Detection and significance of a discrete very low frequency rhythm in RR interval variability in chronic congestive heart failure

doi:10.1016/S0002-9149(96)00199-3

The American Journal of Cardiology

Volume 77, Issue 15, 15 June 1996, Pages 1320-1326

https://doi.org/10.1016/S0002-9149(96)00199-3 Get rights and content

Abstract

Although in advanced chronic congestive heart failure (CHF) very low frequency (<0.04 Hz, VLF) oscillations are prominent, the clinical importance and the physiologic basis of these rhythms have not been elucidated. To investigate the physiologic determinants of the VLF rhythms in RR interval variability, we studied 36 patients with stable, moderate to severe CHF (33 men, age: 58 ± 8 years, ejection fraction 25 ± 10%, peak oxygen consumption 18.1 ± 4.6 ml/kg/min) and 12 age- and sex-matched controls using autoregressive spectral analysis of RR interval, blood pressure, and respirator/ signals during controlled conditions. We quantified low frequency (LF) (0.04 to 0.15 Hz), high frequency (HF) (0.15 to 0.40 Hz), VLF, and total power (0 to 0.5 Hz), and calculated the coherence between systolic blood pressure and RR interval variability within each band. Peripheral chemosensitivity was assessed by the ventilatory response to hypoxia using transient inhalation of pure nitrogen. The influence of transient inactivation of peripheral chemoreceptors on the VLF rhythm was investigated by exposing 6 patients to hyperoxic (60% oxygen) conditions for 20 minutes. Twenty-three patients (64%) with CHF, but no controls, had a discrete VLF rhythm (0.019 ± 0.008 Hz) in RR variability. The presence of VLF rhythm was not related to any difference in clinical parameters (etiology, New York Heart Association class, ejection fraction, oxygen uptake) but rather to a different pattern in RR interval and blood pressure variability: lower LF power (2.8 ± 1.6 ms² natural logarithm [ln]) compared either to patients without VLF (4.0 ± 1.3 ms² ln) or to controls (5.9 ± 0.7 ms² ln), higher percentage of power within VLF band (86.3 ± 8.3% vs 77.5 ± 7.9% and 61.5 ± 14.1%) and a markedly impaired coherence between RR interval and systolic blood pressure variability within the LF band (0.26 ± 0.10 vs 0.42 ± 0.18 and 0.63 ± 0.15, in patients with vs without VLF peak and controls, respectively). Patients with VLF had significantly increased hypoxic chemosensitivity, and hyperoxic conditions were able to decrease VLF power and abolish the VLF rhythm in 5 of 6 patients with CHF. Discrete VLF oscillations in RR variability are common in patients with advanced CHF and appear to be related to severely impaired autonomic regulation and suppression of baroreceptor function, with enhancement of hypoxic chemosensitivity. We hypothesize that this rhythm represents an enhanced chemoreflex harmonic oscillation in CHF patients, which may have application for arrhyrhmogenesis.

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This behavior is expected in response to tilt, as the sympathetic activation induced by the orthostatic stress is known to reduce the variability of RR in the VLF and especially HF bands and thus to isolate the power content in the LF band [48,51]. Moreover, the effect may be emphasized in AMI patients where confounding effects may arise also from the VLF band; in fact, the presence of important VLF rhythms has been put in relation to the markedly impaired autonomic control of cardiovascular system, down-regulation of baroreceptor function and enhancement of chemosensitivity, especially in subjects presenting a more augmented sympathetic tone and attenuated baroreflex activity [49]. The other differences observed between the global and local approaches mostly concern comparisons involving the Old group; these may be explained also by the small size of this group (see Section 4.4).
The objective of this study is to present a new method to assess in the frequency domain the directed interactions between the spontaneous variability of systolic arterial pressure (SAP) and heart period (HP) from their linear model representation, and to apply it for studying the baroreflex control of arterial pressure in healthy physiological states and after acute myocardial infarction (AMI). The method is based on pole decomposition of the model transfer function and on the following evaluation of causal measures of coupling and gain from the poles associated to low frequency (0.04−0.15 Hz) oscillatory components. It is compared with traditional non-causal approaches for the spectral analysis of the baroreflex gain, and with causal approaches based on the directed coherence, in a group of AMI patients and in Young and Old healthy controls studied at rest and during head-up tilt. Analysis of feedforward interactions from RR to SAP is also performed. Our results support the importance of using local causal approaches to quantify separately baroreflex and feedforward interactions between RR and SAP, allowing both to confirm known physiological behaviors (e.g., weaker baroreflex effectiveness and lower sensitivity after AMI) and to suggest novel findings (e.g., preserved low frequency baroreflex response to postural stress after AMI). We also find that the postural stress alters feedforward interactions selectively across groups, being related to decreased coupling only in Young and to increased gain mostly in AMI. These results have a significance for the clinical assessment of the baroreflex and the physiological evaluation of cardiovascular interactions.
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While the HF component is exclusively associated with the parasympathetic branch of the ANS, the LF component encompasses both parasympathetic and sympathetic elements. Therefore the physiological meaning of the LF component is much debated, as it can easily be influenced by other physiological measures such as thermoregulation and myogenic activity of vessels (Ponikowski et al., 1996; Von Borell et al., 2007). A rise in RMSSD is commonly associated with activation of the parasympathic nervous system (Boissy et al., 2007; Zebunke et al., 2013) found that pigs reacted with an elevated RMSSD value to being called for feeding and explained their finding with a positively valenced anticipation of the food.
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Ten chronic obstructive pulmonary disease patients (69±9 years; FEV₁/FVC 59±12% and FEV₁ 41±11% predicted) and nine age-matched healthy volunteers (64±5 years) participated in this study. Heart-rate variability (HRV) was obtained at rest and during respiratory sinusal arrhythmia maneuver (RSA-M) by electrocardiograph.
Chronic obstructive pulmonary disease patients demonstrated impaired cardiac autonomic modulation at rest and during RSA-M when compared with healthy subjects (p<0.05). Moreover, significant and positive correlations between maximal inspiratory pressure (MIP) and the inspiratory-expiratory difference (ΔIE) (r = 0.60, p<0.01) were found.
Patients with chronic obstructive pulmonary disease presented impaired sympathetic-vagal balance at rest. In addition, cardiac autonomic control of heart rate was associated with inspiratory muscle weakness in chronic obstructive pulmonary disease. Based on this evidence, future research applications of respiratory muscle training may bring to light a potentially valuable target for rehabilitation.
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The chemo- and ergoreflexes (muscle receptors) are among the major reflex arches, which adapt the respiratory and the cardiovascular system to the needs of the body and contribute to its homeostasis. The present paper reviews the interplay of these reflexes with other major cardiovascular reflex arches; the methods used for their calculation and their normal range data.
The clinical implications of chemoreflex sensitivities and ergoreflexes in chronic heart failure (CHF) as well as the application of chemoreflexes in coronary artery disease, sudden cardiac death and multiple organ dysfunction syndrome are discussed.
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Objects: Fetal heart rate variability (HRV) is subject to a number of factors, including fetal distress. The aim of this study was to investigate the power spectral distribution of fetal heart rate variability during acute hypoxemia following umbilical artery embolism and to test the hypothesis that the relative proportion of frequency domains in total power of HRV, reflects the changes in HRV during hypoxemia more closely than the absolute values. Methods: Acute hypoxemia was induced in seven catheterized late-gestation fetal sheep by repeated injections of microspheres to cause umbilical artery embolism. The very-low, low-, middle- and high-frequency domains (0–0.025, 0.025–0.125, 0.125–0.20, and 0.20–0.50 cycles/beat, respectively) were determined by power spectral analysis. Results: Umbilical artery embolism induced marked fetal hypoxemia, hypercapnia and acidosis, accompanied by an increase in heart rate and a decrease in arterial blood pressure. These changes were associated with the increase in power over the entire frequency range and in the relative power in the low-frequency range (P<0.01), and with decrease in the relative power in the high-frequency range (P<0.05). Correlations were found between the relative power in the low- and high-frequency ranges and PO₂ and between the relative power in these ranges and mean arterial blood pressure (P<0.05), but not PCO₂ or pH. Conclusions: The present study indicates that acute hypoxemia induced by umbilical artery embolism leads to the redistribution of power spectral density of fetal HRV and that the relative proportion of individual frequency domains may reflect the changes in HRV during acute hypoxemia more closely than the absolute power values.
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Hypertrophic cardiomyopathy (HCM) have been reported to display impaired heart rate variability, although little is known regarding its prognostic value. By using fast Fourier transformation of 24-hour Holter recordings in 73 HCM patients at a stable clinical condition, we computed 4 spectral components: very low frequency, low frequency, high frequency, and total power. During 28 months, 7 HCM patients experienced death or acquired hospitalization for heart failure. Sudden death did not occurred. High frequency component was lower in HCM patients with cardiac events than that in patients without cardiac events (3.78 ± 0.66 vs. 4.43 ± 0.92 In(ms²), P = .045). There were no significant differences in other heart rate variability variables between HCM patients with and without cardiac events. In multivariate analysis, high frequency component remained to be an independent predictor of cardiac events (relative risk=0.10, 95% CI 0.01–0.73, P = .023). Heart rate variability analysis is predictive of heart failure in our cohort of HCM patients, whereas its predictive value of sudden death remains unclear.

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Detection and significance of a discrete very low frequency rhythm in RR interval variability in chronic congestive heart failure

Abstract

Am J Cardiol

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

Am J Cardiol

Assessment of autonomic function in man by heart rate spectral analysis

Am J Physiol

Power spectral analysis of heart rate and arterial pressure variabilities as a marker of sympatho-vagal interaction in man and concious dog

Circ Res

Cardiovascular neural regulation explored in the frequency domain

Circulation

Sympathetic predominance in the progression of chronic heart failure

Eur Heart J

Clinical aspects of sympathetic activation and parasympathetic withdrawal in heart failure

J Am Coll Cardiol

Contribution of muscle afferents to the hemodynamic, autonomic and ventilatory responses to exercise in patients with chronic heart failure

Circulation