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Impaired cardiac autonomic control relates to disease severity in pulmonary hypertension

¹ Dept of Internal Medicine II, Universtätsklinikum Regensburg, Regensburg, ³ Deutsches Herzzentrum München, Klinik der Technischen Universität München, Munich, ⁴ Dept of Internal Medicine B, Ernst-Moritz-Arndt University Greifswald, Greifswald, ⁵ Dept of Internal Medicine, Prosper-Hospital, Recklinghausen, ⁶ Dept of Internal Medicine/Cardiology, DRK Kliniken Berlin Köpenick, Berlin, and ⁷ Center for Pneumonology, Donaustauf Hospital, Donaustauf, Germany. ² International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, UK. ⁸ These authors are joint first authors.

CORRESPONDENCE: R. Wensel, International Centre for Circulatory Health, St Mary's Hospital and Imperial College, 59 North Wharf Rd, London, W2 1LA, UK. E-mail: rolandwensel{at}web.de

Keywords: Exercise capacity, heart autonomic system, heart rate variability, pulmonary hypertension

Received: September 24, 2008
Accepted April 24, 2009

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·s·cm^–5, cardiac index 2.0±0.8 L·min^–1·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·kg^–1·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·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.

This article has been cited by other articles:

				R. Naeije and P. van de Borne Clinical relevance of autonomic nervous system disturbances in pulmonary arterial hypertension Eur. Respir. J., October 1, 2009; 34(4): 792 - 794. [Full Text] [PDF]