Advertisement

Supine low-frequency power of heart rate variability reflects baroreflex function, not cardiac sympathetic innervation

      Background

      Power spectral analysis of heart rate variability (HRV) has been used to indicate cardiac autonomic function. High-frequency power relates to respiratory sinus arrhythmia and therefore to parasympathetic cardiovagal tone; however, the relationship of low-frequency (LF) power to cardiac sympathetic innervation and function has been controversial. Alternatively, LF power might reflect baroreflexive modulation of autonomic outflows.

      Objective

      We studied normal volunteers and chronic autonomic failure syndrome patients with and without loss of cardiac noradrenergic nerves to examine the relationships of LF power with cardiac sympathetic innervation and baroreflex function.

      Methods

      We compared LF power of HRV in patients with cardiac sympathetic denervation, as indicated by low myocardial concentrations of 6-[18F] fluorodopamine-derived radioactivity or low rates of norepinephrine entry into coronary sinus plasma (cardiac norepinephrine spillover) to values in patients with intact innervation, at baseline, during infusion of yohimbine, which increases exocytotic norepinephrine release from sympathetic nerves, or during infusion of tyramine, which increases non-exocytotic release. Baroreflex-cardiovagal slope (BRS) was calculated from the cardiac interbeat interval and systolic pressure during the Valsalva maneuver.

      Results

      LF power was unrelated to myocardial 6-[18F] fluorodopamine-derived radioactivity or cardiac norepinephrine spillover. In contrast, the log of LF power correlated positively with the log of BRS (r = 0.72, P <0.0001). Patients with a low BRS (≤3 msec/mm Hg) had low LF power, regardless of cardiac innervation. Tyramine and yohimbine increased LF power in subjects with normal BRS but not in those with low BRS. BRS at baseline predicted LF responses to tyramine and yohimbine.

      Conclusion

      LF power reflects baroreflex function, not cardiac sympathetic innervation.

      Keywords

      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Heart Rhythm
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Pagani M.
        • Lombardi F.
        • Guzzetti S.
        • Rimoldi O.
        • Furlan R.
        • Pizzinelli P.
        • Sandrone G.
        • Malfatto G.
        • Dell’Orto S.
        • Piccaluga E.
        Power spectral analysis of heart rate and arterial pressure variabilities as a marker of sympatho-vagal interaction in man and conscious dog.
        Circ Res. 1986; 59: 178-193
        • Alvarenga M.E.
        • Richards J.C.
        • Lambert G.
        • Esler M.D.
        Psychophysiological mechanisms in panic disorder: a correlative analysis of noradrenaline spillover, neuronal noradrenaline reuptake, power spectral analysis of heart rate variability, and psychological variables.
        Psychosom Med. 2006; 68: 8-16
        • Eisenhofer G.
        • Friberg P.
        • Rundqvist B.
        • Quyyumi A.A.
        • Lambert G.
        • Kaye D.M.
        • Kopin I.J.
        • Goldstein D.S.
        • Esler M.D.
        Cardiac sympathetic nerve function in congestive heart failure.
        Circulation. 1996; 93: 1667-1676
        • Notarius C.F.
        • Butler G.C.
        • Ando S.
        • Pollard M.J.
        • Senn B.L.
        • Floras J.S.
        Dissociation between microneurographic and heart rate variability estimates of sympathetic tone in normal subjects and patients with heart failure.
        Clin Sci (Lond). 1999; 96: 557-565
        • Scalvini S.
        • Volterrani M.
        • Zanelli E.
        • Pagani M.
        • Mazzuero G.
        • Coats A.J.
        • Giordano A.
        Is heart rate variability a reliable method to assess autonomic modulation in left ventricular dysfunction and heart failure?.
        Int J Cardiol. 1998; 67: 9-17
        • Kingwell B.A.
        • Thompson J.M.
        • Kaye D.M.
        • McPherson G.A.
        • Jennings G.L.
        • Esler M.D.
        Heart rate spectral analysis, cardiac norepinephrine spillover, and muscle sympathetic nerve activity during human sympathetic nervous activation and failure.
        Circulation. 1994; 90: 234-240
        • van de Borne P.
        • Montano N.
        • Pagani M.
        • Oren R.
        • Somers V.K.
        Absence of low-frequency variability of sympathetic nerve activity in severe heart failure.
        Circulation. 1997; 95: 1449-1454
        • Sleight P.
        • La Rovere M.T.
        • Mortara A.
        • Pinna G.
        • Maestri R.
        • Leuzzi S.
        • Bianchini B.
        • Tavazzi L.
        • Bernardi L.
        Physiology and pathophysiology of heart rate and blood pressure variability in humans: is power spectral analysis largely an index of baroreflex gain?.
        Clin Sci (Lond). 1995; 88: 103-109
        • Saul J.P.
        • Arai Y.
        • Berger R.D.
        • Lilly L.S.
        • Colucci W.S.
        • Cohen R.J.
        Assessment of autonomic regulation in chronic congestive heart failure by heart rate spectral analysis.
        Am J Cardiol. 1988; 61: 1292-1299
        • Goldstein D.S.
        • Holmes C.
        • Li S.T.
        • Bruce S.
        • Metman L.V.
        • Cannon R.O.
        Cardiac sympathetic denervation in Parkinson disease.
        Ann Intern Med. 2000; 133: 338-347
        • Goldstein D.S.
        • Eldadah B.A.
        • Holmes C.
        • Pechnik S.
        • Moak J.
        • Saleem A.
        • Sharabi Y.
        Neurocirculatory abnormalities in Parkinson disease with orthostatic hypotension.
        Hypertension. 2005; 46: 1333-1339
        • Goldstein D.S.
        • Eldadah B.
        • Holmes C.
        • Pechnik S.
        • Moak J.
        • Sharabi Y.
        Neurocirculatory abnormalities in chronic orthostatic intolerance.
        Circulation. 2005; 111: 839-845
        • Goldstein D.S.
        • Holmes C.
        • Frank S.M.
        • Dendi R.
        • Cannon R.O.
        • Sharabi Y.
        • Esler M.D.
        • Eisenhofer G.
        Cardiac sympathetic dysautonomia in chronic orthostatic intolerance syndromes.
        Circulation. 2002; 106: 2358-2365
        • Lord S.W.
        • Clayton R.H.
        • Mitchell L.
        • Dark J.H.
        • Murray A.
        • McComb J.M.
        Sympathetic reinnervation and heart rate variability after cardiac transplantation.
        Heart. 1997; 77: 532-538
        • Goldstein D.S.
        • Eisenhofer G.
        • Dunn B.B.
        • Armando I.
        • Lenders J.
        • Grossman E.
        • Holmes C.
        • Kirk K.L.
        • Bacharach S.
        • Adams R.
        Positron emission tomographic imaging of cardiac sympathetic innervation using 6-[18F]fluorodopamine: initial findings in humans.
        J Am Coll Cardiol. 1993; 22: 1961-1971
        • Goldstein D.S.
        • Tack C.
        Non-invasive detection of sympathetic neurocirculatory failure.
        Clin Auton Res. 2000; 10: 285-291
        • Goldstein D.S.
        • Horwitz D.
        • Keiser H.R.
        Comparison of techniques for measuring baroreflex sensitivity in man.
        Circulation. 1982; 66: 432-439
        • Goldstein D.S.
        • Brush Jr, J.E.
        • Eisenhofer G.
        • Stull R.
        • Esler M.
        In vivo measurement of neuronal uptake of norepinephrine in the human heart.
        Circulation. 1988; 78: 41-48
        • Koh J.
        • Brown T.E.
        • Beightol L.A.
        • Ha C.Y.
        • Eckberg D.L.
        Human autonomic rhythms: vagal cardiac mechanisms in tetraplegic subjects.
        J Physiol. 1994; 474: 483-495
        • Saul J.P.
        • Rea R.F.
        • Eckberg D.L.
        • Berger R.D.
        • Cohen R.J.
        Heart rate and muscle sympathetic nerve variability during reflex changes of autonomic activity.
        Am J Physiol. 1990; 258: H713-H721
        • Wiklund U.
        • Koskinen L.O.
        • Niklasson U.
        • Bjerle P.
        • Elfversson J.
        Endoscopic transthoracic sympathectomy affects the autonomic modulation of heart rate in patients with palmar hyperhidrosis.
        Acta Neurochir (Wien). 2000; 142: 691-696
        • Kawamata Y.T.
        • Kawamata T.
        • Omote K.
        • Homma E.
        • Hanzawa T.
        • Kaneko T.
        • Namiki A.
        Endoscopic thoracic sympathectomy suppresses baroreflex control of heart rate in patients with essential hyperhidrosis.
        Anesth Analg. 2004; 98: 37-39
        • Goldstein R.E.
        • Beiser G.D.
        • Stampfer M.
        • Epstein S.E.
        Impairment of autonomically mediated heart rate control in patients with cardiac dysfunction.
        Circ Res. 1975; 36: 571-578
        • Cody R.J.
        • Franklin K.W.
        • Kluger J.
        • Laragh J.H.
        Mechanisms governing the postural response and baroreceptor abnormalities in chronic congestive heart failure: effects of acute and long-term converting-enzyme inhibition.
        Circulation. 1982; 66: 135-142
        • Creager M.A.
        Baroreceptor reflex function in congestive heart failure.
        Am J Cardiol. 1992; 69 (discussion 15G–16G): 10G-15G
        • Cevese A.
        • Gulli G.
        • Polati E.
        • Gottin L.
        • Grasso R.
        Baroreflex and oscillation of heart period at 0.1 Hz studied by alpha-blockade and cross-spectral analysis in healthy humans.
        J Physiol. 2001; 531: 235-244
        • deBoer R.W.
        • Karemaker J.M.
        • Strackee J.
        Hemodynamic fluctuations and baroreflex sensitivity in humans: a beat-to-beat model.
        Am J Physiol. 1987; 253: H680-H689