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. 1993 Jun;69(6):525–529. doi: 10.1136/hrt.69.6.525

Autonomic function in hypertrophic cardiomyopathy.

D M Gilligan 1, W L Chan 1, E Sbarouni 1, P Nihoyannopoulos 1, C M Oakley 1
PMCID: PMC1025165  PMID: 8343320

Abstract

BACKGROUND--Autonomic dysfunction has been found to be a powerful predictor of arrhythmic events and sudden death after myocardial infarction. Hypertrophic cardiomyopathy carries a risk of sudden death and this risk is increased by the occurrence of syncope. OBJECTIVES--To determine if autonomic dysfunction occurs in patients with hypertrophic cardiomyopathy and if it is associated with the occurrence of syncope. PATIENTS AND METHODS--Autonomic function was measured in 30 patients with hypertrophic cardiomyopathy, 15 with and 15 without a history of syncope, and in 28 healthy volunteers. RESULTS--Tests of parasympathetic activity showed that the mean (SD) variation in heart rate during deep breathing was reduced in patients compared with controls, 17 (9) v 22 (9) beats/min, p = 0.03, the Valsalva ratio was also reduced in patients, 1.52 (0.33) v 1.70 (0.36), p = 0.05 but the immediate heart rate response to standing, the 30:15 ratio, was similar in both groups. Tests of sympathetic activity--namely the diastolic blood pressure response to sustained handgrip and the change in systolic blood pressure on standing--did not differ between patients and controls. There was no significant difference in autonomic function between patients with and without a history of syncope. A secondary predetermined analysis showed that the degree of impairment in variation of heart rate with breathing was correlated with the severity of left ventricular hypertrophy, r = 0.39, p = 0.03. CONCLUSIONS--Patients with hypertrophic cardiomyopathy have a selective impairment of variability of heart rate with deep breathing and the Valsalva manoeuvre indicating decreased cardiac parasympathetic activity. The data suggest that the afferent limb of these reflexes is impaired and that the severity of impairment is related to the degree of left ventricular hypertrophy.

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Selected References

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  1. Airaksinen K. E., Ikäheimo M. J., Koistinen M. J., Takkunen J. T. Impaired vagal heart rate control in aortic valve stenosis. Eur Heart J. 1988 Oct;9(10):1126–1130. doi: 10.1093/oxfordjournals.eurheartj.a062409. [DOI] [PubMed] [Google Scholar]
  2. Airaksinen K. E., Ikäheimo M. J., Linnaluoto M. K., Niemelä M., Takkunen J. T. Impaired vagal heart rate control in coronary artery disease. Br Heart J. 1987 Dec;58(6):592–597. doi: 10.1136/hrt.58.6.592. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Billman G. E., Schwartz P. J., Stone H. L. Baroreceptor reflex control of heart rate: a predictor of sudden cardiac death. Circulation. 1982 Oct;66(4):874–880. doi: 10.1161/01.cir.66.4.874. [DOI] [PubMed] [Google Scholar]
  4. Casolo G., Balli E., Taddei T., Amuhasi J., Gori C. Decreased spontaneous heart rate variability in congestive heart failure. Am J Cardiol. 1989 Nov 15;64(18):1162–1167. doi: 10.1016/0002-9149(89)90871-0. [DOI] [PubMed] [Google Scholar]
  5. Ewing D. J. Cardiovascular reflexes and autonomic neuropathy. Clin Sci Mol Med. 1978 Oct;55(4):321–327. doi: 10.1042/cs0550321. [DOI] [PubMed] [Google Scholar]
  6. Ewing D. J., Clarke B. F. Diagnosis and management of diabetic autonomic neuropathy. Br Med J (Clin Res Ed) 1982 Oct 2;285(6346):916–918. doi: 10.1136/bmj.285.6346.916. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Ewing D. J., Hume L., Campbell I. W., Murray A., Neilson J. M., Clarke B. F. Autonomic mechanisms in the initial heart rate response to standing. J Appl Physiol Respir Environ Exerc Physiol. 1980 Nov;49(5):809–814. doi: 10.1152/jappl.1980.49.5.809. [DOI] [PubMed] [Google Scholar]
  8. Fananapazir L., Tracy C. M., Leon M. B., Winkler J. B., Cannon R. O., 3rd, Bonow R. O., Maron B. J., Epstein S. E. Electrophysiologic abnormalities in patients with hypertrophic cardiomyopathy. A consecutive analysis in 155 patients. Circulation. 1989 Nov;80(5):1259–1268. doi: 10.1161/01.cir.80.5.1259. [DOI] [PubMed] [Google Scholar]
  9. Farrell T. G., Paul V., Cripps T. R., Malik M., Bennett E. D., Ward D., Camm A. J. Baroreflex sensitivity and electrophysiological correlates in patients after acute myocardial infarction. Circulation. 1991 Mar;83(3):945–952. doi: 10.1161/01.cir.83.3.945. [DOI] [PubMed] [Google Scholar]
  10. Giannattasio C., Seravalle G., Bolla G. B., Cattaneo B. M., Cléroux J., Cuspidi C., Sampieri L., Grassi G., Mancia G. Cardiopulmonary receptor reflexes in normotensive athletes with cardiac hypertrophy. Circulation. 1990 Oct;82(4):1222–1229. doi: 10.1161/01.cir.82.4.1222. [DOI] [PubMed] [Google Scholar]
  11. Gilligan D. M., Nihoyannopoulos P., Chan W. L., Oakley C. M. Investigation of a hemodynamic basis for syncope in hypertrophic cardiomyopathy. Use of a head-up tilt test. Circulation. 1992 Jun;85(6):2140–2148. doi: 10.1161/01.cir.85.6.2140. [DOI] [PubMed] [Google Scholar]
  12. Kleiger R. E., Miller J. P., Bigger J. T., Jr, Moss A. J. Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol. 1987 Feb 1;59(4):256–262. doi: 10.1016/0002-9149(87)90795-8. [DOI] [PubMed] [Google Scholar]
  13. La Rovere M. T., Specchia G., Mortara A., Schwartz P. J. Baroreflex sensitivity, clinical correlates, and cardiovascular mortality among patients with a first myocardial infarction. A prospective study. Circulation. 1988 Oct;78(4):816–824. doi: 10.1161/01.cir.78.4.816. [DOI] [PubMed] [Google Scholar]
  14. Maron B. J., Savage D. D., Wolfson J. K., Epstein S. E. Prognostic significance of 24 hour ambulatory electrocardiographic monitoring in patients with hypertrophic cardiomyopathy: a prospective study. Am J Cardiol. 1981 Aug;48(2):252–257. doi: 10.1016/0002-9149(81)90604-4. [DOI] [PubMed] [Google Scholar]
  15. McKenna W. J., Camm A. J. Sudden death in hypertrophic cardiomyopathy. Assessment of patients at high risk. Circulation. 1989 Nov;80(5):1489–1492. doi: 10.1161/01.cir.80.5.1489. [DOI] [PubMed] [Google Scholar]
  16. McKenna W. J., England D., Doi Y. L., Deanfield J. E., Oakley C., Goodwin J. F. Arrhythmia in hypertrophic cardiomyopathy. I: Influence on prognosis. Br Heart J. 1981 Aug;46(2):168–172. doi: 10.1136/hrt.46.2.168. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Niemelä M. J., Airaksinen K. E., Ikäheimo M. J., Takkunen J. T. Vagal heart rate control after percutaneous transluminal coronary angioplasty. Eur Heart J. 1990 Apr;11(4):320–322. doi: 10.1093/oxfordjournals.eurheartj.a059704. [DOI] [PubMed] [Google Scholar]
  18. O'Brien I. A., O'Hare P., Corrall R. J. Heart rate variability in healthy subjects: effect of age and the derivation of normal ranges for tests of autonomic function. Br Heart J. 1986 Apr;55(4):348–354. doi: 10.1136/hrt.55.4.348. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Palatini P., Mos L., Mormino P., Munari L., Del Torre M., Valle F., Scaldalai E., Pessina A. C. Intra-arterial blood pressure monitoring in the evaluation of the hypertensive athlete. Eur Heart J. 1990 Apr;11(4):348–354. doi: 10.1093/oxfordjournals.eurheartj.a059709. [DOI] [PubMed] [Google Scholar]
  20. Perloff J. K. Pathogenesis of hypertrophic cardiomyopathy: hypotheses and speculations. Am Heart J. 1981 Feb;101(2):219–226. doi: 10.1016/0002-8703(81)90669-4. [DOI] [PubMed] [Google Scholar]
  21. Schwartz P. J., Vanoli E., Stramba-Badiale M., De Ferrari G. M., Billman G. E., Foreman R. D. Autonomic mechanisms and sudden death. New insights from analysis of baroreceptor reflexes in conscious dogs with and without a myocardial infarction. Circulation. 1988 Oct;78(4):969–979. doi: 10.1161/01.cir.78.4.969. [DOI] [PubMed] [Google Scholar]
  22. Zipes D. P. Influence of myocardial ischemia and infarction on autonomic innervation of heart. Circulation. 1990 Oct;82(4):1095–1105. doi: 10.1161/01.cir.82.4.1095. [DOI] [PubMed] [Google Scholar]
  23. Zipes D. P. Sympathetic stimulation and arrhythmias. N Engl J Med. 1991 Aug 29;325(9):656–657. doi: 10.1056/NEJM199108293250911. [DOI] [PubMed] [Google Scholar]

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