Heart rate variability: from bench to bedside

Spectral analysis of heart rate variability (HRV) may predict the future development of essential hypertension

Presently, essential hypertension (EH) is among the most common morbid disorders of mankind. The fundamental pathophysiology of EH is sympathetic overactivity. It has been observed that the people having common risk factors for hypertension such as obesity, insulin resistance and stress generally have increased sympathetic activity. Therefore, it is presumed that patients suffering from EH develop some degree of increased sympathetic activity much before they clinically develop hypertension. Spectral analysis of heart rate variability (HRV) has been demonstrated to accurately assess change in sympathovagal balance (autonomic activity) even when the alteration is in its minimal form. Therefore, in the present paper we hypothesize that spectral analysis of HRV could be utilized for early prediction of EH. We also suggest that the predictive knowledge of sympathovagal imbalance in the development of EH should be employed in elucidating the mechanisms for prevention of this dysfunction.

Spirituality and autonomic cardiac control

BACKGROUND

Spirituality has been suggested to be associated with positive health, but potential biological mediators have not been well characterized.

PURPOSE AND METHODS

The present study examined, in a population-based sample of middle-aged and older adults, the potential relationship between spirituality and patterns of cardiac autonomic control, which may have health significance. Measures of parasympathetic (high-frequency heart rate variability) and sympathetic (pre-ejection period) cardiac control were obtained from a representative sample of 229 participants. Participants completed questionnaires to assess spirituality (closeness to and satisfactory relationship with God). Personality, demographic, anthropometric, health behavior, and health status information was also obtained. A series of hierarchical regression models was used to examine the relations between spirituality, the autonomic measures, and two derived indexes--cardiac autonomic balance (CAB, reflecting parasympathetic to sympathetic balance) and cardiac autonomic regulation (CAR, reflecting total autonomic control).

RESULTS

Spirituality, net of demographics, or other variables were found to be associated with enhanced parasympathetic as well as sympathetic cardiac control (yielding a higher CAR) but was not associated with CAB. Although the number of cases was small (N = 11), both spirituality and CAR were significant negative predictors of the prior occurrence of a myocardial infarction.

CONCLUSIONS

In a population-based sample, spirituality appears to be associated with a specific pattern of CAR, characterized by a high level of cardiac autonomic control, irrespective of the relative contribution of the two autonomic branches. This pattern of autonomic control may have health significance.

Cardiac autonomic balance versus cardiac regulatory capacity

The concept of autonomic balance views autonomic states along a bipolar continuum from sympathetic (S) to parasympathetic (P) dominance, whereas regulatory capacity models emphasize overall autonomic flexibility as a marker of the capacity for regulation. These two concepts were evaluated for their utility in characterizing patterns of autonomic control. Measures of P (high frequency heart rate variability, HF) and S (preejection period, PEP) cardiac control were obtained. A measure of cardiac autonomic balance (CAB) was derived as the difference in the normalized P index minus the S index, and a measure of cardiac autonomic regulation (CAR) was derived as the normalized P index plus the S index. Results reveal that CAR, but not CAB, was a significant predictor of the prior occurrence of a myocardial infarction, net of demographic and other variables, whereas CAB, but not CAR, was a significant predictor of concurrent diabetes.

Heart rate variability in mice: a theoretical and practical guide

The mouse is the animal model principally used to study biological processes in mammals. The mutation, overexpression or knockout of one or several genes can provide insight into human disease. In cardiovascular research, evaluation of autonomic nervous function is an essential tool for a better understanding of the pathophysiological conditions in which cardiomyopathy arises and develops. Analysis of heart rate variability is the least invasive method to evaluate the sympathovagal balance on the sino-atrial level. The need to perform this technique on freely moving mice emerged in the 1990s, but despite previous studies it has been difficult to set up and standardize a common protocol. The multitudes of techniques used, plus subtle differences in methodology, impede the comparison and clear interpretation of results. This article aims to make a survey of heart rate variability analysis and to establish a standardized protocol for the assessment of the autonomic neural regulation of heart rate in mice.

Wavelet transform: A better approach for the evaluation of instantaneous changes in heart rate variability

The aim of our study was to validate the Vaidyanathan wavelet tool for HRV analysis during orthostatic testing. Two groups of normotensive male subjects were studied: 13 adolescents and 27 young adults. Both groups consisted of subjects with negative, (N-), and with positive family history for hypertension, (N+). These subjects underwent 5-minute active standing upright, preceded and followed by 5-minute periods in supine position. Continuous electrocardiogram (ECG) was recorded and HRV indices were calculated using wavelet (WT) and fast Fourier transform (FFT) simultaneously. WT and FFT data showed high level of correlation (>0.9). Due to its inherent properties, WT proved to be more informative than FFT in the analysis of the non-stationary ECG signal during orthostatic testing. WT revealed HRV dynamics more accurately since it allowed HRV evaluation for shorter intervals (60 s) than FFT (256 s). During the initial and recovery period lower parasympathetic activity (P < 0.0001; P < 0.02) and higher ratio of autonomic balance (sympathetic vs. parasympathetic) (P < 0.0001; P < 0.02) were evidenced in (N+) as compared to (N-). The upright posture was accompanied by a prompt decrease in HRV and by an elevation of the index of autonomic balance. These alterations were more pronounced in N(+). In conclusion, we believe that wavelet analysis is an appropriate approach for the estimation of HRV dynamics in non-stationary conditions. Furthermore, we demonstrate certain essential alterations in the autonomic modulation of the cardiovascular system in young normotensives with positive family history for essential hypertension.

Sympathovagal imbalance in acromegalic patients

CONTEXT

Sympathovagal imbalance is a common finding in diabetes and is considered to be a cardiovascular risk factor. No data are available on sympathovagal balance (SB) in acromegalic patients.

OBJECTIVE

The objective of this study was to evaluate SB in acromegalic patients.

PATIENTS

Twenty nondiabetic, nonhypopituitary, acromegalic patients (13 women and seven men; mean age +/- sem, 51.30 +/- 3.09 yr) were compared with age-matched subjects (21 normal subjects, 20 patients with type 1 diabetes mellitus, and 15 patients with type 2 diabetes mellitus).

INTERVENTIONS

Autonomic tests, used to evaluate SB, were performed by power spectral analysis of heart rate variability in clinostatism (c) and orthostatism (o), using a frequency domain method. Power spectral analysis identifies peaks of power: high frequency (HF), which expresses vagal activity, and low frequency (LF), which expresses sympathetic activity.

RESULTS

Acromegalic patients displayed significantly lower LFc/HFc (P = 0.002) and LFo/HFo (P < 0.001) ratios than normal subjects. HFo was significantly higher in acromegalic patients than in normal subjects (P < 0.001) and patients with type 1 diabetes mellitus (P = 0.004), but no different from that in type 2 diabetes mellitus patients (P = 0.069). In untreated acromegalic patients, the alterations found in the whole group were confirmed; no statistically significant differences were found between untreated acromegalic patients and those treated with somatostatin analogs. Similarly, the same alterations found in the whole group were evident in the controlled acromegalic patients, and no significant differences were found between controlled and uncontrolled patients.

CONCLUSION

Our study evidenced that sympathovagal imbalance in acromegalic patients, due to vagal hypertone, is difficult to reverse and is not influenced by medical therapy. This could be a new cardiovascular risk factor.