Heart rate variability in children with aortic valve stenosis - a pilot study

Heart Rate Variability Analysis on Electrocardiograms, Seismocardiograms and Gyrocardiograms of Healthy Volunteers and Patients with Valvular Heart Diseases

Heart rate variability (HRV) is the physiological variation in the intervals between consecutive heartbeats that reflects the activity of the autonomic nervous system. This parameter is traditionally evaluated based on electrocardiograms (ECG signals). Seismocardiography (SCG) and/or gyrocardiography (GCG) are used to monitor cardiac mechanical activity; therefore, they may be used in HRV analysis and the evaluation of valvular heart diseases (VHDs) simultaneously. The purpose of this study was to compare the time domain, frequency domain and nonlinear HRV indices obtained from electrocardiograms, seismocardiograms (SCG signals) and gyrocardiograms (GCG signals) in healthy volunteers and patients with valvular heart diseases. An analysis of the time domain, frequency domain and nonlinear heart rate variability was conducted on electrocardiograms and gyrocardiograms registered from 29 healthy male volunteers and 30 patients with valvular heart diseases admitted to the Columbia University Medical Center (New York City, NY, USA). The results of the HRV analysis show a strong linear correlation with the HRV indices calculated from the ECG, SCG and GCG signals and prove the feasibility and reliability of HRV analysis despite the influence of VHDs on the SCG and GCG waveforms.

Cardiac Autonomic Response to Active Standing in Calcific Aortic Valve Stenosis

Aortic stenosis is a progressive heart valve disorder characterized by calcification of the leaflets. Heart rate variability (HRV) analysis has been proposed for assessing the heart response to autonomic activity, which is documented to be altered in different cardiac diseases. The objective of the study was to evaluate changes of HRV in patients with aortic stenosis by an active standing challenge. Twenty-two volunteers without alterations in the aortic valve (NAV) and twenty-five patients diagnosed with moderate and severe calcific aortic valve stenosis (AVS) participated in this cross-sectional study. Ten minute electrocardiograms were performed in a supine position and in active standing positions afterwards, to obtain temporal, spectral, and scaling HRV indices: mean value of all NN intervals (meanNN), low-frequency (LF) and high-frequency (HF) bands spectral power, and the short-term scaling indices (α₁ and α_sign1). The AVS group showed higher values of LF, LF/HF and α_sign1 compared with the NAV group at supine position. These patients also expressed smaller changes in meanNN, LF, HF, LF/HF, α_1, and α_sign1 between positions. In conclusion, we confirmed from short-term recordings that patients with moderate and severe calcific AVS have a decreased cardiac parasympathetic supine response and that the dynamic of heart rate fluctuations is modified compared to NAV subjects, but we also evidenced that they manifest reduced autonomic adjustments caused by the active standing challenge.

On the risk of aortic valve replacement surgery assessed by heart rate variability parameters

In recent years the number of arterial stenosis (AS) patients has grown rapidly and valvular disease is expected to be the next great epidemic. We studied a group of 385 arterial valve replacement (AVR) surgery patients, of whom 16 had died in the postoperational period (up to 30 d after the operation). Each patient had a heart rate variability (HRV) recording made prior to the operation in addition to a full set of medical diagnostics including echocardiography. We formed 16 age, sex, New York Heart Association (NYHA) class, and BMI adjusted control pairs for each person who died in the perioperative period. Our aim was to find indications of the risk from AVR surgery based on the medical data and HRV properties. Besides standard, linear HRV methods, we used indexes of time irreversibility introduced by Guzik (G%), Porta (P%), Ehlers (index E) and Hou (index D). In addition, we analyzed the multiscale multifractal properties of HRV calculating the Hurst surface. The nonlinear analysis methods show statistically significant indications of the risk of AVR surgery in an increase of multifractality and an increase of time irreversibility of the HRV measured prior to the operation.