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Is abnormal heart rate variability a specific feature of congestive heart failure?

2001; Elsevier BV; Volume: 87; Issue: 10 Linguagem: Inglês

10.1016/s0002-9149(01)01499-0

1879-1913

Gustavo A. Lopera, Heikki V. Huikuri, Timo H. Mäkikallio, Jari Tapanainen, Simon Chakko, Raul D. Mitrani, Alberto Interian, Agustín Castellanos, Robert J. Myerburg,

ECG Monitoring and Analysis

Heart rate variability (HRV), analyzed in the time and frequency domain, is reduced in patients with congestive heart failure (CHF). 1 Casolo G.C Heart rate variability in patients with heart failure. in: Malik M Camm A.J Heart Rate Variability. Futura,, Armonk, NY1995: 466-499 Google Scholar , 2 Nolan J Batin P.D Andrews R Lindsay S.J Brooksby P Mullen M Baig W Flapan A.D Cowley A Prescott R.J Neilson J.M Fox K.A Prospective study of heart rate variability and mortality in chronic heart failure. Results of the United Kingdom heart failure evaluation and assessment of risk trial (UK-Heart). Circulation. 1998; 98: 1510-1516 Crossref PubMed Scopus (1045) Google Scholar , 3 Woo M.A Stevenson W.G Moser D.K Middlekauff H.R Complex heart rate variability and serum norepinephrine levels in patients with advanced heart failure. J Am Coll Cardiol. 1994; 23: 565-569 Abstract Full Text PDF PubMed Scopus (173) Google Scholar , 4 Szabo B.M van Veldhuisen D.J van der Veer N Brouwer J De Graeff P.A Crijns H.J Prognostic value of heart rate variability in chronic congestive heart failure secondary to idiopathic or ischemic dilated cardiomyopathy. Am J Cardiol. 1997; 79: 978-980 Abstract Full Text Full Text PDF PubMed Scopus (135) Google Scholar Fractal characteristics of heart rate (HR) behavior are also altered in patients with CHF, 5 Mäkikallio T.H Hoiber S Kober L Torp-Pedersen C Peng C.K Goldberger A.L Huikuri H.V the TRACE InvestigatorsFractal analysis of heart rate dynamics as a predictor of mortality in patients with depressed left ventricular function after acute myocardial infarction. Am J Cardiol. 1999; 83: 836-839 Abstract Full Text Full Text PDF PubMed Scopus (252) Google Scholar , 6 Huikuri H.V Mäkikallio T.H Peng C.K Goldberger A.L Hintze U Moller M for the DIAMOND Study GroupFractal correlation properties of R-R interval dynamics and mortality in patients with depressed left ventricular function after an acute myocardial infarction. Circulation. 2000; 101: 47-54 Crossref PubMed Scopus (542) Google Scholar and traditional and fractal analysis methods of HRV provide prognostic information on patients with CHF. 2 Nolan J Batin P.D Andrews R Lindsay S.J Brooksby P Mullen M Baig W Flapan A.D Cowley A Prescott R.J Neilson J.M Fox K.A Prospective study of heart rate variability and mortality in chronic heart failure. Results of the United Kingdom heart failure evaluation and assessment of risk trial (UK-Heart). Circulation. 1998; 98: 1510-1516 Crossref PubMed Scopus (1045) Google Scholar , 5 Mäkikallio T.H Hoiber S Kober L Torp-Pedersen C Peng C.K Goldberger A.L Huikuri H.V the TRACE InvestigatorsFractal analysis of heart rate dynamics as a predictor of mortality in patients with depressed left ventricular function after acute myocardial infarction. Am J Cardiol. 1999; 83: 836-839 Abstract Full Text Full Text PDF PubMed Scopus (252) Google Scholar , 6 Huikuri H.V Mäkikallio T.H Peng C.K Goldberger A.L Hintze U Moller M for the DIAMOND Study GroupFractal correlation properties of R-R interval dynamics and mortality in patients with depressed left ventricular function after an acute myocardial infarction. Circulation. 2000; 101: 47-54 Crossref PubMed Scopus (542) Google Scholar Despite these clinical observations, the pathophysiologic background for altered HRV is not well established. Two mechanisms have been proposed: (1) altered HRV in CHF results from abnormal afferent neural input from the failing heart to central cardiovascular autonomic regulatory systems, 7 Schwartz P.J Pagani M Lombardi F Malliani A Brown A.M A cardiocardiac sympathovagal reflex in the cat. Circ Res. 1973; 32: 215-220 Crossref PubMed Scopus (214) Google Scholar , 8 Schwartz P.J Pagani M Lombardi F Recordati G Malliani A Brown A.M Reflex changes in cardiac vagal efferent nervous activity elicited by stimulation of afferent fibres in the cardiac sympathetic nerves. Brain Res. 1972; 42: 482-485 Crossref PubMed Scopus (13) Google Scholar or (2) changes in neurohumoral activity caused by CHF result in altered efferent cardiac autonomic outflow. 9 Saul J.P Arai Y Berger R.D Lilly L.S Colucci W.S Cohen R.J Assessment of autonomic regulation in chronic congestive heart failure by heart rate spectral analysis. Am J Cardiol. 1988; 61: 1292-1299 Abstract Full Text PDF PubMed Scopus (643) Google Scholar In this study, we tested these hypotheses by comparing traditional with nonlinear indexes of HRV in a variety of cases of appropriate sinus tachycardia and CHF to evaluate the specificity of the changes in HR dynamics among patients with CHF.