Comparison of different methods for assessing sympathovagal balance in chronic congestive heart failure secondary to coronary artery disease

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Abstract

Twenty-five patients (aged 62 ± 2 years) with stable, moderate to severe ischemic congestive heart failure (CHF) (New York Heart Association class II/III: 15/10; ejection fraction 21.6 ± 2%; and peak oxygen uptake 13.6 ± 0.7 ml/kg/min) were studied to evaluate the ability of different methods to characterize autonomic tone in chronic CHF. Sympathovagal balance was assessed by: (1) heart rate variability in the time domain, assessed by the SD of RR intervals; (2) heart rate variability in the frequency domain, assessed by low- (0.03 to 0.14 Hz) and high- (0.18 to 0.40 Hz) frequency components of heart rate variability by autoregressive power spectral analysis; (3) 24-hour, daytime and nighttime heart rate; (4) submaximal heart rate during upright bicycle exercise, with respiratory gas analysis to obtain peak oxygen uptake; and (5) radiolabeled norepinephrine spillover. These methods did not correlate, with the exception of day and nighttime heart rate (r = 0.74; p < 0.001) and the expected inverse correlation between low and high frequency (r = −0.92; p < 0.001). No method correlated significantly with peak oxygen uptake, exercise tolerance or ejection fraction.

After 8 weeks of physical training at home, all methods showed improvement in autonomic balance: increases in SD of RR intervals (+21%; p < 0.02) and high frequency (+41%; p < 0.007), and decreases in low frequency (−19%; p < 0.002), low-/high-frequency ratio (−48%; p < 0.03), norepinephrine spillover (−28.9%; p < 0.03), 24-hour heart rate (−2.7%; p < 0.005) and submaximal heart rate (−10.8%; p < 0.01). However, neither the absolute values nor percent changes of the individual measures of autonomic function after training showed a significant correlation between each other. In patients with CHF, the individual parameters of autonomic control reflect different aspects of circulatory control. A comprehensive description of autonomic tone probably needs multiple methods.

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    This study was supported by the British Heart Foundation, London; Eli Lilly, Basingstoke, Hampshire; ICI, Macclesfield; and Squibb, London, United Kingdom.

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