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Session III: Annual Review of Key Papers in Heart-Brain Medicine

Supine low-frequency power of heart rate variability reflects baroreflex function, not cardiac sympathetic innervation

Jeffrey P. Moak, MD, David S. Goldstein, MD, PhD, Basil A. Eldadah, MD, PhD, Ahmed Saleem, MD, Courtney Holmes, CMT, Sandra Pechnik, RN and Yehonatan Sharabi, MD
Cleveland Clinic Journal of Medicine February 2009, 76 (4 suppl 2) S51-S59; DOI: https://doi.org/10.3949/ccjm.76.s2.11
Jeffrey P. Moak
Children’s National Medical Center, Washington, DC
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  • For correspondence: [email protected]
David S. Goldstein
Clinical Neurocardiology Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD
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Basil A. Eldadah
Clinical Neurocardiology Section, NINDS, NIH, Bethesda, MD
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Ahmed Saleem
Clinical Neurocardiology Section, NINDS, NIH, Bethesda, MD
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Courtney Holmes
Clinical Neurocardiology Section, NINDS, NIH, Bethesda, MD
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Sandra Pechnik
Clinical Neurocardiology Section, NINDS, NIH, Bethesda, MD
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Yehonatan Sharabi
Clinical Neurocardiology Section, NINDS, NIH, Bethesda, MD
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ABSTRACT

Background Power spectral analysis of heart rate variability (HRV) has been used to indicate cardiac autonomic function. High-frequency power relates to respiratory sinus arrhythmia and therefore to parasympathetic cardiovagal tone; however, the relationship of low-frequency (LF) power to cardiac sympathetic innervation and function has been controversial. Alternatively, LF power might reflect baro reflexive modulation of autonomic outflows.

Objective We studied normal volunteers and chronic autonomic failure syndrome patients with and without loss of cardiac noradrenergic nerves to examine the relationships of LF power with cardiac sympathetic innervation and baroreflex function.

Methods We compared LF power of HRV in patients with cardiac sympathetic denervation, as indicated by low myocardial concentrations of 6-[18F]fluorodopamine-derived radioactivity or low rates of norepinephrine entry into coronary sinus plasma (cardiac norepinephrine spillover) to values in patients with intact innervation, at baseline, during infusion of yohimbine, which increases exocytotic norepinephrine release from sympathetic nerves, or during infusion of tyramine, which increases non-exocytotic release. Baroreflex-cardiovagal slope (BRS) was calculated from the cardiac interbeat interval and systolic pressure during the Valsalva maneuver.

Results LF power was unrelated to myocardial 6-[18F]fluorodopamine-derived radioactivity or cardiac norepinephrine spillover. In contrast, the log of LF power correlated positively with the log of BRS (r = 0.72, P < 0.0001). Patients with a low BRS (⩽ 3 msec/mm Hg) had low LF power, regardless of cardiac innervation. Tyramine and yohimbine increased LF power in subjects with normal BRS but not in those with low BRS. BRS at baseline predicted LF responses to tyramine and yohimbine.

Conclusion LF power reflects baroreflex function, not cardiac sympathetic innervation

  • © 2009 The Cleveland Clinic Foundation. All Rights Reserved.
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Cleveland Clinic Journal of Medicine: 76 (4 suppl 2)
Cleveland Clinic Journal of Medicine
Vol. 76, Issue 4 suppl 2
1 Feb 2009
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Supine low-frequency power of heart rate variability reflects baroreflex function, not cardiac sympathetic innervation
Jeffrey P. Moak, David S. Goldstein, Basil A. Eldadah, Ahmed Saleem, Courtney Holmes, Sandra Pechnik, Yehonatan Sharabi
Cleveland Clinic Journal of Medicine Feb 2009, 76 (4 suppl 2) S51-S59; DOI: 10.3949/ccjm.76.s2.11

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Supine low-frequency power of heart rate variability reflects baroreflex function, not cardiac sympathetic innervation
Jeffrey P. Moak, David S. Goldstein, Basil A. Eldadah, Ahmed Saleem, Courtney Holmes, Sandra Pechnik, Yehonatan Sharabi
Cleveland Clinic Journal of Medicine Feb 2009, 76 (4 suppl 2) S51-S59; DOI: 10.3949/ccjm.76.s2.11
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