Heart rate variability in left ventricular hypertrophy

Relationship between right ventricular remodeling and heart rate variability in arterial hypertension

OBJECTIVE

We aimed at evaluating right ventricular remodeling (structure, function, and mechanics) and heart rate variability (HRV), as well as their interaction, in untreated hypertensive patients.

METHOD

This cross-sectional study involved 55 untreated hypertensive patients and 40 patients with no risk factors, similar by sex and age. All the patients underwent a 24-h Holter monitoring and comprehensive two-dimensional and three-dimensional echocardiography assessment (2DE and 3DE).

RESULTS

All time and frequency domain HRV variables were reduced in the hypertensive patients. Right ventricular systolic and diastolic function, as well as right ventricular longitudinal strain, was significantly impaired in the hypertensive patients. Parameters that indicate comprehensive right ventricular remodeling (right ventricular wall thickness, tricuspid E/e' ratio, 2DE right ventricular longitudinal strain, and 3D right ventricular ejection fraction) correlated with the parameters of cardiac sympathovagal balance (SD of all normal RR intervals, root mean square of the difference between the coupling intervals of adjacent RR intervals, 24-h low-frequency domain, 24-h high-frequency domain, and 24-h total power). Of note, right ventricular diastolic function, right ventricular longitudinal function, and 3DE right ventricular ejection fraction were associated with cardiac autonomic nervous function, independently of age, BMI, blood pressure, and left ventricular hypertrophy.

CONCLUSIONS

Right ventricular structure, systolic and diastolic function, as well as right ventricular longitudinal deformation, are significantly impaired in untreated hypertensive patients. HRV variables are also decreased in hypertensive population. 2DE and 3DE parameters resembling right ventricular remodeling are independently associated with cardiac autonomic nervous system markers in the whole study population.

Heart rate variability in patients with cardiac hypertrophy--relation to left ventricular mass and etiology

BACKGROUND

Decreased heart rate variability (HRV) has been shown to reflect disturbances of the autonomic nervous system that is related to increased cardiovascular mortality. Most studies investigated HRV in patients with systolic left ventricular dysfunction due to remote myocardial infarction or dilated cardiomyopathy. To date, only few data are available on HRV in patients with predominant diastolic dysfunction in the presence of cardiac hypertrophy of different etiologies.

METHODS

Time domain analysis of HRV was performed from digital 24-hour Holter electrocardiogram recordings in 86 patients with sinus rhythm and cardiac hypertrophy, which was due to aortic valve stenosis in 33 patients, hypertrophic cardiomyopathy in 29 patients, and hypertensive heart disease in 24 patients. Heart rate variability analysis was compared with 91 healthy controls.

RESULTS

The SD of all normal-to-normal R-R intervals (SDNN) was reduced in patients with aortic valve stenosis, hypertrophic cardiomyopathy, and hypertensive heart disease when compared with controls (SDNN 119 +/- 42 vs 154 +/- 36 milliseconds, P < .001). The extent of cardiac hypertrophy indexed by echocardiography based left ventricular mass calculation and increased patient age were independent predictors for depression of SDNN.

CONCLUSIONS

Cardiac hypertrophy of various etiologies is related to decreased HRV on 24-hour Holter electrocardiogram. Both the patient age and the extent of left ventricular hypertrophy are independently associated with depression of HRV. These findings are independent of the cause of cardiac hypertrophy. The significance of these findings remains to be determined by future studies.

Cardiac function after orthotopic liver transplantation and the effects of immunosuppression: a prospective randomized trial comparing cyclosporin (Neoral) and tacrolimus

There are several case reports in the literature that describe cardiac complications in the first few weeks after orthotopic liver transplantation (OLT) in patients receiving tacrolimus as their primary immunosuppressive therapy. In this study, we investigated the cardiac function of patients on tacrolimus (T) compared with those on cyclosporin (C) (Neoral; Novartis, Basel, Switzerland) immunosuppression, after OLT, in a prospective randomized trial. We randomized 40 adult patients with cirrhosis to either T or C with azathioprine and prednisolone immunosuppression and followed up on them for 3 months after OLT. All had detailed clinical, biochemical, electrocardiographic and echocardiographic assessments at regular intervals. Abnormalities in cardiac function were common after OLT and significant deterioration in left ventricular diastolic function was demonstrable up to 3 months in both patient groups. Cardiac function was similar in the T and C arms and no significant electrocardiographic differences were observed, although reduced heart rate variability (HRV) and higher mean serum brain natriuretic peptide (BNP) levels were identified in the T group. The percentage increase in posterior wall thickness was higher in the T group. Cardiac dysfunction as shown by worsening echocardiographic measures of left ventricular diastolic function and by clinical cardiac events is common in the first 3 months after OLT in patients with cirrhosis. HRV and BNP values in the T group were worse than in the C group, but this was not translated to an increase in cardiac clinical events in this study.