Circulation, Vol 90, 234-240, Copyright © 1994 by American Heart Association
BA Kingwell, JM Thompson, DM Kaye, GA McPherson, GL Jennings and MD Esler
BACKGROUND: Although heart rate variability (HRV) at 0.1 Hz has been
proposed as a noninvasive clinical measure of cardiac sympathetic nerve
firing, this premise has not been sufficiently validated by comparison with
techniques such as microneurography and the measurement of norepinephrine
spillover from the heart that more directly reflect presynaptic sympathetic
activity. METHODS AND RESULTS: We compared the three techniques under
conditions of effective cardiac sympathetic denervation, pure autonomic
failure (n = 4), dopamine beta-hydroxylase deficiency (n = 1), and after
cardiac transplantation (n = 9) as well as in the context of sympathetic
nervous activation in cardiac failure (n = 15) and with aging (n = 10).
Age-matched comparisons were made in each case with healthy individuals
drawn from a pool of 52 volunteers. In pure autonomic failure and early
after transplantation, cardiac norepinephrine spillover was negligible, and
HRV was low. Late after transplantation, however, cardiac norepinephrine
spillover returned to normal levels, and HRV remained low. In comparison to
younger subjects (18 to 35 years old), older individuals (60 to 75 years
old) had higher muscle sympathetic nerve activity (young, 22.9 +/- 1.9;
old, 31.3 +/- 5.8 bursts per minute; P < .05) and cardiac norepinephrine
spillover (young, 14.3 +/- 2.5; old, 20.1 +/- 3.0 ng/min; P < .05). In
contrast, total HRV was reduced by 89%, and at 0.1 Hz it was reduced by 93%
(P < .05). Cardiac failure was also characterized by elevated cardiac
norepinephrine spillover (cardiac failure patients, 59 +/- 4; healthy
volunteers, 18 +/- 3 ng/min; P < .01) but reduced 0.1 Hz HRV (cardiac
failure patients, 49 +/- 17; healthy volunteers, 243 +/- 4 ms2; P <
.05). CONCLUSIONS: HRV at 0.1 Hz depends on factors in addition to cardiac
sympathetic nerve firing rates, including multiple neural reflexes, cardiac
adrenergic receptor sensitivity, postsynaptic signal transduction, and
electrochemical coupling, and is not directly related to cardiac
norepinephrine spillover, which is a more direct measure of the sympathetic
nerve firing rate.
ARTICLES
Heart rate spectral analysis, cardiac norepinephrine spillover, and muscle sympathetic nerve activity during human sympathetic nervous activation and failure
Alfred and Baker Medical Unit, Baker Medical Research Institute, Prahran, Victoria, Australia.
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