Cited by 349Heart Rate Variability and Autonomic ControlCardiac electrophysiology and arrhythmiasNon-Invasive Vital Sign Monitoring

Pitfalls of assessment of autonomic function by heart rate variability

Open access
Hayano, Junichiro, Yuda, Emi·2019·Journal of Physiological Anthropology

Abstract

Although analysis of heart rate variability is widely used for the assessment of autonomic function, its fundamental framework linking low-frequency and high-frequency components of heart rate variability with sympathetic and parasympathetic autonomic divisions has developed in the 1980s. This simplified framework is no longer able to deal with much evidence about heart rate variability accumulated over the past half-century. This review addresses the pitfalls caused by the old framework and discusses the points that need attention in autonomic assessment by heart rate variability.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1186/s40101-019-0193-2

Cites

7 of 7 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 65

  1. [1]Appel ML Berger RD Saul JP Smith JM Cohen RJ Beat to beat variability in cardiovascular variables: noise or music? J Am Coll Cardiol 1989 14 1139 1148 2681319
  2. [3]Katona PG Poitras JW Barnett GO Terry BS Cardiac vagal efferent activity and heart period in the carotid sinus reflex Am J Phys 1970 218 4 1030 1037 5435400
  3. [4]Hyndman BW Kitney RI Sayers BM Spontaneous rhythms in physiological control systems Nature. 1971 233 339 341 4940430
  4. [5]Sayers BM Analysis of heart rate variability Ergonomics. 1973 16 1 17 32 4702060
  5. [6]Hyndman BW Gregory JR Spectral analysis of sinus arrhythmia during mental loading Ergonomics. 1975 18 3 255 270 1193079
  6. [7]Pomeranz B Macaulay RJ Caudill MA Kutz I Adam D Gordon D Kilborn KM Barger AC Shannon DC Cohen RJ Assessment of autonomic function in humans by heart rate spectral analysis Am J Phys 1985 248 1 Pt 2 H151 H153 3970172
  7. [8]Pagani M Lombardi F Guzzetti S Rimoldi O Furlan R Pizzinelli P Sandrone G Malfatto G Dell'Orto S Piccaluga E Turiel M Baselli G Cerutti S Malliani A Power spectral analysis of heart rate and arterial pressure variabilities as a marker of sympatho-vagal interaction in man and conscious dog Circ Res 1986 59 178 193 2874900
  8. [11]Hayano J Yasuma F Hypothesis: respiratory sinus arrhythmia is an intrinsic resting function of cardiopulmonary system Cardiovasc Res 2003 58 1 1 9 12667941
  9. [13]Sands KEF Appel ML Lilly LS Schoen FJ Mudge GH Jr Cohen RJ Power spectrum analysis of heart rate variability in human cardiac transplant recipients Circulation. 1989 79 76 82 2642758
  10. [15]Hayano J Sakakibara Y Yamada M Kamiya T Fujinami T Yokoyama K Watanabe Y Takata K Diurnal variations in vagal and sympathetic cardiac control Am J Phys 1990 258 3 Pt 2 H642 H646 2316678
  11. [16]Kamiya A Kawada T Yamamoto K Michikami D Ariumi H Miyamoto T Shimizu S Uemura K Aiba T Sunagawa K Sugimachi M Dynamic and static baroreflex control of muscle sympathetic nerve activity (SNA) parallels that of renal and cardiac SNA during physiological change in pressure Am J Phys 2005 289 6 H2641 H2648 16055514
  12. [17]Kamiya A Kawada T Yamamoto K Michikami D Ariumi H Miyamoto T Uemura K Sugimachi M Sunagawa K Muscle sympathetic nerve activity averaged over 1 minute parallels renal and cardiac sympathetic nerve activity in response to a forced baroreceptor pressure change Circulation. 2005 112 3 384 386 15998668
  13. [18]Kleiger RE Miller JP Bigger JT Jr Moss AJ the Multicenter Post-Infarction Research G Decreased heart rate variability and its association with increased mortality after acute myocardial infarction Am J Cardiol 1987 59 256 262 3812275
  14. [19]Bigger JT Jr Fleiss JL Steinman RC Rolnitzky LM Kleiger RE Rottman JN Frequency domain measures of heart period variability and mortality after myocardial infarction Circulation. 1992 85 164 171 1728446
  15. [20]Huikuri HV Mäkikallio TH Peng CK Goldberger AL Hintze U Moller M Grp DS Fractal correlation properties of R-R interval dynamics and mortality in patients with depressed left ventricular function after an acute myocardial infarction Circulation. 2000 101 47 53 10618303
  16. [21]Kiyono K Hayano J Watanabe E Struzik ZR Yamamoto Y Non-Gaussian heart rate as an independent predictor of mortality in patients with chronic heart failure Heart Rhythm 2008 5 2 261 268 18242551
  17. [22]Suzuki M Hiroshi T Aoyama T Tanaka M Ishii H Kisohara M Iizuka N Murohara T Hayano J Nonlinear measures of heart rate variability and mortality risk in hemodialysis patients Clin J Am Soc Nephrol 2012 7 9 1454 1460 22723446 PMC3430947
  18. [23]Costa MD Redline S Davis RB Heckbert SR Soliman EZ Goldberger AL Heart rate fragmentation as a novel biomarker of adverse cardiovascular events: the multi-ethnic study of atherosclerosis Front Physiol 2018 9 1117 30233384 PMC6129761
  19. [25]Bauer A Kantelhardt JW Barthel P Schneider R Makikallio T Ulm K Hnatkova K Schomig A Huikuri H Bunde A Malik M Schmidt G Deceleration capacity of heart rate as a predictor of mortality after myocardial infarction: cohort study Lancet. 2006 367 9523 1674 1681 16714188
  20. [26]Hayano J Yasuma F Watanabe E Carney RM Stein PK Blumenthal JA Arsenos P Gatzoulis KA Takahashi H Ishii H Kiyono K Yamamoto Y Yoshida Y Yuda E Kodama I Blunted cyclic variation of heart rate predicts mortality risk in post-myocardial infarction, end-stage renal disease, and chronic heart failure patients Europace. 2017 19 1392 1400 27789562 PMC5834062
  21. [28]Hayano J Mukai S Fukuta H Sakata S Ohte N Kimura G Postural response of low-frequency component of heart rate variability is an increased risk for mortality in patients with coronary artery disease Chest. 2001 120 1942 1952 11742926
  22. [29]La Rovere MT Bigger JT Jr Marcus FI Mortara A Schwartz PJ Investigators A Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction Lancet. 1998 351 478 484 9482439
  23. [31]Yoshida Y Furukawa Y Ogasawara H Yuda E Hayano J Longer lying position causes lower LF/HF of heart rate variability during ambulatory monitoring 2016 Kyoto 2016 IEEE 5th Global Conference on Consumer Electronics (GCCE)
  24. [32]Akselrod S Gordon D Ubel FA Shannon DC Barger AC Cohen RJ Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat-to-beat cardiovascular control Science. 1981 213 220 222 6166045
  25. [33]Berger RD Saul JP Cohen RJ Transfer function analysis of autonomic regulation. I. Canine atrial rate response Am J Phys 1989 256 1 Pt 2 H142 H152 2912176
  26. [34]Penaz J. Mayer waves: history and methodology. Automedica. 1978;2:135-141.
  27. [35]Madwed JB Albrecht P Mark RG Cohen RJ Low-frequency oscillation in arterial pressure and heart rate: a simple computer model Am J Phys 1991 256 H1573 H15H9 2735430
  28. [36]Rahman F Pechnik S Gross D Sewell L Goldstein DS Low frequency power of heart rate variability reflects baroreflex function, not cardiac sympathetic innervation Clin Auton Res 2011 21 3 133 141 21279414 PMC3094491
  29. [37]Hayano J Sakakibara Y Yamada M Ohte N Fujinami T Yokoyama K Watanabe Y Takata K Decreased magnitude of heart rate spectral components in coronary artery disease. Its relation to angiographic severity Circulation. 1990 81 4 1217 1224 2317904
  30. [38]Vaschillo EG Vaschillo B Lehrer PM Characteristics of resonance in heart rate variability stimulated by biofeedback Appl Psychophysiol Biofeedback 2006 31 2 129 142 16838124
  31. [39]Lehrer PM Gevirtz R Heart rate variability biofeedback: how and why does it work? Front Psychol 2014 5 756 25101026 PMC4104929
  32. [40]Woo MA Stevenson WG Moser DK Middlekauff HR Complex heart rate variability and serum norepinephrine levels in patients with advanced heart failure J Am Coll Cardiol 1994 23 565 569 8113535
  33. [41]Woo MA Stevenson WG Moser DK Trelease RB Harper RM Patterns of beat-to-beat heart rate variability in advanced heart failure Am Heart J 1992 123 704 710 1539521
  34. [42]Binkley PF Eaton GM Nunziata E Khot U Cody RJ Heart rate alternans Ann Intern Med 1995 122 2 115 117 7503828
  35. [43]Stein PK Domitrovich PP Hui N Rautaharju P Gottdiener J Sometimes higher heart rate variability is not better heart rate variability: results of graphical and nonlinear analyses J Cardiovasc Electrophysiol 2005 16 9 954 959 16174015
  36. [44]Stein PK Le Q Domitrovich PP Investigators C Development of more erratic heart rate patterns is associated with mortality post-myocardial infarction J Electrocardiol 2008 41 2 110 115 18328334 PMC2323590
  37. [45]Costa MD Davis RB Goldberger AL Heart rate fragmentation: a symbolic dynamical approach Front Physiol 2017 8 827 29184505 PMC5694498
  38. [46]Costa MD Davis RB Goldberger AL Heart rate fragmentation: a new approach to the analysis of cardiac interbeat interval dynamics Front Physiol 2017 8 255 28536533 PMC5422439
  39. [47]Taylor EW The evolution of efferent vagal control of the heart in vertebrates Cardioscience. 1994 5 3 173 182 7827254
  40. [48]Taylor EW Hoar WS Randall DJ Farrell AP Nervous control of the heart and cardiorespiratory interactions. Fish Physiology vol XII B 1992 New York Academic Press 343 387
  41. [49]Melcher A Respiratory sinus arrhythmia in man: a study in heart rate regulating mechanisms Acta Physiol Scand 1976 Suppl 435 1 31 788462
  42. [50]Hirsch JA Bishop B Respiratory sinus arrhythmia in humans: how breathing pattern modulates heart rate Am J Phys 1981 241 H620 H6H9 7315987
  43. [51]Brown TE Beightol LA Koh J Eckberg DL Important influence of respiration on human R-R interval power spectra is largely ignored J Appl Physiol 1993 75 2310 2317 8307890
  44. [52]Eckberg DL Human sinus arrhythmia as an index of vagal cardiac outflow J Appl Physiol 1983 54 961 966 6853303
  45. [53]Kollai M Mizsei G Respiratory sinus arrhythmia is a limited measure of cardiac parasympathetic control in man J Physiol (Lond) 1990 424 329 342 2391653 PMC1189816
  46. [54]Hayano J Mukai S Sakakibara M Okada A Takata K Fujinami T Effects of respiratory interval on vagal modulation of heart rate Am J Phys 1994 267 1 Pt 2 H33 H40 7914066
  47. [55]Taylor JA Myers CW Halliwill JR Seidel H Eckberg DL Sympathetic restraint of respiratory sinus arrhythmia: implications for vagal-cardiac tone assessment in humans Am J Phys 2001 280 H2804 H2814 11356639
  48. [56]Cohen MA Taylor JA Short-term cardiovascular oscillations in man: measuring and modelling the physiologies J Physiol 2002 542 Pt 3 669 683 12154170 PMC2290446
  49. [57]Taylor EW Jordan D Coote JH Central control of the cardiovascular and respiratory systems and their interactions in vertebrates Physiol Rev 1999 79 855 916 10390519
  50. [58]Jones JFX Wang Y Jordan D Activity of C-fiber cardiac vagal efferents in anaesthetized cats and rats J Physiol (Lond) 1998 507 869 880 9508846 PMC2230810
  51. [60]Taylor EW Al-Ghamdi MS Ihmied IH Wang T Abe AS The neuranatomical basis of central control of cardiorespiratory interactions in vertebrates Exp Physiol 2001 86 6 771 776 11698972
  52. [62]Yasuma F Hayano J Respiratory sinus arrhythmia: why does the heartbeat synchronize with respiratory rhythm? Chest. 2004 125 2 683 690 14769752
  53. [63]Ito S Sasano H Sasano N Hayano J Fisher JA Katsuya H Vagal nerve activity contributes to improve the efficiency of pulmonary gas exchange in hypoxic humans Exp Physiol 2006 91 5 935 941 16809376
  54. [65]Goldberger JJ Ahmed MW Parker MA Kadish AH Dissociation of heart rate variability from parasympathetic tone Am J Phys 1994 266 H2152 H21H7 8203614
  55. [66]Goldberger JJ Challapalli S Tung R Parker MA Kadish AH Relationship of heart rate variability to parasympathetic effect Circulation. 2001 103 15 1977 1983 11306527
  56. [67]Sakakibara M Takeuchi S Hayano J Effect of relaxation training on cardiac parasympathetic tone Psychophysiology. 1994 31 223 228 8008785
  57. [68]Bonnet MH Arand DL Heart rate variability: sleep stage, time of night, and arousal influences Electroencephalogr Clin Neurophysiol 1997 102 390 396 9191582
  58. [69]Arai Y Saul JP Albrecht P Hartley LH Lilly LS Cohen RJ Colucci WS Modulation of cardiac autonomic activity during and immediately after exercise Am J Phys 1989 256 H132 HH41 2643348
  59. [70]Yamamoto Y Hughson RL Peterson JC Autonomic control of heart rate during exercise studied by heart rate variability spectral analysis J Appl Physiol 1991 71 1136 1142 1757310
  60. [71]Taylor JA Hayano J Seals DR Lesser vagal withdrawal during isometric exercise with age J Appl Physiol 1995 79 805 811 8567521
  61. [72]Sakakibara M Kanematsu T Yasuma F Hayano J Impact of real-world stress on cardiorespiratory resting function during sleep in daily life Psychophysiology. 2008 45 4 667 670 18503486
  62. [73]Shannon DC Carley DW Benson H Aging of modulation of heart rate Am J Phys 1987 253 H874 H8H7 3661736
  63. [74]Saul JP Arai Y Berger RD Lilly LS Colucci WS Cohen RJ Assessment of autonomic regulation in chronic congestive heart failure by heart rate spectral analysis Am J Cardiol 1988 61 1292 1299 3376889
  64. [75]Randall DC Brown DR Raisch RM Yingling JD Randall WC SA nodal parasympathectomy delineates autonomic control of heart rate power spectrum Am J Phys 1991 260 3 Pt 2 H985 H988 1672056
  65. [76]Moak JP Goldstein DS Eldadah BA Saleem A Holmes C Pechnik S Sharabi Y Supine low-frequency power of heart rate variability reflects baroreflex function, not cardiac sympathetic innervation Heart Rhythm 2007 4 12 1523 1529 17997358 PMC2204059

Cited by

Sorted by citations

Authors
Hayano, J., & Yuda, E.
Affiliations
Nagoya City University (JP)
Corresponding author
Hayano, Junichiro
Venue
Journal of Physiological Anthropology
Published
2019-03-13
Volume
38
Issue
1
Pages
3-3
ISSN
  • 1880-6791 (ISSN-L)
  • 1880-6805
OpenAlex
W2942459206
Cited by
349
References
7
Citations by year
2026: 53 · 2025: 44 · 2024: 40 · 2023: 67 · 2022: 53 · 2021: 44 · 2020: 42 · 2019: 6
FWCI
6.56
Type
journal article
Language
en
Open access
Locations
  • Journal of PHYSIOLOGICAL ANTHROPOLOGY (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
  • Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
Keywords
heart rate variability, autonomic function testing, sympathetic nervous system, parasympathetic nervous system, low-frequency and high-frequency components, sympathovagal balance
MeSH terms
Autonomic Nervous System, Electrocardiography, Female, Heart Rate, Humans, Male, Monitoring, Physiologic, Posture, Signal Processing, Computer-Assisted, Spectrum Analysis, Accelerometry, Respiratory Sinus Arrhythmia

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review