceuticals. Abstract, Noninvasive methods in cardiology, 2. 11. 2004, Congress MEFA,
Brno, Czech Republic, 2.–4. 11. 2004, p. 19.
132.	 Siegelova J, Dusek J, Fiser B, Homolka P, Vank P, Cornelissen G, Halberg F. Vztah mezi vekem a cirkadianni
variabilitou krevniho tlaku. Cor Vasa 2004; 46 (4) (Suppl): 81.
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133.	 Siegelova J, Dusek J, Fiser B, Homolka P, Vank P, Cornélissen G, Halberg F. Rozdily v krevnim tlaku
mezi dnem a noci a vik. Congress of Atherosclerosis, TIGIS, Prague 2004. Abstract, DMEV 2004,
­Suppl 3, p. 38.
134.	 Siegelova J, Dusek J, Fiser B, Homolka P, Vank P, Cornélissen G, Halberg F. The relationship between
age and circadian blood pressure variation. J Hypertens 2004; 22 (Suppl 2): S210.
135.	 Siegelova J, Dusek J, Fiser B, Homolka P, Vank P, Cornélissen G, Halberg F. Rozdily v krevnim tlaku
mezi dnem a noci a vek 26. Abstract, XXI. konference Ceske spolecnosti pro hypertenzi, XIII. konference
pracovni skupiny Preventivni kardiologie CKS, Konference pracovni skupiny Srdecni selhani
CKS, Prague, 2004. p. 44.
136.	 Siegelova J, Dusek J, Fiser B, Homolka P, Vank P, Cornélissen G, Halberg F. Circadian blood pressure
variation analyzed from 7-day monitoring. Abstract, Noninvasive methods in cardiology, 2. 11. 2004,
Congress MEFA, Brno, Czech Republic, 2.–4. 11. 2004, p. 12.
137.	Siegelova J, Dusek J, Homolka P, Vank P, Vlcek J, Cornélissen G, Halberg F. The relationship between
age and circadian blood pressure variation. In: Cornélissen G, Kenner R, Fiser B, Siegelova J, eds. Proceedings,
Symposium: Chronobiology in Medicine. Dedicated to the 85th Anniversary of Professor
Franz Halberg. Brno: Masaryk University; 2004. p. 110–116.
138.	 Siegelova J, Homolka P, Cornélissen G, Fiser B, Dusek J, Halberg F. Health watch in Brno, Czech Republic.
Abstract S8-13, 3rd Int Congress on Cardiovascular Disease, Taipei, Taiwan, 26–28 Nov 2004.
Int J Cardiol 2004; 97 (Suppl 2): S15–S16.
139.	 Siegelova J, Homolka P, Cornélissen G, Fiser B, Dusek J, Vank P, Masek M, Halberg F. Ambulatory
blood pressure monitoring: Health Watch in Brno, Czech Republic. Abstract, Noninvasive methods in
cardiology, 2. 11. 2004, Congress MEFA, Brno, Czech Republic, 2.–4. 11. 2004, p. 10.
140.	 Bhatt MLB, Singh RK, Cornélissen G, Srivastava M, Rai G, Singh R, Halberg Francine, Siegelova J,
Fiser B, Dusek J, Halberg F. Chronoradiotherapy guided by circadian rhythm in tumor temperature.
Abstract, Noninvasive Methods in Cardiology, Brno, Czech Republic, September 14, 2005, p. 19.
141.		 Cornélissen G, Delcourt A, Toussaint G, Otsuka K, Watanabe Y, Siegelova J, Fiser B, Dusek J, Homolka
P, Singh RB, Kumar A, Singh RK, Sanchez S, Gonzalez C, Holley D, Sundaram B, Zhao Z, Tomlinson B,
Fok B, Zeman M, Dulkova K, Halberg F. Opportunity of detecting pre-hypertension: worldwide data
on blood pressure overswinging. Biomedicine & Pharmacotherapy 2005; 59 (Suppl 1): S152–S157.
142.	 Cornélissen G, Halberg F, Schwartzkopff O, Gvozdjakova A, Siegelova J, Fiser B, Dusek J, Mifkova L,
Chopra RK, Singh RB. Coenzyme-Q10 effect on blood pressure variability assessed with a chronobiological
study design. Abstract, Noninvasive Methods in Cardiology, Brno, Czech Republic, Septem-
ber 14, 2005, p. 10.
143.	 Cornélissen G, Schwartzkopff O, Katinas G, Halberg F, Bakken EE, Holley D, Sundaram S, Sanchez
S, Gonzalez C, Delcourt A, Toussaint G, Siegelova J, Fiser B, Dusek J, Homolka P, Zeman M, Dulkova
K, Otsuka K, Watanabe Y, Tomlinson B, Fok B, Zhao ZY, Singh RB, Singh RK, Kumar A, Chibisov SM.
Diagnosing blood pressure overswinging chronomically worldwide. Abstract, III International Conference,
Civilization diseases in the spirit of V.I. Vernadsky, People’s Friendship University of Russia,
Moscow, Oct. 10–12, 2005, p. 34–35.
144.	 Cornélissen G, Watson D, Mitsutake G, Fiser B, Siegelova J, Dusek J, Vohlidalova L, Svacinova H, Halberg
F. Mapping of circaseptan and circadian changes in mood. Scripta medica 2005; 78: 89–98.
145.	 Dusek J, Siegelova J, Homolka P, Fiser B, Masek M, Cornélissen G, Halberg F. Ambulatory blood pressure
monitoring lasting seven days. J Hypertens 2005; 34 (Suppl 2): S154.
146.	 Fiser B, Siegelova J, Dusek J, Homolka P, Vank P, Cornélissen G, Halberg F. Seven-day blood pressure
monitoring and casual blood pressure measurement. Abstract, Noninvasive Methods in Cardiology,
Brno, Czech Republic, September 14, 2005, p. 11.
147.		 Fiser B, Siegelova J, Dusek J, Moudr J, Cornélissen G, Halberg F. Assessment of high blood pressure
risk for stroke. J Hypertens 2005; 34 (Suppl 2): S151.
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148.	 Gvozdjakova A, Kucharska J, Cornélissen G, Singh RB, Mikulecky M, Siegelova J, Fiser B, Dusek J,
Halberg F. Coenzyme Q10 and the circadian system of cardiac oxidative phosphorylation in rats. Abstract,
Noninvasive Methods in Cardiology, Brno, Czech Republic, September 14, 2005, p. 24.
149.		 Halberg F, Cornélissen G, Otsuka K, Fiser B, Mitsutake G, Wendt HW, Johnson P, Gigolashvili M, Breus
T, Sonkowsky R, Chibisov SM, Katinas G, Siegelova J, Dusek J, Singh RB, Berri BL, Schwartzkopff O.
Incidence of sudden cardiac death, myocardial infarction and far- and near-transyears. Biomedicine
& Pharmacotherapy 2005; 59 (Suppl 1): S239–S261.
150.	 Halberg F, Katinas G, Cornélissen G, Schwartzkopff O, Fiser B, Siegelova J, Dusek J, Jancik J. Ambulatory
blood pressure monitoring: the need of 7-day record. Scripta medica 2005; 78: 83–88.
151.		 Halberg F, Katinas G, Schwartzkopff O, Siegelova J. Fiser B, Dusek J, Cornélissen G. An about-2-year
component in 15-year, largely half-hourly human blood pressure but not heart rate records. Abstract,
Noninvasive Methods in Cardiology, Brno, Czech Republic, September 14, 2005, p. 7.
152.	 Katinas G, Nintcheu-Fata S, Cornélissen G, Siegelova J, Dusek J, Vlcek J, Masek M, Halberg F. Moving
least-squares spectra scrutinize chronomics in and around us. Scripta medica 2005; 78: 115-120.
153.	 Regal P, Cornélissen G, Siegelova J, Fiser B, Dusek J, Halberg F. Chronomics, the site-specific magnetic
environment and an opportunity for the World Health Organization. Abstract, Noninvasive Methods
in Cardiology, Brno, Czech Republic, September 14, 2005, p. 9.
154.	 Schwartzkopff O, Cornélissen G, Halpin C, Katinas G, Siegelova J, Fiser B, Dusek J, Halberg F. Untreated
transient longer than 7-day CHAT, circadian hyper-amplitude-tension, in a 7-year perspective.
Scripta medica 2005; 78: 75–82.
155.	 Schwartzkopff O, Schwartzkopff C, Katinas GS, Siegelova J, Fiser B, Dusek J, Cornélissen G, Halberg
F. Chronomes, not imaginary baselines, are needed as longitudinal reference values. Abstract, Noninvasive
Methods in Cardiology, Brno, Czech Republic, September 14, 2005, p. 8.
156.	 Singh RB, Cornélissen G, Kumar A, Bathina S, Siegelova J, Fiser B, Dusek J, Vohlidalova I, Halberg F.
Effect of prayer on heart rate variability in Asian Indians. Abstract, Noninvasive Methods in Cardiology,
Brno, Czech Republic, September 14, 2005, p. 20.
157.		 Sonkowsky RP, Cornélissen G, Siegelova J, Fiser B, Dusek J, Masek M, Halberg F. Myriadennian cyclicities
in the tradition of Archimedes and the International System of Units (SI): invitation for comment.
Abstract, Noninvasive Methods in Cardiology, Brno, Czech Republic, September 14, 2005, p. 21.
158.	 Watanabe Y, Cornélissen G, Kodera I, Shimizu J, Ohmo G, Siegelova J, Fiser B, Dusek J, Vlcek J, Halberg
F. Chronomics of human blood pressure and heart rate in the Antarctic. Abstract, Noninvasive Methods
in Cardiology, Brno, Czech Republic, September 14, 2005, p. 22.
159.		 Yamanaka T, Cornélissen G, Kazuma M, Kazuma N, Murakami S, Otsuka K, Siegelova J, Dusek J,
Sosikova M, Halberg F. Further mapping of the natality chronome, in Toda City (Japan) Maternity
Hospital. Scripta medica 2005; 78: 99–106.
160.	 Cornélissen G, Delcourt A, Toussaint G, Otsuka K, Watanabe Y, Siegelova J, Fiser B, Dusek J, Homolka
P, Singh RB, Kumar A, Singh RK, Sanchez S, Gonzalez C, Holley D, Sundaram B, Zhao Z, Tomlinson
B, Fok B, Zeman M, Dulkova K, Halberg F. Opportunity of detecting pre-hypertension: worldwide
data on blood pressure overswinging. (Reprint of Biomedicine & Pharmacotherapy 2005; 59 [Suppl 1]:
S152-S157. Proceedings, International Conference on the Frontiers of Biomedical Science: Chronobiology,
Chengdu, China, September 24–26, 2006, p. 123–129.
161.	Cornélissen G, Halberg F, Katinas G, Schwartzkopff O, Holley D, Borer K, Homolka P, Siegelova J, Fiser
B, Dusek J, Otsuka K, Yano A, Delcourt A, Toussaint G, Sanchez de la Peña S, Gonzalez C, Zhao Z, Aslanian
N, Singh RB, Kumar A, Tarquini R, Perfetto F. Stroke and other vascular disease prevention by
chronomics. Scripta medica (Brno) 2006; 79 (3): 141–146.
162.	 Cornélissen G, Halberg F, Katinas G, Watanabe Y, Sothern RB, Siegelova J, Fiser B, Dusek J, Homolka
P, Prikryl P, Singh RB, Otsuka K, Schwartzkopff O, Refinetti R. Chronotheranostics of MESORnormotension
vs. circadian overswing, i.e., CHAT. In: Halberg F, Kenner T, Fiser B, Siegelova J, eds.
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Proceedings, Symposium, Noninvasive Methods in Cardiology. Brno, Czech Republic: Department of
Functional Diagnostics and Rehabilitation, Faculty of Medicine, Masaryk University; 2006. p. 30–32.
163.	 Dusek J, Fiser B, Siegelova J, Holub J, Mazankova V, Cornélissen G, Halberg F. Decrease of myocardial
infarction mortality and seasonal mortality in the Czech Republic in the period from 1994 to 2003. J
Hypertension 2006; 24 (Suppl 4): 245.
164.	 Dusek J, Siegelova J, Fiser B, Cornélissen G, Holub J, Mazankova V, Halberg F. Mortality data of stroke:
50-year record in the Czech Republic. Abstract 367, 10th Annual Meeting, French Society of Pharmacology,
73rd Annual Meeting, Society of Physiology, 27th pharmacovigilance meeting, 54th APNET
Seminar and 4th CHU CIC meeting (Corum Montpellier 10–12 April 2006). Fundamental and Clinical
Pharmacology 2006; 201: 206.
165.	 Dusek J, Siegelova J, Fiser B, Holub J, Mazankova V, Cornélissen G, Halberg F. Pokles celkove a sezonni
umrtnosti pro infarkt myokardu v Ceske Republice v letech 1994–2003. Supplementum Cor
Vasa 2006; 48 (4): 21.
166.	 Fiser B, Cornélissen G, Siegelova J, Pohanka M, Tarasova M, Barlova B, Nosavcova E, Dusek J, Homolka
P, Erajhi AA, Abais FH, Holub J, Mazankova V, Halberg F. Stroke in the Czech Republic. In: Halberg
F, Kenner T, Fiser B, Siegelova J, eds. Proceedings, Symposium, Noninvasive Methods in Cardiology.
Brno, Czech Republic: Department of Functional Diagnostics and Rehabilitation, Faculty of Medicine,
Masaryk University; 2006. p. 55–61.
167.		 Fiser B, Siegelova J, Dusek J, Holub J, Mazankova V, Cornélissen G, Halberg F. Spektralni analyza
umrtnosti na infarkt myokardu v Ceske Republice. Supplementum Cor Vasa 2006; 48 (4): 26.
168.	 Fiser B, Siegelova J, Dusek J, Holub J, Mazankova V, Cornélissen G, Halberg F. Spectral analysis of the
myocardial infarction mortality data in the Czech Republic. J Hypertension 2006; 24 (Suppl 4): 246.
169.		 Halberg F, Cornélissen G, Schwartzkopff O, Katinas G, Siegelova J, Fiser B, Dusek J, Homolka P, Vank
P. Seven day blood pressure measurement: contraversion in single 24-h profiles of blood pressure and
heart rate. In: Halberg F, Kenner T, Fiser B, Siegelova J, eds. Proceedings, Symposium, Noninvasive
Methods in Cardiology. Brno, Czech Republic: Department of Functional Diagnostics and Rehabilitation,
Faculty of Medicine, Masaryk University; 2006. p. 10–26.
170.	 Halberg F, Katinas G, Cornélissen G, Otsuka K, Sothern RB, Singh RB, Schwartzkopff O, Siegelova J,
Fiser B, Dusek J, Homolka P, Prikryl P, Refinetti R. Lessons about “loads” learned while detecting and
greatly reducing residual MESOR-hypertension and CHAT. In: Halberg F, Kenner T, Fiser B, Siegelova
J, eds. Proceedings, Symposium, Noninvasive Methods in Cardiology. Brno, Czech Republic: Department
of Functional Diagnostics and Rehabilitation, Faculty of Medicine, Masaryk University; 2006.
p. 27–29.
171.		 Hillman D, Halberg F, Cornélissen G, Katinas G, Sothern RB, Otsuka K, Singh RB, Siegelova J, Fiser B,
Dusek J, Homolka P, Prikryl P, Schwatzkopff O. Need to standardize data collection and reference values.
In: Halberg F, Kenner T, Fiser B, Siegelova J, eds. Proceedings, Symposium, Noninvasive Methods
in Cardiology. Brno, Czech Republic: Department of Functional Diagnostics and Rehabilitation, Faculty
of Medicine, Masaryk University; 2006. p. 36–38.
172.	 Katinas G, Halberg F, Cornélissen G, Otsuka K, Singh RB, Siegelova J, Fiser B, Dusek J, Homolka P, Prikryl
P, Schwatzkopff O. Chronobiologic serial sections complement spectra to seek social vs. physical
signatures in human heart rate circaseptans. In: Halberg F, Kenner T, Fiser B, Siegelova J, eds.
Proceedings, Symposium, Noninvasive Methods in Cardiology. Brno, Czech Republic: Department of
Functional Diagnostics and Rehabilitation, Faculty of Medicine, Masaryk University; 2006. p. 39–41.
173.		 Rostagno C, Cornélissen G, Halberg F, Tarquini R, Perfetto F, Jozsa R, Siegelova J, Fiser B, Dusek J,
Homolka P, Prikryl P, Bakken EE. Yet another cis-semiannual (cis-halfyear) spectral component in
cardiac arrhythmia: in Italy. Proceedings, International Conference on the Frontiers of Biomedical
Science: Chronobiology, Chengdu, China, September 24–26, 2006, p. 61–63.
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174.		 Schwartzkopff O, Halberg F, Cornélissen G, Katinas G, Sothern RB, Siegelova J, Fiser B, Dusek J, Homolka
P, Prikryl P, Singh RB. Occasional transient CHAT occurs in the MESOR-normotensive individual.
In: Halberg F, Kenner T, Fiser B, Siegelova J, eds. Proceedings, Symposium, Noninvasive
Methods in Cardiology. Brno, Czech Republic: Department of Functional Diagnostics and Rehabilitation,
Faculty of Medicine, Masaryk University; 2006. p. 33–35.
175.		 Siegelova J, Dusek J, Fiser B, Homolka P, Vank P, Cornélissen G, Halberg F. Blood pressure variation
analyzed from seven day monitoring. Abstract 366, 10th Annual Meeting, French Society of Pharmacology,
73rd Annual Meeting, Society of Physiology, 27th pharmacovigilance meeting, 54th APNET
Seminar and 4th CHU CIC meeting (Corum Montpellier 10–12 April 2006). Fundamental and Clinical
Pharmacology 2006; 201: 205.
176.		 Siegelova J, Dusek J, Fiser B, Homolka P, Vank P, Kohzuki M, Cornélissen G, Halberg F. Relationship
between circadian blood pressure variation and age analyzed from 7-day ambulatory monitoring.
Abstract PM1-10-05, 21st Scientific Meeting, International Society of Hypertension, Fukuoka, Japan,
October 15–19, 2006. J Hypertension 2006; 24 (Suppl 6): 122.
177.		 Watanabe Y, Katinas G, Cornélissen G, Sothern RB, Siegelova J, Fiser B, Dusek J, Homolka P, Prikryl P,
Singh RB, Schwartzkopff O, Halberg F. Time course of blood pressures over 18 years analyzed separately
by day and by week. In: Halberg F, Kenner T, Fiser B, Siegelova J, eds. Proceedings, Symposium,
Noninvasive Methods in Cardiology. Brno, Czech Republic: Department of Functional Diagnostics
and Rehabilitation, Faculty of Medicine, Masaryk University; 2006. p. 42–46.
178.		 Cornélissen G, Halberg F, Bakken EE, Wang Z, Tarquini R, Perfetto F, Laffi G, Maggioni C, Kumagai
Y, Homolka P, Havelkova A, Dusek J, Svacinova H, Siegelova J, Fiser B. Chronobiology of high blood
pressure. Scripta medica (Brno) 2007; 80 (4): 157-166.
179.		 Dusek J, Siegelova J, Fiser B, Forejt M, Homolka P, Vank P, Hollan J, Cornélissen G, Halberg F. Blood
pressure and the illumination of bedroom at night. P1.31, 17th European Meeting on Hypertension,
Milan, June 15–19, 2007. J Hypertension 2007; 25 (Suppl 2): S33.
180.	 Fiser B, Siegelova J, Dusek J, Pohanka M, Masek M, Barak J, Moudr J, Cornélissen G, Halberg F. Analysis
of baroreflex function by means of mathematical model. In: Halberg F, Kenner T, Fiser B, Siegelova
J, eds. Proceedings, Noninvasive Methods in Cardiology 2007, Brno, Czech Republic, November 11–14,
2007. Brno: Department of Functional Diagnostics and Rehabilitation, Faculty of Medicine, Masaryk
University (ISBN 978 80 7018 463 4); 2007. p. 90–93.
181.		 Halberg F, Cornélissen G, Katinas G, Dusek J, Homolka P, Karpisek Z, Sonkowsky RP, Schwartzkopff
O, Fiser B, Siegelova J. Chronomics and genetics. Scripta medica (Brno) 2007; 80 (4): 133–150.
182.	 Havelkova A, Siegelova J, Fiser B, Mifkova L, Chludilova V, Pochmonova J, Vank P, Pohanka M, Dusek
J, Cornélissen G, Halberg F. Physiotherapy and circadian blood pressure variability. In: Halberg F,
Kenner T, Fiser B, Siegelova J, eds. Proceedings, Noninvasive Methods in Cardiology 2007, Brno,
Czech Republic, November 11–14, 2007. Brno: Department of Functional Diagnostics and Rehabilitation,
Faculty of Medicine, Masaryk University (ISBN 978 80 7018 463 4); 2007. p. 113–120.
183.	 Havelkova A, Siegelova J, Fiser B, Mifkova L, Chludlikova V, Pochmonova J, Vank P, Pohanka M,
Dusek J, Cornélissen G, Halberg F. Circadian blood pressure variability and exercise therapy. Scripta
medica (Brno) 2007; 80 (5): 191–196.
184.	 Siegelova J, Dusek J, Fiser B, Homolka P, Vank P, Masek M, Havelkova A, Cornélissen G, Halberg F.
Circadian blood pressure variation analyzed from 7-day monitoring. In: Halberg F, Kenner T, Fiser B,
Siegelova J, eds. Proceedings, Noninvasive Methods in Cardiology 2007, Brno, Czech Republic, November
11–14, 2007. Brno: Department of Functional Diagnostics and Rehabilitation, Faculty of Medicine,
Masaryk University (ISBN 978 80 7018 463 4); 2007. p. 75–89.
185.	 Siegelova J, Dusek J, Fiser B, Homolka P, Vank P, Masek M, Havelkova A, Cornélissen G, Halberg F. The
relationship between circadian blood pressure variation and age analysed from 7-day monitoring.
Scripta medica (Brno) 2007; 80 (4): 179–187.
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186.	 Halberg F, Cornélissen G, Siegelova J, Fiser B, Dobsak P, Kenner T, Placheta Z, Dusek J, Homolka P, AlKubati
M, Schwartzkopff O, Blagonravov MB, Chibisov SM, Agarwal RK. Blood pressure or, rather,
blood pressure variability disorders, VVDs, discussed in Brno on October 6, 2008. Bulletin of People’s
Friendship University of Russia: Series Medicine 2008; (7): 26–30.
187.		 Halberg F, Cornélissen G, Otsuka K, Sanchez de la Peña S, Schwartzkopff O, Watanabe Y, Pati AK,
Wall DG, Delmore P, Borer K, Beaty LA, Nolley ES, Adams C, Siegelova J, Homolka P, Dusek J, Fiser
B, Prikryl P. Why and how to implement 7-day/24-hour blood pressure monitoring? Int J GerontoGeriatrics
2005; 8 (1): 1–31. [Dated 2005 but published in June 2008.]
188.	 Halberg F, Cornélissen G, Otsuka K, Watanabe Y, Singh RB, Revilla M, Sanchez de la Pena S, Gon-
zalez C, Siegelova J, Homolka P, Dusek J, Zeman M, Singh RK, Johnson D, Fiser B. Home C-ABPM for
preventive and curative health care and transdisciplinary science. World Heart J 2008; 1 (3): 233–261.
189.	 Halberg F, Cornélissen G, Siegelova J, Fiser B, Dobsak P, Kenner T, Placheta Z, Dusek J, Homolka P, AlKubati
M, Schwartzkopff O, Blagonravov MB, Chibisov SM, Agarwal RK. Blood pressure or, rather,
blood pressure variability disorders, VVDs, discussed in Brno on October 6, 2008. Bulletin of People’s
Friendship University of Russia: Series Medicine 2008; (7): 26–30.
190.	 Halberg F, Schwartzkopff O, Cornélissen G, Hardeland R, Müller-Bohn T, Katinas G, Revilla MA,
Beaty L, Otsuka K, Jozsa R, Zeman M, Csernus V, Hoogerwerf WA, Nagy G, Stebelova K, Olah A, Singh
RB, Singh RK, Siegelova J, Dusek J, Fiser B, Czaplicki J, Kumagai Y, Chibisov SM, Frolov VA. Vaskuläres
Variabilitäts-Syndrom (VVS) und andere Chronomik 2005-2007. In: Hardeland R, ed. Sonderdruck
aus Abhandlungen der Leibniz-Sozietät der Wissenschaften, Band 23: Facetten der Chronobiologie.
Berlin: trafo verlag; 2008. p. 89–154.
191.		 Siegelova J, Fiser B, Havelkova A, Dobsak P, Dusek J, Pohanka M, Cornélissen G, Halberg F. Ambulatory
arterial stiffness index in patients monitored for 6 consecutive days. In: Halberg F, Kenner T,
Fiser B, Siegelova J, eds. Proceedings, Noninvasive Methods in Cardiology, Brno, Czech Republic, October
4–7, 2008. p. 233–237. Proceedings volume downloadable free of charge from http://web.fnusa­.
cz/files/kfdr2008/sbornik_2008.pdf [3133]
192.	 Siegelova J, Fiser B, Havelkova A, Dobsak P, Pohanka M, Dusek J, Cornélissen G, Halberg F. Sevenday
ambulatory blood pressure monitoring and ambulatory arterial stiffness index. Scripta medica
(Brno) 2008; 81 (3): 181–184.
193.	 Halberg F, Cornélissen G, Otsuka K, Siegelova J, Fiser B, Dusek J, Homolka P, Sanchez de la Pena S,
Singh RB, BIOCOS project. Extended consensus on means and need to detect vascular variability disorders
(VVDs) and vascular variability syndromes (VVSs). Leibniz-Online Nr. 5, 2009 (http://www.
leibniz-sozietaet.de/journal). 35 pp, AND World Heart J, in press.
194.	 Savin, E., Siegelova, J., Fiser, B., & Martineaud, J.-P. (1996). Non-invasive determination of aortic compliance
in man. [Determination non invasive de la compliance aortique chez l’homme] Archives of
Physiology and Biochemistry, 104(3), 257–264.
195.	 Siegelova, J., Fiser, B., Dusek, J., & Al-Kubati, M. (1995). Baroreflex sensitivity in patients with essential
hypertension: Role of enalapril. [Baroreflex-sensitivitatsmessung bei patienten mit essentieller
hypertonie: einfluss von enalapril] Nieren- Und Hochdruckkrankheiten, 24(1), 20–22.
196.	 Dušek J., Siegelová J., Přikryl P., Fišer B., Karpíšek Z., Prášek J. (1992) Alpha2 Adrenozeptoren bei
essentieller Hypertonie: Einfluss eines ACE-Inhibitors. Nieren- Und Hochdruckkrankheiten, 24(1),
658–659.
197.		 Savin, E., Siegelova, J., Fiser, B., & Bonnin P. (1997) Intra- and extracranial artery blood velocity
­during a sudden blood pressure decrease in humans. Eur J Appl Physiol 76: 289–293.
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PROF. FRANZ HALBERG, M.D., PH.D., DR. H. C. MULTI,
5 JULY 1919 – 9 JUNE 9 2013
JARMILA SIEGELOVÁ
Department of Physiotherapy and Rehabilitation
Faculty of Medicine, Masaryk University, Brno, Czech Republic
Franz Halberg, M.D., Dr. h.c. (Montpellier), Dr. h.c. (Ferrara), Dr. h.c. (Tyumen),
Dr. h.c. (Brno), Dr. h.c. (L’Aquila), Dr. h.c. (People’s Friendship University of Russia, Moscow),
Professor of Laboratory Medicine and Pathology, Physiology, Biology, Bioengineering and Oral medicine,
Director, Halberg Chronobiology Center, University of Minnesota, USA
Brno Chronobiology team that cooperated with Halberg Chronobiology Center under the guidance of
Professor Franz Halberg from 1988 was deeply sad that Professor Franz Halberg, the great scientific personality,
exceptional man, passed away on Sunday, June 9, 2013. Franz Halberg was 94 years and was active
until the last days of his live; he cooperated with Masaryk University of Brno and with us. We lost a good
friend and a great scientist.
Franz Halberg is a founder of modern chronobiology. Unlike other famous scientists devoting their
activities mostly to presentation of honorary lectures at international scientific conferences, Prof. Halberg
pursued his scientific work. This fact is demonstrated by the list of his scientific 34000 papers, on WEB
of Science which contains 1149 scientific papers, Science Citation Report of Franz Halberg contains 12670
citations, and his H-index is 51. Prof. Halberg has dedicated almost 60 years of his life to chronobiological
research.
Chronobiology, the study of mechanisms underlying diversity in time, and chronomics, the mapping
of chronomes – time structures, could complement genetics. It is the study of mechanisms underlying diversity
in space and also genomics, the mapping of the genomes. Halberg focused on the chronobiologicchronomic
assessment of blood pressure and heart rate variability as the alternative to the spotcheck of
blood pressure advocated by official current guidelines. Chronobiology allows us to approach risks, diagnosis
and treatment dependent on time, especially of the dynamics of time, gender, age, ethnicity and
geographical location.
His chronobiological studies represent a new original Minnesotan branch of science based upon resolving
the chronome and its mapping from womb to tomb. Womb-to-tomb chronome initiative consists
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in extension of a unique existing data archive and reference standard bank on variables of biomedical
interests: heart rate, blood pressure, body temperature, a lot of chemical determinations on blood, saliva
and urine.
Every biologic variable is characterized by chronomes, describing the structure of rhythms and trends
in its physiological and pathophysiological range of variations. The chronome provides new endpoints for
ruling in health or recognizing increased disease risk before the occurrence of overt illness. Prof. Halberg’s
long-lasting basic scientific work is directed, at the beginning of the new century, to chronobiometry
(physiological and statistical evaluation of the genetically anchored and cosmically influenced time
structures), chronobioengineering (collecting physiological data by means of sophisticated equipment),
chronobiological diagnosis of disease risk syndromes, and the chronotherapy, improvement of prognosis
and treatment in different fields of medicine, and, last but not least, chronoastrobiology focusing on
rhythms and broader chronomes to explore the origins of life.
Needless to say, not only those researchers who are deeply interested in this field, but also others who
are less interested, have all been strongly impressed by such incomparable records of work achieved by
Prof. Halberg. In recent years he has been strenuously promoting chronobiological research further in the
field of clinical medicine on the worldwide scale.
In the year 2000, Prof. Franz Halberg from University of Minnnesota, USA, received the degree of
honorary doctor of Masaryk University and thus has the honor to be a member of Masaryk University
Brno. In the last 15 years, the cooperation between Masaryk University and University of Minnesota was
intensive and was enlarged also to the international project BIOCOS.
The international project on The Biosphere and the Cosmos originated on June 30, 1997, when the Russian
Academy of Medical Sciences convened a special session at its headquarters in Moscow to discuss and,
at the end of this meeting, to unanimously endorse a project on “The BIOsphere and the COSmos” (BIOCOS).
Figure 1 Professor Franz Halberg during Symposium in Masaryk University Brno in 2003
The role of chronomics within the context of Non-communicable Diseases and Mental Health is mostly
studied in cardiovascular variables but is not limited only to the cardiovascular system. The same methodology
remains applicable to a wide range of problems. Cancer prevention and optimization by the scheduling
of treatment administration is another important problem. But the main focus of BIOCOS in health
promotion upon the circulation by “prehabilitation”, to reduce the cost of rehabilitation by education of use
of chronobiology.
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Chronobiology, studied by Franz Halberg, showed broad spectrum of rhythms in us and around us;
they are being marched up by the dozens but have not yet been recognized in terms of their pertinence to
everyday life. It should be taught that circadians, now a fashion in molecular biology, tip the scale between
life and death, as do extra-circadians, the many different, more or less periodic changes evolved and built
into human physiology under the influence of cosmos. Infradians are apparent in military-political affairs,
including aggression, notably crime, international battles and terrorism; in economics, in opinion polls, in
education and, most important, in health care. Chronobiologically interpreted blood pressure and heart
rate monitoring detects prehypertension, prediabetes and a premetabolic syndrome in vascular variability
disorders, that interact with a reliably diagnosed MESOR hypertension that can carry a risk greater
than a high blood pressure and that can coexist to form vascular variability syndromes, unrecognized in
a conventional health care, but some of them already treatable. It is not yet generally known that in the
human newborn, variables such as heart rate or blood pressure have an about-weekly component which
is more prominent than the 24-hour change and awaits testing as a gauge of risk, or that in the incidence
spectrum of sudden cardiac death (ICD10, code I46.1) an about 5-month and an about 17-month (transyear)
component, cyclic signatures of space weather, replace Minnesota’s midcontinental winters and summers.
Dependent on geography, a host of congruent spectral components is found in both spectra of the solar
wind and other aspects of space weather on the one hand and in the human circulation, in electrical accidents
of the heart and in the extreme depression resulting in suicide on the other hand. When cardiovascular
health and its relation to cosmos is viewed in 40 years of around-the-clock measurements, there is
selective congruence between about 5-month components in solar flares and in the heart rate of a clinically
healthy man. These are the latest discoveries of Prof. Franz Halberg.
Professor Halberg was quite unhappy that his ideas are ahead of the development of science for tens
of years. He suggested the ambulatory 24-hour blood monitoring in 1948. The first scientific study using
this method in the Czech Republic was published in 1994. Also the treatment of oncological diseases on the
chronobiological basis started many years after Halberg suggested it. The last Halberg proposal for diagnosis
of vascular variability disorders on the basis of ambulatory blood pressure and heart rate monitoring or
self-monitoring lasting several days is nowadays not broadly accepted, even if it enables the risk stratification
of hypertensive patients. The risk-stratification guided treatment is more effective than the treatment
based on the diagnosis only.
Franz Halberg was a founder of modern chronobiology. Unlike other famous scientists devoted their
activities mostly to presentation of honorary lectures at international scientific conferences, hold every
year in Brno. Prof Halberg was unhappy that his ideas are ahead of the development of science for tens of
years. He suggested the ambulatory 24 hours blood monitoring in 1948. In 1990 started the cooperation
between Masaryk University Professor Jarmila Siegelová, Professor Bohumil Fiser and University of Minnesota,
Halberg Chronobiology Center, namely Professor Franz Halberg and Professor Germaine Cornélissen.
The first scientific study using this method in the Czech Republic was published in 1994 by us.
In 1990 Prof. Franz Halberg and Prof. Germaine Cornélissen visited for the first time Masaryk University
in Brno and presented chronobiological results in cardiovascular parameters in man on the Brno
Symposium. Immediately, an intensive cooperation started between Brno team, consisting of Prof. Bohumil
Fiser, emeritus head of the Physiology Department, Czech ministry of health, Executive board member
of WHO, Dr. Jiri Dusek, me and Prof. Franz Halberg and Prof. Germaine Cornélissen from University of
Minnesota.
In Brno we carried out at that time the beat-by-beat noninvasive measurement of blood pressure,
developed by Prof. Jan Penaz and young scientist Prof. Fiser, measurement of baroreflex sensitivity and
heart rate variability and we had the equipment for ambulatory 24-h blood pressure monitoring for adults.
University of Minnesota lent us equipment for oscilometric measurement of blood pressure in new born
children. At the beginning we started with common scientific work and our data were measured in the
Czech population, at first faxed, later on line via e-mail sent to Chronobiological laboratories in Minnesota,
Halberg Chronobiology Center and analyzed in the University of Minnesota, USA. Then for 22 years until
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now the chronobiological data from Brno were immediately analyzed by Prof. Germaine Cornélissen and
the results of these analyses served not only for scientific work, but also for therapy of the Czech population.
Between the years 2000 and 2008 the Brno team consisting of Prof. Fiser, Dr. Dusek and me collected
73 888 sets of blood pressure and heart rate measurements and all data were analyzed the following day
by Prof. G. Cornélissen. The daily data exchange and analysis continues until now. Very important chronobiological
data are found in new born children blood pressure, in blood pressure changes after administration
of low dose aspirin, in baroreflex sensitivity, in groups of normotensive subjects and hypertensive
patients with antihypertensive therapy and without therapy. The cooperation resulted in a lot of common
publications.
From 1990 every year, sometimes two times per year, common meetings were organized in Brno, such
as MEFA Congress or chronobiological congress presenting a lot of latest findings and scientific lectures,
with the participation of Prof. Cornélissen, Prof. Halberg from Minnesota, Prof. Thomas Kenner, former
president of University of Graz, Austria and Prof. J.P. Martineaud, Hopital Lariboisiere, Medical Faculty
Paris, France. Prof. Germaine Cornélissen prepared a lot of publications for congresses and symposia in
Brno.
The last symposium hold in Brno in May 3 and 4, 2013 was by videoconference taken together with
Brno and Minnesota scientist Professor Franz Halberg and Professor Germaine Cornélissen as can be seen
in the figure. We believe that we could continue the cooperation between Halberg Chronobiology Center
and Professor Germaine Cornélissen to finish the international scientific projects as BIOCOS.
We believe this is Professor Franz Halberg’s legacy, to be continued by Prof. Cornélissen of Halberg
Chronobiology Center University Minnesota, who will continues cooperate with European and other
countries. Our chronobiological team of Masaryk University of Brno will, together with Halberg Chronobiological
Center in University of Minnesota, answer scientific chronobiological scientific questions and
continue Professor Halberg’s scientific work.
Figure 2 Professor Franz Halberg, Dr. Othild Schwartzkopff, Professor Germaine Cornélissen in Halberg
Chronobiology Center, University Minnesota on May 3-4, 2013 during Symposium (videoconference)
in Masaryk University Brno with participation of Professor Kenner and Brno team
from the Department of Physiotherapy and Rehabilitation
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SOME REMARKS CONCERNING THE CHRONOBIOLOGY
OF EARLY HUMAN DEVELOPMENT
THOMAS KENNER
Department of Physiology, Medical University in Graz
In the work of Franz Halberg, the early development of the human fetus, the birth and the further development
of babies and children was not so much in the focus of interest. In connection with the research
of our group in Graz, Franz Halberg was visiting Graz, and the Department of Physiology of the University
in Graz. One publication of this term was presented in Brno (1). Our interest in early development was
raised by the pathologic phenomenon of sudden infant death (SIDS). The study of normal and pathologic
development brought us in contact with Prof. Heinz Prechtl. In the meantime a research group is existing
and the incidence of SIDS decreased markedly during the last years.
The main research about early human development was initiated and developed by H. Prechtl in Groningen.
H. Prechtl is now retired and lives in Graz and he is Honorary Professor in the Department of Physiology
of the Medical University in Graz.
Main publications can be found in the book (2) edited by Christa Einspieler, Heinz F.R. Prechtl, Arend
F. Bos, Fabrizio Ferrari and Giovanni Gioni – with the Title: “Prechtl’s Method on the Qualitative Assessment
of General Movements in Preterm, Term and Young Infants.” Cambridge University Press, 2004.
Figure 1 from lit. (2)
On page 10 of the cited book the movements of babies before and after birth are described. The term
General movements (GMs) was coined by H. Prechtl in an observational study on spontaneous motility in
carefully selected low-risk preterm infants. GMs have by and large a similar appearance from early foetal
life until the end of the second month postterm (“term” means time of birth). The GMs are slow and go
through the whole body or extremity. About 6 to 9 weeks after birth, GMs with a writhing (slow) character
gradually disppear while socalled fidgety (small and more frequent) movements gradually emerge. At
Prechtl & Einspieler (1997)
HUMAN DEVELOPMENT OF MOTOR CONTROL
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the time of around 20 weeks after birth the fidgety movements disappear and intentional and antigravity
movements occur and start to dominate.
In the diagram of the first picture – Fig. 1 – one can see a graphic explanation of the changing pattern
of movements. In a rough summary it may be said: From start on at first slow (writhing) and then faster and
faster and finally more and more adjusted to specific needs – including very fast reaction.
With respect to the so called Sudden Infant Death (short: SIDS, where the final S indicates “Syndrome”)
the time scale is important. In the first picture Fig. 1, the time scale is presented in weeks, starting with
the conception. In the second picture Fig. 2 the time scale is presented in months-intervals and starts with
term (birth).
Figure 2 from lit. (3)
In this second picture – Fig. 2 – by Molz and Hartmann (3) the diagram shows on the ordinate the relative
numbers in % of the total incidence of SIDS in two publications.
It is noteworthy, that early after birth in the time of slow “writhing” movements the incidence of SIDS
is low. Then, with the appearance of fast fidgety movements, the incidence of SIDS increases. The peaks of
incidence in the second picture correspond to the time of decrease of fidgety movements.
From an attempt to interpret the modification of the frequency of movements as generated from exiting
relatively simple neural networks, the so called logistic equation (4) could be used as a model to analyze
and simulate generation of movements.
Figure 3 The following sketch shows the basic “structure” of the “logistic equation”: The process in this system is
initiated from central. One impulse is enough to generate a circular process which as effect can generate (depending on
the adjustment by the parameter) periodic processes (slow in one direction “writhing”), periodic fast (may be “fidgety”)
and – always depending on the parameter – chaotic.
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The logistic equation works as a feedback system. A sketch of the basc structure is shown in Fig. 3 at
the end of this paper. The “activity” is started by an input signal. The equation can be imagined as describing
the activity of a nerve structure network system which modifies the input signal. The output-signal is
sent to some effector, and produces at this location an effect, e.g., the contraction of a muscle. However, the
same output-signal is at the same time fed back to the entrance of the system. It has the function to modify
the next output. Therefore it is obvious that the next output will be different from the first. The result depends
on the magnitude of the modification of the signal. It is possible to explain automatic variations of
the frequency of the output and other modifications. Under certain conditions such systems may also be
able to generate abnormal, chaotic and, therefore even dangerous reactions.
REFERENCES
1.	 Halberg G., Kenner T., Fiser B., Siegelova J. (eds): Chronobiology in health and disease, control of cardiovascular
and respiratory function. Med. Faculty Masaryk University Brünn (1994)
2.	 Christa Einspieler, Heinz F.R. Prechtl, Arend F. Bos, Fabrizio Ferrari and Giovanni Gioni: “Prechtl’s
Method on the Qualitative Assessment of General Movements in Preterm, Term and Young Infants.”
Cambridge University Press, 2004.
3.	 Hartmann H.P., Molz G.: Unerwarteter Säuglingstod. Bulletin de l’office federal de la santé publique,
No. 50 (1985)
4.	 Bassingthwaighte J.B., Liebovitch L.S., West, B.J.: Fractal Physiology, New York, Oxford (1994). Pp.:
120–121
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NONINVASIVE METHODS IN CARDIOLOGY 2013
REMEMBERING A BELOVED TEACHER AND DEAR
FRIEND, FRANZ HALBERG (5 JULY 1919 – 9 JUNE 2013)
IN APPRECIATION
GERMAINE CORNELISSEN1, OTHILD SCHWARTZKOPFF1, JIRI DUSEK2, JARMILA
SIEGELOVA3
1 Halberg Chronobiology Center, University of Minnesota, Minneapolis, MN, USA
2 Health Medical Center, South Moravia Region, Brno, Czech Republic
3 Department of Functional Diagnostics and Rehabilitation, St. Anna Teaching Hospital, Brno, Czech Republic
Figure 1 Franz Halberg
On Sunday morning June 9, 2013, one of the greatest scientists of the 20th and 21st centuries left us. His
close associates also lost a very staunch friend and a mentor who never ceased to inspire. Franz Halberg’s
passing shy of his 94th birthday leaves a void that cannot be filled.
Over 40 years ago, as a young inexperienced student, I had the good fortune of meeting Franz in Paris
at a conference of the Groupe d’Etude des Rythmes Biologiques. That day changed my life. It was the start
of an exciting journey in science, when I first discovered quantitative chronobiology (1), then chronomics
(2), the two disciplines Franz will be remembered for founding. These new transdisciplinary scientific
disciplines could not have come to fruition without Franz’s unveiling predictable variations as a function
of TIME that occur within the physiological range and his vision that they had far-reaching implications.
Franz not only gathered a critical mass of data, he developed inferential statistical methods for their
analysis and interpretation, so as to establish a solid foundation for the new science. Details of a rich time
structure could thus be revealed, akin to the finer spatial resolution obtained with a microscope. As data
accumulated and longitudinal records became available, Franz Halberg’s keen observations and methodical
scrutiny led him to find periodicities shared between biological systems and their broad environment.
Seen (photic) and unseen (non-photic) influences from the Sun and the cosmos led to chronomics in a way
reminiscent of discoveries enabled by the advent of the telescope.
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Franz Halberg was born on July 5, 1919 in Bistritz, Romania. There, he received his elementary and
secondary schooling. Franz received his medical degree from the University of Cluj in Koloszvar in 1943.
Becoming a citizen of Austria, Franz worked in the Department of Anatomy at the University of Innsbruck
from 1946 to 1948 where he studied the adrenal. In 1948, he came to the United States with a World Health
Organization fellowship in clinical endocrinology, continuing his work at Harvard Medical School, also
holding a position of Assistant in Medicine at the Peter Bent Brigham Hospital in Boston. Franz joined the
staff at the University of Minnesota Medical School in 1949. There, his breakthrough experiments led to
the important discovery that circadian rhythms are partly endogenous and can be manipulated by environmental
synchronizers, notably the lighting and feeding schedules (3, 4). His documentation that biologic
rhythms tip the scale between health and disease and even between life and death led him to coin
the term circadian (5). Franz’s results were widely published, including a 1969 citation classic (1). By 1958,
Franz had recognized the important role played by the cell’s RNA and DNA cycles. He was first to show that
the hypothalamic-pituitary-adrenal system served as mediator of photic inputs (6). Pineal feedsidewards
were subsequently added, as was the understanding that there are endogenous physiologic networks that
respond to the cosmos (7, 8).
Franz’s recent work demonstrated that, beyond circadians, many built-in cycles resonate in part with
their counterparts in our broad environment. The growing edifice of shared periodicities with bridges
across disciplines Franz built (9, 10) addresses wide-ranging applications, from the optimization of individualized
health care to concerns for the health of societies. Franz strived to understand how to enhance
positive thoughts and emotions as a scaffold for tolerance and love by seeking optimal configurations of
the time structured realm of the mind, what he called the chronousphere (11). He was a scholar in the true
sense of the word, combining science, philosophy, poetry, and spirituality, laying the foundation of chronobioethics
(7).
Franz’s legacy is far-reaching. He will not only be remembered for his work in cancer chronotherapy,
showing that increased efficacy and lesser undesired side effects can be achieved by timing cancer treatment
according to marker rhythms (12). Franz will also be remembered for showing that a calorie acts
differently whether it is consumed at breakfast or dinner (4, 13). But first and foremost, his principle of
“Primum nil nocere” (above all, do no harm) prompted Franz to advocate the individualization of treatment,
guided by marker rhythms, with important applications in preventive cardiology. By screening for
abnormal patterns of blood pressure variability (10), appropriate circadian timed treatment more than
halved the risk of stroke and other adverse cardiovascular events. Franz’s approach to primary prevention,
which he called “prehabilitation” aimed at curtailing the need for rehabilitation.
Franz Halberg is regarded as the father of modern chronobiology and its undisputed leader, particularly
as it relates to biomedical research and therapy (14). Many trained in his laboratory over the years,
including senior investigators and leading chronobiologists. Franz Halberg served for more than 10 years
as President of the International Society for the Study of Biological Rhythms, and, after the Society’s name
was changed in 1971 at its meeting in Little Rock, Arkansas, he continued to serve as President of the International
Society for Chronobiology for another 15 years (14). Franz also served as Editor-in-Chief of the
journal Chronobiologia, published between 1974 and 1994, the then official journal of the Society.
Many worldwide indeed call Franz Halberg their mentor and turned to him for advice, from study
design and data analysis to the interpretation of results in the time dimension. In cooperation with colleagues
from around the world, Franz authored over 3,500 scientific publications. He treasured the close
cooperation with the Brno team. Together, we showed that timing the administration of low-dose aspirin
could be optimized (15) and that the best circadian stage for its anti-coagulation action differed from that
related to its blood pressure lowering effect (16) in an N-of-6 pilot study (Figure 2). Together, we mapped
the biologic week in neonates, demonstrating its partly endogenous nature (17), Figure 3. Together, we
learned about Vascular Variability Disorders (18) and their bearing on adverse cardiovascular outcomes
(19) (Figure 4), to cite but a few examples of a lasting fruitful cooperation.
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NONINVASIVE METHODS IN CARDIOLOGY 2013
Figure 2 Low-dose aspirin lowers blood pressure when administered in the afternoon but not when it is taken upon
awakening or around bedtime.
Figure 3 The about 7-day (circaseptan) component in systolic blood pressure of neonates monitored in early extrauterine
life is synchronized among different babies by the time of birth rather than by the day of the week, suggesting that
developmental age is more important than the social schedule
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Figure 4 Results in Brno, Czech Republic: a Pulse Pressure product (PPP) above 100 (mmHgxbeats/min)/100 is associated
with a relative risk (RR) of overall mortality statistically significantly larger than one, as seen from the non-overlap of
one (equal risk) by the 95% confidence interval (CI) of RR. The risk associated with an excessive PPP is compared with the
risk of other Vascular Variability Anomalies (VVAs) or Disorders (VVDs) in the same population.
Minnesota Medicine called Franz Halberg “Father Time” (20), and colleagues in Russia and Azerbaijan
honored him as “Lord of Time” (21). Franz’s endeavors earned him numerous awards. Apart from holding
professorships in Laboratory Medicine and Pathology, Physiology, Biology, Bioengineering and Oral
Medicine at the University of Minnesota, he was a Fellow of the New York Academy of Science and of the
American Association for the Advancement of Science. Franz was a honorary member of the Romanian
Academies of Science and Medical Sciences. He was also elected Corresponding Member of the French National
Academy of Medicine. His Chronobiology Laboratories were officially affiliated with the University
of L’Aquila in L’Aquila (Italy), the René Descartes University in Paris (France), and the Faculty of Computer
Science at the Autonomous University in Madrid (Spain). Franz received medals from the University of
Montpellier (France), the University of Krakow (Poland), the University of Ferrara (Italy), the University of
Szeged (Hungary), and the Therapeutic Society of Moscow (Russia). Franz also received honorary doctorates
from the University of Montpellier (France), Ferrara (Italy), Tyumen (Siberia), Brno (Czech Republic),
L’Aquila (Italy), and People’s Friendship University of Russia (Moscow, Russia). Franz was awarded the
prestigious Arnold-Lucius-Gesell Prize from the Theodor-Hellbrügge Foundation. He was an elected member
of the prestigious Leibniz Society and of the International Academy of Science. His achievements in
the new field of chronomics earned him the O.Yu. Schmidt Medal and diploma for outstanding merits in
development of geophysics, the first such award given to a non-physicist.
Until his last breath, Franz strived to introduce timing for diagnosis, prognosis, treatment, and first
and foremost prevention into clinical practice. At over 93 years of age and still active 7 days a week in the
Halberg Chronobiology Center at the University of Minnesota, which continues his work, he was one of
the last two recipients of a lifetime career award from the National Institutes of Health. The impact Franz
had in science stemmed not only from his original findings but primarily from his vision of their implications
that led beyond a scientific breakthrough to a new way of thinking. Franz’s incredible persistence
and intellectual clarity in the face of entrenched thinking in fields that transcend disciplinary boundaries
sets him apart as a truly great scientist. As we say farewell with a great sense of loss, we remember Franz
Halberg as a trail blazer who leaves a remarkable legacy that will live forever.
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REFERENCES
1.	 Halberg F. Chronobiology. Annu Rev Physiol 1969; 31: 675–725.
2.	 Halberg F, Cornelissen G, Otsuka K, Schwartzkopff O, Halberg J, Bakken EE. Chronomics. Biomed &
Pharmacother 2001; 55 (Suppl 1): 153s–190s.
3.	 Halberg F. Some physiological and clinical aspects of 24-hour periodicity. Journal-Lancet (Minneapolis)
1953; 73: 20–32.
4.	 Halberg F, Visscher MB, Bittner JJ. Eosinophil rhythm in mice: Range of occurrence; effects of illumination,
feeding and adrenalectomy. Amer J Physiol 1953; 174: 109–122.
5.	 Halberg F. Physiologic 24-hour periodicity; general and procedural considerations with reference to
the adrenal cycle. Z Vitamin-, Hormon-u Fermentforsch 1959; 10: 225–296.
6.	 Barnum CP, Jardetzky CD, Halberg F. Time relations among metabolic and morphologic 24-hour
changes in mouse liver. Amer J Physiol 1958; 195, 301–310.
7.	 Halberg F, Cornelissen G, Katinas GS, Hillman D, Otsuka K, Watanabe Y, Wu J, Halberg Francine, Halberg
J, Sampson M, Schwartzkopff O, Halberg E. Many rhythms are control information for whatever
we do: an autobiography. Folia anthropologica 2012; 12: 5–134. http://ttk.nyme.hu/blgi/Knyvek%20ki-
advnyok/FOLIA%20ANTHROPOLOGICA/folia12.pdf
8.	 Halberg F, Guillaume F, Sanchez de la Pena S, Cavallini M, Cornelissen G. Cephalo-adrenal interactions
in the broader context of pragmatic and theoretical rhythm models. Chronobiologia 1986; 13: 137–154.
9.	 Halberg F, Cornelissen G, Sothern RB, Katinas GS, Schwartzkopff O, Otsuka K. Cycles tipping the scale
between death and survival (= “life”). Progress of Theoretical Physics 2008; Suppl. 173: 153–181.
10.	 Halberg F, Powell D, Otsuka K, Watanabe Y, Beaty LA, Rosch P, Czaplicki J, Hillman D, Schwartz-
kopff O, Cornelissen G. Diagnosing vascular variability anomalies, not only MESOR-hypertension. Am
J Physiol Heart Circ Physiol 2013; 305 (3): H279–H294.
11.	 Halberg Franz, Cornelissen G, Beaty L, Schwartzkopff O, Halberg Francine, Revilla M, Siegelova J,
Chibisov S, Breus T. Aligned physiological-epidemiological-physical environmental monitoring of
variability in Vernadsky’s noösphere: a chronousphere. Proceedings, Space Weather Effects on Humans
in Space and on Earth, Moscow, 4-8 June 2012, p. 28–30.
12.	 Halberg F, Cornelissen G, Wang ZR, Wan C, Ulmer W, Katinas G, Singh Ranjana, Singh RK, Singh
Rajesh, Gupta BD, Singh RB, Kumar A, Kanabrocki E, Sothern RB, Rao G, Bhatt MLBD, Srivastava M,
Rai G, Singh S, Pati AK, Nath P, Halberg Francine, Halberg J, Schwartzkopff O, Bakken E, Shastri VK.
Chronomics: circadian and circaseptan timing of radiotherapy, drugs, calories, perhaps nutriceuticals
and beyond. J Exp Therapeutics Oncol 2003; 3: 223–260.
13.	 Halberg F, Haus E, Cornelissen G. From biologic rhythms to chronomes relevant for nutrition. In: Marriott
BM. (Ed.) Not Eating Enough: Overcoming Underconsumption of Military Operational Rations.
Washington DC: National Academy Press; 1995. p. 361–372.
14.	 Pauly JE, Scheving LE. Dedication. In: Advances in Chronobiology, Part A. Pauly JE, Scheving LE.
(Eds.), New York; Alan R. Liss, 1987, pp. xxiii–xxvii.
15.	 CornelissenG,HalbergF,PrikrylP,DankovaE,SiegelovaJ,DusekJ,InternationalWomb-to-TombChronome
Study Group: Prophylactic aspirin treatment: the merits of timing. JAMA 1991; 266: ­3128–3129.
16.	 Siegelova J, Cornelissen G, Dusek J, Prikryl P, Fiser B, Dankova E, Tocci A, Ferrazzani S, Hermida R,
Bingham C, Hawkins D, Halberg F. Aspirin and the blood pressure and heart rate of healthy women.
Policlinico (Chrono) 1995; 1 (2): 43–49.
17.	 Siegelova J, Cornelissen G, Schwartzkopff O, Halberg F. Time structures in the development of children.
Neuroendocrinol Lett 2003; 24 (Suppl 1): 126–131.
18.	 Halberg F, Cornelissen G, Otsuka K, Siegelova J, Fiser B, Dusek J, Homolka P, Sanchez de la Pena S,
Singh RB, BIOCOS project. Extended consensus on means and need to detect vascular variability disorders
(VVDs) and vascular variability syndromes (VVSs). World Heart J 2010; 2(4): 279–305.
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19.	 Cornelissen G, Siegelova J, Watanabe Y, Otsuka K, Halberg F. Chronobiologically-interpreted ABPM reveals
another Vascular Variability Anomaly (VVA): excessive pulse pressure product (PPP) – updated
conference report. World Heart J 2012; 4 (4): 237–245.
20.	Kiser K. Father Time. Minnesota Medicine 2005 [November]: 26–29, 42–43.
21.	 Lord of Time. London: Science without Borders / International Publishing House SWB; 2011. 45 pp.
Correspondence:
Germaine Cornelissen, PhD
Professor, Integrative Biology and Physiology
Director, Halberg Chronobiology Center
University of Minnesota – MMC8609
420 Delaware Street SE
Minneapolis, MN 55455, USA
Tel: 612-624-6976
Fax: 612-624-9989
Email: corne001@umn.edu
Website: http://www.msi.umn.edu/~halberg/ 	
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NONINVASIVE METHODS IN CARDIOLOGY 2013
DR OTHILD SCHWARTZKOPFF CHRONOBIOLOGIST,
HALBERG CHRONOBIOLOGY CENTER UNIVERSITY OF
MINNESOTA, USA
GERMAINE CORNÉLISSEN
Halberg Chronobiology Center University of Minnesota, USA
With great pleasure, we honor Dr Othild Schwartzkopff on the occasion of her birthday this month.
Dr Othild Schwartzkopff was born on 18 May 1922 in Germany and received
her medical degree in 1946 at the University of Goettingen. After an
Internship at the hospital in her home town (1946–1947), and residencies
in surgery (1947–1948) and medicine (1949–1950) in Duderstadt, she joined
the Pediatrics Department of the General Hospital in Rheydt/Rheinland
­(1952–1955), and later the Children’s Tuberculosis Institute in Aprath/Rheinland
(1955–1958).
When Othild moved to Canada in 1958, she worked as an intern and
later as a resident at the Grey Nuns Hospital and at the General Hospital in
Regina, Saskatchewan. Othild completed her residency in 1960. She passed
the Licenses Examination in Winnipeg, Manitoba, in 1960. She worked as a
General Practitioner in her own private practice in Herbert, Saskatchewan,
from 1960 to 1962. From 1962 to 1963, she held the position of a pediatric resident
at Vancouver General Hospital. She was licensed in British Columbia. In 1963, Dr Schwartzkopff became
a Member of the College of Physicians and Surgeons. She then moved to Sault Ste. Marie, Ontario,
where she continued her work as a pediatrician in a group practice from 1963 to 1968.
In September 1964, while continuing to practice in Canada, Othild passed her American Board of Pediatrics
in Minneapolis, Minnesota, USA. In 1967, she passed the Basic Science Examination at the Minnesota
State Board of Examiners. After passing the examinations of the State Board of Medical Examiners in July
1968, she received her license to practice and moved to Minnesota. Dr Schwartzkopff became a Fellow of
the American Academy of Pediatrics (FAAP) in April 1971. From 1968 to 1988, she was in general pediatric
practice in St. Paul, Minnesota, USA. During her last years in practice, she held a clinical academic position
in the Pediatrics Department at the University of Minnesota. There, as a clinical assistant professor of
pediatrics, she introduced second year medical students to the problems they might face in practice.
Throughout her career, Dr Schwartzkopff has volunteered her time and talents in delivering health
care in places as varied as the Amazon rainforest, Peru, and parts of Mexico.
In the mid-1990s, Dr Schwartzkopff joined the Halberg Chronobiology Center, where she now serves
as a Clinical Director. She already had an interest in the cardiovascular system and chronobiology when
in 1945, for her dissertation on “The effects of nicotinic acid and nicotinic acid amide on the cardiovascular
system, blood pressure in particular”, she measured the blood pressure at about the same time each day,
covering usually at least a week on each patient. She thus collected data that are now of interest in a transverse
way for looking at about half-weekly and weekly components. As part of the BIOCOS Project, Othild
has indeed participated in many studies, with collaborators around the world, as attested by her over 270
publications and her numerous invitations to lecture abroad, notably here in Brno, but also in Austria,
China, India, Russia, Saudi Arabia, Slovakia, Taiwan, Turkey and Vietnam, among others. Her message
reflects that of the Center, namely to screen for Vascular Variability Anomalies for pre-habilitation, while
using the information from longitudinal records to learn about influences from our environment near and
far, striving for a unified science.
Ad multos annos sanos!
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DECADAL AND MULTIDECADAL CYCLES IN THE
CARDIOVASCULAR SYSTEM, RELATING TO
DIAGNOSIS AND TREATMENT?
FRANZ HALBERG1, GERMAINE CORNELISSEN1, OTHILD SCHWARTZKOPFF1,
PRATEEK KASHIGAWALA1, DEWAYNE HILLMAN1, ROBERT B SOTHERN1,
GEORGE KATINAS1, SHIYU HONG1, JARMILA SIEGELOVA2
1 Halberg Chronobiology Center, University of Minnesota, Minneapolis, MN, USA
2 Department of Physiotherapy and Rehabilitation, St. Anna University Hospital, Brno, Czech Republic
Brno is renowned for Johann Gregor Mendel, who is regarded as the father of modern genetics (1).
But Mendel also studied astronomy and meteorology. The majority of his published works were related to
meteorology. Broad time structures (chronomes) in us have a strong genetic component which, in turn,
entered the genome in response to environmental chronomes, explored meteorologically by Mendel. The
more remote environmental origin of rhythms and their less remote genetic aspect both qualify biological
chronomes as the legacy of Mendel the meteorologist as well as the geneticist.
The need for coordinated physical and biological monitoring, the topic of a project on The BIOsphere
and the COSmos (BIOCOS) to complement genomics, can also be viewed as the legacy of Mendel the meteorologist/cartographer.
The mapping of chronomes in organisms and their environment is also associated in
Brno and beyond with the work of Jarmila Siegelova. Evidence gathered by BIOCOS suggests that genomes
have incorporated more and more of the cycles of the very environment in which they evolved, not only
by an adaptive natural selection but also by an integrative evolution (2, 3). Herein, we describe the path
from circadian to multidecadal variability, from Mendel’s genetics to Siegelova’s chronomics, achieved by
adding TIME as an indispensable dimension in biology. Chronobiology having emerged from entering the
physiological range to resolve lawful variations in time otherwise regarded and random and trivial, it has
been described as a microscopy in time (Figure 1).
Figure 1 Compared to the microscope enabling a higher spatial resolution, chronobiology achieves a higher resolution in
time by entering the physiological range to resolve lawful variations as a function of time. © Halberg.
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In 1603, Harvey wrote that the movement of the blood is due to the beating of the heart. In 2013, we add
that the human blood circulation reflects the PAST and PRESENT signatures of the cosmos (4). Variability
in the count of eosinophil cells (5) led to the coining of “circadian” in 1950. This predictable variation could
not have been obtained without splitting the otherwise unexplorable fiction of a normal range invariably
applied indiscriminately for either sex at any age. Just as circadians could be resolved by entering the normal
range, so can other cycles, as demonstrated herein for the multidecadals.
Just as the atom can be split to release energy (as apparent from the Trinity nuclear test on 16 July
1945), splitting the normal range releases information. It led to personalized spheres of the human mind,
or chrono-noosphere (briefly chronousphere), in keeping with a prediction by Stetson that “Perhaps some
… science shall yet evolve, that shall discover that Mind after all is the one persisting reality” (6). With the
atomic bomb releasing nuclear energy, we learned what the stars had done and are doing with their atoms.
Humans, in turn, changed the passive internal and equally passive external Darwinian evolution into one
guided by the sphere of the human mind. We can monitor it on ourselves for personalized surveillance
while our emotions and thoughts and the mental accomplishments of a few contribute to a generalized
chronousphere, Figure 2.
Figure 2 Passive (I & II) versus eventually active (III) evolution. From: adaptations of an organism’s parts to each other
(I) and to their environment (II) via hominization by an internally (left, I) and externally (middle, II) coordinated passive
evolution with overdue monitoring of individuals and species (chronobiology) and of societies and of their habitats
(chronomics); To: a personalized surveillance of individuals’ chronouspheres and a generalized chronousphere (right,
III) on the maturing time structured internet for resolving interactions of socio-ecologic synchronizers, modulators and
other influencers with genetically coded pacemakers, pace-resetters, amplifiers and integrators in a spatio-temporal
structure, manifesting itself with a wide frequency range at different levels of integration. I & II drawn in consultation
with the late Andrew Ahlgren. © Halberg.
By 1969, rhythms obvious to the naked eye in different frequency regions relevant to different physiological
systems and specifically to the nervous system were aligned with a very broad ultradian to multidecadal
transdisciplinary spectrum. We learned that in the same variable of the same person cycles with
different periods can be detected and that the 95% confidence intervals of some of their periods overlap
across different variables while others do not overlap, Figures 3–6.
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Figure 3 Example of non-overlapping 95% confidence intervals of components characterizing systolic
and diastolic blood pressure and pulse pressure. © Halberg.
Figure 4 Example of overlapping 95% confidence intervals of components characterizing systolic
and diastolic blood pressure and pulse pressure. © Halberg.
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Figure 5 Example of overlapping 95% confidence intervals of components characterizing systolic
and diastolic blood pressure and pulse pressure. © Halberg.
Figure 6 Example of non-overlapping 95% confidence intervals of components characterizing systolic
and diastolic blood pressure and pulse pressure. © Halberg.
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Figure 7 Similarities and differences in cycles characterizing cardiovascular variables self-measured
for 28.8 years by a man (SBS). © Halberg.
Figure 8 Similarities and differences in cycles characterizing cardiovascular variables self-measured
for 19.7 years by a woman (MIS). © Halberg.
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As shown in a 28.8-year record, a broad spectrum unfolds, Figure 7. A 0.5-year component in arterial
pressure and heart rate is likely a signature in geomagnetics. Near-transyears in systolic blood pressure,
heart rate and pulse pressure product may be related to solar magnetism. Far-transyears are also detected.
The near- and far-transyears, together with decadals, are also detected in a 19.7-year record, Figure 8. The
presence of near-transyears (with a period slightly but statistically significantly longer than one year)
­illustrates the need to analyze longitudinal records without first stacking the data monthly over a presumed
calendar year cycle, as done since the days of General Sir Edward Sabine and Julius Bartels (7).
Cycles with periods clustering around 5 and 10 years are found in longitudinal records of blood pressure
and heart rate from several individuals spanning several decades. Cycles with similar periods are
also found in anthropometric records at birth (8), Figure 9. Summarizing the periods of the cycles detected
in these longitudinal records in a histogram reveals a sharp peak around 10 years, Figure 10.
The foregoing summaries stem from global analyses, that is from analyses of the records as a whole.
Because non-photic cycles tend to be non-stationary, complementary local analyses are recommended. In
order to gain information about changes in cycle characteristics as a function of time, local analyses include
gliding spectral windows and chronobiologic serial sections. Both methods are based on analyses
carried out on intervals shorter than the entire record that are progressively moved by a given increment
throughout the entire record. It is recommended to use varied interval lengths. Gliding spectra aligned
with global spectra are “glocal” in that they provide both a local view of changes with time in a given spectral
range and an overall global assessment of all available data.
Figure 9 Periods of cycles detected with their uncertainties in anthropometric measures at birth and in systolic (S) and
diastolic (D) blood pressure (BP) and heart rate (HR) of 7 bio-medical scientists, including 5 physicians, four of them
under hypotensive treatment. Another subject (CH-M) contributed data on the urinary excretion of 17-ketosteroids (17KS)
for 15 years). Note cluster around 10 years with a vertical shaded yellow band indicating Wolf numbers during the
prior 100 years with their uncertainty and a vertical shaded green band giving the 95% confidence limits of the period of
the equatorial geomagnetic index Dst during the past 27 years. © Halberg.
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Figure 10 Cluster of periods in the human circulation peaking putatively near the peak
of the Horrebow-Schwabe cycle in relative sunspot (Wolf) numbers. © Halberg.
To these “glocograms” (9), local sliding spectrograms (10) were added, as illustrated in Figure 11. It can
be seen that lines are really bands when sliding spectra are used to summarize them. Whereas a 1-year
synchronized component is seen to characterize systolic blood pressure of RBS (Figure 11, left), a much
broader spectral band is observed for his father (Figure 11, middle), and for his mother (Figure 11, right) the
period becomes longer than 1 year toward the end of the record.
Figure 11 Summary from familial rhythmometry: the systolic blood pressure of the son (RBS; left)
is characterized by a 1-year synchronized component, with a band riding on precisely 1-year;
that of the father (SBS; middle) and of the mother (MIS; right) show an about-yearly component
with its period lengthening as a function of time. Analyses by J Czaplicki (10). © Halberg.
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Departure from the 1-year synchronized calendar year has been observed in other instances. To distinguish
between circannual and para-annual variations, it is thus important to estimate the period with
its 95% confidence interval. Non-overlap of 95% confidence intervals of periods of two or more variables
has been used as a criterion of congruence (11). By the criterion of congruence, the estimation of 1 minute
by a healthy man more than matched in its association with either terrestrial or solar magnetism the association
of terrestrial to solar magnetism with each other (11, 12).
Now that a molecular basis has been documented underlying the circadian system, it is widely accepted
that the about-daily variations in physiological functions are partly endogenous and that they can be
synchronized by environmental cycles such as the lighting regimen, temperature and the feeding schedule.
As organisms evolve in an open environment, the question may be raised whether cycles shared between
biology and physics may also be partly inherited, in view of the coperiodisms observed in different
frequency regions between organisms and their environment. After all, cycles are essential for life (13)!
Figure 12 Illustrative example of long record: mean arterial pressure self-measured for 45.6 years by a healthy man.
Data (dots) are fitted with a model determined by the extended linear-nonlinear cosinor.
Periods of cycles thus detected in this and other longitudinal biospheric records spanning decades
are summarized in the histogram shown in Figure 13. © Halberg.
As an example of the magnitude of long cycles characterizing vital signs and other variables, Figure 12
illustrates in the time domain a 45.6-year record of mean arterial pressure self-measured about 5 to 6 times
per day by a clinically healthy man. Major spectral peaks characterizing biospheric variables recorded
over decades such as the data series pictured in Figure 12 have been summarized in a histogram, Figure 13.
It includes all periods found in our meta-analyses of the life’s work of Alexander Leonidovich Chijevskiy,
Raymond Holder Wheeler, Andrew Ellicott Douglas, and, among others, our own. The mega-atomic bombs
that sunspots are have acted in a thus far passive evolution, reflected in the circulation of blood with their
past and partly present periods. The major peak at Hale’s bipolarity cycle of about 20 years is readily apparent
in Figure 13’s histogram. The solar wind has blown since time immemorial, before satellites recorded it.
Solar flares erupted for an equally long passive internal and external evolution of the universe.
As Stetson put it (6), “Mind after all is the one persisting reality”. Let us monitor our minds to know
ourselves, as implemented already on hundreds of individuals by Jarmila Siegelova and her colleagues in
Brno, whereby they erected a monument for the difficult concept of “Know thyself” in a personalized chro-
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nousphere (14). The same data reflecting populations and emotions may contribute to a special compartment
in the generalized chronousphere that can be moved by emotions. Thus far only a few outstanding
minds can teach us about the new transdisciplinary spectrum that reveals cyclicity as the ubiquitous,
albeit Aeolian phenomenon. It is important for cardiovascular diagnosis and treatment. It is important for
a lot more, including concerns about societal and natural cataclysms (15).
Figure 13 Major cycles characterizing long biological records preferentially assume
periods of about 20 and/or 10 years. © Halberg.
Support: University of Minnesota Supercomputing Institute.
REFERENCES
1.	 Halberg F, Cornelissen G, Wendt H, Siegelova J, Dusek J, Fiser B. New trends in cosmobiophysics and
the need for a space weather report. Folia Mendeliana 31-32, Supplementum ad Acta Musei Moraviae,
Scientiae naturales LXXXI–II: 13–15,1996/1997.
2.	 Halberg F, Marques N, Cornelissen G, Bingham C, Sanchez de la Peña S, Halberg J, Marques M, Wu J,
Halberg E. Circaseptan biologic time structure reviewed in the light of contributions by Laurence K.
Cutkomp and Ladislav Dérer. Acta entomol bohemoslov 1990; 87: 1–29.
3.	 Halberg F, Cornelissen G, Prikryl P, Katinas G, Dusek J, Homolka P, Karpisek Z, Sonkowsky RP,
Schwartzkopff O, Fiser B, Siegelova J, International BIOCOS Project Team. Chronomics complement
genomics in Brno. What Johann Gregor Mendel wished, Jarmilka Siegelova accomplished: Broadening
system times and transdisciplinary time horizons. In: Halberg F, Kenner T, Fiser B. (Eds.) Proceedings,
Symposium: The Importance of Chronobiology in Diagnosing and Therapy of Internal Diseases.
Faculty of Medicine, Masaryk University, Brno, Czech Republic, January 10–13, 2002. Brno: Masaryk
University; 2002. pp. 7–56.
4.	 Sutcliffe J, Duin N. A History of Medicine. New York: Barnes & Noble; 1992. 256 pp.
5.	 Halberg F, Visscher MB. Regular diurnal physiological variation in eosinophil levels in five stocks of
mice. Proc Soc exp Biol (N.Y.) 1950; 75: 846–847.
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6.	 Stetson HT. Man and the Stars. New York: Whittlesey House, McGraw-Hill; 1930.pp. 158.
7.	 Halberg F, Düll-Pfaff N, Gumarova L, Zenchenko TA, Schwartzkopff O, Freytag EM, Freytag J, Cornélissen
G. 27-day cycles in human mortality: Traute and Bernhard Düll. Hist Geo Space Sci 2013; 4: 47–59.
doi:10.5194/hgss-4-47-2013. NIHMSID: 485452.
8.	 Halberg F, Cornelissen G, Sothern RB, Hillman D, Watanabe Y, Haus E, Schwartzkopff O, Best WR.
Decadal cycles in the human cardiovascular system. World Heart J 2013; 4(4), in press.
9.	 Halberg F, Cornelissen G, Regal P, Otsuka K, Wang ZR, Katinas GS, Siegelova J, Homolka P, Prikryl P,
Chibisov SM, Holley DC, Wendt HW, Bingham C, Palm SL, Sonkowsky RP, Sothern RB, Pales E, Mikulecky
M, Tarquini R, Perfetto F, Salti R, Maggioni C, Jozsa R, Konradov AA, Kharlitskaya EV, Revilla
M, Wan CM, Herold M, Syutkina EV, Masalov AV, Faraone P, Singh RB, Singh RK, Kumar A, Singh R,
Sundaram S, Sarabandi T, Pantaleoni GC, Watanabe Y, Kumagai Y, Gubin D, Uezono K, Olah A, Borer
K, Kanabrocki EA, Bathina S, Haus E, Hillman D, Schwartzkopff O, Bakken EE, Zeman M. Chronoastrobiology:
proposal, nine conferences, heliogeomagnetics, transyears, near-weeks, near-decades,
phylogenetic and ontogenetic memories. Biomed & Pharmacother 2004; 58 (Suppl 1): S150–S187.
10.	 Halberg F, Powell D, Otsuka K, Watanabe Y, Beaty LA, Rosch P, Czaplicki J, Hillman D, Schwartzkopff
O, Cornelissen G. Diagnosing vascular variability anomalies, not only MESOR-hypertension. Am J
Physiol Heart Circ Physiol 2013; 305: H279–H294. doi: 10.1152/ajpheart.00212.2013.
11.	 Halberg F, Cornelissen G, Grambsch P, McCraty R, Beaty L, Siegelova J, Homolka P, Hillman DC, Finley
J, Thomas F, Kino T, Revilla M, Schwartzkopff O. Personalized chronobiologic cybercare; other
chronomics’ progress by transdisciplinary cycles’ congruences: Season’s Appreciations 2009. J Appl
Biomed 2011; 9: 1–34. DOI 10.2478/v10136-009-0022-8.
12.	 Cornelissen G, Grambsch P, Sothern RB, Katinas G, Otsuka K, Halberg F. Congruent biospheric and
solar-terrestrial cycles. J Appl Biomed 2011; 9: 63–102. DOI 10.2478/v10136-009-0023.
13.	 Halberg F, Cornelissen G, Sothern RB, Katinas GS, Schwartzkopff O, Otsuka K. Cycles tipping the scale
between death and survival (= “life”). Progress of Theoretical Physics 2008; Suppl. 173: 153–181.
14.	 Halberg F, Cornelissen G, Beaty L, Schwartzkopff O, Halberg Francine, Revilla M, Siegelova J, Chibisov
S, Breus T. Aligned physiological-epidemiological-physical environmental monitoring of variability
in Vernadsky’s noösphere: a chronousphere. Proceedings, Space Weather Effects on Humans in Space
and on Earth, Moscow, 4–8 June 2012, pp. 28–30.
15.	 Halberg F, Cornelissen G, Schwartzkopff O, Khalilov E, Khalilov T, Damirov F, Wang Z, Watanabe Y,
Otsuka K, Siegelova J, al-Abdulgader AA. Preventive cardiology concerns avoidance of personal and
societal health-related and natural cataclysms. In: Halberg F, Kenner T, Fiser B, Siegelova J. (Eds.) Noninvasive
Methods in Cardiology, October 17, 2011, Brno, Czech Republic. Brno: Faculty of Medicine,
Masaryk University. p. 33–44.
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SUNSPOT CYCLES DRIVE THE CARDIOVASCULAR
SYSTEM IN A UNIFIED SCIENCE
GERMAINE CORNELISSEN1, PRATEEK KASHIGAWALA1, DEWAYNE HILLMAN1,
JARMILA SIEGELOVA3, FRANZ HALBERG1
1 Halberg Chronobiology Center, University of Minnesota, Minneapolis, MN, USA
2 Department of Functional Diagnostics and Rehabilitation, St. Anna University Hospital, Brno, Czech Republic
Dedicated to Othild Schwartzkopff on the occasion of her birthday.
In 1995, Roederer (1) proposed that cycles of biospheric processes be divided into photic and non-photic
cycles, in line with the nature of those environmental processes. Photic cycles are associated with electromagnetic
radiation in the visible frequency range. Non-photic cycles are related a.o., to corpuscular emissions
from the Sun or space more generally, UV radiation, gravity, and geomagnetism. Prominent about
the non-photic cycles are the about 11-year solar activity cycle and about 50-year variations also detected
in solar activity and found in a number of biological records (2–4).
Surprisingly, both the about 11-year and 50-year cycles were first reported by economists. Hyde Clarke
(1838) was first to report in print an about 11-year economic cycle (5). In that same year, Schwabe (1789–
1876) published data clearly showing the cycle, but refrained from writing about periodicity (6, 7). Christian
Pedersen Horrebow (1718–1776), a Danish astronomer, son of Peder (Nielsen) Horrebow (1679–1764),
whom he succeeded as head of the astronomical observatory associated with the University of Copenhagen,
deserves credit for a thorough sunspot data collection between 1761 and the time of his death (16 years),
continued by his successor only until 1777 (8). Elsewhere (9), we showed that an about 11-year cycle could
be documented based on these early sunspot data collected before Samuel Heinrich Schwabe who started
recording sunspot numbers in 1826 and continued to do so for 17 years.
Changes in solar activity, in turn, have been associated with changes in the weather (10), which are
thought to influence economic cycles (11). Kondratiev is particularly known for economic cycles averaging
about 50 years and ranging from approximately 40 to 60 years. Kondratiev identified three phases in
the cycle, namely expansion, stagnation, and recession. Modern modifications of Kondratiev’s theory led
to the identification of technological cycles such as the Industrial Revolution (1771), the age of steam and
railways (1829), the age of steel and heavy engineering (1875), the age of oil, electricity, the automobile and
mass production (1908), and the age of information and telecommunications (1971) (12). While Kondratiev
was first to bring his observations to international attention in 1925 (13), two Dutch economists had already
argued for the existence of such a long cycle by 1913 (14). The presence of an about 50-year cycle in world
GDP dynamics detected by spectral analysis recently corroborated Kondratiev’s theory (15).
Herein, we revisit the about 11-year and 50-year cycles in economy and illustrate the presence of similar
periodicities in biology. About 11-year cycles in merchandise exported to India (1708–1734) preceded
those found in the cardiovascular system (16). The about 50-year economic cycle was noted almost two
centuries before a similar cycle was reported in the context of preventive cardiology (17). The question is
raised whether multi-frequency coperiodisms in cardiology can lead the way toward a unified science.
Solar activity follows an about 11-year cycle. Its period, however, is highly variable from cycle to cycle
(18). An about 11-year cycle has been observed in economics as early as 1813 (19). Deduced from authentic
documents, and founded upon practical experience obtained in the course of seven voyages to India and
China, William Milburn published a table listing the number of ships sent out from England by the Honorable
East India Company, with their chartered tonnage, the amount of merchandise and bullion exported,
the number of ships lost or taken, and the sale amount of the goods imported by the Company each year
between 1708–1709 and 1733–1734 (19).
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Figure 1 Time course of the yearly values of merchandise
exported to India (1708-1734) (19). © Halberg.
Figure 2 Least squares spectrum of data from W Milburn
shown in Figure 1 reveals a large peak corresponding to a
period of about 10.7 years. © Halberg.
Figure 3 Model derived by the extended linear-nonlinear cosinor (Figure 2)
is plotted with the original data (Figure 1). © Halberg.
Some regularity in the values of merchandise exported to India (1708–1734) is readily apparent from
Figure 1. A large spectral peak is revealed by the extended linear-nonlinear cosinor (20–22), corresponding
to a period of 10.67 years, with a 95% confidence interval (CI) extending from 9.61 to 11.74 years, Figure 2.
As seen from Figure 3, the model fits the data well. Other entries published by Milburn (19) presented an
increasing trend as a function of time. Accordingly, the data were detrended prior to analysis by the extended
linear-nonlinear cosinor, yielding the following results: for the number of ships, in addition to a
component with a period of about 9.54 [CI: 6.64–12.44] years, another cycle is detected with a longer period
of 17.74 [CI: 6.93–28.54] years of similar prominence; for tonnage, a similar model applies, consisting of
two components with periods of 9.90 [CI: 6.62–13.18] and 18.56 [CI: 3.13–33.98] years; for the imports’ sale
amount, a component with a period of about 10.20 [CI: 6.58–13.82] years is also detected, together with
a component with a shorter period of about 2.357 [CI: 2.165–2.549] years; only for bullion is the about 11year
component not found, the model consisting in this case of components with periods of about 19.44
[CI: ­8.44–30.44] and 6.71 [CI: 5.45–7.98] years. Of course, due to the relatively short records, the CIs are quite
wide. Major components detected by wavelets are summarized in Figure 4.
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NONINVASIVE METHODS IN CARDIOLOGY 2013
Figure 4 Results from wavelet analysis of the data from W Milburn (19). © Halberg.
In the Railway Register in January 1847 (26: 155), Hyde Clarke (23) already wrote about decadal sequences:
“We have just gone through a time of busy industry, and are come upon sorrow and ill fortune; but
the same things have befallen us often within the knowledge of those now living. Of 1837, of 1827, of 1817, of
1806, of 1796, there are men among us who can remember the same things as we now see in 1847. A period
of bustle, or of gambling, cut short in a trice and turned into a period of suffering and loss, is a phenomenon
so often recorded, that what is most to be noticed is that it should excite any wonder or alarm.”
Clarke (23) also wrote about a 54-year cycle (26: 159): “In searching for a period supposed to be of fiftyfour
years, it became a question whether the period were to be reckoned back from 1846 or from 1847.
I … found that about 1793 a great deficiency of food was felt in France, which aggravated the sufferings
consequent on the revolution, but the circumstances of the period of 1793 did not seem to me to determine
it sufficiently. I next sought back from 1793 for … fifty-four years, which led me to 1739 or 1740 as the approximate
date. The character of 1740 I found well determined as that of a time of great dearth, and it is
so mentioned by Adam Smith, in the Wealth of Nations, Book I. chap. ii, where he says — ‘The year 1740,
however, was a year of extraordinary scarcity.”
Our analyses of the South English Price Index (24) also showed the presence of an about 50-year cycle,
among other components with long periods discussed elsewhere (1). As seen in Figure 5, after detrending
the data, the estimated 49.7-year cycle has an uncertainty (CI) of 48.4 to 50.9 years. Since around 1720, this
component has a relatively stable phase and an amplitude that increases as a function of time, Figure 6.
Solar signatures, such as the about 10.5-year and 21-year cycles are ubiquitous, also in biology (2). It
even modulates the circadian acrophase of oxygen production by a population of the giant unicell Acetabu-
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NONINVASIVE METHODS IN CARDIOLOGY 2013
laria mediterranea (25). Decadals and other long cycles are detected in all longitudinal blood pressure and
heart rate records spanning decades that were available for analysis, reviewed elsewhere in this volume
(26).
Figure 5 Data on the South English Price Index (24), available from 1495 to 1954 (top), detrended by means of a 6th-order
polynomial (middle), are characterized by several long cycles, including an about 50-year Kondratiev cycle, as revealed in
the least squares spectrum (bottom) obtained by the extended linear-nonlinear cosinor analysis. © Halberg.
Figure 6 Analysis by chronobiologic serial section of the data on the South English Price Index (24) shown in Figure 5 at a
trial period of 49.67 years indicates the increased prominence of the Kondratiev cycle as a function of time (the amplitude
becomes larger) and a relatively stable phase since about 1720. © Halberg.
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NONINVASIVE METHODS IN CARDIOLOGY 2013
Decadal and other long cycles are not trivial since they also characterize the incidence patterns of
major vascular conditions such as myocardial infarctions (Figure 7) (27) and strokes (17, 27, 28), Figure 8.
About 50-year cycles, first described in economics, are also detected not only in the incidence of strokes in
Minnesota and in the Czech Republic, but also in a number of other data pertinent to human affairs, Figure
9. It is observed in natality in the USA, in anthropometric data in Russia, in homicides in the USA, in an
index of international wars, in the incidence of large earthquakes and accompanying tsunamis, as well as
in Wolf numbers representing solar activity (2, 4, 29–31).
Slowly assessed, and replicated even more slowly, about 10-year and 50-year cycles have been described
for individuals in longitudinal records and in populations contributing transverse and/or hybrid
records. The uncertainties of the periods involved, dependent on the length of the time series available for
analysis, constitute a major problem in extending the lessons from circadians to long-period cycles. This
problem represents an urgent challenge in transdisciplinary science. A repository of data and maps of photic
and non-photic cycle characteristics derived therefrom is a first step toward a systematic documentation
of coperiodisms linking environmental cycles to cycles in biology and human affairs more generally,
in an attempt to gain a better understanding of how humans interact with their environment.
Monitoring vital signs and other physiological variables is facilitated by modern technology. A concerted
effort to collect serial data and to analyze them as-one-goes may eventually lead to what Franz Halberg
visualized as a “unified science”. Apart from the obvious benefit to individual health, physiological
surveillance, combined with existing monitoring by physicists may help improve the health of societies,
by enhancing the “good”, reducing the “bad” (criminality, terrorism), and avoiding consequences from
natural cataclysms (32).
Figure 7 Mortality from myocardial infarction in Minnesota (1968-1996) follows an about 10.5-year cycle, accounting for
an excess of 220 deaths per year during years of maximal solar activity as compared to years of minimal solar activity. ©
Halberg.
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NONINVASIVE METHODS IN CARDIOLOGY 2013
Figure 8 An about 50-year cycle characterizes the incidence of strokes in Minnesota and in the Czech Republic.
Whereas the estimated periods are similar (Figure 9), there is a substantial phase difference, pointing to the need to
account for geographic difference when mapping non-photic cycles. © Halberg.
Figure 9 About 50-year cycles characterizing the incidence of strokes in Minnesota and in the Czech Republic, first
found in economics, are also observed in natality in the USA, in anthropometric data in Russia, in homicides in the USA,
in an index of international wars, in the incidence of large earthquakes and accompanying tsunamis, as well as in Wolf
numbers representing solar activity. © Halberg.
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NONINVASIVE METHODS IN CARDIOLOGY 2013
Support: University of Minnesota Supercomputing Institute.
REFERENCES
1.	 Halberg F, Cornelissen G, Sothern RB, Czaplicki J, Schwartzkopff O. Thirty-five-year climatic cycle in
heliogeophysics, psychophysiology, military politics, and economics. Izvestiya, Atmospheric and Oceanic
Physics 2010; 46 (7): 844–864.
2.	 Halberg F, Cornelissen G, Katinas G, Appenzeller O, Otsuka K, Sothern RB, Tarquini R, Perfetto F, Maggioni
C, Wilson D, Schröder W, Schwartzkopff O, Kessler T, Wang Z, Burioka N, Watanabe Y, Bakken E.
System times and time horizons for biospheric near-matches of primarily non-photic environmental
cycles. Biomed & Pharmacother 2002; 56 (Suppl. 2): 266s–272s.
3.	 Halberg F, Cornelissen G, Salti R, Perfetto R, Tarquini R, Stagi S, Hillman DC, Katinas GS, Hoogerwerf
WA, Carandente F, Otsuka K, Czaplicki J, Chibisov SM, Scheving LA, Syutkina EV, Masalov A, Mitsutake
G, Wang ZR, Wan CM, Schwartzkopff O, Bakken EE. Chronoauxology. Chronomics: trends and
cycles in growth and cosmos rather than secularity. In: Proceedings, 10th Auxology Congress: Human
Growth in Sickness and in Health, Florence, 4–7 July 2004. Florence: Edizioni Centro Studi Auxologici;
2010. 92 pp.
4.	 Cornelissen G, Wendt H, Halberg F. Earthquakes, features of the dynamics of the lithosphere, mirror
the heliosphere, as do physiopathologic aspects of the biosphere. In: Proceedings, Natural Cataclysms
and Global Problems of the Modern Civilization, Istanbul, 19-21 September 2011. London: SWB International
Publishing House; 2012. pp. 288–293.
5.	 Schove DJ. (Ed.). Sunspot Cycles. Benchmark Papers in Geology/68, Stroudsburg, PA: Hutchinson Ross,
1983. 397 pp.
6.	 Schwabe H. Über die Flecken der Sonne, Astronomische Nachrichten 1838; 15: 244–248 (no. 350).
7.	 Schwabe H. Sonnen-Beobachtungen im Jahre 1843, Astronomische Nachrichten 1844; 21: 254–256
(no. 495).
8.	 Thiele ThN. De Macularum Solis antiquioribus quibusdam observationibus Hafniae institutis. Astronomische
Nachrichten 1859; 50: 259–261.
9.	 Cornelissen G, Halberg F, Sonkowsky R, Siegelova J, Homolka P, Dusek J, Fiser B. Meta-analysis of Horrebow’s
and Schwabe’s scholarship with a view of sampling requirements. In: Proceedings, Noninvasive
Methods in Cardiology, Brno, Czech Republic, July 7-10, 2009 p. 141–158. http://web.fnusa.cz/files/
kfdr2009/sbornik_2009.pdf
10.	 Labitzke K, van Loon H. Some recent studies of probable connection between solar and atmospheric
variability. Annales Geophysicae 1993; 11: 1084–1094.
11.	 Kondratiev ND. The long waves in economic life. Review of Economic Statistics 1935; 17(6): 105–115.
12.	 http://en.wikipedia.org/wiki/Kondratiev_wave
13.	 Kondratiev ND. The Major Economic Cycles. Voprosy Conjunktury (Problems of Economic Conditions)
1925; 1: 28–79.
14.	 Van Gelderen J. (alias J. Fedder) Springvloed, Beschouwingen over industriële ontwikkeling en prijsbeweging.
De Nieuwe Tijd 1913; 18: 253–445. See also de Wolff S. Prosperitäts- und Depressionperiode.
In: Jensen O. (Ed.). Der Lebendige Marxismus: Festgabe “Zum 70. Geburtstage von Karl Kautsky”. Jena:
Thuringer Verlagsanstalt; 1924. Pp. 13–43.
15.	 Korotayev AV, Tsirel SV. A Spectral Analysis of World GDP Dynamics: Kondratieff Waves, Kuznets
Swings, Juglar and Kitchin Cycles in Global Economic Development, and the 2008–2009 Economic Crisis.
Structure and Dynamics 2010; 4 (1): 3–57.
16.	 Halberg F, Cornelissen G, Sothern RB, Hillman D, Watanabe Y, Haus E, Schwartzkopff O, Best WR.
Decadal cycles in the human cardiovascular system. World Heart J 2013; 4(4), in press.
17.	 Fiser B, Cornelissen G, Siegelova J, Dusek J, Homolka P, Mazankova V, Halberg F. Increase in stroke
deaths after 1997 in the Czech Republic. Scripta medica (Brno) 2002; 75: 95–100.
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18.	 Cornelissen G, Halberg F, Gheonjian L, Paatashvili T, Faraone P, Watanabe Y, Otsuka K, Sothern RB,
Breus T, Baevsky R, Engebretson M, Schröder W. Schwabe’s ~10.5- and Hale’s ~21-year cycles in human
pathology and physiology. In: Schröder W, editor. Long- and Short-Term Variability in Sun’s History
and Global Change. Bremen: Science Edition; 2000. p. 79–88.
19.	 Milburn W. Oriental Commerce. Vol. 1. London: Black, Parry & Co.; 413 + cii pp.
20.	Halberg F. Chronobiology: methodological problems. Acta med rom 1980; 18: 399–440.
21.	 Cornelissen G, Halberg F. Chronomedicine. In: Armitage P, Colton T. (Eds.) Encyclopedia of Biostatistics,
2nd ed. Chichester, UK: John Wiley & Sons Ltd; 2005. p. 796–812.
22.	Refinetti R, Cornelissen G, Halberg F. Procedures for numerical analysis of circadian rhythms. Biological
Rhythm Research 2007; 38 (4): 275–325. http://dx.doi.org/10.1080/09291010600903692. PMCID:
PMC3663600.
23.	Clarke H. Physical Economy: A preliminary inquiry into the physical laws governing the periods of
famines and panics. Railway Register 1847; 5(26): 155–169.
24.	Goldstein JS. Long Cycles: Prosperity and War in the Modern Age. New Haven: Yale University Press,
1988, 433 pp.
25.	Halberg F, Cornelissen G, Katinas GS, Hillman D, Berger S, Woolum JC, Sanchez de la Peña S, Siegelova
J. The cosmos in a eukaryotic unicell. In: Halberg F, Kenner T, Fiser B, Siegelova J. (Eds.) Proceedings,
Noninvasive Methods in Cardiology, Brno, Czech Republic, October 4-7, 2008. p. 32–43. http://web.
fnusa.cz/files/kfdr2008/sbornik_2008.pdf
26.	Halberg F, Cornelissen G, Schwartzkopff O, Kashigawala P, Hillman D, Sothern RB, Katinas G, Hong S,
Siegelova J. Decadal and multidecadal cycles in the cardiovascular system, relating to diagnosis and
treatment. This volume.
27.	 Cornelissen G, Halberg F, Breus T, Syutkina EV, Baevsky R, Weydahl A, Watanabe Y, Otsuka K, Siegelova
J, Fiser B, Bakken EE. Non-photic solar associations of heart rate variability and myocardial
infarction. J Atmos Solar-Terr Phys 2002; 64: 707–720.
28.	Cornelissen G, Dusek J, Kenner T, Kenner B, Schwartzkopff O, Siegelova J. In honor of Bohumil Fiser:
educator, physiologist, chronobiologist, administrator, Czech minister of health, and executive board
member of the World Health Organization. This volume.
29.	Halberg F, Cornelissen G, Otsuka K, Syutkina EV, Masalov A, Breus T, Viduetsky A, Grafe A, Schwartzkopff
O. Chronoastrobiology: neonatal numerical counterparts to Schwabe’s 10.5 and Hale’s 21-year
sunspot cycles. In memoriam Boris A. Nikityuk. Int J Prenat Perinat Psychol Med 2001; 13: 257–280.
30.	Wheeler RH. War 599 B.C. 1950 A.D. Indexes of International and Civil War Battles of the World. New
York: Foundation for the Study of Cycles; 1951. 15 pp.
31.	 Halberg F, Cornelissen G, Otsuka K, Katinas G, Schwartzkopff O. Essays on chronomics spawned by
transdisciplinary chronobiology: Witness in time: Earl Elmer Bakken. Neuroendocrinol Lett 2001; 22:
359–384.
32.	Halberg F, Cornelissen G, Schwartzkopff O, Khalilov E, Khalilov T, Damirov F, Wang Z, Watanabe Y,
Otsuka K, Siegelova J, al-Abdulgader AA. Preventive cardiology concerns avoidance of personal and
societal health-related and natural cataclysms. In: Halberg F, Kenner T, Fiser B, Siegelova J. (Eds.) Noninvasive
Methods in Cardiology, October 17, 2011, Brno, Czech Republic. Brno: Faculty of Medicine,
Masaryk University. p. 33–44.
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SEVEN-DAY AMBULATORY BLOOD PRESSURE
MONITORING: BLOOD PRESSURE VARIABILITY
AT REST AND DURING EXERCISE
SIEGELOVÁ J., HAVELKOVÁ A., DUŠEK J., POHANKA M., DUNKLEROVÁ L., DOBŠÁK P.,
SINGH, RB*, CORNÉLISSEN G.*,
Department of Physiotherapy, Department of Sport Medicine and Rehabilitation, Faculty of Medicine, Masaryk
University, St. Anna University Hospital, Brno, CZ
*University of Minnesota, USA
Dedicated to the memory of Professor Franz Halber, M.D., Dr.h.c. multi
INTRODUCTION
Regular exercise increases life expectancy, quality of life and work capability and productivity. European
Society of Cardiology, International College of Cardiology, American Heart Association Council on
Clinical Cardiology and American College of Sports Medicine call on all population of the world to create a
culture of physical activity and health for the prevention of cardiovascular diseases and diabetes mellitus
(Singh RB and Indian Consensus Group, 2010, Singh RB et al., 2011, Singh RB et al., 2013).
Usually there is no prescribed time of exercises. There is evidence that incidence of cardiovascular
events peaks in the morning around 09:00 to 11:00 (Smolensky et al., 1972, Cornélissen et al., 1994).
In one subject, based on 7-day C-ABPM, time of the evening exercise was associated with the presence
of a circadian overswing (CHAT, abbreviation for Circadian Hyper-Amplitude Tension), not found when
the same subject exercised in the morning (Homolka et al., 2005, Halberg et al., 2005, Cornélissen et al.,
1994). A brief description of the subject results with exercise and circadian timing has been published
(Singh et al., 2012).
THE PURPOSE OF THE STUDY
The aim of the study was to compare 24-hour profile of 7-day blood pressure monitoring at rest and
during exercise. The further aim was to compare the healthy subject at rest and during exercise and patients
with coronary heart disease at rest and during exercise.
SUBJECTS
We examined 21 men, healthy subjects, mean age 29±4.9 years (from 23 to 39).
For exercise training we used bicycle ergometer Kettler, type X7, Germany, 2x during week, constant
load 120 W, duration 60 min. Every exercise unit was composed of warm-up period 3 min, load 54 min and
cool-down period 3 min.
PATIENTS WITH CORONARY HEART DISEASE
The set being monitored consisted of 20 patients after myocardial infarction in the past history more
than 3 months before, of mean age 63±6.5 years and mean ejection fraction of the left ventricle 43±12.3 %.
The patients underwent phase II of cardiovascular rehabilitation (controlled ambulatory rehabilitation
program) lasting two to three months with the frequency of three times in a week at the Department
of Functional Diagnostics and Rehabilitation of St. Anna University Hospital.
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NONINVASIVE METHODS IN CARDIOLOGY 2013
METHODS
In both groups the seven-day blood pressure monitoring was made by using the instrument TM – 2421
of the Japanese firm AD on the principle of oscillometric methods of blood pressure measurement. The regime
of measurement of blood pressure was realized for 7 days repeatedly every 30 minutes from 5 to 22 h
during the day time and once in an hour from 22 to 5 h at night (Siegelová et al. 2006).
The average SBP and DBP and their standard deviations (SD) in the given days were determined by
the calculation of arithmetic mean of these values. We calculated the 7-day mean for systolic and diastolic
blood pressure.
The study was approved by local ethic committee and the patients signed the informed consent.
Figure 1
Figure 2
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NONINVASIVE METHODS IN CARDIOLOGY 2013
RESULTS
The healthy subjects (men) were ordered according to mean 7-day SBP (subject No 1: 107 mmHg, subject
No 21: 121 mmHg; median value: 121 mmHg).
The variability of one-daytime SBP values during 7-day monitoring is seen in Fig. 3 at rest and in Fig. 4
during exercise.
100
110
120
130
140
150
160
0 5 10 15 20 25
MEN
SBP[mmHg]
MEAN 24h interval
Figure 3 Variability of 24-hour mean systolic blood pressure (black points)
and 7-day mean systolic blood pressure (red line) at rest in 21 healthy subjects
100
105
110
115
120
125
130
135
140
145
0 2 4 6 8 10 12 14 16 18 20 22
MEN
SBP[mmHg]
MEAN Cycling 8 - 12 h Cycling 12 - 16 h Cycling 16 - 20 h
Figure 4 Variability of 24-hour mean systolic blood pressure (points in color)
and 7-day mean systolic blood pressure (red line) during exercise in 21 healthy subjects
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NONINVASIVE METHODS IN CARDIOLOGY 2013
Variability of one-daytime DBP values during 7-day monitoring is seen in Fig. 5 at rest and in Fig. 6
during exercise.
Mean 7-day DBP (subject No 1: 61 mmHg, subject No 21: 85 mmHg; median value: 70 mmHg).
50
55
60
65
70
75
80
85
90
0 5 10 15 20 25
MEN
DBP[mmHg]
MEAN 24h interval
Figure 5 Variability of 24-hour mean diastolic blood pressure (black points)
and 7-day mean diastolic blood pressure (red line) at rest in 21 healthy subjects
50
55
60
65
70
75
80
85
90
0 2 4 6 8 10 12 14 16 18 20 22
MEN
DBP[mmHg]
MEAN Cycling 8 - 12 h Cycling 12 - 16 h Cycling 16 - 20 h
Figure 6 Variability of 24-hour mean diastolic blood pressure (points in color)
and 7-day mean diastolic blood pressure (red line) during exercise in 21 healthy subjects
The patients with coronary heart disease (men) were ordered according to mean 7-day SBP (subject No
1: 107 mmHg, subject No 20: 141 mmHg).
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NONINVASIVE METHODS IN CARDIOLOGY 2013
Variability of one-daytime SBP values during 7-day monitoring is seen in Fig. 7 at rest and in Fig. 8
during exercise.
100
105
110
115
120
125
130
135
140
145
150
0 2 4 6 8 10 12 14 16 18 20
PATIENTS
SBP[mmHg]
MEAN 24 h interval
Figure 7 Variability of 24-hour mean systolic blood pressure (black points)
and 7-day mean systolic blood pressure (red line) at rest in 20 patients with coronary heart diseases
100
105
110
115
120
125
130
135
140
145
150
0 2 4 6 8 10 12 14 16 18 20 22
PATIENTS
SBP[mmHg]
MEAN Exercise 8:00-12:00 Exercise 12:00-16:00 Exercise 16:00-20:00
Figure 8 Variability of 24-hour mean systolic blood pressure (points in color)
and 7-day mean systolic blood pressure (red line) during exercise in 20 patients with coronary heart diseases
Variability of one-daytime DBP values during 7-day monitoring in patients with coronary heart disease
is seen in Fig. 9 at rest and in Fig. 10 during exercise.
Mean 7-day DBP (subject No 1: 66 mmHg, subject No 20: 92 mmHg).
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NONINVASIVE METHODS IN CARDIOLOGY 2013
50
55
60
65
70
75
80
85
90
95
100
0 2 4 6 8 10 12 14 16 18 20
PATIENTS
DBP[mmHg]
MEAN 24 h interval
Figure 9 Variability of 24-hour mean diastolic blood pressure (black points)
and 7-day mean diastolic blood pressure (red line) at rest in 20 patients with coronary heart diseases
50
55
60
65
70
75
80
85
90
95
100
0 2 4 6 8 10 12 14 16 18 20
PATIENTS
DBP[mmHg]
MEAN Exercise 8:00-12:00 Exercise 12:00-16:00 Exercise 16:00-20:00
Figure 10 Variability of 24-hour mean diastolic blood pressure (points in color)
and 7-day mean diastolic blood pressure (red line) during exercise in 20 patients with coronary heart diseases
DISCUSSION
As the diagnosis of hypertension is generally based on casual measurement of blood pressure in general
practitioner office and these values of blood pressure are higher than the values of ambulatory blood
pressure monitoring, the table of blood pressure thresholds for definition of hypertension with different
types of measurement is included in the Guidelines for Management of Hypertension 2007 (O’Brient et al.,
1998, Ohkubo et al., 2002, Hansen et al., 2005, Ingelsson et al., 2006, Mancia et al., 2006).
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NONINVASIVE METHODS IN CARDIOLOGY 2013
According to this table the threshold for systolic blood pressure is 140 mmHg in the office or clinic,
125–130 mmHg during 24 hours, 130–135 mmHg during day and 120 mmHg during night.
The corresponding values for diastolic blood pressure are 90 mmHg in the office and clinic, 80 mmHg
during 24 hours, 85 mmHg during day and 75 mmHg during night.
The values for home measurement are the same as for ambulatory monitoring during day.
The condition for reliability of diagnosis is low day-to-day variation of night-time and day-time pressure
values (Siegelová, et al. 2006, 2011).
Tab. 1 Blood pressure thresholds (mmHg) for definition of hypertension with different types of measurement
SBP DBP
Office or clinic 140 90
24-hour 125–130 80
Day 130–135 85
Night 120 70
Home 130–135 85
J Hypertension 2007
Seven-day ambulatory blood pressure monitoring demonstrates large day-to-day variability of blood
pressure at rest. Our studies indicate with ambulatory blood pressure monitoring, that a longer monitoring,
preferably for 7 days, is recommended (Halberg et al., 2009, 2010, 2011, 2012).
In our presentation we show a large variability of 24-hour profile at rest in 5 days and in 2 days with
exercise in healthy subjects and in patients with coronary heart disease.
The variability in healthy subject (day-to-day in 24-hour profile) was presented at rest and during exercise
in 21 healthy subjects. During exercise, even when these data were measured only for two days, we
observed similar variability as it was described at rest before.
The variability in patients with coronary hearth disease (day-to-day in 24-hour profile) was presented
at rest and during exercise in 20 patients. During exercise, even when these data were measured only for
two days, we observed similar variability as it was described at rest before.
Hypertension is currently diagnosed mostly by means of a single or a few measurements during few
consecutive examinations. This practice can be associated with over 40 % false diagnoses due in part to a
large variability in blood pressure as such and in response to external factors.
It is clear that 24-hour monitoring is better than a single or a few measurements, but for avoiding
misdiagnosis it is not sufficient (Halberg et al. 2009, 2010, 2011, 2012). Our results show that 7-day blood
pressure monitoring is the best way for blood pressure real values and it is in agreement with the results of
BIOCOS project, carried out under the guidance of late professor Halberg and professor Cornélissen (Halberg
et al., 2009, Cornélissen et al., 1994, 2005).
Self-measurement of blood pressure at home can also provide very important blood pressure values
that, when averaged over a period of a few days, are more reproducible and predict the presence and progression
of organ damage as well as the risk of cardiovascular events better than office values. Home blood
pressure measurement for suitable periods can be recommended before and during the treatment also
because this relatively cheap procedure may improve patient adherence to the treatment.
The immediate response of blood pressure and heart rate to graded exercise was also circadian stagedependent
in an earlier study. Exercise done by a 46-year old man in the Czech Republic was associated
with an increase in the circadian amplitude of blood pressure that was more pronounced when exercise
was done in the evening than in the morning, in his case leading to an abnormal circadian pattern carrying
an increased cardiovascular disease risk (Halberg et al., 2009, Homolka et al., 2005). Depending
on whether the circadian pattern of blood pressure tends to have too large amplitude at the outset or not,
exercise should be timed to reduce both long-term and short-term blood pressure without bringing about
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Vascular Variability Disorders that may be harmful and associated with a higher risk of a serious ischemic
event than MESOR-hypertension (Halberg et al., 2010).
CONCLUSION
From the results we can conclude that 24-hours blood pressure profile at rest and during exercise from
day-to-day vary in healthy subjects as well as in patients with coronary heart disease. On the basis of our
results we recommend the 7-day blood pressure monitoring or home blood pressure monitoring. The education
for long-lasting self-monitoring is the best approach for management of hypertension.
REFERENCES
1.	 E O’Brien, J Sheridan and K O’Malley, Dippers and non-dippers, Lancet 332 (1988), p.397.
2.	 Singh RB, and Indian Consensus Group. Prevalence and prevention of hypertension, diabetes mellitus,
and coronary artery disease in India: A scientific statement of the International College of Nutrition
and International College of Cardiology. World Heart 2010,2: 31–44
3.	 Singh RB, Kumar A, Neki NS, Pella D, Rastogi SS, Basu TK, Acharya SN, Juneja L, Toru T, Otsuka K, De
Meester F and Wilson DW, Diet and Lifesyle Guidelines and Desirable Levels of factors for Prevention
od Cardiovascular Disease and Diabetes among Elderly Subjects. A Revised Scientific Statement of the
International College of Cardiology and International College of Nutrition – 2011. World Heart J 2011;
3: 305–18
4.	 America Heart Association Council on Nutrition, Physical Activity, and Metabolism; America Heart
Association Council on Clinical Cariology; American College of sports medicine. Exercise and acute
cardiovascular events placing the risks into perspective: a scientific statement from the America
Heart Association Council on Nutrition, Physical Activity, and Metabolism and the Council on clinical
Cardiology. Circulation. 2007; 115: 2358–68.
5.	 Homolka A, Siegelova J, Halberg F. Exercise-associated transient circadian hypertension (CHAT)?
Abstract. III international Conference, Civilization diseases in the spirit of V.I. Vernadsky, People’s
Friendship University of Russia, Moscow. Oct. 10–12, 2005, p.419–421.
6.	 Smolensky M, Halberg F, Sargent F II, Chronobiology of the life sequence. In: Itoh S, Ogata K , Yoshimura
H.(Eds.) Advances in Climatic Physiology. Tokyo.Igaku Shoin Ltd.; 1972.p.281–318
7.	 Cornelissen G, Tamura K, Tarquini B, Germano G, Fersini C, Rostagno C, Zaslavskaya RM, Cardendente
O, Carandente F, Halberg F. Differences in some Circadian patterns of cardiac arrhythmia, myocardial
infarction and other adverse vascular events. Chronobiologia 1994; 21: 79–88.
8.	 Singh RB, Halberg F, Siegelova J, Cornelissen G. What is the best time to exercise? In eds. Halberg F.,
Kenner T., Siegelová J., Dobšák P. Noninvasive Methods in Cardiology. 2012; 163–64.
9.	 T Ohkubo, A Hozawa and J Yamaguchi et al., Prognostic significance of the nocturnal decline in blood
pressure in individuals with and without high 24-h blood pressure: the Ohasama study, J Hypertens
20 (2002), pp. 2183–2189.
10.	 TW Hansen, J Jeppesen, F Rasmussen, H Ibsen and C Torp-Pedersen, Ambulatory blood pressure monitoring
and mortality: a population-based study, Hypertension 45 (2005), pp. 499–504.
11.	 E Ingelsson, K Björklund, L Lind, J Ärnlöv and J Sundström, Diurnal blood pressure pattern and risk of
congestive heart failure, JAMA 295 (2006), pp. 2859–2866.
12.	 G Mancia, R Facchetti, M Bombelli, G Grassi and R Sega, Long-term risk of mortality associated with
selective and combined elevation in office, home, and ambulatory blood pressure, Hypertension 47
(2006), pp. 846–853.
13.	 P Verdecchia, C Porcellati and G Schillaci et al., Ambulatory blood pressure. An independent predictor
of prognosis in essential hypertension, Hypertension 24 (1994), pp. 793–801.
14.	 José Boggia, Yan Li, Lutgarde Thijs et all. Prognostic accuracy of day versus night ambulatory blood
pressure: a cohort study. Lancet 370 (2007), p.1219–1229.
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NONINVASIVE METHODS IN CARDIOLOGY 2013
15.	 The Task Force for the Management of Arterial hypertension of the European Society of Hypertension
(ESH) and of the European Society of Cardiology (ESC). 2007 Guidelines for the Management of Arterial
Hypertension. J Hypertension 2007, 25:1105–1187.
16.	 J. Siegelová, J. Dusek, B. Fiser, P. Homolka, P. Vank, M. Kohzuki, G. Cornellisen, F. Halberg. Relationship
between circadian blood pressure variation and age analyzed from 7-day ambulatory monitoring.
J Hypertension, 2006, vol. 24, Suppl.6, p. 122.
17.	 Redón J, Vicente A, Alvarez V et. al. Circadian rhythm variability of arterial pressure: methodological
aspects for the measurement. Med Clin, 1999 112:258–289.
18.	 Cornélissen G, Delcour A, Toussain G et al. Opportunity of detecting pre-hypertension: world wide
data on blood pressure overswinging. Biomedicine and Pharmacotherapy 59 (2005) S152–S157.
19.	 Management Committee, Australian National Blood Pressure Study: The Australian Therapeutic Trial
in Mild Hypertension. Lancet 1980, (June 14)i(8184):1261–7.
20.	Zarnke KB, Feagan BG, Mahon JL et al. A randomized study comparing a patient-directed hypertension
management strategy with usual office-based care. Am J. Hypertension 1997, 10:58–67.
21.	 Halberg F, Cornelissen G, Hillman D, Beaty lA, Hong S, Schwarzkoppf O, Watanabe Y, Otsuka K, Siegelova
J. Chronobiologically interpreted ambulatory blood pressure monitoring in health and disease.
Global Adv Health Med 2012;1(2):66–123
22.	Halberg F, Cornelissen G, Katinas GS, Watanabe Y, Siegelova J. Follow-up to the Cornelissen-series:
Inheritance of form in space from parents and of form in time from the cosmos: From Brno’s Mendel
and Siegelova, respectively. Cosmic inheritance rules.in eds. 3.Halberg F, Kenner T, Fiser B, Siegelova
J. Noninvasive methods in cardiology 2009.Masaryk University, Brno. 2009, p.13–39, ISBN 978-80-­
-7013-501-3.
23.	Siegelova J, Fiser B. Day-to-day variability of 24-h mean values of SBP and DBP in patients monitored
for 7 consecutive days. J Hypertens,2011;29,4:818–819.
24.	Halberg F, Cornelissen G, Otsuka K, Siegelova J, Fiser B, Dusek J, Homolka P, Sanches de la Pena S,
Singh RB and the BOCOS project. Extended consensus on means and need to detect vascular variability
disorders and vascular variability syndrome. World Heart J 2010; 2,4:279–305 (cf. Leibnitz-online
Nr.5 ,2009, http:www2hu-berlin.de/Leibnitz-sozietaet/journal/archive _5_09.html. 35 pp).
25.	Halberg F, Cornelissen G, Dusek J, Kenner B, Kenner T, Schwarzkoppf O, Siegelova J. Bohumil Fiser
(*22 October 1943 – 21 March 2011): Chronobiologist, Emeritus Head of the Physiology Department
at Masaryk University (Brno, Czech Republic), Czech Minister of Health, and Executive Board Member
of World Health Organization: His Legacies for Public and Personal Health Care. World Heart J
2011;3,1:63–77.
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ABOUT HALF-WEEKLY (CIRCASEMISEPTAN)
RHYTHM IN URINARY NEOSPORIN OF HEALTHY
WOMAN: METHODOLOGIC MODEL
CHRISTIAN SCHUBERT1, GERMAINE CORNELISSEN2, FRANZ HALBERG2
1 Clinical Department of Medical Psychology, Innsbruck Medical University, Innsbruck, Austria
2 Halberg Chronobiology Center, University of Minnesota, Minneapolis, MN, USA
INTRODUCTION
As a follow-up on a study of “stress” system dynamics during “life as it is lived” (1), data from a healthy
25-year old woman are further analyzed from a chronobiologic viewpoint. The subject had collected her
entire urine over a 63-day span in 12-hour intervals. Neosporin, an immune activation marker, was determined,
as was creatinine for the purpose of normalization. Emotional variables (stressors, irritation,
positive incidents, anxiety/depression, lack of arousal, performance, complacency, extra-/introversion)
recorded concomitantly were also analyzed.
With sampling more frequent than twice-a-day measurements, the about-weekly (circaseptan)
rhythm was found to dominate over the circadian variation in negative affect, whereas positive affect in
the PANAS questionnaire (2) had a dominant circadian rhythm (3). More prominent circaseptan changes
have also been found in depressed elderly citizens as compared to non-depressed controls (4). Circaseptan
and circasemiseptan changes have also been documented in blood pressure and heart rate of populations
in Minnesota (5), the Czech Republic (6), India (7), and Japan (8).
METHODS
Details about the subject and the chemical determinations can be found in the original publication (1).
In their study, the authors (1) modeled the data. Residuals from their model have also been analyzed herein.
Differences between the urinary neopterin determinations of the healthy woman obtained in the
morning and evening were computed as were morning versus evening differences in the neopterin/creatinine
ratios. A paired t-test assessed the presence of any circadian variation. Their daily averages, morning
and evening values were separately analyzed by the extended linear-nonlinear cosinor (9–11). Least
squares spectra were computed in the frequency range of one cycle in 63 days to one cycle in about 3 days.
Nonlinear least squares (12) were used to estimate the periods corresponding to major spectral peaks with
their 95% confidence intervals (CIs).
RESULTS
Figure 1 displays the neopterin/creatinine ratios as a function of time. Differences (PM-AM) between
evening (PM) and morning (AM) values are shown in Figure 2. As seen in Figure 3, evening values are statistically
significantly higher than morning values (paired t = 3.605, P < 0.001), suggesting the presence of
a circadian variation. With only two measurements per day, estimates of its characteristics cannot be obtained,
however. Differences between evening and morning values of the residual values stemming from
the model originally published (1) also show larger evening values as compared to morning values (paired
t = 3.145, P = 0.003), suggesting that factors originally accounted for did not include variability related to
the circadian rhythm.
Least squares spectra of the morning and evening neopterin/creatinine ratios and of their daily averages
are shown in Figure 4. Spectral peaks are readily seen, corresponding to components with periods of
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NONINVASIVE METHODS IN CARDIOLOGY 2013
about one month, one week and 5 days, further resolved by nonlinear least squares. In view of the relatively
small number of data available for analysis, only two components could be assessed concomitantly
with this procedure.
Figure 1 Time course of urinary neopterin/creatinine
ratios of 25-year old healthy woman. Morning (AM) and
evening (PM) values are plotted together with their daily
means. © Halberg.
Figure 2 Time course of differences (PM-AM) between
evening (PM) and morning (AM) determinations of
urinary neopterin/creatinine ratios of 25-year old woman.
© Halberg.
Figure 3 Evening determinations of urinary neopterin/creatinine ratio are consistently higher than morning values,
suggesting the presence of a circadian variation. © Halberg.
The about monthly component is found to be statistically significant in both morning and evening
determinations, albeit with a slightly longer period of about 47 days for the morning values. The circaseptan
component, however, is only detected in the morning data with a CI of its amplitude slightly overlapping
zero. Specifically, the morning data can be modeled with a two-component model consisting of cosine
curves with periods of 47.6 [CI: 31.4, 63.8] and 6.99 [CI: 6.54, 7.45] days, with corresponding amplitudes of
16.84 [CI: 1.27, 32.42] and 14.22 [−0.75, 29.18], respectively. A similar model applied to the evening data yields
estimates of the periods of 35.2 [CI: 22.6, 47.8] and 7.20 [CI: 6.53, 7.87] days, with corresponding amplitudes
of 15.41 [CI: 0.19, 30.63] and 10.66 [CI: −5.32, 26.64], respectively. The fact that the CI of the circaseptan amplitude
overlaps zero indicates that this component is not statistically significant for the evening values.
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NONINVASIVE METHODS IN CARDIOLOGY 2013
Figure 4 Least squares spectra of morning (AM) and evening (PM) values of urinary neopterin/creatinine
ratios of a healthy 25-year old woman and of their daily means. Spectral peaks are observed,
corresponding to periods of about one month, one week and 5 days. © Halberg.
Figure 5 Morning urinary neopterin/creatinine ratios fitted with a 2-component model consisting of cosine curves with
periods of about 47 days and 7 days (fixed as it is likely synchronized to the social week). © Halberg.
Since the circaseptan component is likely synchronized to the 7-day social week, its period can be
fixed in the model. Using this approach, the model reaches statistical significance for the morning values,
the amplitude of both components having a CI that does not overlap zero. The fitted model is shown with
the original morning data in Figure 5. In the case of the evening determinations, the monthly variation is
detected with statistical significance but not the 7-day component.
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Figure 6 Least squares spectra of morning (AM) and evening (PM) residual values of urinary neopterin/creatinine
ratios of a healthy 25-year old woman and of their daily means, after removing model originally derived
from the data (1). Spectral peaks at about 7 and 5 days are still observed, whereas the low-frequency
component is no longer seen, likely accounted for by the model. © Halberg.
Figure 7 Residuals from original model (1) of morning urinary neopterin/creatinine ratios fitted with model
consisting of cosine curves with periods of 7 days (fixed) and about 5 days (adjusted). © Halberg.
Similar results are obtained on the residuals, except that the model used in the original publication (1)
accounted for most of the low-frequency changes, as apparent from the least squares spectra of Figure 6.
Nonlinearly, the circaseptan component is detected with statistical significance for the moring but not for
the evening values when this component is fitted alone. As the period estimate is very close to 7 days (6.99
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NONINVASIVE METHODS IN CARDIOLOGY 2013
[CI: 6.60, 7.38]), its period has again been fixed to 7 days in a composite model including the about 5-day
component. As seen in Figure 7, the model fits the residuals relatively well, the 7-day component remaining
statistically significant, with an amplitude of 0.0383 [CI: 0.0006, 0.0760], and the about 5-day variation
reaching borderline statistical significance (the CI of the amplitude only slightly overlaps zero), with
a period estimate of 5.23 [CI: 4.97, 5.49] days and a corresponding amplitude of 0.0361 [CI: −0.0014, 0.0735].
Least squares spectra of emotional variables recorded concomitantly did not show a statistically
significant circaseptan variation in the morning. Only positive incidents (P = 0.052), anxiety/depression
(P = 0.069), and all stressors (P = 0.078) had a 7-day component of borderline statistical significance
(­P-values not adjusted for multiple testing), suggesting that the weekly variation observed in urinary
­neopterin/­creatinine ratios of this 25-year old healthy woman does not stem solely from her emotional
state.
Surprisingly, least squares spectra of neopterin and creatinine analyzed as such rather than as their
ratio are characterized by a spectral peak corresponding to a period of 3.5 days, whereas components with
periods of about 7 or 5 days are not statistically significant for the morning values, Figures 8 and 9.
Figure 8 In the absence of spectral peaks at 7 and 5 days,
urinary neopterin data (AM) are characterized by an
about 3.5-day component. © Halberg.
Figure 9 In the absence of spectral peaks at 7 and 5 days,
urinary creatinine data (AM) are characterized by an
about 3.5-day component. © Halberg.
DISCUSSION AND CONCLUSION
Urine and serum neopterin concentrations are widely used to monitor patients with HIV-1 infection
(13). Increased neopterin concentrations have been found in patients with an activated cellular immune
response which includes allograft rejection, viral infection and auto-immune disorders as well as various
malignant tumors, a higher neopterin concentration being an independent predictor of a shorter survival
in patients with several types of cancer (14).
A circadian rhythm has been documented for urinary neopterin in five healthy young men, with
a peak in the early morning, around 06:30 and a peak-trough difference reaching 50% (15). This result is in
keeping with the statistically significant morning-evening differences found herein.
To summarize findings in the present study, a circaseptan component is detected in the urinary neopterin/creatinine
ratio. It is more prominently expressed in the morning than in the evening data. Circaseptan
components could not be detected with statistical significance with the sampling used in emotional
variables recorded concomitantly. A half-weekly component is only statistically significant (P=0.045, not
corrected for multiple testing) for positive incidents. When neopterin and creatinine are analyzed as separate
variables rather than as a ratio, a half-weekly component is detected rather than about 7- and 5-day
components. Circasemiseptans are characteristics of the data analyzed. They can be tested as gauges of
strain and compared for their usefulness with the circaseptans detected in their ratio.
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Support: University of Minnesota Supercomputing Institute.
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M, Nunoda S, Nishimura Y, Shibata K, Saitoh H, Nishinaga M, Ishine M, Wada T, Okumiya K,
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monitoring reveals a circaseptan rhythmicity of blood pressure in depressive citizens in a community.
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Rhythm Research 2007; 38 (4): 275–325. http://dx.doi.org/10.1080/09291010600903692. PMCID:
PMC3663600.
12.	 Marquardt DW. An algorithm for least-squares estimation of nonlinear parameters. J Soc Indust Appl
Math 1963; 11: 431–441.
13.	 Fuchs D, Jaeger H, Popescu M, Reibnegger G, Werner ER, Kaboth W, Wachter H. Comparison of serum
and urine neopterin concentrations in patients with HIV-1 infection. Clinica Chimica Acta 1990; 187:
125–130.
14.	 Sucher R, Schroecksnadel K, Weiss G, Margreiter R, Fuchs D, Brandacher G. Neopterin, a prognostic
marker in human malignancies. Ancer Letters 2010; 287: 13–22.
15.	 Auzéby A, Bogdan A, Krosi Z, Touitou Y. Time-dependence of urinary neopterin, a marker of cellular
immune activity. Clin Chem 1988; 34 (9): 1866–1867.
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NONINVASIVE METHODS IN CARDIOLOGY 2013
AN ATLAS OF CHRONOMES
TO MAP BROAD TIME STRUCTURES
GERMAINE CORNELISSEN1, LARRY A BEATY1,2, JARMILA SIEGELOVA3,
CATHY LEE GIERKE1, KUNIAKI OTSUKA4, YOSHIHIKO WATANABE4, ELENA V SYUTKINA5,
ANATOLY MASALOV6, LYAZZAT GUMAROVA1,7, FRANZ HALBERG1
1 Halberg Chronobiology Center, University of Minnesota, Minneapolis, MN, USA
2 Phoenix Project Study Group, Institute of Electrical and Electronics Engineers
3 Department of Functional Diagnostics and Rehabilitation, St. Anna Teaching Hospital, Brno, Czech Republic
4 Tokyo Women’s Medical University, Daini Hospital, Tokyo, Japan
5 Institute of Pediatrics, Scientific Center for Children’s Health, Russian Academy of Medical Sciences, Moscow,
Russia
6 Lebedev Physical Institute, Moscow, Russia
7 Al-Farabi Kazakh National University, Almaty, Kazakhstan
Dedicated to the memory of Professor Franz Halberg (Figure 1) who first envisioned an atlas of
chronomes, with the pledge to endeavor fulfilling our dear teacher’s dream.
Figure 1 Franz Halberg
WHAT IS AN ATLAS OF CHRONOMES?
An atlas is defined as a collection of maps. Most common are atlases of regions on Earth, but an atlas
can also contain other kinds of maps, such as charts of planets, stars, and galaxies. Usually used to find
places, such as countries or cities, an atlas generally consists of several kinds of maps, some showing geographical
features, others also providing statistics on social, political or economic aspects of each region.
Atlases have traditionally been bound into book form, but multimedia formats are getting more popular
today as they possess new capabilities such as facilitating searches and providing additional educational
materials.
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Figure 2 Acrophase chart summarizing peak times with their 95% confidence intervals (horizontal bars)
of circadian rhythms in whole body and organs mapped in humans. © Halberg.
Within the scope of chronobiology, the study of non-random changes as a function of time in biology,
charts have already been prepared and compiled in several publications (e.g., 1–3). They primarily consist
of maps of acrophases (phases of maxima of cosine curves with known periods fitted to data by least
squares) shown with their 95% confidence intervals. An example is provided in Figure 2. Circadian (aboutdaily),
circaseptan (about-weekly), circatidal (about tidal or 12.4-hourly), and circannual (about-yearly)
charts provide information about times within a day, week, lunar cycle and year when high and low values
can be expected to occur. These components all have a well-defined environmental counterpart, serving as
strong synchronizers. From a biological standpoint, the environmental cycles are fairly stable as a function
of time in terms of the extent to which their periods remain more or less constant.
Compiling information for a host of variables determined in blood, urine, and/or saliva in humans
and/or different animal species provides information about chains of physiological events. When acrophase
charts report results for one or several variables separately for males and females of different age
groups, important gender differences and changes as a function of age come readily to the fore (4). Similar
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charts summarizing times when different diseases are more or less likely to occur are also available, their
usefulness consisting of knowing when to implement protective measures to shield at-risk individuals,
to initiate any needed protective action, and to assure sufficient staffing in clinics and emergency rooms.
There are also charts specifically prepared to list times of peak susceptibility or resistance to different
drugs. For instance, results from 35 studies on over 5000 rodents indicate that the anti-cancer drug daunomycin
is best tolerated when it is administered in the middle of the light (rest) span, whereas cyclophosphamide
is best tolerated around the time of dark onset and cisplatin is best tolerated in the middle of the
dark (active) span (3), results that can readily be translated for application in the clinic.
An atlas of chronomes should encompass all the above charts. It should also include information about
the notoriously wobbly non-photic environmental cycles, which also influence biota (2, 5, 6). In view of the
non-stationary nature of the non-photic environmental cycles, an atlas of chronomes should focus primarily
on the periods of the cycles, to be estimated with their uncertainties, information about amplitude and
phase becoming meaningful only when sufficiently close estimates for the period of a given component can
be specified to be compared between biological and environmental variables.
USES FOR AN ATLAS OF CHRONOMES
Long cycles related to solar activity and space weather more generally are not trivial if they can lead to
erroneous interpretations and unwarranted decisions. Let us review several scenarios.
◆◆ First, observing an increasing trend in blood pressure over several months or years may lead to the
decision to treat, when the trend is only part of a longer cycle, as was the case for a 38.5-year physicianscientist
(EH), as seen in Figure 3 (7). Another example, depicted in Figure 4, relates to the urinary
excretion of 17-ketosteroids (17-KS) by a clinically healthy man (CH): seeing the steady decrease in 17-KS
(Figure 4, left), CH considered the need for androgen substitution therapy; the decrease in 17-KS was
followed by an increase (Figure 4, middle), both trends being part of a decadal cycle (Figure 4, right) (8).
◆◆ Associations between solar activity and/or geomagnetic storms with heart rate variability and the incidence
of myocardial infarction, reported in the Russian literature (9), could not always be replicated
(10, 11). Results from systematic as-one-goes analyses of important morbidity/mortality statistics in different
geographic locations could help resolve some of the controversies. For instance, mortality from
myocardial infarction in Minnesota (1968-1996) was shown to follow an about 11-year cycle similar to
the solar activity cycle when considering all data covering about 3 solar cycles (6). When data were analyzed
separately for each solar cycle, the association could be demonstrated during the first two cycles
but not during the third (6).
◆◆ A difference in the circadian amplitude of blood pressure, originally detected in school children with
versus without a family history of high blood pressure and/or related cardiovascular disease (12), was
also found in newborn babies monitored in 1985 and 1986 (13), Figure 5. The finding, however, could not
be validated in a follow-up study in 1987-1989 (14). In the absence of a change in the blood pressure MESOR
(Midline Estimating Statistic Of Rhythm, a rhythm-adjusted mean) between 1985-1986 and 1987-
1989, the circadian amplitude increased slightly, but it did so more and with statistical significance
for babies with a negative family history than for babies with a positive family history (14). A possible
explanation for the controversial results was obtained from the independent monitoring of newborns
over two decades in Moscow, Russia (15), involving decadal cycles modulating both the MESOR and
the circadian amplitude of blood pressure. Understanding the origin of the discrepancy is important
because a larger circadian amplitude of neonatal blood pressure has also been associated with the intrauterine
exposure to betamimetics, suggesting this treatment may increase cardiovascular disease risk
later in life, confirmed in adolescence (16).
◆◆ As seen from Figure 6, differences in the characteristics of the about 10-year cycle between babies
with a positive or negative family history of high blood pressure illustrate how differences in circa-
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dian endpoints between the two groups may change as a function of the stage of the lower-frequency
component (15).
◆◆ Caution should be exercised in interpreting changes with age in 1-minute time estimation, sometimes
used as a gauge of age-related changes in verbal and visual-spatial functions (17). Indeed, depending
on whether measurements are taken in the morning or evening, changes in opposite directions can be
observed (18). Consideration of the circadian variation in 1-minute time estimation provides an answer
to the puzzle, since apart from the MESOR, the circadian amplitude and phase also change with age (18).
◆◆ The relative prominence of non-photic cycles has been seen to vary depending on when measurements
were taken along the circadian scale (19, 20).
Figure 3 Systolic Blood Pressure (SBP) self-measurements by EH (M, 38.5 years of age at start),
averaged over consecutive 2-day intervals, were analyzed by the extended cosinor. The least squares
spectrum revealed the presence of components with periods of about 12 and 6 years, resolved by nonlinear
least squares. Nonlinear results were used to estimate the fitted model shown with the 2-day means.
The increase observed in 1965 appears to be part of a decadal cycle persisting until the 1980s. © Halberg.
Figure 4 Increasing, followed by decreasing trend for several years each in the urinary excretion of 17-ketosteroids
by a healthy man are “short-time” views of a much longer cycle. © Halberg.
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Figure 5 Neonates with a positive family history of high blood pressure and/or related cardiovascular disease have a more
prominent circadian variation of blood pressure than babies with a negative family history. Results shown for systolic
blood pressure (SBP) monitored during 1985-1986. © Halberg.
Figure 6 An about 10-year cycle modulates the circadian MESOR of systolic blood pressure (SBP-M) of neonates.
Differences in its characteristics between babies with a positive or negative family history accounts for the fact that
differences in opposite directions can be observed at different times along the scale of the about 10-year cycle. © Halberg.
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THE BIOLOGIC WEEK: PARTLY ENDOGENOUS, PARTLY
RESPONDING TO SOCIETY AND GEOMAGNETICS
As an illustration of challenges facing the organization of the atlas, let us focus on the about-weekly
component. About weekly variations in biology are often viewed as no more than a response to the social
week. Whereas the social schedule can be a strong synchronizer of circaseptan rhythms, much evidence
has accumulated illustrating that this component has a dual aspect, being partly endogenous while also
responding not just to the social week but also to circaseptans in geomagnetics. All these aspects should be
represented in the atlas.
Figure 7 Hint of a circaseptan variation in neonatal blood pressure. © Halberg.
Figure 8 Change in infradian-to-circadian prominence in neonatal heart rate monitored
around the clock during the first 40 days of life. © Halberg.
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Figure 9 Individual record of neonatal blood pressure illustrates reproducibility of circaseptan
variation over more than 3 cycles. © Halberg.
Figure 10 Larger prominence of endogenous (left) than exogenous (societal; right) circaseptan component
of neonatal systolic blood pressure (SBP) suggested by stacking the data in relation to the time of birth
(developmental age; left) or day of week (society; right). © Halberg.
The prominence of the circaseptan component in neonatal blood pressure was first revealed in hybrid
data from a study in Florence, Italy, by the late Brunetto Tarquini, Figure 7 (21). A longitudinal record spanning
the first 40 days of life showed that the transition from circaseptan to circadian prominence takes
about a month, Figure 8 (22). Records obtained in the Czech Republic by Jarmila Siegelova documented that
the about-weekly variation could be reproduced over several cycles and suggested that it may be partly
endogenous since the estimated periods did not invariably cover exactly 7 days for all babies, Figure 9 (23).
Corroboration came from a summary of records from all babies, Figure 10 (23). Stacking the data by the day
of the week did not yield a statistically significant 7-day pattern, but stacking the data by post-natal day
did, suggesting that developmental age contributed more to the weekly pattern than any societal schedule,
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Figure 10 (23). Additional evidence for a partly endogenous weekly component stemmed from a study on
twins monitored in the neonatal intensive care unit at the University of Minnesota (24). Analysis by intraclass
correlation showed that the circaseptan period was more closely related between the twins in a pair
than among different twin pairs, Figure 11 (24).
Figure 11 The nonlinearly estimated circaseptan period of diastolic blood pressure (top), heart rate (middle),
and body weight (bottom) is more similar between neonates within a twin pair than among twin pairs,
as shown by the intra-class correlation coefficient. © Halberg.
Changes as a function of age in the relative circaseptan-to-circadian prominence indicated a resurgence
of the about-weekly variation in the elderly, Figure 12 (25). The question may be raised whether this
is a common feature of non-photic cycles, since a similar trend with age is found for the relative prominence
of transyears versus the 1-year synchronized variation in blood pressure and heart rate, Figure 13
(26).
A spectral peak around one cycle per week is also detected in the geomagnetic disturbance index, Kp,
corresponding to the fourth harmonic of the solar rotation period (27). In Moscow, Russia, the circaseptan
period of neonatal blood pressure and heart rate, estimated nonlinearly, correlated positively and with statistical
significance with the circaseptan period of the local K index monitored during spans matching the
neonatal records, Figure 14 (28). These results suggest that early after birth, babies, who do not yet have a
strong circadian system, may be more susceptible to geomagnetics. This hypothesis is also in keeping with
the about 10-year cycle detected in neonatal blood pressure (Figure 6).
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Figure 12 Double amplitude of systolic (left) and diastolic (right) blood pressure is statistically
significantly larger in the young and elderly than in mid-adulthood. © Halberg.
Figure 13 Prominence of a non-photic (transyear) cycle over a photic (circannual)
component early and late in life. © Halberg.
TASKS AHEAD
Cycles with periods of about 5 and 16 months, 10.5, 21, 35, and 50 years, all observed in the non-photic
environment, are also detected in longitudinal records of physiological variables and in patterns of mortality
incidence from various causes (2). Thus far, their presence has been demonstrated, and in a few cases,
their characteristics have been quantified with a measure of uncertainty. Much more needs to be done
for these cycles to become truly useful. They need to be systematically mapped and reported in an atlas
that is easy to consult, just as astronomers have started the mapping of stars and galaxies, and unmanned
vehicles are exploring the terrain on Mars. Connections need to be made between the presence of nonphotic
cycles in the cosmos, how they may be affecting the ionosphere (29) and influence weather on Earth
(30), and how these changes can, in turn, have an impact on agriculture (31), nutrition, the presence of
pathogens and overall human health (32, 33). The atlas will thus need to organize charts in a way that best
conveys sequences of events along a given time scale (i.e., cycle length).
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Figure 14 Example of circaseptan spectral peak in neonatal record of heart rate and corresponding index
f local geomagnetic disturbance, K (left). Nonlinearly estimated circaseptan periods of neonatal blood pressure
and heart rate correlate positively with corresponding estimates of K (right). © Halberg.
Figure 15 Example of geographic map comparing cycle length of incidence patterns of diphtheria
in different countries. © Halberg.
In contrast with the relatively stable 24-hour day and 12-month year, non-photic cycles in the environment
related to solar-terrestrial magnetism vary as a function of time. They undergo changes in cycle duration
and in their relative prominence. These features can be exploited to go beyond the simple observation
of cycles shared between physics and biology (34, 35). They can help our understanding of environmental
effects, making it possible to predict the future course of the biological variables (such as the incidence of
various diseases) by monitoring cycles in the environment, a task which is facilitated by the availability
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online of comprehensive databases on a variety of environmental factors prepared by physicists. The atlas
will thus need to include not just a list of cycle characteristics, but also a description of how these cycle
characteristics change as a function of time. This feature can be referred to as a “glocality” in time, where
“glocal” stems from the combined “global” view of the cycle as a whole, over as long a time scale as allowed
by the available data, and a “local” assessment of shorter-term changes in the cycles’ characteristics.
Any geographic differences should also be considered. For instance, latitude dependence was found
for an about 21-year cycle in religious motivation (36). The incidence of sudden cardiac death follows a
transyear rather than a 1-year synchronized variation in Minnesota and the Czech Republic, but not in
some other locations, such as Arkansas (37). A transyear in natality is detected in the Philippines but not
in Minnesota, Italy or Japan, where the circannual variation is most prominent (38). Long cycles in the
incidence of cholera and diphtheria have been mapped in different geographic locations, Figure 15 (39, 40).
Geographic differences are to be expected for oscillations related to solar-terrestrial magnetism as magnetic
storms show a strong dependence on latitude. Entries in the atlas will thus need to specify where the
data yielding the listed results were collected.
ATLAS CONSTRUCTION CONSIDERATIONS
When considering the actual construction of the atlas, we view it as an “information product” (though
not a product that would be sold for profit). To help ensure that we create the atlas in a useful form, we look
at examples of other atlases and, to determine some of the presentation details of the atlas, we take some
cues from typical product development processes, which generally start out with steps similar to 1) seeing
a need or problem to solve, 2) envisioning a product that solves it, 3) specifying the characteristics of the
product, and 4) defining the specific form of the product.
We expect our atlas to contain not only a substantial collection of useful chronome “maps” resulting
from recent research, but it also might contain charts with different views of the same data, tables of related
information, and indexes organized in different fashions, all in a way that is similar to many traditional
atlases of maps with their associated geographic and other data.
The desires and needs for the atlas have been clear for some time, and include dissemination of information
resulting from research at the Halberg Chronobiology Center and within the broader BIOCOS
project in a consolidated form, publishing a reference of information to be used in interpreting results as
trends when they actually are part of a cycle with a period longer than the investigation span, and explaining
discrepant results when such cycles are not recognized.
The “specifications” of the product characteristics typically come from elucidating examples of the
usage of the atlas. These “user scenarios” or “use cases” lead us to a detailed understanding of the audience
for the atlas, which in turn should affect how the textual additions to the figures are written. The use cases
should also help us refine the list of printed indexes or online search mechanisms to be included.
The atlas to be produced should provide an indispensable guide for short-term as well as long-term
studies in view of the fact that cycles with shorter periods are often modulated in their characteristics by
cycles with much longer periods. Interest in this kind of endeavor among experienced research-focused
chronobiologists and other biologists is evident from work already done in Russia (41-43), where interest in
cosmic influences on human well-being has been strong ever since Chizhevsky’s publications (39, 44, 45).
The atlas should also interest niches in the fields of space weather, geophysics, meteorology, ecology and
environmental sciences, among others.
Considering the multi-facetted aspects of the compendium to be assembled, its scope extends beyond
the usual atlas. A better term for it might be an encyclopedic atlas, since educational materials are to be
included in the volume. Encyclopedic atlases of the human body, of the world, of wine, etc., can already be
found online. By including educational materials, the atlas should be useful to those who work at growing
the interest in understanding chronobiology amongst researchers and other people with sufficient education,
experience, or reason to be interested.
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Use cases also help us recognize what the atlas is not. For example, when we look at a sample list of uses
of the atlas:
◆◆ construct a model of environment affecting human physiological health to be tested;
◆◆ construct a model of prediction of psychological effects to be tested;
◆◆ put results of testing a model testing (i.e., research) back into the atlas as a new entry;
◆◆ understand effects of environment on physiological measurements;
◆◆ correcting misinterpretation of correlations measured at different times, due to unstable (“aeolian”)
cycles;
◆◆ plan a roadmap of future research projects,
we would notice that we do not expect the atlas to be used as a tutorial for beginner students, and we presume
users to have an elementary knowledge of rudimentary math, biology, and physics.
The specific form of the atlas is likely to be two-fold. We would engage a self-publishing company that
can make printed copies of the atlas available on an as-needed basis, at the non-profit cost of printing and
mailing. An online version would be presented as a collection of HTML web pages that may contain nondisplayed
meta keywords for web-accessible search engines to index in addition to the visible text on and
around the charts themselves. The online version would presumably be updated more regularly than the
physical book. Changing online web pages creates something of a referential integrity problem for those
who wish to make references to the online form of the atlas in academic literature. We expect that a policy
of not removing important information if it becomes outdated, adding instead an explanation of how and
why the outdated information has been updated or superseded will be a sufficient solution to prevent references
to the online form of the atlas from going out of date.
In book form, the atlas should include references to publications providing additional information
about each chart and the origin of the data, together with details about their analysis. Indexing in this case
should be key to facilitate searches. Electronically, the charts can be linked to the actual numbers used to
generate them. In addition, links can be put in place to the actual data files, allowing other investigators to
run independent analyses. Links can also be provided to the original publications.
Whether the atlas is consulted in book form or online, it will be important to provide for each entry
in each chart a set of specifications regarding the input data (variable kind, span of observation, sampling
rate, location of collection, experimental conditions). Specifications should also be provided for each output,
including the period range of interest, and if warranted, corresponding information on the ­MESOR,
amplitude, and acrophase, as well as a list of environmental factors exhibiting coperiodisms with the given
spectral component and variable of interest. A field making use of the conclusion from the study is to
be added whenever possible, so that healthcare could take advantage of results on drug interaction or effectiveness,
and meteorology could take advantage of cycles observed in a geomagnetic study.
Lessons can already be learned from efforts from Gamburtsev and Nikolaev who with support from
the Russian Ministry of Science and the Russian Foundation for Basic Research have published an atlas
of natural processes in 3 volumes (41–43). The three books, written in Russian, contain numerous charts,
including gliding spectra for viewing changes in dynamics of natural processes as a function of time. They
are organized as series of chapters contributed by different authors, presented in different sections dealing
first with ideological issues of nature and society development, then with processes in natural and
social spheres on different time and space scales, providing results from different investigators and their
comparison.
The encyclopedic atlas visualized herein should build on this existing work. Presenting the information
in a more dynamic form made possible by tools available online, our encyclopedic atlas should document
the following points:
1.	 Characteristics of cycles with different periods;
2.	 The existence of coperiodisms between physics and biology;
3.	 Similarities in the changes with time in environmental and biological cycles;
4.	 Differences in environmental-biological associations by geographic location;
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5.	 Encyclopedic entries complementing the charts, drawing conclusions from information presented
therein or summarizing results displayed in a set of different charts (as an example, charts related to
the biologic week could make the point that different environmental factors influence its pattern at
birth, as reviewed above); and
6.	 Models to predict peaks and troughs to help plan for contingencies, and hopefully for the design of
countermeasures.
Support: Halberg Chronobiology Fund, University of Minnesota Supercomputing Institute.
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Bakken EE. Yearly and perhaps transyearly human natality patterns near the equator and at higher
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NONINVASIVE METHODS IN CARDIOLOGY 2013
APPLICATION OF CARDIO-ANKLE VASCULAR INDEX
(CAVI) IN CLINICAL AND EPIDEMIOLOGICAL STUDY
DOBŠÁK P., FRANTISOVÁ M., ASOCHOR O., BRÁČEK V., CŠRÁMKOVÁ T., POHANKA M.,
HOMOLKA P., SOSÍKOVÁ M., CDUŠEK L., DWOTKE J., SIEGELOVÁ J.
Department of Physiotherapy and Rehabilitation, Faculty of Medicine, Masaryk University, Brno, Czech Republic
and Department of Sports Medicine and Rehabilitation, St .Anna University Hospital, Masaryk University of
Brno, Czech Republic
a
1st
Department of Internal Medicine, St. Anna University Hospital, Brno
b
2nd
Department of Internal Medicine, St .Anna University Hospital and Masaryk University, Brno, Czech Republic
c
Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
d
Institute of Pathological Anatomy, St.Anna University Hospital, Brno
Dedicated to the memory of my friend, teacher
and outstanding scientist Professor Bohumil Fišer, Ph.D.
ABSTRACT
Cardio-ankle vascular stiffness index (CAVI), a blood-pressure independent index of arterial stiffness,
is a comprehensive indicator of various conditions, such as cardiovascular or life-style related diseases and
aging, as well as unknown factors that enhance development of atherosclerosis. The main advantage of
CAVI is the simplicity of measurement in daily clinical practice, its importance in the evaluation of disease
grade and cardiovascular risk factors, and its usefulness in the treatment decisions. CAVI could be used
also to assess the effects of life-style modification. Until May 2013, CAVI was measured in 3.581 subjects
aged 16–70 years (1.657 men and 1.924 women) from the population of the South Moravia region. The strategic
aim of this still running study is to provide local standardization of CAVI and to help to establish new
international atherosclerosis standards.
Summary statistics of CAVI values (n = 3.581)
1,0
3,2
11,5
19,2
22,8
19,9
15,0
4,6
2,8
1,0
3,3
11,0
19,7
22,3
19,5
15,6
5,2
2,4
0
5
10
15
20
25
<= 4 4-5 5-6 6-7 7-8 8-9 9-10 10-11 >11
Patients(%)
CAVI
L and R CAVI values
are not statistically
different
(p = 0.087; Wilcoxon
paired test)
N=3581 Mean 95%CI Median 5-95% quantile
R-CAVI 7.795 (7.741; 7.849) 7.80 (5.20; 10.40)
L-CAVI 7.811 (7.756; 7.865) 7.80 (5.20; 10.40)
average CAVI 7.803 (7.749; 7.856) 7.80 (5.25; 10.45)
Figure 1
118
NONINVASIVE METHODS IN CARDIOLOGY 2013
1,6
5,2
19,8
29,7
12,8
6,5
1,1
0,4
0,6
26,1
23,1
9,4
4,3
22,9
1,8
4,1
10,1
20,5
0
5
10
15
20
25
30
35
40
<=
4
4-5
5-6
6-7
7-8
8-9
9-1010-11
>11
Differentiation of diagnoses based on averaged L and R CAVI
1,6
5,2
19,8
29,7
22,9
12,8
6,5
1,1
0,4
0,2
22,7
26,8
14,7
8,2
17,5
7,4
2,2
0,4
0
5
10
15
20
25
30
35
40
<=
4
4-5
5-6
6-7
7-8
8-9
9-1010-11
>11
Control (N= 1543) vs. CAD (N=503)
Patients(%)
CAVI
Control
Disease
Control (N= 1543) vs. Hypertension (N=1335)
1,6
5,2
19,8
29,7
22,9
12,8
6,5
1,1
0,4
0,0
1,8
25,0
35,7
5,4
3,6
1,8
7,1
19,6
0
5
10
15
20
25
30
35
40
<=
4
4-5
5-6
6-7
7-8
8-9
9-1010-11
>11
Control (N= 1543) vs. CHF (N=56)
Patients(%)
CAVI
1,6
5,2
19,8
29,7
22,9
12,8
6,5
1,1
0,4
0,0
22,7
25,5
14,3
8,0
2,0
1,6
5,6
20,3
0
5
10
15
20
25
30
35
40
<=
4
4-5
5-6
6-7
7-8
8-9
9-1010-11
>11
Control (N= 1543) vs. Diabetes (N=251)
CAVI
CAVI
p value: statistical
significance of
difference between
control and given
group of patients
(t-test)
p<0.001
p<0.001p<0.001
p<0.001
Figure 2
1,6
5,2
19,8
29,7
12,8
6,5
1,1
0,4
0,0
37,5
25,0
12,5
0,0
22,9
0,0
0,0
12,5
12,5
0
5
10
15
20
25
30
35
40
<=
4
4-5
5-6
6-7
7-8
8-9
9-1010-11
>11
1,6
5,2
19,8
29,7
22,9
12,8
6,5
1,1
0,4
0,4
25,9
22,4
8,7
4,6
23,0
11,1
2,9
1,2
0
5
10
15
20
25
30
35
40
<=
4
4-5
5-6
6-7
7-8
8-9
9-1010-11
>11
Control (N= 1543) vs. Dyslipidemia (N=1117)
Patients(%)
CAVI
Control
Disease
Control (N= 1543) vs. OTS (N=8)
1,6
5,2
19,8
29,7
22,9
12,8
6,5
1,1
0,4
0,0
8,0
32,0
20,0
4,0
4,0
8,0
4,0
20,0
0
5
10
15
20
25
30
35
40
<=
4
4-5
5-6
6-7
7-8
8-9
9-1010-11
>11
Control (N= 1543) vs. RA (N=25)
Patients(%)
CAVI
CAVI
p<0.001
p value: statistical
significance of
difference between
control and given
group of patients
(t-test)
1,6
5,2
19,8
29,7
22,9
12,8
6,5
1,1
0,4
0,0
0,0
0,0
20,0
0,0
0,0
20,0
60,0
0,0
0
10
20
30
40
50
60
<=
4
4-5
5-6
6-7
7-8
8-9
9-1010-11
>11
Control (N= 1543) vs. Dialysis
(N=5)
Patients(%)
CAVI
p=0.890
1,6
5,2
19,8
29,7
22,9
12,8
6,5
1,1
0,4
0,0
0,0
28,6
14,3
7,1
0,0
7,1
7,1
35,7
0
5
10
15
20
25
30
35
40
<=
4
4-5
5-6
6-7
7-8
8-9
9-1010-11
>11
Control (N= 1543) vs.
Erectile dysfunction
(N=14)
Patients(%)
CAVI
p=0.001
Differentiation of diagnoses based on averaged L and R CAVI
p<0.001
p<0.001
Figure 3
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NONINVASIVE METHODS IN CARDIOLOGY 2013
5
6
7
8
9
10
11
C
ontrol
C
AD
H
ypertension
C
HF
D
iabetes
D
yslipidem
ia
O
TS
R
A
D
ialysis
Erectile
dysfunction
Control
Disease
CAVI mean 95% CI
p value: statistical significance of difference
between control and given group of patients
(t-test).
p<0.001*
p<0.001*
p<0.001* p<0.001*
p<0.001*
p<0.001*
p<0.001*
N=1543 N=503 N=1335 N=56 N=251 N=1117 N=8 N=25
p=0.890
p=0.001*
N=5 N=14
Differentiation of diagnoses based on averaged L and R CAVI
Figure 4
4
5
6
7
8
9
10
11
12
< 20 20 -
24
25 -
29
30 -
34
35 -
39
40 -
44
45 -
49
50 -
54
55 -
59
60 -
64
65 -
69
>70
4
5
6
7
8
9
10
11
12
< 20 20 -
24
25 -
29
30 -
34
35 -
39
40 -
44
45 -
49
50 -
54
55 -
59
60 -
64
65 -
69
70+
Comparison of calibration datasets between the Czech Republic and Japan
Age (yrs) Age (yrs)
Healthy subjects
N=5 969 (M: 2 239; F: 3 730)
Healthy subjects
N=1543 (M: 545; F: 998)
Mean ± SD
Mean ± SD
CAVI
Suzuki K et al,
Tohoku Pulse-Wave Information,
Workshop Jul. 2007
Czech CAVI dataset
(subjects below 20 years were
included in the analysis)
Figure 5
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NONINVASIVE METHODS IN CARDIOLOGY 2013
INTRODUCTION
Many studies revealed that high aortic pulse wave velocity is a strong risk factor independent of other
known risk factors enhancing the onset of cardiovascular diseases. Vascular, coronary, renal, cerebral,
and other organ damage is closely related to central aortic blood pressure and pulse pressure (1). Blood
pressure has a great influence on pulse wave velocity and blood pressure greatly varies at the time of PWV
measurement, regardless of a presence of hypertension. Recently, a new parameter of arterial stiffness
evaluation has been introduced into clinical practice – cardio-ankle vascular index or CAVI (2). Arterial
stiffness screening system “VaSera” can evaluate arterial stiffness using the CAVI parameter measured by
a simple method which is minimally affected at the time of measurement. The results can be quickly used
in the individual evaluation in daily clinical practice and therapeutic procedure. Aortic stiffness expressed
by CAVI is a valuable indicator of atherosclerosis, such as cardiovascular diseases, life-style related diseases
and aging. This study is a continuation of the long-term CAVI project in Czech Republic focusing on
the systematic screening of arterial stiffness in Czech healthy population and people with cardiovascular
and other lifestyle related diseases.
PATIENTS AND METHODS
Recruitment of healthy volunteers and patients aged 16–70 years was realized using a campaign in
radio and newspapers in close cooperation with different departments from St. Anna Faculty Hospital in
Brno.
CAVI MEASUREMENT
CAVI was assessed by the VaSera 1500 vascular screening system (Fukuda Denshi Co., J). CAVI is measured
from the beginning of the aorta to the tibial artery above the ankle and covering central elastic
artery (aorta) and peripheral muscular arteries (femoral and tibial artery).
STATISTICAL ANALYSIS (IBA, MASARYK UNIVERSITY)
	 Visualization of data is based on comparative histograms and box-whisker plots. Visual comparison
of Czech results with Japanese data uses data description by arithmetic mean and standard deviation.
The descriptive summary of L and R CAVI values is based on robust non-parametric statistics, i.e., median
and 5th–95th percentile range. The statistical significance of difference between L and R CAVI values was
tested by Wilcoxon matched paired test. Statistical significance of differences in averaged values of CAVI
among categories of key descriptors was evaluated using one-way ANOVA followed by Tukey post-hoc test;
the variables were described using mean and its 95% confidence interval. Comparison of two groups of patients
within age category was computed using standard t-test for comparison of two independent samples
(with homogeneous within group variance). Spearman correlation coefficient was applied for the analysis
of relationship between CAVI and other descriptors.
RESULTS
CAVI was measured in 3.581 subjects aged 16–70 years (1.657 men and 1.924 women) from the population
of the South Moravia region. Of that total, 1.543 healthy people were recruited (545 men; 998 women).
The rest were subjects with hypertension (n = 1.335), dyslipidemia (n = 1.117), coronary artery disease
(n = 503), diabetes mellitus (n=251), chronic heart failure (n = 56), orthotopic heart transplantation (n = 8),
rheumatoid arthritis (n = 25), males with erectile dysfunction (n = 14) and patients on chronic hemodialysis
(n = 5). Statistical analysis did not show significant difference between right and left CAVI (R-CAVI and
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NONINVASIVE METHODS IN CARDIOLOGY 2013
L-CAVI; Fig. 1). Statistical analysis proved significantly higher CAVI value in patients with hypertension,
dyslipidemia, coronary artery disease, diabetes mellitus, chronic heart failure, orthotopic heart transplantation,
rheumatoid arthritis, and also in men with erectile dysfunction (Fig. 2, 3 and 4). Only in patients
on chronic hemodialysis the results of CAVI measurement were without statistical significance but
this result can be attributed to too low number of analyzed subjects (only 5 persons). We found a similar
CAVI development in Czech and Japanese dataset (Fig. 5). It seems that the distinct increase of arterial stiffness
is present in Czech men and women from 50 years of age compared to their Japanese counterparts.
Thus, the Czech population over 50 years has a significant risk for development of atherosclerosis.
CAVI IN PROFESSIONAL SPORTSMEN
We also evaluated CAVI in 31 players of one Czech professional ice-hockey team (mean age 27.1 ± 3.31
years). The mean CAVI value in ice-hockey players was 5.77 ± 0.7 in comparison with the healthy standards
from Czech CAVI dataset which is actually 6.2 ± 0.8 (difference −0.45). This result could be regarded as a
sign of a lower sympatho-adrenergic activity in well trained endurance athletes.
DISCUSSION
Aging is very important risk factor of atherosclerosis. In our study we found that CAVI with age rises
by approximately 0.5 in men than women (equivalent to ten years of aging). The present study conclusively
demonstrated that CAVI increases not only with age but also in patients with coronary artery disease
(CAD), hypertension, diabetes mellitus, dyslipidemia, chronic heart failure, orthotopic heart transplantation,
rheumatoid arthritis erectile dysfunction and also patients on chronic hemodialysis. Several authors
reported that CAVI reflects the real effects of blood pressure on the properties of arterial wall and development
of atherosclerosis is preceded by decreased elasticity resulting from structural changes in the arterial
wall (3 and 4). It has been proven that CAVI significantly increases in patients with decreased diastolic
function of left ventricle (5). The overproduction of inflammatory and vasoactive substances triggers vessel
wall remodelation. One recent study showed that CAVI may reflect global inflammatory reaction of vessels
in whole organism - Wakabayashi et al. reported that CAVI rises with increased plasmatic level of CRP,
amyloid A, sialic acid, fibrinogen, etc. in diabetes mellitus type 2 (6). Primary prevention of cardiovascular
diseases is a priority No.1 in a public health policy of developed and developing countries. The fundamental
strategy consists in identifying people in a high risk situation in which preventive measures are effective.
Improvement of these predictions in our country will have an immediate clinical and health impact and
a short term public effect. The screening based on CAVI parameter is quick, easy and low-cost technique
to diagnose arterial stiffness. Higher CAVI values could have a strong preventive effect of interventions in
people with symptomatic cardiovascular diseases and it is likely that these interventions will have a protective
effect on early risk factors modification and pharmacotherapy in subjects with subclinical disease
(7 and 8). Incorporation of the systematic CAVI measurement into regular screening for arterial stiffness
may improve cardiovascular risk stratification and increase early identification of patients with high cardiovascular
risk. Current knowledge supports the international consensus for risk screening but more
future trials are needed to determine whether adding CAVI assessment in the screening strategies would
be also cost-effective.
CONCLUSION
In the past 4 years our team made a considerable effort in which is concerning the CAVI measurement
and interpretation. We succeeded to collect and publish important and unique data about CAVI in patients
with chronic dyslipidemia, chronic heart failure. Professor Bohumil Fišer, an outstanding Czech expert
in cardiovascular physiology, highlighted several times the importance and diagnostic value
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NONINVASIVE METHODS IN CARDIOLOGY 2013
of the CAVI measurement and strongly supported its introduction into clinical practice (9). However,
despite the undeniable clinical value, the systematic evaluation of CAVI in clinical practice in Czech
Republic is realized only by few outpatient physicians and by only one clinical department in St. Anna
Faculty Hospital Brno. Arterial stiffness in the developed countries is strongly influenced by risky behavior
(dietary habits, physical inactivity, smoking, etc.) and this type of lifestyle often results in obesity, high
blood pressure and atherosclerosis progression (10). Therefore, much more attention should be paid to the
early detection of changes in arterial stiffness and to popularize the clinical importance of the diagnostic
potential of CAVI in primary prevention.
Acknowledgement: The presented study was realized in the cooperation with Fukuda Denshi Co.,Tokyo,
Japan.
REFERENCES
1.	 Takata M. Clinical significance of CAVI as a blood independent arterial stiffness index. CAVI J 2013; 2:
9–13.
2.	 Shirai K, Utino J, Otsuka K, et al. A novel blood pressure-independent arterial wall stiffness parameter;
cardio-ankle vascular index (CAVI). J Atheroscler Thromb 2006; 13: 101–107.
3.	 Shirai K, Hiruta N, Song M, et al. Cardio-Ankle Vascular Index (CAVI) as a Novel Indicator of Arterial
Stiffness: Theory, Evidence and Perspectives. J Atheroscler Thromb 2011; 18: 49–55.
4.	 Nakamura K, Tomaru T, Yamamura S, et al. Cardio-ankle vascular index is a candidate predictor of
coronary atherosclerosis. Circ J 2008; 72: 598–604.
5.	 Mizuguchi Y, Oishi Y, Tanaka H, et al. Arterial stiffness is associated with left ventricular diastolic
function in patients with cardiovascular risk factors: early detection with the use of cardio-ankle vascular
index and ultrasonic strain imaging. J Card Fail 2007; 13: 744–151.
6.	 Wakabayashi I and Masuda H. Association of acute-phase reactants with arterial stiffness in patients
with type 2 diabetes mellitus. Clin Chim Acta 2006; 365: 230–235.
7.	 Ramos-Blanes R. Prevalence of arterial stiffness in Mediterranean population and the potrential value
of CAVI to stratify cardiovascular risk: Preliminary results of the MARK study. CAVI J 2013; 2: 14–20.
8.	 Noike H, Nakamura K, Sugiyama Y, et al. Changes in cardio-ankle vascular index in smoking cessation.
J Atheroscler Thromb 2010; 17: 517–525.
9.	 Fišer B., Siegelová J., Dušek J., Dobšák P. Cardio-ankle vascular index, aortic compliance and pressure
wave velocity is measure of arterial stiffness. Scripta Medica 2008; 81: 175–180.
10.	 Dobšák P., Sosíková M., Dušek L., Souček M., Nováková M., et al. Arterial stiffness in Czech population
measured by VASERA 1500. Scripta med. (Brno), 2010; 83: 2, 85–91.
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NONINVASIVE METHODS IN CARDIOLOGY 2013
SEVEN DAY AMBULATORY BLOOD PRESSURE
MONITORING AND LEFT VENTRICULAR MASS INDEX
IN PATIENTS AFTER INFARCTUS OF MYOCARDIUM
IN CARDIOVASCULAR REHABILITATION
JARMILA SIEGELOVÁ, ALENA HAVELKOVÁ, JIŘÍ DUŠEK, PAVEL VANK,
MICHAL POHANKA, GERMAINE CORNÉLISSEN*, FRANZ HALBERG*
Department of Physiotherapy, Department of Sports Medicine and Rehabilitation, Masaryk University Brno, St.
Anna Faculty Hospital Brno, Czech Republic,
*University of Minnesota, USA
Dedicated to memory Professor Bohumil Fišer, Ph.D.
Franz Halberg, Germaine Cornélissen and BIOCOS scientific group, of which we are the members
from the beginning, provided strong evidence for the need to account for day-to-day changes in blood pressure
and heart rate variables in the similar way as a circadian assessment considers the hour-to-hour variability
(Halberg 1953, 1969, Halberg et al., 2000, 2001, Cornélissen et al., 1989).
In our paper dealing with 7-day ambulatory blood pressure monitoring study we described the relationship
between age and circadian variations of systolic blood pressure (SBP) and diastolic blood pressure
(DBP) (Siegelová et al., 2006).
MESOR – mean values of systolic SBP and DBP were increasing with age up to 75 years, but night-day
difference (double amplitude) of SBP and DBP reached the maximum value at 45 years and then decreased
(Siegelová et al., 2006). The evidence led to the recommendation of around-the-clock monitoring for 7 days
at the outset (Halberg et al., 2002, Cornélissen et al., 2004) to be continued whenever needed, until monitoring
for a lifetime becomes more readily feasible.
European guidelines on hypertension management from European Society of Hypertension in 2007,
2009 and 2013 have shown that hypertensive patients have left ventricular hypertrophy due to essential
hypertension (Mancia et al. 2007, 2009, 2013).
Left ventricular mass index (LVMI) values, considered as a gauge of cerebrovascular risk, are greatly
elevated when abnormal circadian patterns of systolic (SBP) and diastolic (DBP) blood pressure are diagnosed
in hypertensive patients. Vascular variability disorders, described by prof. Franz Halberg in Brno
Consensus together with the Biocos international participation, showed the risk of chronobiologically interpreted
around-the-clock ambulatory blood pressure monitoring and related to outcomes in three different
investigations, carried out in the Czech Republic, Japan and Taiwan. Vascular variability disorders
include, with an elevated blood pressure (MESOR-hypertension, an excessive pulse pressure, too large a
circadian amplitude of blood pressure (Circadian Hyper Amplitude Tension – CHAT), an odd timing of the
circadian variation in blood pressure, a too small standard deviation of heart rate (short for deficient heart
rate variability). Hypertension characterized by elevated blood pressure increases left ventricular mass.
Increase of left ventricular mass in hypertension is dangerous for cardiovascular morbidity and mortality
(Halberg et al., 2007, 2011 Cornélissen et al., 2010, 2013, Siegelová et al., 2011).
The relationship between left ventricular mass index (LVMI) and circadian and circaseptan blood
pressure values and double amplitude (difference between the increase of SBP and DBP during day time
and the decrease of SBP or DBP at night) in patients after myocardial infarction was the aim of the present
study. The evaluation of blood pressure variability by 7-day ambulatory blood pressure monitoring in
patients with coronary heart disease was the other aim of the present study.
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NONINVASIVE METHODS IN CARDIOLOGY 2013
Figure 1 Relationship between MESOR of systolic blood pressure (SBP, mmHg), measured by 7-day ambulatory blood
pressure monitoring, and age (years) in healthy subjects (blue) and in patients with coronary heart disease (red).
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NONINVASIVE METHODS IN CARDIOLOGY 2013
Figure 2 Relationship between MESOR of diastolic blood pressure (DBP, mmHg), measured by 7-day ambulatory blood
pressure monitoring for 24 h and age (years) in healthy subjects (blue) and in patients with coronary heart disease (red).
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NONINVASIVE METHODS IN CARDIOLOGY 2013
Figure 3 Relationship between MESOR of heart rate (HR, bpm), measured by 7-day ambulatory blood pressure
monitoring, and age (years) in healthy subjects (blue) and in patients with coronary heart disease (red).
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Figure 4 Relationship between circadian amplitude of systolic blood pressure (SBP, mmHg), measured by 7-day
ambulatory blood pressure monitoring, and age (years) in healthy subjects (blue) and in patients with coronary heart
disease (red).
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Figure 5 Relationship between circadian amplitude of diastolic blood pressure (DBP, mmHg), measured by 7-day
ambulatory blood pressure monitoring, and age (years) in healthy subjects (blue) and in patients with coronary heart
disease (red).
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METHODS
The set being monitored consisted of 51 patients with ischemic heart disease (IM) of the age 63 ± 6,3
years (age between 41 and 77 years) and ejection fraction (43 ± 12,3) %.
The patients were subjected to phase II of cardiovascular rehabilitation (controlled ambulatory rehabilitation
program) lasting three months with the frequency of three times a week at the Department of
Functional Diagnostics and Rehabilitation of St. Anna Teaching Hospital. The duration of the training unit
was 60 min and it consisted of warm-up phase (10 min), aerobic phase (25 min), toning phase (15 min) and
relaxation phase (10 min).
In the course of rehabilitation the patients underwent 7-day ambulatory monitoring of blood pressure.
During blood pressure recording they did not interrupt pharmacotherapy (ACE inhibitors, statins, betablokers,
Ca antagonists).
7-day monitoring of blood pressure was made by means of the instrument TM – 2421 of Japanese firm
AD operating on the principle of oscillometric analysis. The instrument measured blood pressure for 7 days
repeatedly every 30 min from 5 to 22 o’clock and once an hour from 22 to 5 o’clock. If a value not much probable
from the point of view of the instrument setting was recorded, another check measurement was made
(Siegelová et al. 2004).
The results were processed by using Halberg cosinor analysis. The data were smoothed by a sinusoidal
curve. The mean value of the sinusoid, designated MESOR, and amplitude of circadian fluctuation were
determined. Sinusoidal curve was fitted (least square method) and mean value and amplitude of the curve
(double amplitude corresponds to the night-day difference) were evaluated every day of monitoring. Average
7-day values of the mean (MESOR) and of double amplitude (2A) for systolic BP (SBP), diastolic BP (DBP)
and heart rate (HR) were determined for each subject of both sets.
Left ventricular mass index was calculated from echocardiography from the thickness of septum and
dorsal wall of left ventricle.
The study was approved by local ethic committee and the patients signed informed consent.
RESULTS
We evaluated blood pressure by 7-day ambulatory blood pressure monitoring in patients with coronary
heart disease.
A significant increase of systolic blood pressure (SBP) MESOR with age was found in healthy subjects
(r = 0.39, p < 0.01), but not in patients with coronary heart disease IM (r = 0.23) as is shown in Fig. 1. Diastolic
BP (DBP) MESOR was not related to age in healthy subjects (r = 014) but the decrease of DBP with age
in patients with coronary heart disease IM was observed (r = 0.362, p < 0.05) as is seen in Fig. 2. Mean value
of SBP MESOR was higher in healthy subjects C than in patients with coronary heart disease IM (128 ± 9
vs. 121 ± 8 mmHg, p < 0.01), as well as DBP MESOR (81 ± 7 vs. 74±7 mmHg, p < 0.01). Double amplitude of SBP
decreased with age in healthy subjects C (r = 0.30, p < 0.05) but not in patients with coronary heart disease
IM (r = 0.03), as is shown in Fig.4. Similarly double amplitude of DBP decreased with age in healthy subjects
C (r = 0.41, p < 0.01) and not in patients with coronary heart disease IM (r = 0.08), as we can see in Fig. 5.
Mean values of double amplitude were lower in patients with coronary heart disease IM (double amplitude
SBP: 21 ± 10 vs. 16±8 mmHg, p < 0.01; double amplitude DBP: 16 ± 8 vs. 12 ± 5 mmHg, p < 0.01). Heart rate (HR)
was not age-related in both groups, difference in mean values of heart rate was not observed (C: 71 ± 10, IM:
65 ± 8 bpm). Double amplitude of heart rate was lower in patients with coronary heart disease IM (15 ± 8
vs. 9 ± 5 bpm).
We evaluated circadian and circaseptan values of systolic and diastolic blood pressure and left ventricular
mass in patients with coronary heart disease.
The results of left ventricular mass index and circadian rhythm in systolic and diastolic blood pressure
are presented on Fig. 6, 7, 8, 9.
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NONINVASIVE METHODS IN CARDIOLOGY 2013
LVMI and Mesor 24 h SBP
y = 0,248x + 91,03
R2
= 0,0035
0
50
100
150
200
250
0 20 40 60 80 100 120 140 160
Mesor SBP (mmHg)
LVMI(g/(m*m))
Figure 6 Relationship between MESOR of systolic blood pressure (SBP, mmHg) measured by 7-day ambulatory blood
pressure monitoring, 24 h, and LVMI (g/m*m) in patients with coronary heart disease.
LVMI and Mesor 24 h DBP
y = -0,5117x + 159,62
R2
= 0,0157
0
50
100
150
200
250
0 20 40 60 80 100 120
Mesor DBP (mmHg)
LVMI(g/(m*m))
Figure 7 Relationship between MESOR of diastolic blood pressure (DBP, mmHg) measured by 7-day ambulatory blood
pressure monitoring, 24 h, and LVMI (g/m*m) in patients with coronary heart disease.
LVMI and Amp 24 h SBP
y = -0,1525x + 122,5
R2
= 0,0005
0
50
100
150
200
250
0 5 10 15 20 25
Amplitude SBP (mmHg)
LVMI(g/(m*m))
Figure 8 Relationship between circadian amplitude of systolic blood pressure (SBP, mmHg) measured by 7-day
ambulatory blood pressure monitoring, and LVMI (g/m*m) in patients with coronary heart disease.
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NONINVASIVE METHODS IN CARDIOLOGY 2013
LVMI a Amp 24 h DBP
y = -1,039x + 127,19
R2
= 0,0079
0
50
100
150
200
250
0 2 4 6 8 10 12 14 16
Amplitude DBP (mmHg)
LVMI(g/(m*m))
Figure 9 Relationship between circadian amplitude of diastolic blood pressure (DBP, mmHg) measured by 7-day
ambulatory blood pressure monitoring, and LVMI (g/m*m) in patients with coronary heart disease.
LVMI and Mesor 168 h SBP
y = 0,1371x + 104,46
R
2
= 0,0011
0
50
100
150
200
250
0 20 40 60 80 100 120 140 160
Mesor SBP (mmHg)
LVMI(g/(m*m))
Figure 10 Relationship between MESOR of systolic blood pressure (SBP, mmHg) measured by 7-day ambulatory blood
pressure monitoring, 168 h, and LVMI (g/m*m) in patients with coronary heart disease.
LVMI and Mesor 168 h DBP
y = -0,5856x + 165,64
R
2
= 0,0206
0
50
100
150
200
250
0 20 40 60 80 100 120
Mesor DBP (mmHg)
LVMI(g/(m*m))
Figure 11 Relationship between MESOR of diastolic blood pressure (DBP, mmHg) measured by 7-day ambulatory blood
pressure monitoring, 168 h, and LVMI (g/m*m) in patients with coronary heart disease.
The correlation between LVMI and circaseptan MESOR and amplitude are on Fig. 10, 11, 12, 13. We have not found the
correlation between mean value of LVMI and MESOR and amplitude of SBP and DBP.
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NONINVASIVE METHODS IN CARDIOLOGY 2013
LVMI and Amp 168 h SBP
y = -2,4934x + 131,17
R2
= 0,0237
0
50
100
150
200
250
0 1 2 3 4 5 6 7 8 9 10
Amplitude SBP (mmHg)
LVMI(g/(m*m))
Figure 12 Relationship between circaseptan amplitude of systolic blood pressure (SBP, mmHg) measured by 7-day
ambulatory blood pressure monitoring, and LVMI (g/m*m) in patients with coronary heart disease.
LVMI and Amp 168 h DBP
y = -4,5858x + 135,16
R2
= 0,0508
0
50
100
150
200
250
0 1 2 3 4 5 6 7 8
Amplitude DBP (mmHg)
LVMI(g/m*m))
Figure 13 Relationship between circaseptan amplitude of diastolic blood pressure (DBP, mmHg) measured by 7-day
ambulatory blood pressure monitoring, and LVMI (g/m*m) in patients with coronary heart disease.
DISCUSSION
There is a growing body of evidence suggesting that time structures in us and around us are intricately
interwoven. Most if not all components of variation found in biota are also found in the environment,
and vice versa (Halberg et al., 2000). For instance, about daily changes are seen in almost every biological
variable under 24-hour synchronized conditions. It has also long been known that the phase of circadian
rhythms can be manipulated by changing the phase of the environmental cycles (Halberg, 1969). At least
for the case of circadian rhythms, their genetic inheritance has been demonstrated on a molecular basis
(Halberg et al., 2002) suggesting that the influence from the environment has been acquired genetically
during the course of evolution.
The mapping of chronomes should benefit our understanding of human health and disease in several
ways. The study of human chronomes can serve to defined reference values to better define health and to
identify pre-disease, so that prophylactic interventions can be instituted as early as possible, preferably
before the disease sets in (Halberg et al., 1993, Cornélissen et al., 1993, 1994). The focus is thus put on pre-
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NONINVASIVE METHODS IN CARDIOLOGY 2013
habilitation, in the hope that the need for re-habilitation will thereby be reduced (Halberg et al., 2002a,b,
Cornélissen et al., 1999).
Several studies (Kumagai et al., 1993, Schaffer et al., 2001) comparing the classification of patients
based on single office measurements with that based on ambulatory monitoring for one to seven days suggest
that the incidence of misdiagnosis is around 40%, in keeping with the 48% response to placebo in the
Australian Therapeutic Trial (Management Committee, 1980, Halberg et al., 1988). Comparison of circadian
characteristics from day to day in records spanning at least two days further indicates the shortcomings
of monitoring limited to a single 24-hour span (Halberg et al., 1988, Cornélissen et al., 1987, Tamura
et al., 1990). Prolonging the monitoring from one to two days reduces the uncertainty in the estimation of
circadian parameters by about 35% (Watanabe et al., 1997), whereas further information on the biological
week (Halberg et al., 1984, 1995, Cornélissen et al., 1996, Caradente et al., 1994) requires monitoring for at
least 7 days, the current recommendation of BIOCOS for everybody at the outset (Sing et al., 2002). It is
now widely accepted that prognosis of target organ damage is by far superior when it is based on around
the clock monitoring than on single office measurements (Siegelová et al., 2000, 2011, Halberg et al., 2000,
Mancia et al., 1996, Mallion et al., 1999).
The mistaken impression that the circadian variation in blood pressure and heart rate is sufficiently
stable to be approximated by a single 24-hour profile stems in large part from the use of statistical methods
on groups of subjects rather than focusing on the individual patient. Correlation analyses applied to large
groups of subjects with a wide range of average values emphasize similarity. Statistical analyses focusing
on individual differences observed from one profile to another, however, yield the information more likely
to help the patient in need of the treatment (Cornélissen et al., 1987). Several case reports document this
point (Cornélissen et al., 1993, 1996, 1997, Halberg et al., 1995, 2002, Mancia et al., 2000). Continued monitoring
is the most logical solution.
An important distinction must be made between lessons learned from large clinical trials and their
application for the individual patient. Differences and trends uncovered in studies made on groups, even
when each subject provides only one or a few measurements, cannot be similarly assessed in medical practice
when a decision must be made for treating the individual patient. In order to be able to reach an informed
decision for the given patient, serial rather than single data should be collected. When time series
are available, it becomes possible to assess risk elevation or the response to treatment for that particular
patient.
In our former study we observed the age dependence of the circadian amplitude. Mean values of SBP
and DBP were increasing with age up to 75 years, but night-day difference of SBP and DBP reached the
maximum value at 45 years and then decreased. This decline of day-night difference was not seen in our
patients with heart disease. Furthermore the day-night difference in about 50 years old treated patients
was lower than in our about 50 years of age controls. This fact is positive because excessive day-night difference
is accompanied with an increased risk for morbidity and mortality.
Comparison of treated patients after myocardial infarction with healthy subjects revealed that the
treatment decreased the risk of high blood pressure as well as the risk of high blood pressure variability.
The differences could be influenced by the medical therapy.
For a long time, hypertension guidelines focused on blood pressure lowering only. The European
Guidelines from 2007 for the management of arterial hypertension developed recommendations based on
prevention of coronary heart disease in clinical practice (Mancia et al., 2007, 2009, 2013).
In our study we have not found an increased blood pressure in the group of patients with coronary
heart disease and correlation between 24-h MESOR of SBP and DBP and left ventricular mass index, nor
between 168 h MESOR of SBP and DBP and left ventricular mass index in treated patients with coronary
heart disease.
The values of double amplitude of SBP and DBP in circadian rhythm and circaseptan rhythm were not
correlated in treated patients with coronary heart disease.
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NONINVASIVE METHODS IN CARDIOLOGY 2013
The evidence of increase of left ventricular mass index is available on the predictive power of cardiac
abnormalities as detected by echocardiography because of its ability to more directly and precisely quantify
left ventricular mass and geometric left ventricular mass patterns. A retrospective study has recently
updated information from more than 35 000 normotensive and hypertensive participants with normal left
ventricular ejection fraction (Mancia et al., 2009, Milani et al., 2006).
The increased risk associated with left ventricular mass has been confirmed by other observations. In
a prospective study on a cohort of 1652 Greek hypertensive patients followed up for 6 years, echocardiographic
left ventricular mass was significantly associated with either a composite of all-cause mortality
and cardiovascular events (hazard ratio 1.53) and with stroke (hazard ration 2.01), after adjustment for
major cardiovascular risk factors (Mancia et al., 2009, Tsioufis et al., 2009). A retrospective analysis of 1447
Japanese hypertensive patients who participated in the CASE-J trial showed that cardiovascular events
occurred about 2.6 times more frequently in patients with a left ventricular mass index 125 g/m2 or more
(Yasuno et al., 2009, Mancia et al., 2009).
In the PAMELA population, echocardiographic left ventricular mass was associated with a four-fold
to five-fold significance increase in cardiovascular morbidity and mortality when data where adjusted for
a large number of potential In the PAMELA population, echocardiographic left ventricular mass was associated
with a four-fold to five-fold significance increase in cardiovascular morbidity and mortality when
data where adjusted for a large number of potential confounders, including office, home and ambulatory
blood pressure values., including office, home and ambulatory blood pressure values. A 10 % increase in left
ventricular mass increased the risk more markedly when baseline left ventricular mass was already abnormal
but an increasing risk was evident also when calculated from left ventricular mass values within
normal range (Mancia et al., 2009, Bomvelli et al., 2009).
In patients with coronary heart disease only a few studies have addressed the usefulness of ambulatory
blood pressure monitoring. In most cases a significant relationship was found between coronary heart
disease prevalence and either nondipping or increased ambulatory pulse pressure (O´Brien et al., 2013,
Fagard et al., 2008).
Ambulatory blood pressure monitoring can also be useful in predicting prognosis in patients with
coronary heart disease.
CONCLUSION
In our former study we observed the age dependence of the circadian amplitude. Mean values of SBP
and DBP were increasing with age up to 75 years, but night-day difference of SBP and DBP reached the
maximum value at 45 years and then decreased.
This decline of day-night difference was not seen in our patients with heart disease. Furthermore
the day-night difference in about 50 years old treated patients was lower than in our about 50 years of age
controls. This fact is positive because excessive day-night difference is accompanied with an increased risk
for morbidity and mortality.
Comparison of treated patients after myocardial infarction with healthy subjects revealed that the
treatment decreased the risk of high blood pressure as well as the risk of high blood pressure variability.
Our results showed that left ventricular mass index and blood pressure in patients after infarctus
myocardium in contrast to findings in hypertensives are not related to circadian and circaseptan values of
diastolic and systolic blood pressure abnormalities.
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47.	 Tsioufis C, Vezali E, Tsiachris D, Dimitriadis K, Taxiarchou E, Chatzis D, Thomopoulos C, Syrseloudis D,
Stefanadi E, Mihas C, Katsi V, Papademetriou V, Stefanadis C. Left ventricular hypertrophy versus
chronic kidney disease as predictors of cardiovascular events in hypertension: a Greek 6-year-followup
study. J Hypertens 2009; 27:744–752.
48.	Yasuno S, Ueshima K, Oba K, Fujimoto A, Ogihara T, Saruta T, Nakao K. Clinical significance of left
ventricular hypertrophy and changes in left ventricular mass in high-risk hypertensive patients:
a subanalysis of the Candesartan Antihypertensive Survival Evaluation in Japan trial. J Hypertens
2009; 27:1705–1712.
49.	Bombelli M, Facchetti R, Carugo S, Madotto M, Arenare F, Quarti-Trevanop F, Capra A, Giannattasi
C, Dell’Oro R, Grassi G, Sega R, Mancia G. Left ventricular hypertrophy increases cardiovascular risk
independently of-in and out-off office blood pressure values. J Hypertens 2009; (Epub ahead of print)
50.	O’Brien E, Parati G, Stergiou G, et al. European Society of Hypertension Position Paper on Ambulatory
Blood Pressure Monitoring. J Hypertens 31:1731–1768 2013
51.	 Fagard RH, Thijs L, Staessen JA, Clement DL, De Buyzere ML, De Bacquer DA. Prognostic significance
of ambulatory blood pressure in hypertensive patients with history of cardiovascular disease. Blood
Press Monit 2008; 13:325–332
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THE DUSTY BOXES IN MY OFFICE AND SOME
SURPRISING HISTORICAL AND SCIENTIFIC
OBSERVATIONS
THOMAS KENNER
Department of Physiology, Medical University in Graz
INTRODUCTION 1
In connection with the word “historical” in the title, a short personal introductory note: Most Austrians (real
Austrians) have some root in one of the countries of the former Austrian monarchy. The father of my mother came
from Northern Moravia and had settled long before my time in Vienna. Nevertheless, there must exist some inborn
drive or reason, why I love to visit Brno, whenever possible.
INTRODUCTION 2
When I started my work as new chairman of physiology in Graz, my activity had to begin in a provisional
location, in empty rooms of an old hospital building which was more or less empty. The construction
work of the new building – a few streets away and around the corner – was just in its beginning – and lasted
another 5 years. Some old stuff like historic instruments and boxes, books and papers were transferred
from an earlier store into the provisional location. During the following years my young coworkers and
I started to work and started to teach, to perform experiments and to publish.
After the new building was finished and ready, everything, including historic stuff and boxes had to
be transported to the new place. It could not be that some some instruments disappeared. The main part
arrived well in the neo location. Some boxes in which I recognized layers of paper were transported into
my new room and stored into a chest.
Only after my retirement I started to wonder about the contents of the boxes.
The observations I made when I opened some of the old and dusty (zaprášený) boxes in my office were
surprising.
There were records, from before the year 1900, of arterial pulses (on smoked paper). Among these
records I found one, with a note added. “Measured on the radial artery of Dr. Pregl.” This Dr. Pregl had
performed with coworkers experiments to study the effect of extract of rat-testicles on the development of
force of muscles. Much more fascinating is, that this Dr. Pregl in 1923 received the Nobel-Price for his developments
of microchemical techniques. He had moved from Graz to Innsbruck, where he was Chairman
of the department of Physiology and where he performed the work on microchemical techniques.
Another unexpected surprise was, that in one box I found about 10 m records (from before 1900!)
with ink-writer on paper: arterial pulse and respiration. The analysis of these records and, possibly others
which are lost, were published by Dr. Rudolf Klemensievicz, an assistent who worked as Dozent in the
Department of Physiology in Graz. Results were published in “Berichte der kaiserlichen Akademie der
Wissenschaften in Wien. Volume 74, 1876” (1).
Now I have to add an additional explanation concerning the topic. About a year or even more a discussion
was started among friends in Graz, in Kiel and in Potsdam about the phenomenon of synchronization,
particularly between heart beat and respiration. Some day I looked through an old Textbook of Physiology,
printed in Vienna 1881 (2), written by the former chairman of Physiology in Vienna, Ernst Brücke. In the
chapter about the influence of the oscillations of the respiration onto the arterial blood pressure. In fig. 1
(= fig. 23 in Brücke’s textbook on page 161) one can find an increase of the arterial pressure which starts simultaneously
with the exspiration. In the text is mentioned, that the experiments had been performed in the
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Department of Physiology in Vienna by Chairman Prof. Carl Ludwig and by Dr. Einbrodt, a physician from
Moskow, who worked in Ludwigs laboratory.
Figure 1 (= fig. 23 from Physiology textbook by Ernst Brücke from 1881).
The synchronization of arterial pulse and respiration can well be seen.
Approximately 30 years ago years ago we had started in Graz experiments on the problem of synchronization
with a different technique (3). The procedure which we had developed is explained in the
following display (fig. 2) from a record in an anesthetized rabbit. The figure shows in the lower tracing (VT)
the tidal volume and in the upper tracing the time of each breath starting (0 starting of each inspiration)
from the lower line to the upper end. Each mark indicates the time (within each breath) when a heart beat
(­R-wave of EKG) is recorded. Synchronization in this disply is indicated, as long as the points, which indicate
the location of an R-wave, can be seen as parallel lines. Further studies performed by our group are
published in a Book on “Cardiovascular System Dynamics” (4).
The interpretation regarding the interaction and the role of the synchronization of two processes is of
great importance. This was already recognized by Steven Hales who was the first to measure arterial blood
pressure in a horse, i.e., a warm-blooded animal.
The control mechanisms responsible for the timing of the heart-lung interaction are on one hand tasks
of Vagus and Sympathicus. However, it seems, that there are also more direct mechanical interactions
between lung and heart.
It can be concluded that even the study of historic experiments can lead to an improved understanding
of the desynchronization between heart and lung.
The following summarizing description (5) is based on a translation of papers by Carl Ludwig by
J. Schaefer and B. Lohff with a little additional support by T. Kenner:
(5): Respiratory-related interactions with the heart have remained  a challeging physiological phenome-
non since more than two and a half centuries. In the course of translating into English the seminal publications
of Carl Ludwigand Pjetr Einbrodt – Ludwig’s disciple - we became aware of some aspects of their work that have
apparently not been commented on hitherto, but which we believe might be of scientific interest. The arrhythmic effects
of respiratory movements which Ludwig had observed in his experiments on dogs and horses and on which he
published a paper in 1847 – they were later called respiratory arrhythmia – left him in doubt as to the causes of this
phenomenon. Thus it is no surprise that he subsequently undertook further work on this problem, together with Dr.
Einbrodt. In the introduction to the resulting paper published in 1860 hewrote:
“The phenomena which undergo modification as a result of the respiratory movements and which initially
come into question with regard to the influence of breathing elude more precise analysis, because they are all composed
of different and at the same time always changing elements, the occurrence of which can therefore never be
observed individually; the sequence of heartbeats, for example, is well known to be derived from many basic elements,
being affected by the excitability of the heart (its muscles, nerves and motoric centres), the degree of excitation
of the prolonged medulla (medulla oblongata) and of the vagus nerves, the blood volume of the animal, which
can vary over a broad range, the temperature of the blood flowing into the heart and so forth.” (pp. 266, 362)
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In order to overcome these experimental handicaps Dr. Einbrodt decided to concentrate on the role of mechanical
factors of the respiratory movements. He developed methods to increase or decrease the pressure of the air the
animal had to breathe. This procedure led to a greater or lesser degree of compression or decompression of all the
organs in the thoracic cavity. As it is written in Einbrodt’ and Ludwig’s paper:
“…Itshouldbeparticularlyemphasizedthatduringtheexecutionof+RP[=increasedrespiratorypressure]the
respiratory movements can be absent for several minutes without exerting a detrimental influence on the animal or
inducing a condition of asphyxia … There is another reason why the absence of the respiratory movements deserves
our attention, namely that this is the only case allowing blood pressure curves to be obtained that are completely
free of the influence of respiration, in which each heartbeat is the same as the preceding and succeeding ones and
the blood pressure shows only those fluctuations that are dependent on the contraction of the heart.” (pp. 272, 368).
Such a statement is quite astonishing in view of the many other influences that may modulate heart rate and
cardiac activity, as the authors themselves argue elsewhere in the same 1860-paper. – It had been known since 1845,
from work by E. F. Weber, that the vagus nerves exert strong inhibiting influences on the heartbeat. In the following
years the mode of action of the N. sympathicus and of various other factors, structures, centers, and receptors
became apparent.
How the mechanical influence of breathing affects cardiac activity during respiratory arrhythmia has been
the subject of scientific discussions and controversies over a period of more than 150 years and may still be unresolved.
Recent publicationsindicate that cardiac mechano-electric couplingplays an important role.
In the following I return to our experiments on rabbits. The figure 2 shows the interesting variation of
synchronization and shows also the fact, that sighs – deep short.
Inspirations – are in most examples followed by a change or variation of the synchronization pattern.
Figure 2 Records from an anesthetized rabbit. For explanation see text
It was approximately in the same time, when I looked at the contents of the boxes, that our group of
scientific friends had initiated to work on the application of a mathematically improved description of the
evaluation of synchronization (6).
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NONINVASIVE METHODS IN CARDIOLOGY 2013
The observation of the more or less unexpected observation of historic recordings has stimulated
a search in earlier literature. Some remarks can be found in our publication on the “cardiac phase response
curve” (6).
REFERENCES
1.	 Rudolf Klemensievicz: Berichte der kaiserlichen Akademie der Wissenschaften in Wien. Volume 74,
1876.
2.	 Ernst Brücke: Vorlesungen über Physiologie, 1. Band (dritte Auflage, Verlag Wilhelm Braumüller)
Wien 1881
3.	 H. Pessenhofer, T. Kenner: Zur Methodik der kontinuierlichen Bestimmung der Phasenbeziehung
zwischen Herzschlag und Atmung. Pflügers. Arch. 355. 77–83 (1975)
4.	 T. Kenner, R. Busse, H. Hinghofer.-Szalkay (eds): Cardiovascular System Dynamics – Models and Measurements.
Plenum Press, Now York and London 1982
5.	 B. Kralemann, M. Frühwirth, A. Pikowsky, M. Rosenblum, T. Kenner, J. Schaefer, M. Moser. Nature
Communications 2013; 4:2418. doi: 10.1038/ncomms3418
6.	 J. Schaefer, B. Lohff, T. Kenner: Carl Ludwig, Pjetr Einbrodt and Mechano-electric coupling. To be pu-
blished.
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NONINVASIVE METHODS IN CARDIOLOGY 2013
REHABILITATION OF SPASTICITY IN PATIENTS
WITH STROKE
PETR KONECNY1,2,3, MILAN ELFMARK4,5, KATERINA BELOHLAVKOVA3,
KAROLINA REZKOVA4, ROBERT MIKULIK4, JARMILA SIEGELOVA2, PETR DOBSAK2
1Department of Rehabilitation SMN Prostejov, 2Department of Physiotherapy and Rehabilitation, Masaryk University,
Brno, 3ICRC Brno, 4Department of Rehabilitation Palacky University Olomouc, 5Department of Natural
Sciences in Kinanthropology, Palacky University Olomouc
INTRODUCTION
Spasticity is one of the symptoms of the upper motor neuron syndrome after stroke. The main clinical
manifestations of spasticity include: reduced muscle strength, impaired targeted motor coordination
and isolated movements, increased reflex retrieval, abnormal position of extremities – spastic dystonia,
clonus, associated movements – synkinesia and cocontraction (1). Excessive muscle tone along with other
symptoms of spastic manifestations significantly impair quality of life in patients after a stroke, reduce patient’s
mobility, reduce his activities of daily living and self-sufficiency (2). Therapeutic approach to spasticity
is an important part of care for these patients. Therapy involves a comprehensive approach including
pharmacotherapy (including local treatment with botulinum toxin), physiotherapy, occupation therapy
(ergotheraphy), physical therapy, prosthetic therapy and possibly psychotherapy, nursing care, regime
measures, if indicated also treatment with baclofen pump or surgical solutions (3). The principle in the
treatment of mild spasticity is a combination of pharmacotherapy and rehabilitation using physiotherapy
on the neurophysiological basis (Vojta reflex locomotion, Bobath concept and proprioceptive neuromuscular
facilitation) and relaxation therapy (stretching). As a supplement, splinting is recommended (1).
Graph 1 Clinical scales evaluating spasticity, clinical status, self-sufficiency
and hand function before (V) and after (K) six-week rehabilitation.
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NONINVASIVE METHODS IN CARDIOLOGY 2013
METHODS
A prospective pilot study evaluates effects of a six-week comprehensive therapy. The 12 patients after
stroke with mild to moderate spastic syndrome (Modified Ashworth scale: grade 1–3) were subjected to intensive
rehabilitation involving 2× daily physiotherapy and 1× daily occupational therapy (ergotheraphy)
of the hand, totally 6 hours daily splinting (3 × 2 hours) using a dynamic splint of the forearm and hand
(Figure 1), standard antispastic drug therapy (including the application of botulinum toxin). The patients
were evaluated at the beginning of the treatment and after six weeks of therapy using standard clinical
scales evaluating spasticity (Modified Ashworth Scale – MAS, Tardieu scale), clinical status, self-sufficiency
and hand function (NIHSS, Barthel index, ICF-d440 assessment of hand function to fine movements,
SVH-score of visual evaluation of the hand, visual algic scale – VAS, SF-36 scale of quality of life).
RESULTS
The results were evaluated before and after a comprehensive six-week therapy. Significant changes
were found after a comprehensive therapy, namely improved function of the hand and forearm (SVH, ICFd440)
and the overall condition including quality of life (NIHSS, Barthel index, SF-36). Statistically limit
changes were detected in changes of the muscular tonus – spasticity (MAS, Tardieu) (Graph 1, Table 1).
Table 1 Basic statistics (mean value, standard deviation – SD) before and after six-week rehabilitation
BEFORE AFTER p-value
Mean value SD Mean value SD p < 0,05
MAS 2.17 0.14 1.38 0.64 NS
TardieLOK R2–R1 44.17 22.73 24.59 13.67 NS
TardieRUK R2–R1 28.34 19.66 17.08 12.98 NS
NIHSS 5.68 2.42 2.59 1.83 SS
SVH 7.92 3.37 14.75 4.01 SS
Bathel Index 67.08 15.62 87.08 21.71 SS
ICF-d440 2.67 0.75 1.08 0.51 SS
VAS 3.5 0.43 1.5 0.68 SS
SF-36 66.25 5.31 86.25 7.92 SS
Notes: NS – statistically non-significant change, SS – statistically significant change
DISCUSSION
Each application of botulinum toxin must be followed by a comprehensive rehabilitation program
including physiotherapy, occupation therapy, stretching, splinting, positioning, etc. (4). The most widely
used procedures for management of spasticity are represented by pharmacological treatment aimed at inhibiting
reflex hyperexcitability. In the last decades, several non pharmacological procedures for treating
spasticity have been put forward, including muscle stretching, muscle reinforcement, physical agents and
pain management. These procedures may have both neurophysiological and biomechanical effects on the
spastic movement disorder (5).
Innovation of comprehensive treatment of spasticity is to use dynamic splints (see our study). These
splints are better tolerated by patients and have a better therapeutic effect.
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NONINVASIVE METHODS IN CARDIOLOGY 2013
Figure 1 Dynamic splint of the forearm and hand
CONCLUSION
A comprehensive approach can favorably affect the functional state of the upper extremity even at
persisting spasticity. In this respect, combination of pharmacological therapy, physiotherapy, occupational
therapy (ergotheraphy) and prothetic therapy seems highly beneficial. Treatment of spasticity is a long
term process and requires a multidisciplinary approach.
REFERENCES
1.	 Mayer M, Konecny P. Možnosti ovlivnění spasticity prostředky fyzikální terapie a rehabilitací nemocných
s centrálními poruchami hybnosti. Rehabilitacia 1998 (1): 40–47.
2.	 Konecny P, Elfmark M, Horak S, Siegelova J, Dobsak P, Kadlcik T, Charvatova M, Skotakova J. Dysphagia
after stroke. In: Halberg F, Kenner T, Siegelova J, Dobsak P., eds. Noninvasive methods in cardiology
2012, October 2012, Brno: Faculty of Medicine, Masaryk University, Brno, p. 139–141
3.	 Konecny P, Elfmark M, Urbanek K. Facial paresis after stroke and its impact on patients´ facial movement
and mental status. J Rehabil Med. 2011 Jan; 43 (1): 73–75.
4.	 Ehler E, Vanaskova E, Stetkarova I. Standard komplexní léčby po cévní mozkové příhodě. Cesk Slov
Neurol N 2009; 72/105 (2): 179–181
5.	 Smania N, Picelli A, Munari D, Geroin C, Ianes P, Waldner A, Gandolfi M. Rehabilitation procedures in
the management of spasticity. Eur J Phys Rehabil Med. 2010 Sep; 46(3): 423–438.
NONINVASIVE METHODS IN CARDIOLOGY 2013
Edited by: Kenner T., Cornélissen G., Siegelová J., Dobšák P.
Published by Masaryk University in 2013
First edition, 2013
Print run: 60 copies
Printed by Tiskárna KNOPP, Černčice 24, 549 01 Nové Město nad Metují
Typeset by Radim Šustr (Institute Biostatistics and Analyses, Masaryk University)
Set by Skolar, typeface designed by David Březina.
ISBN 978-80-210-6534-5
ISBN 978-80-210-6534-5