Origin of heart rate variability and turbulence: An appraisal of autonomic modulation of cardiovascular function

Federico Lombardi, Phyllis K. Stein

Research output: Contribution to journalArticle

72 Citations (Scopus)

Abstract

Heart period constantly changes on a beat to beat basis, due to autonomic influences on thesinoatrial node, and changes can be quantified as heart rate variability (HRV). In addition, after a premature ventricular beat, there are reproducible variations in RR interval, also due to baroreflex mediated autonomic influences on the sinoatrial node, that can be measured as heart rate turbulence (HRT). Impaired autonomic function as measured by HRV and HRT has proven to predict adverse outcomes in clinical settings. The ability of reduced HRV and HRT to predict adverse outcomes has been explained by their dependency on vagal mechanisms that could reflect an increased sympathetic and a reduced vagal modulation of sinus node, thus favoring cardiac electrical instability. Analysis of non-linear dynamics of HRV has also been utilized to describe the fractal like characteristic of the variability signal and proven effective in identify patients at risk for sudden cardiac death. Despite the clinical validity of these measures, it has also been evident that the relationship between neural input and sinus node responsiveness is extremely complex and variable in different clinical conditions. Thus, abnormal HRV or HRT on a clinical Holter recordings may reflect non-neural as well as autonomic mechanisms, and this also needs to be taken into account when interpreting any findings. However, under controlled conditions, the computation of the low and high frequency components of HRV and of their normalized powers or ratio seems capable of providing valid information on sympatho-vagal balance in normal subjects, as well as in most patients with a preserved left ventricular function. Thus, analysis of HRV does provide a unique tool to specifically assess autonomic control mechanisms in association with various perturbations. In conclusion, HRV measures are of substantial utility to identify patients with an increased cardiac mortality and to evaluate autonomic control mechanisms, but their ability to capture specific levels of autonomic control may be limited to controlled laboratory studies in relatively healthy subjects.

Original languageEnglish
Article numberArticle 95
JournalFrontiers in Physiology
Volume2 DEC
DOIs
Publication statusPublished - 2011

Fingerprint

Heart Rate
Sinoatrial Node
Fractals
Nonlinear Dynamics
Ventricular Premature Complexes
Baroreflex
Sudden Cardiac Death
Left Ventricular Function
Healthy Volunteers
Mortality

Keywords

  • Autonomic modulation
  • Baroreflex mechanisms
  • Non-invasive evaluation of cardiac function
  • Spectral analysis
  • Sympathetic and vagal control

ASJC Scopus subject areas

  • Physiology
  • Physiology (medical)

Cite this

Origin of heart rate variability and turbulence : An appraisal of autonomic modulation of cardiovascular function. / Lombardi, Federico; Stein, Phyllis K.

In: Frontiers in Physiology, Vol. 2 DEC, Article 95, 2011.

Research output: Contribution to journalArticle

@article{453a9cebc22b42ed870b0b4caca1e1f4,
title = "Origin of heart rate variability and turbulence: An appraisal of autonomic modulation of cardiovascular function",
abstract = "Heart period constantly changes on a beat to beat basis, due to autonomic influences on thesinoatrial node, and changes can be quantified as heart rate variability (HRV). In addition, after a premature ventricular beat, there are reproducible variations in RR interval, also due to baroreflex mediated autonomic influences on the sinoatrial node, that can be measured as heart rate turbulence (HRT). Impaired autonomic function as measured by HRV and HRT has proven to predict adverse outcomes in clinical settings. The ability of reduced HRV and HRT to predict adverse outcomes has been explained by their dependency on vagal mechanisms that could reflect an increased sympathetic and a reduced vagal modulation of sinus node, thus favoring cardiac electrical instability. Analysis of non-linear dynamics of HRV has also been utilized to describe the fractal like characteristic of the variability signal and proven effective in identify patients at risk for sudden cardiac death. Despite the clinical validity of these measures, it has also been evident that the relationship between neural input and sinus node responsiveness is extremely complex and variable in different clinical conditions. Thus, abnormal HRV or HRT on a clinical Holter recordings may reflect non-neural as well as autonomic mechanisms, and this also needs to be taken into account when interpreting any findings. However, under controlled conditions, the computation of the low and high frequency components of HRV and of their normalized powers or ratio seems capable of providing valid information on sympatho-vagal balance in normal subjects, as well as in most patients with a preserved left ventricular function. Thus, analysis of HRV does provide a unique tool to specifically assess autonomic control mechanisms in association with various perturbations. In conclusion, HRV measures are of substantial utility to identify patients with an increased cardiac mortality and to evaluate autonomic control mechanisms, but their ability to capture specific levels of autonomic control may be limited to controlled laboratory studies in relatively healthy subjects.",
keywords = "Autonomic modulation, Baroreflex mechanisms, Non-invasive evaluation of cardiac function, Spectral analysis, Sympathetic and vagal control",
author = "Federico Lombardi and Stein, {Phyllis K.}",
year = "2011",
doi = "10.3389/fphys.2011.00095",
language = "English",
volume = "2 DEC",
journal = "Frontiers in Physiology",
issn = "1664-042X",
publisher = "Frontiers Research Foundation",

}

TY - JOUR

T1 - Origin of heart rate variability and turbulence

T2 - An appraisal of autonomic modulation of cardiovascular function

AU - Lombardi, Federico

AU - Stein, Phyllis K.

PY - 2011

Y1 - 2011

N2 - Heart period constantly changes on a beat to beat basis, due to autonomic influences on thesinoatrial node, and changes can be quantified as heart rate variability (HRV). In addition, after a premature ventricular beat, there are reproducible variations in RR interval, also due to baroreflex mediated autonomic influences on the sinoatrial node, that can be measured as heart rate turbulence (HRT). Impaired autonomic function as measured by HRV and HRT has proven to predict adverse outcomes in clinical settings. The ability of reduced HRV and HRT to predict adverse outcomes has been explained by their dependency on vagal mechanisms that could reflect an increased sympathetic and a reduced vagal modulation of sinus node, thus favoring cardiac electrical instability. Analysis of non-linear dynamics of HRV has also been utilized to describe the fractal like characteristic of the variability signal and proven effective in identify patients at risk for sudden cardiac death. Despite the clinical validity of these measures, it has also been evident that the relationship between neural input and sinus node responsiveness is extremely complex and variable in different clinical conditions. Thus, abnormal HRV or HRT on a clinical Holter recordings may reflect non-neural as well as autonomic mechanisms, and this also needs to be taken into account when interpreting any findings. However, under controlled conditions, the computation of the low and high frequency components of HRV and of their normalized powers or ratio seems capable of providing valid information on sympatho-vagal balance in normal subjects, as well as in most patients with a preserved left ventricular function. Thus, analysis of HRV does provide a unique tool to specifically assess autonomic control mechanisms in association with various perturbations. In conclusion, HRV measures are of substantial utility to identify patients with an increased cardiac mortality and to evaluate autonomic control mechanisms, but their ability to capture specific levels of autonomic control may be limited to controlled laboratory studies in relatively healthy subjects.

AB - Heart period constantly changes on a beat to beat basis, due to autonomic influences on thesinoatrial node, and changes can be quantified as heart rate variability (HRV). In addition, after a premature ventricular beat, there are reproducible variations in RR interval, also due to baroreflex mediated autonomic influences on the sinoatrial node, that can be measured as heart rate turbulence (HRT). Impaired autonomic function as measured by HRV and HRT has proven to predict adverse outcomes in clinical settings. The ability of reduced HRV and HRT to predict adverse outcomes has been explained by their dependency on vagal mechanisms that could reflect an increased sympathetic and a reduced vagal modulation of sinus node, thus favoring cardiac electrical instability. Analysis of non-linear dynamics of HRV has also been utilized to describe the fractal like characteristic of the variability signal and proven effective in identify patients at risk for sudden cardiac death. Despite the clinical validity of these measures, it has also been evident that the relationship between neural input and sinus node responsiveness is extremely complex and variable in different clinical conditions. Thus, abnormal HRV or HRT on a clinical Holter recordings may reflect non-neural as well as autonomic mechanisms, and this also needs to be taken into account when interpreting any findings. However, under controlled conditions, the computation of the low and high frequency components of HRV and of their normalized powers or ratio seems capable of providing valid information on sympatho-vagal balance in normal subjects, as well as in most patients with a preserved left ventricular function. Thus, analysis of HRV does provide a unique tool to specifically assess autonomic control mechanisms in association with various perturbations. In conclusion, HRV measures are of substantial utility to identify patients with an increased cardiac mortality and to evaluate autonomic control mechanisms, but their ability to capture specific levels of autonomic control may be limited to controlled laboratory studies in relatively healthy subjects.

KW - Autonomic modulation

KW - Baroreflex mechanisms

KW - Non-invasive evaluation of cardiac function

KW - Spectral analysis

KW - Sympathetic and vagal control

UR - http://www.scopus.com/inward/record.url?scp=84866306502&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84866306502&partnerID=8YFLogxK

U2 - 10.3389/fphys.2011.00095

DO - 10.3389/fphys.2011.00095

M3 - Article

C2 - 22163222

AN - SCOPUS:84866306502

VL - 2 DEC

JO - Frontiers in Physiology

JF - Frontiers in Physiology

SN - 1664-042X

M1 - Article 95

ER -