Heart Rate Variability Behavior Research Articles

Assessing cardiovascular stress based on heart rate variability in female shift workers: a multiscale-multifractal analysis approach.

Sleep-wake cycle disruption caused by shift work may lead to cardiovascular stress, which is observed as an alteration in the behavior of heart rate variability (HRV). In particular, HRV exhibits complex patterns over different time scales that help to understand the regulatory mechanisms of the autonomic nervous system, and changes in the fractality of HRV may be associated with pathological conditions, including cardiovascular disease, diabetes, or even psychological stress. The main purpose of this study is to evaluate the multifractal-multiscale structure of HRV during sleep in healthy shift and non-shift workers to identify conditions of cardiovascular stress that may be associated with shift work. The whole-sleep HRV signal was analyzed from female participants: eleven healthy shift workers and seven non-shift workers. The HRV signal was decomposed into intrinsic mode functions (IMFs) using the empirical mode decomposition method, and then the IMFs were analyzed using the multiscale-multifractal detrended fluctuation analysis (MMF-DFA) method. The MMF-DFA was applied to estimate the self-similarity coefficients, α(q, τ), considering moment orders (q) between -5 and +5 and scales (τ) between 8 and 2,048 s. Additionally, to describe the multifractality at each τ in a simple way, a multifractal index, MFI(τ), was computed. Compared to non-shift workers, shift workers presented an increase in the scaling exponent, α(q, τ), at short scales (τ < 64 s) with q < 0 in the high-frequency component (IMF1, 0.15-0.4 Hz) and low-frequency components (IMF2-IMF3, 0.04-0.15 Hz), and with q> 0 in the very low frequencies (IMF4, < 0.04 Hz). In addition, at large scales (τ> 1,024 s), a decrease in α(q, τ) was observed in IMF3, suggesting an alteration in the multifractal dynamic. MFI(τ) showed an increase at small scales and a decrease at large scales in IMFs of shift workers. This study helps to recognize the multifractality of HRV during sleep, beyond simply looking at indices based on means and variances. This analysis helps to identify that shift workers show alterations in fractal properties, mainly on short scales. These findings suggest a disturbance in the autonomic nervous system induced by the cardiovascular stress of shift work.

Variabilidade da frequência cardíaca, escalas psicométricas e desempenho de saltos em atletas de voleibol: jogos em casa e fora

The home advantage is very consolidated in the literature. The aim of this research was to evaluate the behavior of heart rate variability (HRV), perceived recovery status (PRS) and rating of perceived exertion (RPE) and vertical jumps performance in professional volleyball athletes in home and away matches. Nine male professional volleyball athletes (25,66 ± 5,7 anos, 97,81 ± 8,65 Kg and 200,94 ± 5,19 cm), with experience in national and international competitions participated in the study. HRV and PRS were evaluated in the morning of the matches. RPE was collected immediately after the matches. Jump performance was monitored during the matches. The data was grouped by home matches and away matches and the t test or Wilcoxon test was performed for comparison. Significance level adopted was α ≤ 0.05. Effect size was analyzed by Cohen’s d coefficient. O nível de significância adotado foi α ≤ 0,05. There were no significant difference in HRV, PRS, RPE, jumps height and number of jumps evaluated in home matches and away matches. We conclude that despite the home advantage consolidated in the literature and possible adverse effects of travel on away matches, the VFC, PRS, RPE and jump performance were similar in the two situations evaluated.

The influence of the angiotensin-converting enzyme gene polymorphism and physical activity level on blood pressure and heart rate variability behavior

The influence of the angiotensin-converting enzyme gene polymorphism and physical activity level on blood pressure and heart rate variability behavior

Heart rate variability behavior in athletes after a sports concussion: A systematic review.

This systematic review aims to investigate the adaptations of the autonomic nervous system (ANS) after a concussion by measuring HRV in athletes over the age of 16 after injury. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Web of Science, Pubmed, SCOPUS, and Sport Discus were searched using predefined search terms to identify relevant original cross-sectional, longitudinal, and cohort epidemiological studies published before December 2021. After screening 1737 potential articles, four studies met the inclusion criteria. Studies included participants with concussion (n = 63) and healthy control athletes (n = 140) who practised different sports. Two studies describe a decrease in HRV following a sports concussion, and one proposed that the resolution of symptoms does not necessarily reflect ANS recovery. Lastly, one study concluded that submaximal exercise induces alteration in ANS, not seen in rest after an injury. In the frequency domain, a decrease in high frequency power and an increase of low frequency/high frequency ratio is expected, as the activity of the sympathetic nervous system increases, and the parasympathetic nervous system decreases after injury. In the frequency domain, heart rate variability (HRV) may help monitor the activity of ANS evaluating signals of somatic tissue distress and early identification of other types of musculoskeletal injuries. Further research should investigate the relationship between HRV and other musculoskeletal injuries.

Heart rate variability behavior in young men after short-term carotenoid-containing supplementation

BackgroundHeart rate variability can reflect the risk of developing cardiovascular disease (CVD), while carotenoids are good for CVD prevention. However, the acute effect of short-term carotenoid-containing supplementation on heart rate variability in young men is unclear. MethodsThirty young men between 20 and 29 years of age without personal or family history of cardiovascular diseases were randomly divided into control and experimental groups. The anthropometric data, physiological parameters, and serum biochemical data were acquired, which were without significant difference between the two groups, at the beginning of trial. The participants in the experimental group consumed one pack of compound nutritional supplements in the morning (e.g., 10 AM) and another pack at night (e.g., 7 PM) each day. Heart rate variability was measured again once a month. Repeated measures analysis of variance with Roy’s largest root test and Bonferroni post hoc test were applied for primary outcomes. ResultsRepeated measures analysis of variance indicated a significant time interaction effect for the estimated marginal means of percussion entropy index scale (T1 versus T3, T1 versus T4, and T2 versus T4 with p = 0.009, 0.005, and 0.032, respectively). Roy’s largest root test indicates there were significant differences between the means of the index after the intervention between two groups only on T3 and T4 (p = 0.007, η2 = 0.232 and p = 0.028, η2 = 0.162, respectively). ConclusionShort-term carotenoid-containing supplementation could help young men by increasing heart rate variability capacity compared to controls over three months.

Active force generation contributes to the complexity of spontaneous activity and to the response to stretch of murine cardiomyocyte cultures.

Cardiomyocyte cultures exhibit spontaneous electrical and contractile activity, as in a natural cardiac pacemaker. In such preparations, beat rate variability exhibits features similar to those of heart rate variability in vivo. Mechanical deformations and forces feed back on the electrical properties of cardiomyocytes, but it is not fully elucidated how this mechano‐electrical interplay affects beating variability in such preparations. Using stretchable microelectrode arrays, we assessed the effects of the myosin inhibitor blebbistatin and the non‐selective stretch‐activated channel blocker streptomycin on beating variability and on the response of neonatal or fetal murine ventricular cell cultures against deformation. Spontaneous electrical activity was recorded without stretch and upon predefined deformation protocols (5% uniaxial and 2% equibiaxial strain, applied repeatedly for 1 min every 3 min). Without stretch, spontaneous activity originated from the edge of the preparations, and its site of origin switched frequently in a complex manner across the cultures. Blebbistatin did not change mean beat rate, but it decreased the spatial complexity of spontaneous activity. In contrast, streptomycin did not exert any manifest effects. During the deformation protocols, beat rate increased transiently upon stretch but, paradoxically, also upon release. Blebbistatin attenuated the response to stretch, whereas this response was not affected by streptomycin. Therefore, our data support the notion that in a spontaneously firing network of cardiomyocytes, active force generation, rather than stretch‐activated channels, is involved mechanistically in the complexity of the spatiotemporal patterns of spontaneous activity and in the stretch‐induced acceleration of beating. Key points Monolayer cultures of cardiac cells exhibit spontaneous electrical and contractile activity, as in a natural cardiac pacemaker. Beating variability in these preparations recapitulates the power‐law behaviour of heart rate variability in vivo. However, the effects of mechano‐electrical feedback on beating variability are not yet fully understood.Using stretchable microelectrode arrays, we examined the effects of the contraction uncoupler blebbistatin and the non‐specific stretch‐activated channel blocker streptomycin on beating variability and on stretch‐induced changes of beat rate.Without stretch, blebbistatin decreased the spatial complexity of beating variability, whereas streptomycin had no effects.Both stretch and release increased beat rate transiently; blebbistatin attenuated the increase of beat rate upon stretch, whereas streptomycin had no effects.Active force generation contributes to the complexity of spatiotemporal patterns of beating variability and to the increase of beat rate upon mechanical deformation. Our study contributes to the understanding of how mechano‐electrical feedback influences heart rate variability.

Fetal Cardiovascular Decompensation During Labor Predicted From the Individual Heart Rate Tracing: A Machine Learning Approach in Near-Term Fetal Sheep Model.

Background: When exposed to repetitive umbilical cord occlusions (UCO) with worsening acidemia, fetuses eventually develop cardiovascular decompensation manifesting as pathological hypotensive arterial blood pressure (ABP) responses to fetal heart rate (FHR) decelerations. Failure to maintain cardiac output during labor is a key event leading up to brain injury. We reported that the timing of the event when a fetus begins to exhibit this cardiovascular phenotype is highly individual and was impossible to predict.Objective: We hypothesized that this phenotype would be reflected in the individual behavior of heart rate variability (HRV) as measured by root mean square of successive differences of R-R intervals (RMSSD), a measure of vagal modulation of HRV, which is known to increase with worsening acidemia. This is clinically relevant because HRV can be computed in real-time intrapartum. Consequently, we aimed to predict the individual timing of the event when a hypotensive ABP pattern would emerge in a fetus from a series of continuous RMSSD data.Study Design: Fourteen near-term fetal sheep were chronically instrumented with vascular catheters to record fetal arterial blood pressure, umbilical cord occluder to mimic uterine contractions occurring during human labor and ECG electrodes to compute the ECG-derived HRV measure RMSSD. All animals were studied over a ~6 h period. After a 1–2 h baseline control period, the animals underwent mild, moderate, and severe series of repetitive UCO. We applied the recently developed machine learning algorithm to detect physiologically meaningful changes in RMSSD dynamics with worsening acidemia and hypotensive responses to FHR decelerations. To mimic clinical scenarios using an ultrasound-based 4 Hz FHR sampling rate, we recomputed RMSSD from FHR sampled at 4 Hz and compared the performance of our algorithm under both conditions (1,000 Hz vs. 4 Hz).Results: The RMSSD values were highly non-stationary, with four different regimes and three regime changes, corresponding to a baseline period followed by mild, moderate, and severe UCO series. Each time series was characterized by seemingly randomly occurring (in terms of timing of the individual onset) increase in RMSSD values at different time points during the moderate UCO series and at the start of the severe UCO series. This event manifested as an increasing trend in RMSSD values, which counter-intuitively emerged as a period of relative stationarity for the time series. Our algorithm identified these change points as the individual time points of cardiovascular decompensation with 92% sensitivity, 86% accuracy and 92% precision which corresponded to 14 ± 21 min before the visual identification. In the 4 Hz RMSSD time series, the algorithm detected the event with 3 times earlier detection times than at 1,000 Hz, i.e., producing false positive alarms with 50% sensitivity, 21% accuracy, and 27% precision. We identified the overestimation of baseline FHR variability by RMSSD at a 4 Hz sampling rate to be the cause of this phenomenon.Conclusions: The key finding is demonstration of FHR monitoring to detect fetal cardiovascular decompensation during labor. This validates the hypothesis that our HRV-based algorithm identifies individual time points of ABP responses to UCO with worsening acidemia by extracting change point information from the physiologically related fluctuations in the RMSSD signal. This performance depends on the acquisition accuracy of beat to beat fluctuations achieved in trans-abdominal ECG devices and fails at the sampling rate used clinically in ultrasound-based systems. This has implications for implementing such an approach in clinical practice.

Heart Rate Variability Behavior during Exercise and Short-Term Recovery Following Energy Drink Consumption in Men and Women.

This study examined the cardiac autonomic responses, as measured by heart rate variability (HRV), during cycling exercise and short-term rest after energy drink consumption. Seventeen participants (seven males and 10 females; age: 22.8 ± 3.5 years; BMI: 24.3 ± 3.3 kg/m2) completed this double-blind, placebo-controlled, counterbalanced crossover design study. Participants received an energy drink formula containing 140 mg of caffeine and a placebo in a randomized order before completing a 10-min steady-state warm up (WUP) and a graded exercise test to exhaustion (GXT) followed by a 15-min short-term rest (STR) period. Heartbeat intervals were recorded using a heart rate monitor. Data were divided into WUP, GXT, and STR phases, and HRV parameters were averaged within each phase. Additionally, root mean square of the standard deviation of R–R intervals (RMSSD) during GXT was analyzed to determine the HRV threshold. Separate two-way (sex (male vs. female) x drink (energy drink vs. placebo)) repeated measures ANOVA were utilized. Significant increases in high frequency (HF) and RMSSD were shown during WUP after energy drink consumption, while interactions between drink and sex were observed for HRV threshold parameters (initial RMSSD and rate of RMSSD decline). No significant differences were noted during STR. Energy drink consumption may influence cardiac autonomic responses during low-intensity exercise, and sex-based differences in response to graded exercise to exhaustion may exist.

Chaotic global analysis of heart rate variability following power spectral adjustments during exposure to traffic noise in healthy adult women

Aim. Previous studies have described the substantial impact of different types of noise on the linear behaviour of heart rate variability (HRV). Yet, there are limited studies about the complexity or nonlinear dynamics of HRV during exposure to traffic noise. Here, we evaluated the complexity of HRV during traffic noise exposure via six power spectra and, when adjusted by the parameters of the Multi-Taper Method (MTM).Material and methods. We analysed 31 healthy female students between 18 and 30 years old. Subjects remained at rest, seated under spontaneous breathing for 20 minutes with an earphone turned off and then the volunteers were exposed to traffic noise through an earphone for a period of 20 minutes. The traffic noise was recorded from a busy urban street and the sound involved car, bus, trucks engineers and horn sounds (71-104 dB).Results. The results stipulate that CFP3 and CFP6 are the best metrics to distinguish the two groups. The most appropriate power spectra were, Welch and MTM. Increasing the DPSS parameter of MTM increased the performance of both CFP3 and CFP6 as mathematical markers. Adaptive was the preferred type for Thomson’s nonlinear combination method.Conclusion. CFP3 with the adaptive option for MTM, and increased DPSS is designated as the best mathematical marker on the basis of five statistical tests.

Linear and Complex Measures of Heart Rate Variability during Exposure to Traffic Noise in Healthy Women

Previous studies have described significant impact of different types of noise on the linear behavior of heart rate variability (HRV). However, there are few studies regarding the complexity of HRV during exposure to traffic noise. In this study, we evaluated the complexity of HRV during traffic noise exposure. We analyzed 31 healthy female students aged between 18 and 30 years. Volunteers remained at rest seated under spontaneous breathing during 10 minutes with an earphone turned off, and then they were exposed to traffic noise through an earphone for a period of 10 minutes. The traffic noise was recorded from a very busy city street and the sound was comprised of car, bus, and trucks engines and horn (71–104 dB). We observed no significant changes in the linear analysis of HRV. CFP3 (Cohen’s d = 1.28, large effect size) and CFP6 (Cohen’s d = 1.11, large effect size) parameters of chaotic global analysis and Shannon (Cohen’s d = 1.13, large effect size), Renyi (Cohen’s d = 1.06, large effect size), and Tsallis (Cohen’s d = 1.14, large effect size) entropies significantly increased (p &lt; 0.005) during traffic noise exposure. In conclusion, traffic noise under laboratory conditions increased the complexity of HRV through chaotic global analysis and some measures of entropy in healthy females.

Behavior of Heart Rate Variability After 10 Repetitions Maximum Load Test for Lower Limbs

Behavior of Heart Rate Variability After 10 Repetitions Maximum Load Test for Lower Limbs

Fractal scaling behavior of heart rate variability in response to meditation techniques

The rescaled range (R/S) analysis was used for analyzing the fractal scaling properties of heart rate variability (HRV) of subjects undergoing premeditation and meditation states. Eight novice subjects and four advanced practitioners were considered. The corresponding pre-meditation and meditation HRV data were obtained from the Physionet database. The results showed that mindfulness meditation induces a decrement of the HRV long-range scaling correlations as quantified with the time-variant Hurst exponent. The Hurst exponent for advanced meditation practitioners decreases up to values of 0.5, reflecting uncorrelated (e.g., white noise-like) HRV dynamics. Some parallelisms between mindfulness meditation and deep sleep (Stage 4) are discussed, suggesting that the former can be regarded as a type of induced deep sleep-like dynamics.

Chaotic analysis of heart rate dynamics after an exercise with flexible pole

INTRODUCTION: Exercises with a flexible pole have been applied in clinical practice for upper limb rehabilitation. Nevertheless, its acute effects on cardiac autonomic regulation are unclear. OBJECTIVE: To evaluate the acute effects of exercise with flexible pole on complex behavior of heart rate variability (HRV). METHOD: We investigated 32 healthy female volunteers aged between 18 and 25 years who performed a session of exercise with a flexible pole. HRV was analyzed 10 minutes before and 10 minutes immediately after the exercise. RESULTS: Exercises with a flexible pole did not significantly change time and frequency domain indices of HRV. Non-linear analysis of HRV through the Higuchi Fractal Dimension was not significantly changed during recovery from exercise compared to the control reading at rest. CONCLUSION: Exercises with the flexible pole were unable to acutely change chaotic behavior of heart rate dynamics. This is advantageous for assessments of levels of rehabilitative treatment required in such patients; and their susceptibility to dynamical diseases.

The recursive combination filter approach of pre-processing for the estimation of standard deviation of RR series.

Variation in the interval between the R-R peaks of the electrocardiogram represents the modulation of the cardiac oscillations by the autonomic nervous system. This variation is contaminated by anomalous signals called ectopic beats, artefacts or noise which mask the true behaviour of heart rate variability. In this paper, we have proposed a combination filter of recursive impulse rejection filter and recursive 20% filter, with recursive application and preference of replacement over removal of abnormal beats to improve the pre-processing of the inter-beat intervals. We have tested this novel recursive combinational method with median method replacement to estimate the standard deviation of normal to normal (SDNN) beat intervals of congestive heart failure (CHF) and normal sinus rhythm subjects. This work discusses the improvement in pre-processing over single use of impulse rejection filter and removal of abnormal beats for heart rate variability for the estimation of SDNN and Poncaré plot descriptors (SD1, SD2, and SD1/SD2) in detail. We have found the 22 ms value of SDNN and 36 ms value of SD2 descriptor of Poincaré plot as clinical indicators in discriminating the normal cases from CHF cases. The pre-processing is also useful in calculation of Lyapunov exponent which is a nonlinear index as Lyapunov exponents calculated after proposed pre-processing modified in a way that it start following the notion of less complex behaviour of diseased states.

Heart rate variability during high-intensity exercise

The aim of this paper is to describe and analyse the behaviour of heart rate variability (HRV) during constant-load, high-intensity exercise using a time frequency analysis (Wavelet Transform). Eleven elite cyclists took part in the study (age: 18.6±3.0 years; VO2max: 4.88±0.61 litres·min−1). Initially, all subjects performed an incremental cycloergometer test to determine load power in a constant load-test (379.55±36.02 W; 89.0%). HRV declined dramatically from the start of testing (p <0.05). The behaviour of power spectral density within the LF band mirrored that of total energy, recording a significant decrease from the outset LF peaks fell rapidly thereafter, remaining stable until the end of the test. HF-VHF fell sharply in the first 20 to 30 seconds. The relative weighting (%) of HF-VHF was inverted with the onset of fatigue, [1.6% at the start, 7.1 (p <0.05) at the end of the first phase, and 43.1% (p <0.05) at the end of the test]. HF-VHFpeak displayed three phases: a moderate initial increase, followed by a slight fall, thereafter increasing to the end of the test. The LF/HF-VHF ratio increased at the start, later falling progressively until the end of the first phase and remaining around minimal values until the end of the test.

Use of Sample Entropy Approach to Study Heart Rate Variability in Obstructive Sleep Apnea Syndrome

Sample entropy, a nonlinear signal processing approach, was used as a measure of signal complexity to evaluate the cyclic behavior of heart rate variability (HRV) in obstructive sleep apnea syndrome (OSAS). In a group of 10 normal and 25 OSA subjects, the sample entropy measure showed that normal subjects have significantly more complex HRV pattern than the OSA subjects (p < 0.005). When compared with spectral analysis in a minute-by-minute classification, sample entropy had an accuracy of 70.3% (69.5% sensitivity, 70.8% specificity) while the spectral analysis had an accuracy of 70.4% (71.3% sensitivity, 69.9% specificity). The combination of the two methods improved the accuracy to 72.9% (72.2% sensitivity, 73.3% specificity). The sample entropy approach does not show major improvement over the existing methods. In fact, its accuracy in detecting sleep apnea is relatively low in the well classified data of the physionet. Its main achievement however, is the simplicity of computation. Sample entropy and other nonlinear methods might be useful tools to detect apnea episodes during sleep.

Cardiac Resynchronization Therapy and phase resetting of the sinoatrial node: A conjecture

Congestive heart failure is a severe chronic disease often associated with disorders that alter the mechanisms of excitation-contraction coupling that may result in an asynchronous left ventricular motion which may further impair the ability of the failing heart to eject blood. In recent years a therapeutic approach to resynchronize the ventricles (cardiac resynchronization therapy, CRT) has been performed through the use of a pacemaker device able to provide atrial-based biventricular stimulation. Atrial lead senses the spontaneous occurrence of cells depolarization and sends the information to the generator which, in turn, after a settled delay [atrioventricular (AV) delay], sends electrical impulses to both ventricles to stimulate their synchronous contraction. Recent studies performed on heart rate behavior of chronically implanted patients at different epochs after implantation have shown that CRT can lead to sustained overall improvement of heart function with a reduction in morbidity and mortality. At this moment, however, there are no studies about CRT effects on spontaneous heart activity of chronically implanted patients. We performed an experimental study in which the electrocardiographic signal of five subjects under chronic CRT was recorded during the activity of the pacemaker programmed at different AV delays and under spontaneous cardiac activity after pacemaker deactivation. The different behavior of heart rate variability during pacemaker activity and after pacemaker deactivation suggested the hypothesis of a phase resetting mechanism induced by the pacemaker stimulus on the sinoatrial (SA) node, a phenomenon already known in literature for aggregate of cardiac cells, but still unexplored in vivo. The constraints imposed by the nature of our study (in vivo tests) made it impossible to plan an experiment to prove our hypothesis directly. We therefore considered the best attainable result would be to prove the accordance of our data to the conjecture through the use of models and physical considerations. We first used the data of literature on far-field effects of cardiac defibrillators to prove that the pacemaker impulses delivered to the two ventricles were able to induce modifications in membrane voltage at the level of the SA node. To simulate a phase resetting mechanism of the SA node, we used a Van der Pol modified model to allow the possibility of changing the refractory period and the firing frequency of the cells separately. With appropriate parameters of the model we reproduced phase response curves that can account for our experimental data. Furthermore, the simulated curves closely resemble the functional form proposed in literature for perturbed aggregate of cardiac cells. Despite the small sample of subjects investigated and the limited number of ECG recordings at different AV delays, we think we have proved the plausibility of the proposed conjecture.

Heart rate variability behaviour during cardiac resynchronization therapy

The influence of cardiac resynchronization therapy (CRT) on heart rate variability (HRV) and therefore on autonomic nervous system in the heart has been discussed recently. Purpose of the study to assess the behaviour of HRV parameters in patients (pts) with chronic heart failure (CHF) treated with CRT therapy in three months follow-up. Methods The study group consisted of 17 pts (3F,14M, aged 53±9 years) with CHF at NYHA class III, EF<35% and significant systolic dyssynchrony of the left ventricle in whom BIV pacemakers InSyncIII (Medtronic) were implanted. HRV “time domain” parameters were calculated based on 24-hour digital Holter monitoring which was performed: before the procedure (I), 3-4(II) days after, 1(III), and 3(IV) months after BIV implantation. View this table: Conclusions The decrease of HRV immediately after BIV implantation and the tendency of HRV improvement during CRT therapy in three months follow-up are observed. CRT therapy may improve the autonomic tone in the heart.

Scaling and wavelet-based analyses of the long-term heart rate variability of the Eastern Oyster

Characterisations of the long-term behaviour of heart rate variability in humans have emerged in the last few years as promising candidates to become clinically significant tools. We present two different statistical analyses of long-time recordings of the heart rate variation in the Eastern Oyster. The circulatory system of this marine mollusk has important anatomical and physiological dissimilitudes compared to that of humans and it is exposed to dramatically different environmental influences. Our results resemble those previously obtained in humans. This suggests that in spite of the discrepancies, the mechanisms of long-term cardiac control on both systems share a common underlying dynamic.

Reversal of deteriorated fractal behavior of heart rate variability by beta-blocker therapy in patients with advanced congestive heart failure.

The slope of the power spectrum in heart rate variability (HRV) reflects the fractal or scaling behavior in HR dynamics and recently was confirmed as an independent predictor of postmyocardial infarction survival. Whether or not the new measurement in HRV foresees the functional evolution in patients with advanced congestive heart failure treated by beta blockers is unclear. Sequential 24-hour Holter ECG recordings were obtained at baseline, and 1 and 3 months after addition of atenolol therapy for advanced congestive heart failure in 10 patients. The slope and intercept of the regression line of power-law behavior, the short- and intermediate-term of detrended fluctuated analysis (DFA), the approximate entropy (ApEn), and the standard frequency spectra of the 24-hour HRV were compared sequentially as well as with those in 12 age-matched normal controls. The results showed that the slope (-1.70 +/- 0.45 vs -1.22 +/- 0.21; P < 0.05) and the intercept (5.11 +/- 0.46 vs 5.62 +/- 0.24; P < 0.05) of the regression line of power-law behavior and the short-term DFA (for 4 to 11 beats) (0.78 +/- 0.18 vs 1.13 +/- 0.21; P < 0.05) increased after 3 months of atenolol treatment. However, the change in intermediate-term DFA (>11 beats) and ApEn was not apparent (1.24 +/- 0.21 vs 1.22 +/- 0.15 and 1.34 +/- 0.14 vs 1.36 +/- 0.11; both P > 0.05). The evolution of the slope or intercept of the regression line of the HRV power spectrum did not correlate with the echocardiographic or clinical cardiac function, or with the frequency spectral components of the HRV (P > 0.05). Additional beta-blocker therapy upregulated the fractal behavior control of the HRV in patients with advanced congestive heart failure. The improvement was independent of subjective and objective global cardiac performance.