Components of heart rate variability measured during healing of acute myocardial infarction

doi:10.1016/0002-9149(88)90917-4

The American Journal of Cardiology

Volume 61, Issue 4, 1 February 1988, Pages 208-215

https://doi.org/10.1016/0002-9149(88)90917-4 Get rights and content

Abstract

A high degree of heart rate (HR) variability is found in persons with normal hearts, whereas low HR variability can be found in patients with severe coronary artery disease, congestive heart failure and diabetic neuropathy. Two weeks after acute myocardial infarction, low HR variability predicted reduced long-term survival even after adjusting for clinical risk indicators, left ventricular ejection fraction, HR and ventricular arrhythmias. The present study elucidated the causes of differences in HR and HR variability between patients with low and high HR variability. In a matched-pair study, 10 patients with low HR variability (24-hour standard deviation of N-N intervals <50 ms) were randomly selected. For each of these 10 patients, a control patient with high HR variability (24-hour standard deviation of N-N intervals ≥100 ms), matched for age, left ventricular ejection fraction and rales in the coronary care unit was selected. Patients who were taking either digitalis or β-adrenergic blocking drugs were excluded. Analysis of 24-hour electrocardiograms showed that for the tew HR variability group compared with the high: (1) the daytime and nighttime average HR was faster; (2) the difference between daytime and nighttime HR was less; (3) the proportion of differences >50 ms between successive N-N Intervals was smaller; and (4) the number of HR “spkes” per day (Increase In HR ≥10 beats/min, lasting from 3 to 15 minutes) was less. These findings Indicate that parasympathetic nervous activity is substantially reduced in patients with tow HR variability compared with control patients. Low parasympathetic activity or high sympathetic activity decreases the electrical ventricular fibrillation threshold and increases the probability of ventricular fibrillation during myocardial ischemia, and may explain the association between low HR variability and mortality after acute myocardial infarction.

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Cited by (338)

Cardiovascular variations in patients with major depressive disorder versus bipolar disorder
2023, Journal of Affective Disorders
Differentiating depression in major depressive disorder and bipolar disorder is challenging in clinical practice. Therefore, reliable biomarkers are urgently needed to differentiate between these diseases. This study's main objective was to assess whether cardiac autonomic function can distinguish patients with unipolar depression (UD), bipolar depression (BD), and bipolar mania (BM).
We recruited 791 patients with mood disorders, including 191 with UD, 286 with BD, and 314 with BM, who had been drug free for at least 2 weeks. Cardiovascular status was measured using heart rate variability (HRV) and pulse wave velocity (PWV) indicators via finger photoplethysmography during a 5-min rest period.
Patients with BD showed lower HRV but higher heart rates than those with UD and BM. The PWV indicators were lower in the UD group than in the bipolar disorder group. The covariates of age, sex, and body mass index affected the cardiovascular characteristics. After adjusting for covariates, the HRV and PWV variations among the three groups remained significant. Comparisons between the UD and BD groups showed that the variable with the largest effect size was the frequency-domain indices of HRV, very low and high frequency, followed by heart rate. The area under the receiver operating characteristic curve (AUC) for each cardiovascular variable ranged from 0.661 to 0.714. The High-frequency index reached the highest AUC.
Limitations.
Cross-sectional design and the magnitude of heterogeneity across participants with mood disorders limited our findings.
Patients with BD, but not BM, had a greater extent of cardiac imbalance than those with UD. Thus, HRV may serve as a psychophysiological biomarker for the differential diagnosis of UD and BD.
Heart rate variability in patients with psychiatric disorders from adolescence to adulthood
2023, General Hospital Psychiatry
Age is associated with changes in autonomic nervous system activity. These changes are assessed using heart rate variability(HRV) indicators; however, the effect of age on HRV in patients with psychiatric disorders remains unclear. Our study aimed to explore this effect and determine its variance across different lifespans.
Consecutive patients(N = 3315), comprising 1833 patients with psychotic disorders, 1040 with mood disorders, and 442 with anxiety disorders, were recruited. The patients were divided into four age groups: adolescence(10–24 years), early adulthood(25–39 years), middle adulthood(40–59 years), and late adulthood(60+ years). HRV indicators were measured during a 5-min rest period.
The heart rate and HRV indices were higher in the adolescent and early adulthood groups than they were in the middle and late adulthood groups(increased HRV is beneficial for health, while reduced HRV is detrimental). Age and all the HRV indices were negatively correlated(r-values 0.153–0.350, p < 0.001), with these correlation patterns being more evident in the adolescent and early adulthood groups than in the middle and late adulthood groups. Stratified by sex, the low-frequency/high-frequency ratio was higher in men than in women across most age groups(p < 0.05), except the late adulthood group(p = 0.085). Stratified by diagnosis, most HRV variables(except very low-frequency) were lower in the psychotic disorder group than they were in the mood and anxiety disorder groups, especially in middle and late adulthood patients. After adjusting for confounders, the HRV variables were significantly associated with age, while older age was associated with lower HRV.
These results indicate that the substantial reduction in HRV with age in patients with psychiatric disorders. The association remains significant after correction for sex, heart rate, and diagnoses; this may prove useful to clinical practice and further research.
Heart Rate Variability Analysis May Identify Individuals With Williams-Beuren Syndrome at Risk of Sudden Death
2023, JACC: Clinical Electrophysiology
Williams-Beuren syndrome (WBS) (Online Mendelian Inheritance in Man #194050) is a rare genetic multisystem disorder resulting from a chromosomal microdeletion at 7q11.23. The condition is characterized by distinct facies, intellectual disability, and supravalvar aortic stenosis. Those with WBS have an increased risk of sudden death, but mechanisms underlying this phenotype are incompletely understood.
The aim of this study was to quantify and compare autonomic activity as reflected by heart rate variability (HRV) measures in a cohort of individuals with WBS (n = 18) and age- and sex-matched control subjects (n = 18).
We performed HRV analysis on 24-hour electrocardiography recordings using nonlinear, time and frequency domain analyses on a cohort of subjects with WBS and age- and sex-matched control subjects enrolled in a prospective cross-sectional study designed to characterize WBS disease natural history.
WBS subjects demonstrated diminished HRV (reflected by the SD of the NN intervals [P = 0.0001], SD of the average NN interval for 5-minute intervals over 24 hours [P < 0.0001], average of the 5-minute SDs of NN intervals for 24 hours [P = 0.0002], root mean square of successive differences of NN intervals [P = 0.0004], short axis of the Poincaré plot (SD1) [P < 0.0001], and long axis of the Poincaré plot [P < 0.0001]) and indirect markers of parasympathetic activity (reflected by the percent of NN intervals different from previous by 50% or more of local average [P < 0.0007], root mean square of successive differences of NN intervals [P = 0.0004], natural log high-frequency power [P = 0.0038], and SD1 [P < 0.0001]). Additional parameters were also significantly different, including natural log very low-frequency power (decreased; P = 0.0002), natural log low-frequency power (decreased; P = 0.0024), and SD1 divided by the long axis of the Poincaré plot (decreased; P < 0.0001).
Individuals with WBS demonstrate significant HRV abnormalities consistent with diminished autonomic reserve. Future studies will be needed to determine the relationship between autonomic dysregulation observed and sudden death risk seen in these patients. (Impact of Elastin Mediated Vascular Stiffness on End Organs; NCT02840448)
Effect of antipsychotic use by patients with schizophrenia on deceleration capacity and its relation to the corrected QT interval
2023, General Hospital Psychiatry
Schizophrenia patients treated with antipsychotics are at higher risk of sudden cardiac death. Decreased deceleration capacity (DC) of the heart rate is an accurate predictor of cardiac mortality. We evaluated the risk of sudden cardiac death due to antipsychotic use by assessing DC and examining the association between DC and the corrected QT interval (QTc) in schizophrenia patients.
We measured the DC and QTc of 138 schizophrenia patients. We then compared the DC of 86 age- and sex-matched healthy controls with that of 86 schizophrenia patients. We investigated the correlation of DC of approximately 138 schizophrenia patients with prescribed doses of antipsychotics using linear regression analysis. We compared the DC of schizophrenia patients with and without prolonged QT intervals.
We found DC significantly differed between schizophrenia patients on antipsychotic medication and healthy controls. Additionally, DC was negatively correlated with antipsychotic use, especially chlorpromazine, zotepine, olanzapine and clozapine, in a dose-dependent manner. There was no significant association between DC and the QTc.
Assessing DC could facilitate monitoring and identification of increased risk of cardiac mortality in patients with schizophrenia that take antipsychotics. Assessing both DC and the QTc may enhance the accuracy of predicting sudden cardiac death.
Association between spatial working memory and Re-experiencing symptoms in PTSD
2022, Journal of Behavior Therapy and Experimental Psychiatry
Citation Excerpt :
The root mean square of successive difference (RMSSD) was used to measure short-term variability (Shaffer & Ginsberg, 2017). RMSSD is an appropriate HRV index related to emotion regulation (Godfrey et al., 2019) and psychophysiology (Bigger et al., 1988; Owen & Steptoe, 2003), is preferred for its statistical characteristics (Buccelletti et al., 2009), and accurately represents parasympathetic activity (Chalmers et al., 2014). Affective Control.
Few studies have evaluated the link between working memory (WM) and post-traumatic stress disorder (PTSD). Further, it is unknown whether this relationship is accounted for by other relevant variables including negative affect, emotional dysregulation, or general non-WM-related cognitive control deficits, which are associated with PTSD. The purpose of this study was to determine the extent to which a computerized WM task could predict PTSD symptomology incrementally beyond the contribution of other relevant variables associated with PTSD.
Thirty veterans were eligible to complete emotional symptom questionnaires, a heart-rate variability measure, and computerized tasks (i.e., emotional Stroop and automated complex span tasks). A three-stage hierarchical regression was conducted with the PCL-5 total score and symptom clusters (i.e., re-experiencing, avoidance, hyperarousal, and negative cognition/mood) as the dependent variable.
Results revealed that only the re-experiencing symptom cluster was significantly predicted by executive, verbal, and visuospatial WM tasks, which explained an additional 29.7% of the variance over and above other relevant variables. Most notably, the visuospatial task was the only WM task that significantly explained PCL-5 re-experiencing symptoms.
This study was based on a small sample of veterans with PTSD and causality cannot be determined with this cross-sectional study.
Overall, the results suggest that deficits in visuospatial WM are significantly associated with PTSD re-experiencing symptoms after controlling for other relevant variables. Further research should evaluate whether an intervention to improve visuospatial WM capacity can be implemented to reduce re-experiencing symptoms.
Adjunct yoga therapy: Influence on heart rate variability in major depressive disorder - A randomized controlled trial
2021, Asian Journal of Psychiatry
HRV is inversely proportional to severity of depression. Effect of 12-weeks adjunct yoga therapy on HRV in patients with MDD was assessed through a randomized controlled trial. Sixty-eight subjects (40 females) with mean age 31.58 ± 8.79 years, scoring ≥ 18 on HDRS were randomized to either (YG; n = 35) or (WG; n = 33). Linear mixed model analysis showed no significant difference between groups. On comparing change in mean percentage, substantial more decrease could be elicited only for LF/HF ratio in YG compared to WG, while being comparable for other variables across the groups. Findings suggest Yoga therapy may help in bringing parasympathetic dominance in patients with MDD.

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^☆: This study was supported in part by grants HL-22982 and HL-70204 from the National Heart, Lung, and Blood Institute and by grant RR-00645 from the Research Resources Administration, Bethesda, Maryland; and by funds from the Gebbie Foundation, Jamestown, New York, Merck, Sharp and Dohme Research Laboratories, West Point, Pennsylvania, and the Winthrop and Chernow Foundations, New York, New York.

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Components of heart rate variability measured during healing of acute myocardial infarction☆

Abstract

Am J Cardiol

Am J Cardiol

Am J Cardiol

Risk stratification and survival after myocardial infarction

N Engl J Med

The relationships among ventricular arrhythmias, left ventricular dysfunction and mortality in the 2 years after myocardial infarction

Circulation

A shape oriented system for automated Holter ECG analysis

Autonomic mechanisms in the initial heart rate response to standing

J Appl Physiol

New method for assessing cardiac parasympathetic activity using 24-hour electrocardiograms

Br Heart J

Assessment of methods for estimating autonomic nervous control of the heart in patients with diabetes mellitus

Diabetes

Cardiovascular reflexes in patients after myocardial infarction: effect of long-term treatment with beta adrenoceptor antagonists

Br Heart J

Sudden large and periodic changes in heart rate in healthy young men after short periods of exercise

Br Med J

The mean square successive difference

Ann Math Stat