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Measuring Cardiac Autonomic Nervous System ANS Activity in Children
Published on: April 29, 2013
Traditional and advanced electrocardiographic measures of autonomic function in the population-based KORA-F3 study
Aenne S von Falkenhausen1,2, Felix N Wenner1, Luisa Freyer1,2
1Department of Cardiology, LMU University Hospital Munich, Ziemssenstr. 5, 80336, Munich, Germany.
Insights
This study provides population-based reference values for heart-rate variability (HRV) and advanced autonomic function measures. Lower HRV and autonomic function were observed in individuals with cardiovascular conditions, highlighting their clinical relevance.
Area of Science:
- Cardiology
- Autonomic Nervous System Function
- Biostatistics
Background:
- Heart-rate variability (HRV) measures autonomic function and predicts cardiovascular mortality post-myocardial infarction (MI).
- Traditional HRV analysis includes time and frequency domains.
- Advanced measures like deceleration capacity (DC) and periodic repolarization dynamics (PRD) offer deeper insights into parasympathetic and sympathetic activity, respectively, but lack population-based reference values.
Purpose of the Study:
- To establish population-based reference values for traditional and advanced HRV measures.
- To investigate the influence of sex, age, and comorbidities on these autonomic function markers.
- To provide a comprehensive dataset for clinical risk stratification.
Main Methods:
- Analysis of 24-h Holter ECGs from 505 participants in the population-based KORA F3 study.
- Assessment of time-domain (SDNN) and frequency-domain (LF/HF-ratio) HRV measures.
- Determination of advanced autonomic function markers: deceleration capacity (DC) and periodic repolarization dynamics (PRD).
Main Results:
- Provided median values for SDNN (141 ms), LF/HF-ratio (3.92), DC (5.32 ms), and PRD (2.92 ms).
- Significant sex differences observed: LF/HF-ratio higher in men than women (p < 0.001).
- Lower SDNN, LF/HF-ratio, and DC found in participants with comorbidities (hypertension, diabetes, history of MI/stroke, beta-blocker use).
Conclusions:
- Systematically presents reference values for cardiac autonomic function using traditional and advanced HRV measures in a large population.
- Stratified reference values by sex, age, and cardiovascular conditions.
- Highlights the utility of these measures for assessing autonomic balance and cardiovascular risk in the general population.
Aims:
Heart-rate variability (HRV) measures are surrogates of autonomic function at the level of the sinus node and have evolved as markers of cardiovascular mortality in patients after myocardial infarction (MI). Traditionally, HRV is assessed in time-domain and frequency domain. Advanced measures of autonomic function include deceleration capacity (DC) and periodic repolarization dynamics (PRD). DC predominantly quantifies the influence of parasympathetic tone. PRD captures low-frequency oscillations of repolarization instability and is considered to reflect sympathetic activity at the level of the left ventricular myocardium. However, population-based reference values are missing.
Methods And Results:
In 505 participants of the population-based KORA F3 study (Cooperative Health Research in the Region of Augsburg) with extant digital 24-h Holter electrocardiograms we assessed markers of HRV in time and frequency domains. Additionally, we determined advanced measures of autonomic function including DC and PRD applying previously established technologies. We used standard, pre-defined cut-off values to define high-risk groups. The cohort's mean age was 63.6 ± 5.5 years, and 256 (50.1%) were women. Among HRV measures, exemplarily the median standard deviation of all normal-to-normal intervals (SDNN) was 141 ms [119;165] and the median low frequency to high frequency ratio (LF/HF-ratio) was 3.92 [2.69;6.18]. Regarding autonomic function, median DC was 5.32 ms [2.69;6.18], and median PRD was 2.92 ms [2.06;4.14]. Among these measures LF/HF-ratio was significantly higher among men (5.15 [3.23; 7.20]) than women (3.37 [2.36;4.53], p < 0.001). Measured distribution is also provided in a cohort subset without overt cardiovascular conditions. While DC decreased with age, SDNN, LF/HF-ratio, and PRD were stable across age-groups. For participants with comorbidities including hypertension, intake of betablockers, history of MI, stroke, or diabetes mellitus significantly lower SDNN, LF/HF-ratio, and DC were observed.
Conclusion:
In a large population-based cohort, we systematically present traditional and advanced measures of HRV of cardiac autonomic function. We report reference values in the overall cohort, as well as stratified by sex, age, and concomitant cardiovascular conditions.
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