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2007, vol. 135, iss. 3-4, pp. 135-142
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The influence of respiratory pattern on heart rate variability analysis in heart failure
Uticaj ritma disanja na analizu varijabilnosti frekvencije rada srca u insuficijenciji srca
aClinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia bUniversity Children's Hospital, Belgrade, Serbia cUniversity of Belgrade, Faculty of Medicine, Institute of Medical Statistics and Informatics, Serbia dUniversity of Belgrade, Faculty of Medicine, Clinical Hospital Center 'Bežanijska kosa', Serbia
email: hose@eunet.yu
Abstract
Introduction. Autonomic dysfunction is present early in the course of heart failure, and has a direct role on deterioration of cardiac function and prognosis. Heart rate variability (HRV) estimates sympathovagal control of heart frequency. The influence of respiratory pattern on HRV is clinically important. Breathing disorders are common in heart failure and highly affect HRV and autonomic evaluation. It was previously shown that slow and deep breathing increased parasympathetic tone, but effects of this respiratory pattern on HRV were not evaluated. Objective. The aim of the study was to estimate effects of slow and deep breathing (SDB) on HRV in heart failure patients. Method. In 55 patients with heart failure (78% male, mean age 57.18±10.8 yrs, mean EF=34.12±10.01%) and 14 healthy controls (57.1% male, mean age 53.1±8.2 yrs), short term HRV spectral analysis was performed (Cardiovit AT 60, Schiller). VLF, LF, HF and LF/HF were determined during spontaneous and deep and slow breathing at 0.1 Hz (SDB). Results. LF, HF and LF/HF significantly increased during SDB compared with spontaneous breathing both in controls (LF 50.71±61.55 vs. 551.14±698.01 ms2, p<0.001; HF 31.42±29.98 vs.188.78±142.74 ms2, p<0.001 and LF/HF 1.46±0.61 vs. 4.21±3.23, p=0.025) and heart failure patients (LF 27.37±36.04 vs. 94.50±96.13 ms2, p<0.001; HF 12.13±19.75 vs. 41.58±64.02 ms2, p<0.001 and LF/HF 3.77±3.79 vs. 6.38±5.98, p=0.031). Increments of LF and HF induced by SDB were significantly lower in patients than healthy controls. Heart failure patients had lower HRV compared to healthy controls both during spontaneous breathing and SDB. During spontaneous breathing, only HF was significantly lower between healthy controls and patients (p=0.002). During SDB VLF (p=0.022), LF (p<0.001) and HF (p<0.001) were significantly lower in heart failure patients compared to controls. Conclusion. These data suggest that SDB increases HRV both in healthy and heart failure patients; the highest increment is in LF range. Differences in spectral profile of HRV between healthy controls and heart failure patients become more profound during SDB. Controlled respiration during HRV analysis might increase sensitivity and reliability in detection of autonomic dysfunction in heart failure patients.
Sažetak
Uvod. Simpatovagusni disbalans javlja se već u ranim fazama insuficijencije srca (IS) i ima direktan uticaj na tok i njenu prognozu. Varijabilnost frekvencije rada srca (VFS) je metod procene simpatovagusne ravnoteže. Uticaj ritma disanja na VFS bolesnika sa IS manje je poznat, ali klinički značajan. Nepravilan ritam disanja je čest u IS, utiče na VFS i na pouzdanost procene autonomnog tonusa. Ranije je pokazano da se kontrolisanim disanjem (sporim i dubokim) može povećati uticaj vagusa na srce. Efekat ovakvog ritma disanja na VFS kod bolesnika sa IS nije detaljnije ispitan. Cilj rada. Cilj rada je bio da se ispita uticaj sporog i dubokog disanja na VFS bolesnika sa hroničnom IS. Metod rada. Kod 51 bolesnika sa IS (78% muškaraca, srednje starosti od 57,18±10,8 godina, prosečne ejekcione frakcije od 34,12±10,01%) i 14 zdravih ispitanika (57,1% muškaraca, srednje starosti od 53,1±8,2 godine) ispitana je VFS spektralnom analizom kratkog EKG zapisa (Cardiovit AT 60, Schiller, CH). Komponente spektra VLF (very low frequency - veoma niska frekvencija), LF (low frequency - niska frekvencija) i HF (high frequency - visoka frekvencija) i odnos LF i HF (LF/HF) su prvo određeni pri spontanom, a potom pri dubokom disanju od 0,1 Hz. Rezultati Vrednosti LF, HF i LF/HF su se značajno povećale dubokim disanjem u odnosu na spontano i kod ispitanika kontrolne grupe (LF 50,71±61,55 prema 551,14±698,01 ms2, p<0,001; HF 31,42±29,98 prema 188,78±142,74 ms2, p<0,001; LF/HF 1,46±0,61 prema 4,21±3,23, p=0,025) i kod bolesnika sa IS (LF 27,37±36,04 prema 94,50±96,13 ms2, p<0,001; HF 12,13±19,75 prema 41,58±64,02 ms2, p<0,001; LF/HF 3,77±3,79 prema 6,38±5,98, p=0,031). Promene VFS izazvane dubokim disanjem bile su statistički značajno manje kod bolesnika nego kod zdravih ispitanika. Bolesnici sa IS imali su nižu VFS i pri spontanom i pri dubokom disanju. Pri spontanom disanju VFS zdravih ispitanika i bolesnika sa IS značajno se razlikovala samo u opsegu HF (p=0,002), dok su pri dubokom disanju razlike bile statistički značajne u sva tri opsega spektra: VLF (p=0,022), LF (p<0,001) i HF (p<0,001). Zaključak. Dubokim i sporim disanjem povećava se VFS, najviše u LF opsegu i kod zdravih osoba i kod bolesnika sa IS. Razlike u spektralnom profilu VFS između zdravih ispitanika i bolesnika su izraženije pri dubokom i sporom, nego pri spontanom disanju. Ovi rezultati sugerišu da bi kontrolisane respiracije tokom analize VFS mogle povećati senzitivnost i pouzdanost VFS u otkrivanju autonomne disfunkcije kod bolesnika sa IS.
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