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The Reproducibility of Short verses Long-Duration Heart Rate Variability Methods and Relations to Aerobic Fitness in Normal Adults
Arner, Alison Elizabeth
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ABSTRACT Heart rate variability (HRV) has been used to evaluate cardiac autonomic function by measuring variations in electrocardiographic R-R intervals between cardiac cycles. HRV was first used to associate decreases in autonomic nervous system (ANS) control with an increased risk of mortality in coronary heart disease and in the diagnosis of diabetes (1). Current clinical research interest has extended to investigate uses of HRV to evaluate changes in the cardiovascular system due to disease, aging, physical activity, and cardiac rehabilitation treatment (2, 5). HRV scores are derivatives of R-R intervals and these may be represented as a function of either time or frequency domain parameters. Time domain analysis is the simplest and includes: the standard deviation of R-R intervals and the number of adjacent RR intervals that differ by >50ms (dRR50). Frequency domain measures involve more elaborate calculation and have been applied in studies to evaluate sympathetic and parasympathetic autonomic balance. The latter include: Low Frequency Power (LF), High Frequency Power (HF), and LF/HF ratio. HRV has been measured in a variety of ways, the most common being a continuous 24-hour collection of R-R data. In recent years, several investigators have sought to assess HRV by utilizing brief collection periods. Controversy exists about the potential of these short-term sampling intervals to yield reproducible and meaningful measurements of HRV. Many confounders such as respiration, stress, and body positioning can influence HRV, which is why a longer collection period has been accepted as the standard for providing a stable index of ANS function. However, short sampling periods would be useful to evaluate HRV when faced with time constraints. The purpose of the current study was to evaluate the reproducibility of HRV using 8-hour daytime measures with the Polar R-R RecorderTM (Polar Electro Oy, Kempele, Finland) and with short sampling duration of 512 cardiac cycles, using the Schiller AT-10TM device (Schiller AG, Baar, Switzerland). Methods: 10 apparently healthy adult volunteers participated in the study, which was conducted at the Sleep Disorders Clinic in Christiansburg, VA. Each subject performed two HRV trials with the Cardiovit AT-10TM device using recordings of 512 cardiac cycles. Within one or two days following the Schiller, the same subjects wore a Polar R-R RecorderTM device to obtain an 8-hour recording of HRV during waking hours; 24-hour urine samples were collected on the same day. Urine was analyzed for catecholamine levels, including norepinephrine and epinephrine in order to evaluate sympathetic nervous system globally. Each subject recorded their personal impressions of unavoidable physical activity and daytime stress demands on the day of the 8-hour recording and urine collection. This entire protocol was repeated one week later. On one of the days of the short sampling recording, VO2pk also was evaluated for each subject using a ramp protocol on the cycle ergometer and a metabolic cart. Results: The correlation analysis for the HRV response variables using the Schiller method indicated a high-to-very high correlation between trials within a day for the time domain measures (r = 0.75-0.99). The frequency domain measures, however, were low-to-moderately correlated (r = 0.24-0.66) between trials within a day for the Schiller method. Correlations between days for HRV response variables using the Schiller method were similarly low for both time (r < 0.5) and (r < 0.4) frequency domain measures. Correlation coefficients between days for the HRV response variables using the Polar method were moderate (r = 0.59-0.67) for the time domain and only low-moderate for the frequency domain measures (r = 0.37-0.69). However, an important finding was that Polar R-R data for two of the subjects contained excessive signal artifact, which affected the fidelity of the HRV scores. When these two cases were excluded from the group analyses, the resulting correlations were high-very high for all time and frequency domain measures (r = 0.70-0.93). The means for each response HRV time and frequency domain variable between the Polar method and Schiller method were significantly different (P < 0.05). Additional correlational analyses did not reveal any systematic associations between HRV measures and simple markers of sympathetic activity (urinary NE or E) and aerobic fitness (VO2pk) in this small sample of subjects. Conclusions: Due to this important change in reproducibility with the Polar method, the consequence of artifact-free recordings is unmistakable. Within the limitations of this small study sample it is concluded that, while HRV in apparently healthy adults may not be measured reliably with brief data collection periods, longer daytime sampling periods of 8 hours (e.g. Polar device) yields acceptable reliability for both time and frequency domain parameters of HRV.
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