Heart rate variability and diastolic heart failure
Rishi Arora1, Andrew Krummerman, Pugazhendihi Vijayaraman
1Division of Cardiology, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, USA.
Insights
Diastolic heart failure patients show reduced heart rate variability (HRV), indicating autonomic dysfunction. However, HRV is less impaired than in systolic heart failure, potentially explaining better prognosis.
Area of Science:
- Cardiology
- Autonomic Nervous System Function
Background:
- Diastolic heart failure (HFpEF) affects up to 40% of congestive heart failure patients.
- While HFpEF has a better prognosis than systolic heart failure, mortality remains higher than in the general population.
- Reduced heart rate variability (HRV), a marker of autonomic dysfunction, is linked to increased mortality in systolic heart failure.
Purpose of the Study:
- To investigate alterations in heart rate variability (HRV) in patients with diastolic heart failure.
- To compare HRV in diastolic heart failure patients with those having systolic heart failure and healthy controls.
Main Methods:
- Twenty-four hour ambulatory Holter recordings were conducted.
- HRV was analyzed using time and frequency domain variables.
- Three groups were studied: diastolic heart failure (n=19), systolic heart failure (n=9), and healthy controls (n=9).
Main Results:
- Both time and frequency domain HRV variables were reduced in both heart failure groups compared to controls.
- Diastolic heart failure patients exhibited relatively higher HRV values than systolic heart failure patients (SDNN, Total power, ULF power, P
- Reduced HRV in diastolic dysfunction suggests a disturbed sympathetic-parasympathetic balance.
Conclusions:
- Patients with diastolic heart failure demonstrate reduced HRV, indicative of autonomic dysfunction.
- The HRV reduction is less profound in diastolic dysfunction compared to systolic dysfunction.
- This relative preservation of autonomic balance may contribute to the better prognosis observed in diastolic heart failure.
Abstract:
Diastolic heart failure accounts for up to 40% of patients with congestive heart failure (CHF), and is associated with a better prognosis as compared to patients with systolic dysfunction. Nevertheless, patients with diastolic dysfunction have a significantly higher mortality as compared to the normal population. Reduced heart rate variability (HRV), a marker of autonomic dysfunction, is associated with increased mortality in patients with systolic heart failure. We therefore sought to determine to what extent HRV is altered in a population of patients with diastolic heart failure. Twenty-four hour ambulatory (Holter) recordings were performed in 19 consecutive patients with diastolic heart failure, in 9 patients with systolic heart failure, as well as in 9 healthy volunteers (normal controls). Time and frequency domain HRV variables were obtained for all three groups of patients. Both Time and Frequency domain variables were found to be reduced in both heart failure groups compared to normal controls. When compared with each other, patients with diastolic function had relatively higher values of HRV variables, compared to those with systolic dysfunction (SDNN, Total power, ULF power, all P
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