Comparison of different methods for assessing sympathovagal balance in chronic congestive heart failure secondary to coronary artery disease

Stamatis Adamopoulos, Massimo Piepoli, Alastair McCance, Luciano Bernardi, Alberto Rocadaelli, Oliver Ormerod, Colin Forfar, Peter Sleight, Andrew J S Coats

Research output: Contribution to journalArticlepeer-review


Twenty-five patients (aged 62 ± 2 years) with stable, moderate to severe ischemic congestive heart failure (CHF) (New York Heart Association class II/III: 15/10; ejection fraction 21.6 ± 2%; and peak oxygen uptake 13.6 ± 0.7 ml/kg/min) were studied to evaluate the ability of different methods to characterize autonomic tone in chronic CHF. Sympathovagal balance was assessed by: (1) heart rate variability in the time domain, assessed by the SD of RR intervals; (2) heart rate variability in the frequency domain, assessed by low- (0.03 to 0.14 Hz) and high- (0.18 to 0.40 Hz) frequency components of heart rate variability by autoregressive power spectral analysis; (3) 24-hour, daytime and nighttime heart rate; (4) submaximal heart rate during upright bicycle exercise, with respiratory gas analysis to obtain peak oxygen uptake; and (5) radiolabeled norepinephrine spillover. These methods did not correlate, with the exception of day and nighttime heart rate (r = 0.74; p <0.001) and the expected inverse correlation between low and high frequency (r = -0.92; p <0.001). No method correlated significantly with peak oxygen uptake, exercise tolerance or ejection fraction. After 8 weeks of physical training at home, all methods showed improvement in autonomic balance: increases in SD of RR intervals (+21%; p <0.02) and high frequency (+41%; p <0.007), and decreases in low frequency (-19%; p <0.002), low-/high-frequency ratio (-48%; p <0.03), norepinephrine spillover (-28.9%; p <0.03), 24-hour heart rate (-2.7%; p <0.005) and submaximal heart rate (-10.8%; p <0.01). However, neither the absolute values nor percent changes of the individual measures of autonomic function after training showed a significant correlation between each other. In patients with CHF, the individual parameters of autonomic control reflect different aspects of circulatory control. A comprehensive description of autonomic tone probably needs multiple methods.

Original languageEnglish
Pages (from-to)1576-1582
Number of pages7
JournalThe American Journal of Cardiology
Issue number20
Publication statusPublished - Dec 15 1992

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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