Circulation, Vol 90, 121-126, Copyright © 1994 by American Heart Association
HV Huikuri, MJ Niemela, S Ojala, A Rantala, MJ Ikaheimo and KE Airaksinen
BACKGROUND: Altered neural regulation of the cardiovascular system may be
an important factor for various manifestations of ischemic heart disease.
This research was designed to compare the circadian rhythm of cardiac
neural regulation and autonomic responses to arousal and upright posture
between patients with uncomplicated coronary artery disease (CAD) and
age-matched subjects with no evidence of heart disease. METHODS AND
RESULTS: Twenty-four-hour heart rate variability (HRV) in the frequency
domain was analyzed in 20 male patients (mean age, 52 +/- 7 years) with
angiographic evidence of CAD without prior myocardial infarction and in 20
healthy men (mean age, 51 +/- 8 years) with no clinical, echocardiographic,
or exercise ECG evidence of heart disease. None of the 24-hour average
frequency-domain components of HRV differed significantly between the two
groups. Healthy subjects had a significant circadian rhythm of normalized
units of high-frequency (HF) power of HRV with higher values during sleep.
Normalized units of low- frequency (LF) power and the LF/HF ratio also
showed a significant circadian rhythm in healthy subjects, with higher
values during the daytime. No significant circadian rhythms in any of the
normalized spectral components of HRV were observed in patients with CAD,
and the night-day difference in LF/HF ratio was smaller in the patients
with CAD than in the healthy subjects (0.5 +/- 1.4 versus 1.8 +/- 0.7, P
< .001). Awakening when in the supine position resulted in a significant
increase in the LF/HF ratio (P < .01) in the healthy subjects, but no
significant changes in HRV were observed after awakening in patients with
CAD. Assumption of upright position resulted in a comparable decrease in
the components of HRV between the groups. CONCLUSIONS: The circadian rhythm
of cardiac neural regulation is altered in patients with uncomplicated CAD.
Reduced autonomic responses to sleep-wake rhythm suggest that the
modulation of cardiac autonomic function by stimuli from the central
nervous system is impaired in CAD.
ARTICLES
Circadian rhythms of frequency domain measures of heart rate variability in healthy subjects and patients with coronary artery disease. Effects of arousal and upright posture
Department of Medicine, University of Oulu, Finland.
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