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396 P A R T III / Assessment of Heart Disease
cited, did not wean them from any medications complicating 3. Task Force of the European Society of Cardiology and the North Ameri-
interpretation. can Society of Pacing and Electrophysiology. (1996). Heart rate variabil-
ity: Standards of measurement, physiological interpretation and clinical
use. Circulation, 93(5), 1043–1065.
Huntington and Parkinson Diseases 4. Coenen, A. J., Rompelman, O., & Kitney, R. I. (1977). Measurement
Analysis of HRV indicates disturbed ANS function in Hunting- of heart-rate variability: Part 2-Hardware digital devices for the assess-
ton disease. 135 Compared with matched healthy controls, geneti- ment of heart-rate variability. Medical & Biological Engineering & Com-
cally and symptomatically positive patients at the mid-stage of puting, 15(4), 423–430.
Huntington disease progression exhibit significantly reduced vagal 5. Rompelman, O., Coenen, A. J., & Kitney, R. I. (1977). Measurement
of heart-rate variability: Part 1-Comparative study of heart-rate variabil-
tone (low HF) and a shift toward sympathetic predominance ity analysis methods. Medical & Biological Engineering & Computing,
(high LF). Degree of disturbance is significantly related to the 15(3), 233–239.
severity of clinical symptoms. 6. Leffler, C. T., Saul, J. P., & Cohen, R. J. (1994). Rate-related and auto-
Little research has been conducted to explore autonomic activ- nomic effects on atrioventricular conduction assessed through beat-to-
ity in patients with Parkinson disease. Further research is needed beat PR interval and cycle length variability. Journal of Cardiovascular
Electrophysiology, 5(1), 2–15.
to determine the representativeness of reported trends of increased 7. Takei, Y. (1992). Relationship between power spectral densities of P-P
SNS tone and reduced HRV. 136 and R-R intervals. Annals of Physiological Anthropology, 113, 325–332.
8. Berntson, G. G., Bigger, J. T., Jr., Eckberg, D. L., et al. (1997). Heart
rate variability: Origins, methods, and interpretive caveats. Psychophysi-
ology, 34(6), 623–648.
IMPACT OF INTERVENTIONS 9. Öri, Z., Monir, G., Weiss, J., et al. (1992). Heart rate variability. Fre-
ON HRV quency domain analysis. Cardiology Clinics, 10(3), 499–537.
10. Pagani, M., Lombardi, F., Guzzetti, S., et al. (1986). Power spectral
analysis of heart rate and arterial pressure variabilities as a marker of
Although decreased HRV is strongly linked with poor prognosis, sympatho-vagal interaction in man and conscious dog. Circulation Re-
the increase of HRV does not directly appear to improve health search, 58, 178–193.
outcomes. 24 Still, there is support for improved health outcomes 11. Akselrod, S., Gordon, D., Ubel, F. A., et al. (1981). Power spectrum
for pharmacologic and nonpharmacologic interventions that are analysis of heart rate fluctuations: A quantitative probe of beat-to-beat
cardiovascular control. Science, 213, 220–222.
also associated with increased HRV. 12. Cowan, M. J., Burr, R. L., Narayanan, S. B., et al. (1992). Comparison
Several pharmacologic therapies are known to increase HRV of autoregression and fast Fourier transform techniques for power spec-
and reduce mortality. These include -blockers after MI (primarily tral analysis of heart period variability of persons with sudden cardiac ar-
through the enhancement of vagal tone), 137 angiotensin-convert- rest before and after therapy to increase heart period variability. Journal
of Electrocardiology, 25(Suppl.), 234–239.
ing enzyme inhibitors and carvedilol (a nonselective -blocker) in 13. Burr, R. L. (2007). Interpretation of normalized spectral heart rate vari-
CHF, sotalol (a class III antiarrhythmic agent and -blocker) in the ability indices in sleep research: A critical review. Sleep, 30(7), 913–919.
treatment of ventricular arrhythmias, and estrogen replacement 14. Bigger, J. T., Jr., Fleiss, J. L., Steinman, R. C., et al. (1995). RR vari-
therapy in postmenopausal women. 24,61 ability in healthy, middle-aged persons compared with patients with
Nonpharmacologic interventions, such as physical training, 89,91 chronic coronary heart disease or recent acute myocardial infarction.
Circulation, 91, 1936–1943.
psychosocial therapy, 122 and combination therapies involving exer- 15. Liao, D., Evans, G. W., Chambless, L. E., et al. (1996). Population-
cise and stress reduction 90 or exercise, diet, and weight loss, 2,138 based study of heart rate variability and prevalent myocardial infarction.
increase HRV and improve cardiovascular status. One nursing study The Atherosclerosis Risk in Communities Study. Journal of Electrocardi-
combined approaches in a randomized controlled trial of a psy- ology, 29(3), 189–198.
chosocial therapy targeting survivors of sudden cardiac arrest (N 16. Sosnowski, M., MacFarlane, P. W., Czyz, Z., et al. (2002). Age-
adjustment of HRV measures and its prognostic value for risk assessment
129). 139 Therapy included three components: physiologic relaxation in patients late after myocardial infarction. International Journal of
with biofeedback; cognitive behavioral therapy aimed at enhancing Cardiology, 86, 249–258.
6
6
mental health; and health education targeting cardiovascular risk fac- 17. Stein, P. K., Le, Q., & Domitrovich, P. P. (2008). Development of more
tors. Based on a 2-year follow-up period, this comprehensive psy- erratic heart rate patterns is associated with mortality post-myocardial
infarction. Journal of Electrocardiology, 41(2), 110–115.
chosocial therapy significantly reduced cardiovascular death. 18. Poulsen, S. H., Jensen, S. E., Moller, J. E., et al. (2001). Prognostic
value of left ventricular diastolic function and association with heart
rate variability after a first acute myocardial infarction. Heart, 86(4),
6
6
376–380.
SUMMARY 19. Kennon, S., Price, C. P., MacCallum, P. K., et al. (2003). Cumulative
risk assessment in unstable angina: Clinical, electrocardiographic, auto-
HRV is disturbed in a number of cardiovascular disorders and nomic, and biochemical markers. Heart, 89, 36–41.
health conditions that predispose cardiac complications. Clini- 20. Kleiger, R. E., Miller, J. P., Bigger, J. T., et al. (1987). Decreased heart
cians and researchers who have knowledge of these HRV pattern rate variability and its association with increased mortality after acute
myocardial infarction. American Journal of Cardiology, 59, 256–262.
anomalies and the factors that shape them will be able to include 21. Ramaekers, D., Ector, H., Aubert, A. E., et al. (1998). Heart rate
this approach in their work, strengthening their assessment and variability and heart rate in healthy volunteers. Is the female auto-
evaluation of the cardiovascular patient. nomic nervous system cardioprotective? European Heart Journal, 19,
1334–1341.
22. La Rovere, M. T., Pinna, G. D., Hohnloser, S. H., et al. (2001). Barore-
R EFE R E NC ES flex sensitivity and heart rate variability in the identification of patients
at risk for life-threatening arrhythmias. Circulation, 103, 2072–2077.
1. Lewis, M. J. (2005). Heart rate variability analysis: A tool to assess cardiac 23. Bettoni, M., & Zimmermann, M. (2002). Autonomic tone variations
autonomic function. Computers, Informatics, Nursing, 23(6), 335–341. before the onset of paroxysmal atrial fibrillation. Circulation, 105,
2. Appel, M. L., Berger, R. D., Saul, J. P., et al. (1989). Beat to beat vari- 2753–2759.
ability in cardiovascular variables: Noise or music? Journal of American 24. Stein, P. K., & Kleiger, R. E. (1999). Insights from the study of heart rate
College of Cardiology, 14(5), 1139–1148. variability. Annual Review of Medicine, 50, 249–261.