Key result
Pulmonary arterial hypertension was associated with reduced high-frequency heart rate variability (239 vs 563 ms2; p<0.05) and blunted baroreflex sensitivity (5.8 vs 13.9 ms/mmHg; p<0.01).
Observational (n=89)
Absolute Event Rate: 239% vs 563%
p-value: p=<0.05
Patients with pulmonary arterial hypertension exhibit marked alterations in cardiac autonomic control that correlate with reduced exercise capacity, suggesting it may serve as an additional marker of disease severity.
May support autonomic metrics as adjunct PAH severity markers; leaves open prospective validation before clinical use.
Pulmonary arterial hypertension (PAH) results in chronic right heart failure, which is associated with an increase in sympathetic tone. This may adversely affect cardiac autonomic control. We investigated the changes in cardiac autonomic nervous activity in relation to disease severity in patients with PAH. In 48 patients with PAH (median World Health Organization class III, pulmonary artery pressure 52+/-14 mmHg, pulmonary vascular resistance 1,202+/-718 dyn x s x cm(-5), cardiac index 2.0+/-0.8 L x min(-1) x m(-2)) and 41 controls, cardiac autonomic nervous activity was evaluated by measurement of heart rate variability (HRV) and baroreflex sensitivity. All patients underwent cardiopulmonary exercise testing (peak oxygen uptake 13.2+/-5.1 mL x kg(-1) x min(-1), minute ventilation/carbon dioxide production slope 47+/-16). In patients with PAH, spectral power of HRV was reduced in the high-frequency (239+/-64 versus 563+/-167 ms2), low-frequency (245+/-58 versus 599+/-219 ms2) and very low-frequency bands (510+/-149 versus 1106+/-598 ms2; all p<0.05). Baroreflex sensitivity was also blunted (5.8+/-0.6 versus 13.9+/-1.2 ms x mmHg(-1); p<0.01). The reduction in high-frequency (r = 0.3, p = 0.04) and low-frequency (r = 0.33, p = 0.02) spectral power and baroreflex sensitivity (r = 0.46, p<0.01) was related to the reduction in peak oxygen uptake. Patients with PAH have a marked alteration in cardiac autonomic control that is related to exercise capacity and may, therefore, serve as an additional marker of disease severity.
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Wensel et al. (2009) conducted an observational in Pulmonary arterial hypertension (n=89). Pulmonary arterial hypertension vs. Controls was evaluated on High-frequency heart rate variability (ms2) (p=<0.05). Pulmonary arterial hypertension was associated with reduced high-frequency heart rate variability (239 vs 563 ms2; p<0.05) and blunted baroreflex sensitivity (5.8 vs 13.9 ms/mmHg; p<0.01).