Day vs night ECG and heart rate variability patterns in patients without obvious heart disease

doi:10.1016/0022-0736(92)90002-H

Journal of Electrocardiology

Volume 25, Issue 3, July 1992, Pages 175-184

https://doi.org/10.1016/0022-0736(92)90002-H Get rights and content

Abstract

The day vs night values of variables that may be related to the autonomic nervous system were compared in 50 individuals without obvious heart disease. Using ambulatory electrocardiographic monitoring and heart rate variability analysis, it was found that in contrast to daytime, nocturnal heart rate and total heart rate variability were reduced and low (0–0.05 Hz) and high (0.2–0.35 Hz) frequency power of nocturnal heart rate variability were increased, whereas mid-frequency (0.05–0.2 Hz) power was reduced. In addition, nocturnal episodes of trapezoidal-shaped waveforms of heart rate increase were present primarily at night and ST was elevated to a greater extent at night. Many of these factors were related to age and tentatively, despite the small sample size, reflect an age-related diminished autonomic nervous system response. These results serve to establish a circadian basis for comparison when evaluating disease states such as ischemic heart disease and its prognosis.

References (45)

G Casolo et al.
Decreased spontaneous heart rate variability in congestive heart failure
Am J Cardiol
(1989)
AL Goldberger et al.
Nonlinear dynamics in heart failure: implications of long-wavelength cardiopulmonary oscillations
Am Heart J
(1984)
JP Saul et al.
Assessment of autonomic regulation in chronic congestive heart failure by heart rate spectral analysis
Am J Cardiol
(1988)
JT Bigger et al.
Comparison of baroreflex sensitivity and heart period variability after myocardial infarction
J Am Coll Cardiol
(1989)
RE Kleiger et al.
Decreased heart rate variability and its association with increased mortality after acute myocardial infarction
Am J Cardiol
(1987)
F Lombardi et al.
Heart rate variability as an index of sympathovagal interaction after acute myocardial infarction
Am J Cardiol
(1987)
MW Rich et al.
Correlation of heart rate variability with clinical and angiographic variables and late mortality after coronary angiography
Am J Cardiol
(1988)
DH Singer et al.
Low heart rate variability and sudden cardiac death
J Electrocardiol
(1988)
MJ Niemela et al.
Impaired parasympathetic control of heart rate after myocardial infarction
Int J Cardiol
(1989)
JT Bigger et al.
Components of heart rate variability measured during healing of acute myocardial infarction
Am J Cardiol
(1988)

K Otsuka et al.

Variant angina and REM sleep

Am Heart J

(1988)

JE Deanfield et al.

Analysis of ST-segment changes in normal subjects: implications for ambulatory monitoring in angina pectoris

Am J Cardiol

(1984)

PM Okin et al.

Effect of baseline ST segment elevation on test performance of standard and heart rate-adjusted ST segment depression criteria

Am Heart J

(1990)

SN Willich et al.

Circadian variation in the incidence of sudden cardiac death in the Framingham Heart Study population

Am J Cardiol

(1987)

D Van Hoogenhuize et al.

Heart rate variability 1989

J Electrocardiol

(1989)

M di Rienzo et al.

24h sequential spectral analysis of arterial blood pressure and pulse interval in free moving subjects

IEEE Trans Biomed Eng

(1989)

G Mancia et al.

Blood pressure and heart rate variabilities in normotensive and hypertensive human beings

Circ Res

(1983)

WN Leimbach et al.

Direct evidence from intraneural recordings for increased central sympathetic outflow in patients with heart failure

Circulation

(1986)

D McAreavy et al.

Cardiac parasympathetic activity during the early hours of acute myocardial infarction

Br Heart J

(1989)

GA Myers et al.

Power spectral analysis of heart rate variability in sudden cardiac death: comparison to other methods

IEEE Trans Biomed Eng

(1986)

J Hayano et al.

Decreased magnitude of heart rate spectral components in coronary artery disease: its relation to angiographic severity

Circulation

(1990)

RK Otnes et al.

Applied time series analysis

(1978)

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Time domain and frequency domain variables are strongly correlated when measured over a 24-h period and indeed frequency-domain analysis are considered to be equivalent to time-domain analysis which is both easier to perform and are more readily available [13]. A circadian rhythm of heart rate variability has been suggested based on differences in HRV during the day compared to the night [14–17] but a test of a difference in two or three time periods during a 24 h day is not an in depth evaluation by a mathematical test of circadian rhythmicity. Similarly, there has been little in-depth evaluation of the relationship between QTc and HRV which would permit an integration of the knowledge about the autonomic nervous system effects on HRV and its relationship to QTc.
Whether the QT interval displays circadian rhythm after heart rate correction is unresolved and the relationship of QT interval to heart rate variability (HRV) is uncertain.
To test the hypothesis that there is a circadian rhythm to QT interval and HRV and determine the relationship between QTc and HRV.
The hourly average ECG data from 24-h ECGs were examined in individuals (50 without medications and 9 on beta blockers only) with no evidence of coronary artery disease or structural heart disease. The QT duration of normal QRS complexes from a series of 30-s windows was measured. The presence of circadian rhythm was tested by the data analytic approach of goodness of fit to a cosine function.
QT interval with and without heart rate correction showed a circadian rhythm for five heart rate adjustment formulae except for the Bazett formula. HRV also showed circadian rhythm but with different acrophages and nadirs depending on the HRV component. There were significant (p < 0.05) positive correlations of QTc with pNN50 rms-SD and SDNN and significant (p < 0.05) negative correlations with SDANN and Tri. The beta blocker group did not generally show circadian rhythm for QT interval or HRV.
QT, after heart rate adjustment, and HRV have circadian rhythmicity. There are significant correlations between QT interval and HRV indices. Circadian rhythm was blunted with beta blockers. The data are consistent with the concept of a predominance of parasympathetic activity to increase QTc and sympathetic activity to shorten QTc, even after ‘correction’ of the QT interval for heart rate.
Circadian variation of heart rate turbulence and the number of ventricular premature beats in patients with mitral valve prolapse
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Therefore, in addition to pure baroreflex sensitivity, HRT also reflects autonomic tone modulation in cardiovascular system. It had been demonstrated in previous studies that the circadian variation of cardiac autonomic tone with the most rapid increase in sympathetic and decrease in vagal-tone in early morning hours in normal individuals [8,9], and also in patients with coronary artery disease [10]. It had been reported that there is a peak in the incidence of myocardial ischemia, acute myocardial infarction and sudden cardiac death in the time [11].
Circadian variation of heart rate variability and the rate of autonomic change in the morning hours in healthy subjects and angina patients
2001, International Journal of Cardiology
Background: Incidence of sudden cardiac death peaks during the early morning hours when there is a rapid withdrawal of vagal and an increase of sympathetic tone. The rate of autonomic change could be of prognostic importance. Patients and methods: A total of 65 patients with angina pectoris, free from other diseases and drug free, were Holter monitored for 24 h. A total of 30 patients were also monitored on isosorbide-5-mononitrate (IS-5-MN) and on metoprolol respectively. A total of 33 age-matched healthy subjects served as controls. Spectral components of heart rate variability (HRV) were analysed hourly, with special reference to the rapid changes of autonomic tone during the night and early morning hours. Circadian variation was assessed in two ways: (1) Mean HRV day (8 a.m.–8 p.m.) and night (0–5 a.m.) were compared. (2) For the morning/night hours (0–10 a.m.), individual hourly values for max. and min. HRV, the difference max.–min. (gradient), the rate of change per hour between max. and min. (velocity) and the largest difference between two consecutive hours (max. velocity) were recorded and the mean value for the group calculated. Results: During the night/morning hours, healthy controls demonstrated faster HF max. velocity (P=0.002) and higher HF gradient (P=0.011) than angina patients. Metoprolol and IS-5-MN increased the HF gradient (P=0.008 and P=0.003, respectively), and metoprolol tended to increase the max. velocity (P=0.02). Metoprolol substantially decreased the LF/HF gradient (P=0.001), velocity (P=0.008) and max. velocity (P=0.0001). Conclusion: Rapid vagal withdrawal seemed to be a sign of a healthy autonomic nervous system in the control group but was significantly slower in angina patients. IS-5-MN and metoprolol tended to normalise vagal withdrawal and metoprolol slowed down the rapid increase in sympathetic predominance in the morning in patients.
Parametric analysis of heart rate variability during hemodialysis
1996, International Journal of Bio-Medical Computing
The problem of evaluating short-term autonomic response to hypovolemia in patients under chronic hemodialysis treatment is considered. Power spectra of the beat-to-beat heart rate variability were evaluated during the dialysis treatment in twenty hemodynamically stable and unstable patients, using a parametric technique. The autoregressive model coefficients were calculated by the modified covariance method, while model order was selected according to the minimum description length criterion. Reported results demonstrate that stable and unstable patients present markedly different spectral patterns. The efficiency of the compensatory response to hemodialysis-induced hypovolemia was evaluated through the ratio between the powers in LF and HF bands. Stable patients exhibit a LF/HF ratio greater than one with large fluctuations over the whole dialysis session. In contrast, all the unstable patients are characterized by a value of LF/HF lower than one and with a reduced time variability. This result suggests that the hemodynamic instability of the hypotension-prone patients may be due to a deficiency in the short-term compensatory response to the hemodialysis-induced hypovolemia.
Detection of regularities in heart rate variations by linear and non-linear analysis: power spectrum versus approximate entropy
1995, Computer Methods and Programs in Biomedicine
Regularity or complexity characteristics of RR interval variations have attained importance in the evaluation of a variety of pathological conditions. Regular periodic fluctuations in heart rate are considered indicators of loss of control in the cardiovascular system and of disturbances in pulmonary function. Methods to detect such loss of cardiopulmonary function have been developed mainly through linear and non-linear system analysis. Both approaches were tested in the present study. MBW, which is the ratio between maximal power spectrum (PS) amplitude and its 3-db bandwidth (BW) in the 0–0.1 Hz frequency range, was calculated and compared for different examples derived from 24 h Holter recordings and for sinusoidal function mixed with varying degrees of noise. Approximate entropy (ApEn), a measure derived from non-linear system analysis has been tested for the same data and compared with the MBW ratio. The results show that MBW effectively differentiates regular and non-regular epochs while ApEn differentiates them in a less optimal manner especially in cases where higher degrees of noise are present but regularity is still observed visually.
Ischemic episodes in 24-h ambulatory electrocardiograms of elderly persons: The cardiovascular health study
1995, International Journal of Cardiology
We examined correlates of ischemic episodes in 24-h ambulatory electrocardiograms (ECG) in a sample of 1511 men and women 65 years old and older. Ischemic episodes had a high prevalence period during early afternoon and also during morning hours after awakening, and the overall prevalence was 13% in men and 9% in women (P < 0.001 for gender difference). The prevalence was 9.6% in participants with no history of myocardial infarction and no major or minor resting ECG abnormalities. In multivariate analysis by logistic regression, being on digitalis medication was associated with over a three-fold risk of ischemic episodes, with an odds ratio (95% confidence limits) of 3.21 (1.80 to 5.74). Left ventricular hypertrophy by ECG and atrial fibrillation had almost a three-fold excess risk of ischemic episodes, with odds ratios 2.81 (1.37 to 5.74) and 2.63 (1.17 to 5.91), respectively. Isolated ST-T abnormalities had almost a two-fold excess of ischemic episodes, with an odds ratio of 1.89 (1.01 to 3.54). Being overweight was associated with a 33% reduced likelihood of ischemic episodes after adjustment for other factors, with an odds ratio of 0.67 (0.46 to 0.98). It is concluded that the prevalence of silent ischemic episodes is high in older men and women.

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Original articleDay vs night ECG and heart rate variability patterns in patients without obvious heart disease

Abstract

Am J Cardiol

Am Heart J

Am J Cardiol

J Am Coll Cardiol

Am J Cardiol

Am J Cardiol

Am J Cardiol

J Electrocardiol

Int J Cardiol

Am J Cardiol

Am Heart J

Am J Cardiol

Am Heart J

Am J Cardiol

Heart rate variability 1989

J Electrocardiol

24h sequential spectral analysis of arterial blood pressure and pulse interval in free moving subjects

IEEE Trans Biomed Eng

Blood pressure and heart rate variabilities in normotensive and hypertensive human beings

Circ Res

Direct evidence from intraneural recordings for increased central sympathetic outflow in patients with heart failure

Circulation

Cardiac parasympathetic activity during the early hours of acute myocardial infarction

Br Heart J

Power spectral analysis of heart rate variability in sudden cardiac death: comparison to other methods

IEEE Trans Biomed Eng

Decreased magnitude of heart rate spectral components in coronary artery disease: its relation to angiographic severity

Circulation

Applied time series analysis

Original article
Day vs night ECG and heart rate variability patterns in patients without obvious heart disease