Measures of cardiovascular autonomic nervous function: agreement, reproducibility, and reference values in middle age and elderly subjects

Abstract

Aims/hypothesis. Currently, three categories of cardiovascular autonomic nervous function measures are used: classic Ewing-test measures, measures of heartrate variability (HRV), and measures of baroreflex sensitivity (BRS). Little is known about the agreement between these measures, and reference and reproducibility values for these measures have not been reported within the same group. Methods. As part of the Hoorn Study, 631 subjects aged 50 to 75 participated in a study of autonomic nervous function. Cardiac cycle duration (RR interval) and continuous finger arterial pressure were measured under three conditions: during spontaneous breathing, during six deep breaths over 1 min, and during an active change in position from lying to standing. From these readings, ten measures of autonomic function were assessed (mean heart rate, three Ewing test measures, five HRV measures and one BRS measure). Results. Regression analysis in a healthy subgroup (n=191) showed sex differences for two of the ten measures and seven measures decreased with age. Therefore, appropriate age-specific and sex-specific reference values were calculated. Reproducibility (n=39) of most measures was moderate, with a reliability coefficient of around 50%. Agreement between the measures of autonomic nervous function varied greatly, between 0% and 87%. The HRV-power ratio measure and the blood pressure changes in the lyingto-standing test showed the lowest agreement with all other measures. Conclusion/Interpretation. This study provides agespecific and sex-specific reference values for a wide range of different autonomic function measures in an elderly population. Agreement among the different measures varied widely and reproducibility was only moderate. [Diabetologia (2003) 46:330-338] Keywords Aging, agreement, baroreflex, diabetes mellitus, heart-rate variability, nervous system, autonomic, reference values, reproducibility.

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“…Five patients but no control had abnormal values (p = 0.037) when compared to age-based normative data (Fig. 2) [14,[16][17][18]. The 30:15 ratio was inversely associated with longer disease duration (r = -0.54, p = 0.014) and had a weak association with disease severity as rated by the functional staging of FARS (r = -0.42, p = 0.065).…”

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“…1). When compared to age-and gender-based normative data [14,[16][17][18], seven patients but no control had an abnormal ratio (Fig. 2) (p \ 0.01).…”

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