The forgotten role of central volume in low frequency oscillations of heart rate variability

Manuela Ferrario, Ulrich Moissl, Francesco Garzotto, Dinna N Cruz, Ciro Tetta, Maria G Signorini, Claudio Ronco, Aileen Grassmann, Sergio Cerutti, Stefano Guzzetti, Manuela Ferrario, Ulrich Moissl, Francesco Garzotto, Dinna N Cruz, Ciro Tetta, Maria G Signorini, Claudio Ronco, Aileen Grassmann, Sergio Cerutti, Stefano Guzzetti

Abstract

The hypothesis that central volume plays a key role in the source of low frequency (LF) oscillations of heart rate variability (HRV) was tested in a population of end stage renal disease patients undergoing conventional hemodialysis (HD) treatment, and thus subject to large fluid shifts and sympathetic activation. Fluid overload (FO) in 58 chronic HD patients was assessed by whole body bioimpedance measurements before the midweek HD session. Heart Rate Variability (HRV) was measured using 24-hour Holter electrocardiogram recordings starting before the same HD treatment. Time domain and frequency domain analyses were performed on HRV signals. Patients were retrospectively classified in three groups according to tertiles of FO normalized to the extracellular water (FO/ECW%). These groups were also compared after stratification by diabetes mellitus. Patients with the low to medium hydration status before the treatment (i.e. 1st and 2nd FO/ECW% tertiles) showed a significant increase in LF power during last 30 min of HD compared to dialysis begin, while no significant change in LF power was seen in the third group (i.e. those with high pre-treatment hydration values). In conclusion, several mechanisms can generate LF oscillations in the cardiovascular system, including baroreflex feedback loops and central oscillators. However, the current results emphasize the role played by the central volume in determining the power of LF oscillations.

Conflict of interest statement

Competing Interests: Ulrich Moissl, Ciro Tetta, and Aileen Grassmann are employees of Fresenius Medical Care Deutschland GmbH. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1. Values of the LF differences…
Fig 1. Values of the LF differences between baseline and last 30 minutes of hemodialysis.
Values of the LF differences between baseline and last 30 minutes of hemodialysis in the three groups by excluding diabetes (see Table 3). The circles represent the singular patients. The errorbar represents the median and the 25th and 75th percentile (patients are grouped by the tertiles of FOpre/ECW% values). Note the increase in LF in the first tertile. The outliers are inserted in the picture at a different scale in order to focus the attention to the errorbars.
Fig 2. Hematocrit values.
Fig 2. Hematocrit values.
Boxplot of patient hematocrit values at the start and end of hemodialysis grouped by pre-dialysis FO/ECW% tertiles. HD: hemodialysis. BVM: Blood Volume Monitor device.

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