Heart rate variability as an index of autonomic imbalance in patients with recent myocardial infarction

  • W. Craelius
  • M. Akay
  • M. Tangella
Physiological Measurement


Autonomic nervous activities are estimated in three groups of patients; Group A consists of patients who had experienced myocardial infarction (MI) within 2–6 weeks before the tests; Group B consists of patients who had MI more than one year previously; Group C consists of matched controls, free of cardiac disease. Autonomic activity is estimated using postural effects on heart rate variability (HRV): a sympathetic activity index is defined as HRV power within a low frequency band (0·04–0·12 Hz) in the tilt position and a parasympathetic activity index is defined as HRV power in a high frequency band (0·18–0·28 Hz) in the supine position. Results show that, relative to controls, Group A patients have reduced parasympathetic activity index (5+3 against 13+8, normalised units; p<0·05) and an increased ratio of sympathetic to parasympathetic activity (17+17 against 4+2; p<0·05). Group B is not significantly different from Group A or C. The period of 2–6 weeks post-MI thus appears to be characterised by depressed parasympathetic nervous activity which can be measured using HRV analysis.


Autonomic nervous system Coronary artery disease Infarction Rehabilitation 


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  1. Bekheit, S., Tangella, M., ElSakr, A., Rashid, Q., Craelius, W. andEl-Sherif, N. (1990) Use of spectral analysis to study the effects of calcium channel blockers on sympathetic activity after myocardial infarction.Am. Heart J.,119, 79–85.Google Scholar
  2. Berger, R.D., Akselrod, S., Gordon, D. andCohen, R.J. (1986). An efficient algorithm for spectral analysis of heart rate variability.IEEE Trans.,BME-33, 900–904.Google Scholar
  3. Bianchi, A., Bontempi, B., Cerutti, S., Gianoglio, P., Comi, G. andNatali Sora, M.G. (1990) Spectral analysis of heart rate variability signal and respiration in diabetic subjects.Med. & Biol. Eng. & Comput.,28, 205–211.CrossRefGoogle Scholar
  4. Bigger, J.T. Jr., Kleiger, R.E., Fleiss, J.L., Rolnitzky, L.M., Steinman, R.C., Miller, J.P. and MCPIR Group (1988) Components of heart rate variability measured during healing of acute myocardial infarction.Am. J. Cardiol.,61, 208–215.CrossRefGoogle Scholar
  5. Craelius, W., Restivo, M., Assadi, M. andEl-Sherif, N. (1988a) Optimal averaging of cardiac signals.IEEE Trans.,BME-33, 957–965.Google Scholar
  6. Craelius, W., Chen, V.K.-H., Restivo, M. andEl-Sherif, N. (1988b) Rhythm analysis of arterial blood pressure.IEEE Trans.,BME-33, (12), 1166–1171.Google Scholar
  7. Hirsch, J.A. andBishop, B. (1981) Respiratory sinus arrhythmia in humans: how breathing pattern modulates heart rate.Am. J. Physiol.,241 (Heart Circ. Physiol.,10), H620-H629.Google Scholar
  8. Inoue, K., Miyake, S., Kumashiro, M., Ogata, H. andYoshimura, O. (1990) Power spectral analysis of heart rate variability in traumatic quadriplegic humans.Am. J. Physiol.,258, H1722-H1726.Google Scholar
  9. Katona, P.G. andJih, F. (1975) Respiratory sinus arrhythmia: noninvasive measure of parasympathetic cardiac control.J. Appl. Physiol.,39, 801–805.Google Scholar
  10. Kleiger, R.E., Miller, J.P., Bigger, J.T., Moss, A. and MCPIR group (1987) Decreased heart rate variability and its association with increased mortality after acute myocardial infarction.Am. J. Cardiol.,59, 256–262.CrossRefGoogle Scholar
  11. Koizumi, K., Terui, N. andKollai, M. (1985) Effect of cardiac vagal and sympathetic nerve activity on heart rate in rhythmic fluctuations.J. Auton. Nerv. Syst.,12, 251–259.CrossRefGoogle Scholar
  12. La Rovere, M.T., Specchia, G., Mortara, A. andSchwartz, P.J. (1988) Baroreflex sensitivity, clinical correlates and cardiovascular mortality among patients with a first myocardial infarction.Circ.,78, 816–824.Google Scholar
  13. Lombardi, F., Sandrone, G., Pernpruner, S., Sala, R., Garimoldi, M., Cerutti, S., Baselli, G., Pagani, M. andMalliani, A. (1987) Heart rate variability as an index of sympathovagal interaction after acute myocardial infarction.Am. J. Cardiol.,60, 1239.CrossRefGoogle Scholar
  14. Pomeranz, M., Macaulay, R.J.B., Caudill, M.A., Kutz, I., Adam, D., Gordon, D., Kilborn, K.M., Barger, A.C., Shannon, D.C., Cohen, R.J. andBenson, M. (1985) Assessment of autonomic function in humans by heart rate spectral analysis.Am. J. Physiol.,248, H151-H153.Google Scholar
  15. Press, W.H., Flannery, B.R., Teukolsky, S.A. andVetterling, W.T. (1986)Numerical Recipes. Cambridge University Press, 420–429.Google Scholar
  16. Rothschild, M., Rothschild, A. andPfeifer, M. (1988) Temporary decrease in cardiac parasympathetic tone after acute myocardial infarction.Am. J. Cardiol.,62, 637–639.CrossRefGoogle Scholar
  17. Ryan, C., Hollenberg, M., Harvey, D.B. andGwynn, R. (1976) Impaired parasympathetic responses in patients after myocardial infarction.Am. J. Cardiol.,37, 1013–1018.CrossRefGoogle Scholar
  18. Schwartz, P.J., Zaza, A., Pala, M., Locati, E., Beria, G. andZanchetti, A. (1988a) Baroreflex sensitivity and its evolution in the first year after myocardial infarction.J. Am. Coll. Cardiol.,12, 629–636.Google Scholar
  19. Schwartz, P.J., Vanoli, E., Stramba-Badiale, M., De Ferrari, G.M., Billman, G.E. andForeman, R.D. (1988b) Autonomic mechanisms and sudden death.Circ.,78, 969–979.Google Scholar
  20. Schwartz, P.J. andDeFerrari, G.M. (1987) The influence of the autonomic nervous system on sudden cardiac death.Cardiol.,74, 297–309.CrossRefGoogle Scholar
  21. Tangella, M., Li, J.-K. andCraelius, W. (1989) Measurement of autonomic balance in patients following myocardial infarction. Proc. IEEE Ann. Conf. Eng. Med. Biol.,11, 1761–1762.Google Scholar
  22. Thames, M.D., Klopfenstein, H.S., Abboud, F.M., Mark, A.K. andWalker, J.L. (1987) Preferential distribution of inhibitory cardiac receptors with vagal afferents to the inferoposterior wall of the left ventricle activated during coronary occlusion in the dog.Circ. Res.,43, 512–519.Google Scholar

Copyright information

© IFMBE 1992

Authors and Affiliations

  • W. Craelius
    • 1
  • M. Akay
    • 1
  • M. Tangella
    • 1
  1. 1.Department of Biomedical EngineeringRutgers-The State UniversityPiscatawayUSA

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