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Heart rate variability in patients with hypertrophic cardiomyopathy: association with clinical and echocardiographic
D Bonaduce1, M Petretta, S Betocchi
1Institute of Internal Medicine, Cardiology and Heart Surgery, University of Naples, Federico II, Italy.
Insights
Autonomic dysfunction in hypertrophic cardiomyopathy (HCM) patients shows reduced vagal heart rate control. Symptoms like syncope and chest pain, along with specific echocardiographic findings, correlate with this parasympathetic withdrawal in HCM.
Area of Science:
- Cardiology
- Autonomic Nervous System Research
- Medical Imaging
Background:
- Autonomic dysfunction is a known complication in hypertrophic cardiomyopathy (HCM).
- Understanding the impact of clinical and echocardiographic features on autonomic balance is crucial for managing HCM patients.
Purpose of the Study:
- To assess the influence of clinical and echocardiographic characteristics on sympathovagal balance in HCM.
- To evaluate heart rate variability (HRV) as a measure of autonomic function in HCM.
Main Methods:
- Compared 33 HCM patients and 33 healthy controls using 24-hour ECG Holter monitoring for HRV analysis.
- Conducted echocardiographic examinations to assess cardiac structure and function.
- Utilized age-corrected multiple regression analysis to identify influencing factors.
Main Results:
- HCM patients exhibited significantly lower vagal modulation of heart rate compared to controls.
- Reduced vagal function was more pronounced in patients with syncope, exertional chest pain, dyspnea, or moderate/severe mitral regurgitation.
- Parasympathetic cardiac control was inversely related to left atrial dimension and directly related to left ventricular end-systolic dimension.
Conclusions:
- Parasympathetic withdrawal is more evident in symptomatic HCM patients.
- Left atrial size and left ventricular end-systolic dimension are key echocardiographic predictors of altered sympathovagal balance in HCM.
Abstract:
Autonomic dysfunction has been reported in patients with hypertrophic cardiomyopathy. To evaluate the influence of different clinical and echocardiographic features of the disease on sympathovagal balance, as assessed by heart rate variability, 33 patients with hypertrophic cardiomyopathy and 33 healthy volunteers underwent echocardiographic examination and 24-hour electrocardiogram Holter recording. Measures of vagal modulation of heart rate were lower in patients with hypertrophic cardiomyopathy than in controls, particularly in those exhibiting syncope, exertional chest pain, dyspnea, or moderate or severe mitral regurgitation. Furthermore, the age-corrected multiple regression analysis showed that the parasympathetic cardiac control was inversely related to left atrial dimension and directly related to left ventricular end-systolic dimension. Therefore in hypertrophic cardiomyopathy the parasympathetic withdrawal is more evident in patients with symptoms than in those without; the reduction in left ventricular end-systolic dimension and the increase in left atrial size are the echocardiographic features that most influence the sympathovagal balance.