Heart Rate Variability: Clinical Applications and Interaction between HRV and Heart Rate

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Karin Trimmel, Jerzy Sacha, Heikki Veli Huikuri
Frontiers Media SA, Oct 7, 2015 - Electronic book - 166 pages

Over the last decades, assessment of heart rate variability (HRV) has increased in various fields of research. HRV describes changes in heartbeat intervals, which are caused by autonomic neural regulation, i.e. by the interplay of the sympathetic and the parasympathetic nervous systems. The most frequent application of HRV is connected to cardiological issues, most importantly to the monitoring of post-myocardial infarction patients and the prediction of sudden cardiac death. Analysis of HRV is also frequently applied in relation to diabetes, renal failure, neurological and psychiatric conditions, sleep disorders, psychological phenomena such as stress, as well as drug and addiction research including alcohol and smoking. The widespread application of HRV measurements is based on the fact that they are noninvasive, easy to perform, and in general reproducible – if carried out under standardized conditions. However, the amount of parameters to be analysed is still rising. Well-established time domain and frequency domain parameters are discussed controversially when it comes to their physiological interpretation and their psychometric properties like reliability and validity, and the sensitivity to cardiovascular properties of the variety of parameters seems to be a topic for further research. Recently introduced parameters like pNNxx and new dynamic methods such as approximate entropy and detrended fluctuation analysis offer new potentials and warrant standardization. 

However, HRV is significantly associated with average heart rate (HR) and one can conclude that HRV actually provides information on two quantities, i.e. on HR and its variability. It is hard to determine which of these two plays a principal role in the clinical value of HRV. The association between HRV and HR is not only a physiological phenomenon but also a mathematical one which is due to non-linear (mathematical) relationship between RR interval and HR. If one normalizes HRV to its average RR interval, one may get ‘pure’ variability free from the mathematical bias. Recently, a new modification method of the association between HRV and HR has been developed which enables us to completely remove the HRV dependence on HR (even the physiological one), or conversely enhance this dependence. Such an approach allows us to explore the HR contribution to the clinical significance of HRV, i.e. whether HR or its variability plays a main role in the HRV clinical value. 

This Research Topic covers recent advances in the application of HRV, methodological issues, basic underlying mechanisms as well as all aspects of the interaction between HRV and HR.

 

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Contents

methodological considerations and clinical applications
6
Heart rate variability a historical perspective
9
an appraisal of autonomic modulation of cardiovascular function
22
Role of editing of RR intervals in the analysis of heart rate variability
29
methodological issues in shortterm frequencydomain HRV
39
The LFHF ratio does not accurately measure cardiac sympathovagal balance
54
Clinical application of heart rate variability after acute myocardial infarction
59
Heart rate turbulence as riskpredictor after myocardial infarction
64
Cardiac rehabilitation outcomes following a 6week program of PCI and CABG Patients
112
Heart rate variability during simulated hemorrhage with lower body negative pressure in high and low tolerant subjects
119
Why should one normalize heart rate variability with respect to average heart rate
128
The effect of heart rate on the heart rate variability response to autonomic interventions
130
A comparison between heart rate and heart rate variability as indicators of cardiac health and fitness
139
a prognostic game
144
Effect of heart rate correction on pre and postexercise heart rate variability to predict risk of mortalityan experimental study on the FINCAVAS cohort
148
new insights from mathematical correction of heart rate
157

Heart rate variability and nonlinear dynamics in risk stratification
72
current strengths and limitations
80
Heart rate variability in normal and pathological sleep
93
Do physiological and pathological stresses produce different changes in heart rate variability?
104
New methods for the analysis of heartbeat behavior in risk stratification
161
Back Cover
167
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