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Cardiac Autonomic Response to Active Standing in Calcific Aortic Valve Stenosis

José M Torres-Arellano1,2, Juan C Echeverría3, Nydia Ávila-Vanzzini4

  • 1Department of Electromechanical Instrumentation, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico.

Journal of Clinical Medicine
|June 2, 2021
PubMed

Insights

Patients with aortic stenosis (AS) show altered heart rate variability (HRV), indicating reduced parasympathetic response and impaired autonomic adjustments during postural changes. This study highlights HRV as a marker for autonomic dysfunction in AS.

Area of Science:

  • Cardiology
  • Autonomic Nervous System Physiology
  • Medical Diagnostics

Background:

  • Aortic stenosis (AS) is a progressive heart valve disease involving leaflet calcification.
  • Heart rate variability (HRV) analysis assesses autonomic nervous system activity, which is often altered in cardiac conditions.
  • Previous research suggests autonomic dysfunction in various heart diseases.

Purpose of the Study:

  • To evaluate changes in heart rate variability (HRV) in patients with aortic stenosis (AS) using an active standing challenge.
  • To compare HRV parameters between individuals with and without AS during supine and standing positions.

Main Methods:

  • A cross-sectional study involving 25 patients with moderate to severe calcific AS and 22 healthy controls (NAV).
  • 10-minute electrocardiograms (ECG) were recorded in supine and active standing positions.
  • Analysis included temporal, spectral (LF, HF), and scaling (α1, αsign1) HRV indices.

Main Results:

  • The AS group exhibited higher LF, LF/HF, and αsign1 in the supine position compared to the NAV group.
  • Patients with AS showed attenuated changes in meanNN, LF, HF, LF/HF, α1, and αsign1 between supine and standing positions.
  • This indicates a decreased parasympathetic response and blunted autonomic adjustments to postural stress in AS patients.

Conclusions:

  • Moderate to severe calcific AS is associated with a reduced cardiac parasympathetic response in the supine position.
  • The dynamic of heart rate fluctuations is altered in AS patients compared to healthy individuals.
  • AS patients demonstrate diminished autonomic adjustments in response to an active standing challenge.

Keywords:
active standingaortic valve diseasecardiac autonomic modulation

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