Sympathetic predominance followed by functional denervation in the progression of chronic heart failure

S. Guzzetti, C. Cogliati, M. Turiel, C. Crema, F. Lombardi, A. Malliani

Research output: Contribution to journalArticlepeer-review


Using spectral analysis of heart rate and systolic arterial pressure variabilities, the study was set up to evaluate cardiovascular efferent autonomic modulation in patients with different degrees of chronic heart failure. We studied 30 patients with stable chronic heart failure and 15 controls of similar age. ECG, arterial blood pressure and respiratory signal were recorded at rest, during controlled respiration and during passive head-up tilting, R-R interval periods of 256-512 were analysed. Routine 2D echocardiogram and Doppler studies were also carried out. As expected, we found a decrease in the mean and variance of R-R intervals in patients with severe heart failure. In New York Heart Association (NYHA) class II patients, the power spectral pattern of the R-R variability was characterized by the predominance of the low frequency component (72 ± 3 nu), considered a marker of sympathetic activity, and by its unresponsiveness to tilting. A drastic decrease in the variance of R-R intervals (191 ± 58 vs 1056 ± 149 ms 2 in controls) and an almost complete absence of the low frequency spectral component (8 ± 3 nu) were present in patients in NYHA class IV. Controlled respiration, which in normal subjects decreased the low frequency component, induced changes that blunted progressively as heart failure increased. These data suggest that autonomic neural modulation and cardiovascular response to neural activity differ at different stages of the disease.

Original languageEnglish
Pages (from-to)1100-1107
Number of pages8
JournalEuropean Heart Journal
Issue number8
Publication statusPublished - 1995


  • Heart rate variability
  • Spectral analysis
  • Sympatho-vagal balance

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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