Skip to main content
NCBI home page
British Heart Journal logoLink to British Heart Journal
. 1995 Feb;73(2):139–144. doi: 10.1136/hrt.73.2.139

Heart rate variability in left ventricular hypertrophy.

M K Mandawat 1, D R Wallbridge 1, S D Pringle 1, A A Riyami 1, S Latif 1, P W Macfarlane 1, A R Lorimer 1, S M Cobbe 1
PMCID: PMC483780  PMID: 7696023

Abstract

BACKGROUND--Electrocardiographic left ventricular hypertrophy and strain are associated with increased cardiac morbidity and mortality. Impaired cardiac autonomic function, assessed non-invasively by spontaneous heart rate variability on Holter monitoring, is associated with an increased risk of sudden death after myocardial infarction. AIM--To study the effect of left ventricular hypertrophy on heart rate variability. PATIENTS--36 controls and 154 patients with left ventricular hypertrophy (94 with hypertension and 60 with aortic valve disease). SETTING--Tertiary referral centre. METHODS--Heart rate variability was measured on 24 h Holter recordings by non-spectral methods. Left ventricular mass index and fractional shortening were measured by echocardiography. RESULTS--Patients with left ventricular hypertrophy had a higher left ventricular mass index (P < 0.001) and reduced heart rate variability (P < 0.001) compared with those of the controls. A continuous inverse relation was apparent between heart rate variability and left ventricular mass index (r = -0.478, P < 0.001). Heart rate variability was not affected by age, the presence of coronary artery disease in patients with left ventricular hypertrophy, or beta blocker treatment for hypertension. Multivariate analysis showed that left ventricular mass index is the most important determinant of heart rate variability. CONCLUSION--Heart rate variability is significantly reduced in patients with left ventricular hypertrophy secondary to hypertension or aortic valve disease. A continuous inverse relation exists between heart rate variability and left ventricular mass index. Impaired cardiac autonomic function in left ventricular hypertrophy may contribute to the mechanism of sudden death.

Full text

PDF
139

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  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. Bigger J. T., Jr, Kleiger R. E., Fleiss J. L., Rolnitzky L. M., Steinman R. C., Miller J. P. Components of heart rate variability measured during healing of acute myocardial infarction. Am J Cardiol. 1988 Feb 1;61(4):208–215. doi: 10.1016/0002-9149(88)90917-4. [DOI] [PubMed] [Google Scholar]
  3. Cripps T. R., Malik M., Farrell T. G., Camm A. J. Prognostic value of reduced heart rate variability after myocardial infarction: clinical evaluation of a new analysis method. Br Heart J. 1991 Jan;65(1):14–19. doi: 10.1136/hrt.65.1.14. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Devereux R. B., Lutas E. M., Casale P. N., Kligfield P., Eisenberg R. R., Hammond I. W., Miller D. H., Reis G., Alderman M. H., Laragh J. H. Standardization of M-mode echocardiographic left ventricular anatomic measurements. J Am Coll Cardiol. 1984 Dec;4(6):1222–1230. doi: 10.1016/s0735-1097(84)80141-2. [DOI] [PubMed] [Google Scholar]
  5. Devereux R. B., Reichek N. Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation. 1977 Apr;55(4):613–618. doi: 10.1161/01.cir.55.4.613. [DOI] [PubMed] [Google Scholar]
  6. Ewing D. J. Heart rate variability: an important new risk factor in patients following myocardial infarction. Clin Cardiol. 1991 Aug;14(8):683–685. doi: 10.1002/clc.4960140811. [DOI] [PubMed] [Google Scholar]
  7. Ewing D. J., Neilson J. M., Shapiro C. M., Stewart J. A., Reid W. Twenty four hour heart rate variability: effects of posture, sleep, and time of day in healthy controls and comparison with bedside tests of autonomic function in diabetic patients. Br Heart J. 1991 May;65(5):239–244. doi: 10.1136/hrt.65.5.239. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Farrell T. G., Bashir Y., Cripps T., Malik M., Poloniecki J., Bennett E. D., Ward D. E., Camm A. J. Risk stratification for arrhythmic events in postinfarction patients based on heart rate variability, ambulatory electrocardiographic variables and the signal-averaged electrocardiogram. J Am Coll Cardiol. 1991 Sep;18(3):687–697. doi: 10.1016/0735-1097(91)90791-7. [DOI] [PubMed] [Google Scholar]
  9. Friberg P., Karlsson B., Nordlander M. Sympathetic and parasympathetic influence on blood pressure and heart rate variability in Wistar-Kyoto and spontaneously hypertensive rats. J Hypertens Suppl. 1988 Dec;6(4):S58–S60. doi: 10.1097/00004872-198812040-00014. [DOI] [PubMed] [Google Scholar]
  10. Hayano J., Sakakibara Y., Yamada M., Ohte N., Fujinami T., Yokoyama K., Watanabe Y., Takata K. Decreased magnitude of heart rate spectral components in coronary artery disease. Its relation to angiographic severity. Circulation. 1990 Apr;81(4):1217–1224. doi: 10.1161/01.cir.81.4.1217. [DOI] [PubMed] [Google Scholar]
  11. Hrushesky W. J., Fader D., Schmitt O., Gilbertsen V. The respiratory sinus arrhythmia: a measure of cardiac age. Science. 1984 Jun 1;224(4652):1001–1004. doi: 10.1126/science.6372092. [DOI] [PubMed] [Google Scholar]
  12. Kannel W. B., Gordon T., Offutt D. Left ventricular hypertrophy by electrocardiogram. Prevalence, incidence, and mortality in the Framingham study. Ann Intern Med. 1969 Jul;71(1):89–105. doi: 10.7326/0003-4819-71-1-89. [DOI] [PubMed] [Google Scholar]
  13. Kleiger R. E., Bigger J. T., Bosner M. S., Chung M. K., Cook J. R., Rolnitzky L. M., Steinman R., Fleiss J. L. Stability over time of variables measuring heart rate variability in normal subjects. Am J Cardiol. 1991 Sep 1;68(6):626–630. doi: 10.1016/0002-9149(91)90355-o. [DOI] [PubMed] [Google Scholar]
  14. 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]
  15. Lown B., Verrier R. L. Neural activity and ventricular fibrillation. N Engl J Med. 1976 May 20;294(21):1165–1170. doi: 10.1056/NEJM197605202942107. [DOI] [PubMed] [Google Scholar]
  16. Macfarlane P. W., Devine B., Latif S., McLaughlin S., Shoat D. B., Watts M. P. Methodology of ECG interpretation in the Glasgow program. Methods Inf Med. 1990 Sep;29(4):354–361. [PubMed] [Google Scholar]
  17. Masaoka S., Lev-Ran A., Hill L. R., Vakil G., Hon E. H. Heart rate variability in diabetes: relationship to age and duration of the disease. Diabetes Care. 1985 Jan-Feb;8(1):64–68. doi: 10.2337/diacare.8.1.64. [DOI] [PubMed] [Google Scholar]
  18. McDonald I. G., Feigenbaum H., Chang S. Analysis of left ventricular wall motion by reflected ultrasound. Application to assessment of myocardial function. Circulation. 1972 Jul;46(1):14–25. doi: 10.1161/01.cir.46.1.14. [DOI] [PubMed] [Google Scholar]
  19. McLenachan J. M., Henderson E., Morris K. I., Dargie H. J. Ventricular arrhythmias in patients with hypertensive left ventricular hypertrophy. N Engl J Med. 1987 Sep 24;317(13):787–792. doi: 10.1056/NEJM198709243171302. [DOI] [PubMed] [Google Scholar]
  20. Messerli F. H., Ventura H. O., Elizardi D. J., Dunn F. G., Frohlich E. D. Hypertension and sudden death. Increased ventricular ectopic activity in left ventricular hypertrophy. Am J Med. 1984 Jul;77(1):18–22. doi: 10.1016/0002-9343(84)90430-3. [DOI] [PubMed] [Google Scholar]
  21. Nolan J., Flapan A. D., Capewell S., MacDonald T. M., Neilson J. M., Ewing D. J. Decreased cardiac parasympathetic activity in chronic heart failure and its relation to left ventricular function. Br Heart J. 1992 Jun;67(6):482–485. doi: 10.1136/hrt.67.6.482. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Pipilis A., Flather M., Ormerod O., Sleight P. Heart rate variability in acute myocardial infarction and its association with infarct site and clinical course. Am J Cardiol. 1991 May 15;67(13):1137–1139. doi: 10.1016/0002-9149(91)90880-t. [DOI] [PubMed] [Google Scholar]
  23. Pringle S. D., Dunn F. G., Tweddel A. C., Martin W., Macfarlane P. W., McKillop J. H., Lorimer A. R., Cobbe S. M. Symptomatic and silent myocardial ischaemia in hypertensive patients with left ventricular hypertrophy. Br Heart J. 1992 May;67(5):377–382. doi: 10.1136/hrt.67.5.377. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Woo M. A., Stevenson W. G., Moser D. K., Trelease R. B., Harper R. M. Patterns of beat-to-beat heart rate variability in advanced heart failure. Am Heart J. 1992 Mar;123(3):704–710. doi: 10.1016/0002-8703(92)90510-3. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES