Factors influencing heart rate variability in patients with severe aortic valve disease

Abstract

SummaryBrrckgroundand hypothesis: Heart rate variability (HRV) is an accepted tool for the assessment of cardiovascular autonomic tone. There are no suficient data concerning its application to patients with severe aortic valve disease (AVD) requiring cardiac surgery.Mcdrods: It was the aim of this study to examine HRV and its physiologic correlates in patients with severe aortic valve disease requiring cardiac surgery. The correlates of time domain indices of HRV obtained from 24-h Holter electrocardiographic recordings were analyzed in 36 consecutive patients (23 men and 13 women, mean age 62 2 1 1 years) with AVD prior to cardiac surgery (aortic stenosis: 17 patients, aortic valve regurgitation: 3 patients, combined aortic valve disease: I 6 patients) .Results Conclusion: Patients with AVD requiring cardiac surgery reveal reduced time domain indices of HRV. This observation is pronounced in patients with a progressed clinical class of heart failure, whereas hemodynamic and echocardiographic parameters seem to have no significant influence on HRV parameters in this population. In addition, there is evidence of a further reduction of HRV time domain indices 1 week after uncomplicated aortic valve replacement.

Severe autonomic failure in moderate to severe aortic stenosis: prevalence and association with hemodynamics and biomarkers

“…Only a small number of clinical studies, including 12-60 patients investigated autonomic function in AS so far. In these studies, autonomic function was found to be generally reduced when compared with controls [10][11][12][13][14][15][16]. This was true for measures of tonic autonomic activity as assessed by heart rate variability in time or frequency domain [11][12][13][14] as well as for measures of reflex autonomic activity as assessed by means of HRT [10], tilt testing [15] or response of heart rate to deep breathing [16].…”

“…In these studies, autonomic function was found to be generally reduced when compared with controls [10][11][12][13][14][15][16]. This was true for measures of tonic autonomic activity as assessed by heart rate variability in time or frequency domain [11][12][13][14] as well as for measures of reflex autonomic activity as assessed by means of HRT [10], tilt testing [15] or response of heart rate to deep breathing [16]. Autonomic dysfunction was shown to be correlated with NYHA-Class [13], left ventricular hypertrophy [11,14], left ventricular enddiastolic pressure [16] and diastolic dysfunction [10].…”

“…This was true for measures of tonic autonomic activity as assessed by heart rate variability in time or frequency domain [11][12][13][14] as well as for measures of reflex autonomic activity as assessed by means of HRT [10], tilt testing [15] or response of heart rate to deep breathing [16]. Autonomic dysfunction was shown to be correlated with NYHA-Class [13], left ventricular hypertrophy [11,14], left ventricular enddiastolic pressure [16] and diastolic dysfunction [10]. Moreover, autonomic dysfunction can recover by effective treatment of AS has demonstrated for patients undergoing aortic valve replacement [12].…”

“…A small number of studies suggest that these changes are paralleled by a shift in sympathovagal balance towards an increased sympathetic and decreased vagal tone [10][11][12][13][14][15][16]. Therefore, markers of cardiac autonomic dysfunction might be sensitive markers reflecting severity of disease and useful for risk prediction.…”

Heart rate variability in children with aortic valve stenosis – a pilot study

“…In one of the few papers concerning HRV in adults with AS, Jung et al . [13] observed relatively low values of the parameters of the time-domain HRV analysis, and the lowest values in patients with the most impaired exercise tolerance. Stein et al .…”