Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2014, 158(3):327-338 | DOI: 10.5507/bp.2014.025

Heart rate variability - current diagnosis of the cardiac autonomic neuropathy. A review

Rudolf Metelka
Department of Internal Medicine III - Nephrology, Rheumatology and Endocrinology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic

Backround. The autonomic nervous system is one of the major homeostatic regulatory systems of the body. Detection of cardiac autonomic neuropathy (CAN), reflected by reduced heart rate variability (HRV), is an independent adverse prognostic factor: sympathovagal balance failure with a sympathetic dominance is the main trigger for lethal arrhythmias and sudden death.

Methods and Results: PubMed database based on original articles from 1983 to 2013 and the author´s clinical experience. This review covers the current status of the methodology and the clinical uses of HRV, especially in the field of internal medicine.

Conclusion: Heart rate variability is making a valuable contribution to the diagnosis of cardiovascular autonomic dysfunction and CAN. It can be assessed from short-term and long-term ECG recordings. It is one of the few methods that allow outpatient CAN diagnosis, monitoring the progress, therapeutic effect and evaluation of patient prognosis. It is used as an independent prognostic factor in combination with other recognized risk factors in risk stratifying after myocardial infarction. It is a unique method of CAN diagnosis particularly in diabetology. Its diagnostic and prognostic potential in other medical fields is being intensively explored.

Keywords: heart rate variability, methodology, cardiac autonomic neuropathy

Received: March 27, 2014; Accepted: May 14, 2014; Prepublished online: July 4, 2014; Published: September 30, 2014  Show citation

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Metelka, R. (2014). Heart rate variability - current diagnosis of the cardiac autonomic neuropathy. A review. Biomedical papers, 158(3), 327-338. doi: 10.5507/bp.2014.025
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    References

    1. Vaseghi M, Shivkumar K. The role of the autonomic nervous system in sudden cardiac death. Prog CV Dis 2008;50:404-19. Go to original source... Go to PubMed...
    2. Hainsworth R. Physiology of the cardiac autonomic system. In: Malik M. (ed) Clinical Guide to Cardiac Autonomic Tests, The Netherlands:Kluwer Academic publishers; 1998, p. 3-28. Go to original source...
    3. Hartikainen JEK, Tahvanainen KUO, Kuusela TA. Short-term measurement of heart rate variability. In: Malik M. (ed) Clinical Guide to Cardiac Autonomic Tests, The Netherlands: Kluwer Academic publishers; 1998, pp.149-76. Go to original source...
    4. Ewing DJ. Practical bedside investigation of diabetic autonomic failure. In: Bannister R. (Ed) Autonomic Failure. A Textbook of Clinical Disorders of the Autonomic Nervous System. Oxford: Oxford Univ Press; 1983, p.371-405.
    5. Pagani M, Lombardi F, Guzzetti S, Rimoldi O, Furlan R, Pizzineli P, Sandrone G, Malfatto G, Dell´Orto S, Piccaluga E, Turiel M, Baselli G, Cerutti S, Malliani A. Power spectral analysis of a beat-to-beat heart rate and blood pressure variability as a possible marker of sympatho-vagal interaction in man and conscious dog. Circ Res 1986;159:178-93. Go to original source... Go to PubMed...
    6. Malliani A, Pagani M, Lombardi F, Cerutti S. Cardiovascular neural regulation explored in the frequency domain. Circulation 1991;84:482-92. Go to original source... Go to PubMed...
    7. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability. Standards of measurement, physiological interpretation and clinical use. Special report. Circulation 1996;93:1043-65. Go to original source... Go to PubMed...
    8. Freeman R. Cardiac Autonomic Syndromes. In: Malik M. (ed) Clinical Guide to Cardiac Autonomic Tests. The Netherlands: Kluwer Academic publishers; 1998, p.357-391. Go to original source...
    9. Schönauer M, Thomas A, Morbach S, Niebauer J, Schönauer U, Thiele H. Cardiac autonomic diabetic neuropathy. Diab Vasc Dis Res 2008;5:336-44. Go to original source... Go to PubMed...
    10. Vinik AI, Erbas T, Casellini CM. Diabetic cardiac autonomic neuropathy, inflammation and cardiovascular disease. J Diabetes Investig 2013;4:4-18. Go to original source... Go to PubMed...
    11. Inoue H, Zipes DP. Time course of denervation of efferent sympathetic and vagal nerves after occlusion of the coronary artery in the canine heart. Circ Res 1988;62:1111-20. Go to original source... Go to PubMed...
    12. Parthenakis FI, Prassopoulos VK, Koukouraki SI, Zacharis EA, Diakakis GF, Karkavitsas NK, Vardas PE. Segmental pattern of myocardial sympathetic denervation in idiopathic dilated cardiomyopathy: relationship to regional wall motion and myocardial perfusion abnormalities. J Nucl Cardiol 2002;9:15-22. Go to original source... Go to PubMed...
    13. Stevens MJ, Raffel DM, Allman KC, Schwaiger M, Wieland DM. Regression and progression of cardiac sympathetic dysinnervation complicating diabetes: an assessment by C-11 hydroxyephedrine and positron emission tomography. Metabolism 1999;48:92-101. Go to original source... Go to PubMed...
    14. Himura Y, Felten SY, Kashiki M, Lewandowski TJ, Delehanty JM, Liang CS. Cardiac noradrenergic nerve terminal abnormalities in dogs with experimental congestive heart failure. Circulation 1993;88:1299-1309. Go to original source... Go to PubMed...
    15. Rubart M, Zipes DP. Mechanisms of sudden cardiac death. J Clin Invest 2005;115:2305-15. Go to original source... Go to PubMed...
    16. Goldstein DS, Bentho O, Park MY, Sharabi Y. Low-frequency power of heart rate variability is not a measure of cardiac sympathetic tone but may be a measure of modulation of cardiac autonomic outflows by baroreflexes. Exp Physiol 2011;96:1255-61. Go to original source... Go to PubMed...
    17. Visser M, Marinus J, Stiggelbout AM, Van Hilten JJ. Assessment of autonomic dysfunction in Parkinson's disease: the SCOPA-AUT. Mov Disord 2004;19:1306-12. Go to original source... Go to PubMed...
    18. Kempler P, Amarenco G, Freeman R, Frontoni S, Horowitz M, Stevens M, Low P, Pop-Busui R,; Tahrani A A, Tesfaye S, Várkonyi T, Ziegler D, Valensi P. Management strategies for gastrointestinal, erectile, bladder, and sudomotor dysfunction in patients with diabetes. Diabetes Metab Res Rev 2011;27:665-77. Go to original source... Go to PubMed...
    19. Solomon Tesfaye, Andrew JM. Boulton, Peter J. Dyck, Roy Freeman, Michael Horowitz, Peter Kempler, Giuseppe Lauria, Rayaz A. Malik, Vincenza Spallone, Aaron Vinik, Luciano Bernardi, Paul Valensi, on behalf of the Toronto Diabetic Neuropathy Expert Group. Diabetic Neuropathies: Update on Definitions, Diagnostic Criteria, Estimation of Severity, and Treatments. Diabetes Care 2010;33:2285-93. Go to original source... Go to PubMed...
    20. Malik R, Veves A, Tesfaye S, Smith G, Cameron N, Zochodne D, Lauria G; on behalf of the Toronto Consensus Panel on Diabetic Neuropathy. Small Fiber Neuropathy: Role in the diagnosis of Diabetic Sensorimotor Polyneuropathy. Diabetes Metab Res Rev 2011;27:678-84. Go to original source... Go to PubMed...
    21. Spiegel J. Diagnostic and Pathophysiological Impact of Myocardial MIBG Scintigraphy in Parkinson's Disease. Parkinsons Dis 2010;2010:295346. Go to original source... Go to PubMed...
    22. Pinna GD, Maestri R, Capomolla S, Febo O, Robbi E, Cobelli F, La Rovere MT. Applicability and clinical relevance of the transfer function method in the assessment of baroreflex sensitivity in heart failure patients. J Am Coll Cardiol 2005;46:1314-21. Go to original source... Go to PubMed...
    23. Opavský J. Autonomní nervový systém a diabetická autonomní neuropatie. Klinické aspekty a diagnostika. Praha: Galén, 2002.
    24. Sundkvist G, Lilja B, Almér LO. Abnormal diastolic blood pressure and heart rate reactions to tilting in diabetes mellitus. Diabetologia 1980;19:433-8. Go to original source... Go to PubMed...
    25. Freeman R, Wieling W, Axelrod FB, Benditt DG, Benarroch E, Biaggioni I, Cheshire WP, Chelimsky T, Cortelli P, Gibbons CH, Goldstein DS, Hainsworth R, Hilz MJ, Jacob G, Kaufmann H, Jordan J, Lipsitz LA, Levine BD, Low PA, Mathias C, Raj SR, Robertson D, Sandroni P, Schatz I, Schondorff R, Stewart JM, van Dijk JG. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res 2011;21:69-72. Go to original source... Go to PubMed...
    26. Wieling W, van Brederode JF, de Rijk LG, Borst C, Dunning AJ.Reflex control of heart rate in normal subjects in relation to age: a data base for cardiac vagal neuropathy. Diabetologia 1982;22:163-6. Go to original source... Go to PubMed...
    27. Gautschy B, Weidmann P, Gnädinger MP. Autonomic function tests as related to age and gender in normal man. Klin Wochenschr 1986;64:499-505. Go to original source... Go to PubMed...
    28. Malik M. Geometrical methods for heart rate variability assessment. In: Malik M, Camm AJ (Eds) Heart Rate Variability. New York:Futura Publishing Company, Inc.; 1995, p.47-61.
    29. Cripps TR, Malik 1, Farrell TG, Camm AJ. Prognostic value of reduced heart rate variability after myocardial infarction: clinical evaluation of a new analysis method. Br Heart J 1991;65:14-9. Go to original source... Go to PubMed...
    30. Bjorkander I, Forslund L, Kahan T, Ericson M, Held C, Rehnqvist N, Hjemdahl P. Differential index: a simple time domain heart rate variability analysis with prognostic implications in stable angina pectoris.Cardiology 2008;111:126-33. Go to original source... Go to PubMed...
    31. Hedman AE, Malik M. Long-Term Measurement of Heart Rate Variability. In: Malik M. (ed) Clinical Guide to Cardiac Autonomic Tests, The Netherlands:Kluwer Academic publishers; 1998, p. 195-238. Go to original source...
    32. Salinger J, Pumprla J, Vychodil R, Stejskal P, Opavský J, Novotný J, Bula J. Microcomputer system for telemetric assessment of short term heart rate variability in time and frequency domain, type VariaCardio TF4. Computers in Cardiology, IEEE 1999;26:599-602. Go to original source...
    33. Nunan D, Sandercock GR, Brodie DA. A quantitative systematic review of normal values for short-term heart rate variability in healthy adults. Pacing Clin Electrophysiol 2010;33:1407-17. Go to original source... Go to PubMed...
    34. Hayano J, Sakakibara Y, Yamada M, Ohte N, Fujinami T, Yokoyama K, Watanabe Y, Takata K. Decreased magnitude of heart rate spectral components in coronary artery disease. Its relation to angiographic severity. Circulation 1990;81:1217-24. Go to original source... Go to PubMed...
    35. Howorka K, Pumprla J, Jirkovska A, Lacigova S, Nolan J. Modified orthostatic load for spectral analysis of short-term heart rate variability improves the sensitivity of autonomic dysfunction assessment. J Diabetes Complications 2010;24:48-54. Go to original source... Go to PubMed...
    36. Brown TE, Beightol LA, Koh J, Eckberg DL. Important influence of respiration on human R-R interval power spectra in largely ignored. J Appl Physiol 1993;75:2310-7. Go to original source... Go to PubMed...
    37. Akselrod S, Gordon D, Ubel FA, Shannon DC, Barger AC, Cohen RJ. Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat to beat cardiovascular control. Science 1981;213:220-2. Go to original source... Go to PubMed...
    38. Hirsch JA, Bishop B. Respiratory sinus arrhythmia in humans: how breathing pattern modulates heart rate. Am J Physiol 1981;241:11620-9. Go to original source... Go to PubMed...
    39. Žujova E, Stejskal P, Jakubec A, Gaul-Alačova P, Salinger J. Respiration frequency and spectral analysis of heart rate variability. Acta Univ Palacki Olomuc Gymn 2004;34:43-7.
    40. Malliani A, Pagani M, Lombardi F. Physiology and clinical implications of variability of cardiovascular parameters with focus on heart rate and blood pressure. Am J Cardiol 1994;73:C3-9. Go to original source... Go to PubMed...
    41. Peňáz J. Mayer wave: History and methodology. Automedica 1978;2:135-41.
    42. Kingwell BA, Thompson JM, Kaye DM, McPherson GA, Jennings GL, Esler MD. Heart rate spectral analysis, cardiac norepinephrine spillover, and muscle sympathetic nerve activity during human sympathetic nervous activation and failure. Circulation 1994;90:234-40. Go to original source... Go to PubMed...
    43. Moak JP, Goldstein DS, Eldadah BA, Saleem A, Holmes C, Pechnik S, Sharabi Y. Supine low-frequency power of heart rate variability reflects baroreflex function, not cardiac sympathetic innervation. Heart Rhythm 2007;4:1523-9. Go to original source... Go to PubMed...
    44. Rahman F, Pechnik S, Gross D, Sewell L, Goldstein DS. Low frequency power of heart rate variability reflects baroreflex function, not cardiac sympathetic innervation.Clin Auton Res 2011;21:133-41. Go to original source... Go to PubMed...
    45. Taylor JA, Carr DL, Myers ChW, Eckberg DL. Mechanisms underlying very-low-frequency RR-interval oscillations in humans. Circulation 1998;98:547-555. Go to original source... Go to PubMed...
    46. Perini R, Orizio C, Baselli G, Cerutti S, Veicsteinas A. The influence of exercise intensity on the power of heart rate variability. Eur J Appl Physiol 1990;61:143-8. Go to original source... Go to PubMed...
    47. Bigger JT, Fleiss JL, Rolnitzsky LM, Steinman RC. Stability over time of heart period variability in patients with previous myocardial infarction and ventricular arrhythmias. Am J Cardiol 1992;69:718-23. Go to original source... Go to PubMed...
    48. Grishin OV, Grishin VG, Yu Uryumtsev D, Smirnov SV, Jilina IG. Metabolic Rate Variability Impact on Very Low-Frequency of Heart Rate Variability World Applied Sciences Journal 2012;19:1133-9.
    49. Lombardi F, Stein PK. Origin of heart rate variability and turbulence: an appraisal of autonomic modulation of cardiovascular function. Front Physiol 2011;2(95):1-7. Go to original source... Go to PubMed...
    50. Bigger JT Jr, Fleiss JL, Steinman RC, Rolnitzky LM, Schneider WJ, Stein PK. RR variability in healthy, middle-aged persons compared with patients with chronic coronary heart disease or recent acute myocardial infarction. Circulation 1995;91:1936-43. Go to original source... Go to PubMed...
    51. Sztajzel J, Jung M, Bayes de Luna A. Reproducibility and gender-related differences of heart rate variability during all-day activity in young men and women.Ann Noninvasive Electrocardiol 2008;13:270-7. Go to original source... Go to PubMed...
    52. Šlachta R, Stejskal P, Elfmark M, Salinger J, Kalina M, Řehová I. Age and spectral analysis of hert rate variability. Acta Univ Palacki Olomuc Gymn 2002; 32: p.59-66.
    53. Vlčková E, Bednařík J, Buršová Š, Šajgalíková K, Mlčáková L. Spektrální analýza variability srdeční frekvence - normativní data. Cesk Slov Neurol N 2010;73/106:663-672.
    54. Agelink MW, Malessa R, Baumann B, Majewski T, Akila F, Zeit T, Ziegler D. Standardized tests of heart rate variability: normal ranges obtained from 309 healthy humans, and effects of age, gender, and heart rate. Clin Auton Res 2001;11:99-108. Go to original source... Go to PubMed...
    55. Sinnreich R. Karl JD, Friedlander Y, Sapoznikov D, Luria MH. Five minute recordings of heart rate variability for population studies: repeatability and age-sex characteristics. Heart 1998;80:156-62. Go to original source... Go to PubMed...
    56. Kleiger RE, Bigger JT, Bosner MS, Chung MK, Cook JR, Rolnitzky LM, Steinman RC, Rottman JN Fleiss JL. Stability over time of variables measuring heart rate variability in normal subjects. Am J Cardiol 1991;68:626-30. Go to original source... Go to PubMed...
    57. Tarkiainen TH, Timonen KL, Tiittanen P, Hartikainen JE, Pekkanen J, Hoek G, Ibald-Mulli A, Vanninen EJ. Stability over time of short-term heart rate variability Clin Auton Res 2005;15:394-9. Go to original source... Go to PubMed...
    58. Ghuran AV, Malik M. Influence of Smoking, Alcohol, Caffeine and Recreational Drugs on Cardiac Autonomic Tests. In: Malik M. (ed) Clinical Guide to Cardiac Autonomic Tests. The Netherlands: Kluwer Academic publishers;1998, p. 331-356. Go to original source...
    59. Allan LM, Ballard CG, Allen J, Murray A, Davidson AW, McKeith IG, Kenny RA. Autonomic dysfunction in dementia. J Neurol Neurosurg Psychiatry 2007;78:671-7. Go to original source... Go to PubMed...
    60. Brown R, Duma S, Piguet O, Broe GA, Macefield VG. Cardiovascular variability in Parkinson's disease and extrapyramidal motor slowing. Clin Auton Res 2012;22:191-6. Go to original source... Go to PubMed...
    61. Reyners AK, Hazenberg BP, Reitsma WD, Smit AJ. Heart rate variability as a predictor of mortality in patients with AA and AL amyloidosis Eur Heart J 2002;23:157-61. Go to original source... Go to PubMed...
    62. Rubinger D, Backenroth R, Sapoznikov D. Sympathetic nervous system function and dysfunction in chronic hemodialysis patients. Semin Dial 2013;26:333-43. Go to original source... Go to PubMed...
    63. Yorgun H, Canpolat U, Aytemir K, Ateş AH, Kaya EB, Akdoğan A, Sunman H, Gökçay Canpolat A, Çalgüneri M, Kabakçi G, Tokgözoğlu L, Oto A. Evaluation of cardiac autonomic functions in patients with systemic lupus erythematosus. Lupus 2012;21:373-9. Go to original source... Go to PubMed...
    64. Duplyakov D, Golovina G, Sysuenkova E, Garkina S. Can the result of a tilt test be predicted in the first five minutes? Cardiol J 2011;18:521-6. Go to original source... Go to PubMed...
    65. Song MK, Ha JH, Ryu SH, Yu J, Park DH. The effect of aging and severity of sleep apnea on heart rate variability indices in obstructive sleep apnea syndrome. Psychiatry Investig 2012;9:65-72. Go to original source... Go to PubMed...
    66. Latalova K, Prasko J, Diveky T, Grambal A, Kamaradova D, Velartova H, Salinger J, Opavsky J. Autonomic nervous system in euthymic patients with bipolar affective disorder. Neuro Endocrinol Lett 2010;31:829-36. Go to PubMed...
    67. Fairchild KD, O'Shea TM. Heart Rate Characteristics: Physiomarkers for Detection of Late-Onset Neonatal Sepsis. Clin Perinatol 2010;37:581-98. Go to original source... Go to PubMed...
    68. Metelka R, Weinbergová O, Opavský J, Salinger J, Ostranský J. Short-term heart rate variability changes after exercise training in subjects following myocardial infarction. Acta Univ Palacki Olomuc Fac Med 1999;142:79-82. Go to PubMed...
    69. Uhlíř P, Opavský J, Zaatar AM, Leisser J, Efekt lázeňské kardio-rehabilitace na variabilitu srdeční frekvence pacientů po aortokoronárním bypassu. Rehabilitation & Physical Medicine / Rehabilitace a Fyzikalni Lekarstvi 2013;20:129-34.
    70. Gademan MG, Swenne CA, Verwey HF, van der Laarse A, Maan AC, van de Vooren H, van Pelt J, van Exel HJ, Lucas CM, Cleuren GV, Somer S, Schalij MJ, van der Wall EE. Effect of exercise training on autonomic derangement and neurohumoral activation in chronic heart failure. J Card Fail 2007;13:294-303. Go to original source... Go to PubMed...
    71. Stejskal P. Využití hodnocení variability srdeční frekvence ve sportovní medicíně. In K. Javorka (ed.) Variabilita frekvencie srdca: Mechanismy, hodnotenie, klinické využitie, Martin: Osveta; 2008, p.168-181.
    72. Bigger, JT Jr., Fleiss JL, Rolnitzky LM, Steinman RC. The ability of several short-term measures of RR variability to predict mortality after myocardial infarction. Circulation 1993;88:927-34. Go to original source... Go to PubMed...
    73. Farrell TG, Bashir Y, Cripps T, Malik M, Poloniecki J, Bennett ED, Ward DE, Camm AJ. Risk stratification for arrhythmic events in postinfarction patients based on heart rate variability, ambulatory electrocardiographic variables and the signal-averaged electrocardiogram. J Am Coll Cardiol 1991;18:687-97. Go to original source... Go to PubMed...
    74. Huikuri HV, Raatikainen MJ, Moerch-Joergensen R, Hartikainen J, Virtanen V, Boland J, Anttonen O, Hoest N, Boersma LV, Platou ES, Messier MD, Bloch-Thomsen PE; Cardiac Arrhythmias and Risk Stratification after Acute Myocardial Infarction study group. Prediction of fatal or near-fatal cardiac arrhythmia events in patients with depressed left ventricular function after an acute myocardial infarction. Eur Heart J 2009;30:689-98. Go to original source... Go to PubMed...

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