Deceleration capacity reflects cardiac mechanics and filling pressures in chronic heart failure

Background Autonomic modulation of heart rate—quantified by acceleration capacity (AC) and deceleration capacity (DC) from 24-hour Holter ECG—has been implicated in ventricular systolic and diastolic function. Transthoracic echocardiography offers a spectrum of parameters to characterize myocardial performance and filling pressures. Understanding how AC and DC relate to these echocardiographic indices may reveal physiological links between autonomic tone and cardiac mechanics. Purpose To evaluate the correlations between acceleration capacity and deceleration capacity of heart rate variability and key echocardiographic parameters of systolic function, diastolic function, atrial remodeling, and right ventricular performance in patients with chronic heart failure. Methods In a cohort of 140 patients with chronic heart failure, AC and DC were computed from 24-hour Holter recordings. Echocardiographic measurements included systolic and diastolic function and right ventricular systolic function. Results AC showed a significant but weak negative correlation with LVEF (ρ modestly below zero) and lateral S′, indicating lower acceleration capacity in patients with impaired global and longitudinal systolic function; however, AC did not correlate significantly with LVEDD or septal S′. In contrast, DC correlated more robustly: a moderate positive correlation with LVEF and lateral S′, and a significant negative correlation with LVEDD, suggesting better systolic function and more normal ventricular dimensions in patients with higher deceleration capacity. Regarding diastolic function, AC had a moderate negative correlation with isovolumic relaxation time and E′ septal, and positive correlations with E/E′ septal and E/E′ mean, linking diminished acceleration capacity to shorter relaxation times and elevated filling pressures. DC exhibited its strongest positive correlation with E′ septal and significant negative correlations with E/E′ septal and IVRT, marking DC as a sensitive indicator of early diastolic dysfunction. For atrial remodeling, AC had no statistically significant correlations with left atrial volume or LAVi, but DC demonstrated a moderate negative correlation with both, implying improved atrial compliance in patients with higher deceleration capacity. Right ventricular parameters showed MAPSE correlating positively with both AC and DC—strongest with DC—while TAPSE correlated negatively only with AC; DC was not significantly related to TAPSE. Finally, DC exhibited the strongest negative correlation with PAPs, suggesting that enhanced deceleration capacity associates with lower pulmonary pressures. Conclusions Deceleration capacity consistently demonstrated stronger and more statistically significant correlations across systolic, diastolic, atrial, and pulmonary hemodynamic parameters than acceleration capacity. DC emerges as a more robust marker of both systolic and diastolic myocardial performance and atrial remodeling.