VASCULAR HEMODYNAMIC DYSFUNCTION AND ITS INTERFERENCE IN HEART RATE VARIABILITY: A REVIEW

VASCULAR HEMODYNAMIC DYSFUNCTION AND ITS INTERFERENCE IN HEART RATE VARIABILITY: A REVIEW | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 4 February 2025 V1 Latest version Share on VASCULAR HEMODYNAMIC DYSFUNCTION AND ITS INTERFERENCE IN HEART RATE VARIABILITY: A REVIEW Authors : Luís Aparecido de Oliveira Freitas 0000-0003-1909-3764 [email protected] and Vera Regina Fernandes da Silva Marães Authors Info & Affiliations https://doi.org/10.22541/au.173867988.83085892/v1 229 views 126 downloads Contents Abstract Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract not-yet-known not-yet-known not-yet-known unknown Background: Cardiovascular diseases are the main causes of mortality and functional disability. It is important to understand that hemodynamic and blood pressure control mechanisms help to understand the origin and development of cardiovascular dysfunctions, since the baroreflex mechanism influences vascular sympathetic control. The objective of this review was to seek an answer to the following guiding question: “Can vascular hemodynamic dysfunction interfere, depending on the location of the alteration, with heart rate variability?” Methodology: This is a review of the English-language literature on vascular dysfunctions that can lead to hemodynamic changes and their impact on cardiac autonomic modulation using the strategy: ((”Vascular Diseases”) AND (“heart rate variability”) AND (hypertension) AND (”Middle Aged” OR Elderly OR Aged)) inserted in the EBSCO, EMBASE, PUBMED, SCIENCE DIRECT, SCOPUS, WEB OF SCIENCE databases in the period between December 2023 and February 2024, which resulted in 2804 articles found, published between 2018 and 2023. Results: The studies described here related arterial dysfunction and low heart rate variability; hemodynamic disturbance as a source of changes in heart rate variability and sympathetic imbalance; vascular obstructive disorders and cardiac autonomic dysfunction. Other results were presented where they clarify that endothelial dysfunction and blood pressure also have an impact on autonomic dysfunction. However, it was identified by one article that the difference in interarm pressure is not associated with dysfunction in cardiac autonomic control. Conclusion: changes in sympathovagal balance detected through the assessment of heart rate variability may be a predictor of changes in vascular dynamics. not-yet-known not-yet-known not-yet-known unknown 1 Introduction Cardiovascular diseases are considered the main causes of mortality and disability in the world. The growing life expectancy of the population provides greater exposure to risk factors, such as hypertension and chronic non-communicable diseases [1][2]. In Brazil, cardiovascular dysfunctions account for 33% of deaths, so that 40% of deaths of the elderly, for example, are caused by ischemic heart disease[3]. Understanding the hemodynamic mechanisms and blood pressure control helps to understand the genesis and development of cardiovascular dysfunctions, as the baroreflex mechanism influences the heart rate rhythm and vascular sympathetic control. It is known that reduced baroreflex excitability in cases of myocardial infarction is directly related to an increased risk of mortality[4]. The sympathetic and parasympathetic autonomic nerve system regulates cardiovascular function through cardiovascular reflexes and helps control hemodynamics, monitoring blood pressure and sending signals to the central nervous system about dysfunctions so that there is a state of homeostasis and control of normal blood pressure levels[5]. In the presence of cardiovascular risk factors, cardiac autonomic modulation is evaluated by measuring heart rate variability. The evaluation may demonstrate dysfunction of autonomic control, perceived by increased sympathetic activity or decreased cardiac parasympathetic activity, as the autonomic nervous system acts directly on heart rate, blood pressure, vascular resistance, and cardiac output[6]. Heart rate variability allows, in a non-invasive way, the evaluation and analysis of heartbeat oscillations and its autonomic function. These measures are related to the time or frequency domain. In the time domain, the indices to be observed are the mean of all normal RR intervals (mean RR), the standard deviation of all normal RR intervals (SDNN), the mean of the standard deviations of the normal RR intervals calculated in 5-minute intervals (SNNi), the standard deviation of the means of the normal RR intervals calculated in 5-minute intervals (SDANN), the square root of the sum of the successive differences between normal RR intervals adjacent to the square and the percentage of normal RR intervals that differ more than 50 milliseconds from their adjacent (pNN50)[7][8][9]. In the frequency domain, the spectral analysis is defined as high frequency (HF)(0.15 – 0.40 Hz) related to the sympathetic nervous system, low frequency (LF)(0.04 – 0.15 Hz) (sympathetic and parasympathetic nervous system), very low frequency (VLF)(0.01 – 0.04 Hz)(sympathetic activity), ultra-low frequency (ULF)(10-5 – 10-2 Hz) (no defined physiological correspondence). The ratio between LF and HF is a marker of sympathovagal balance[7][8][9]. The objective of this research is to evaluate whether vascular hemodynamic dysfunction (obstruction, stenosis, dilation or arterial stiffness) can interfere with heart rate variability. 2 Methodology In this research, a strategy was used to assist in the construction of the guiding question and in the search for evidence. Therefore, the target population of this study is male and female patients with vascular obstruction, and the research aims to evaluate the heart rate variability in these patients. The comparison will be established with healthy patients, without vascular obstruction and the outcome will show the impact of vascular obstructive processes, if any, on heart rate variability. For the survey of scientific articles, the following strategy was used: ((”Vascular Diseases”) AND (\RL“heart rate variability”) AND (hypertension)) inserted in databases Elton Bryson Stephens – EBSCO Information Services – EBSCO, Excerpta Medica dataBASE – EMBASE, Database related to the United States National Library of Medicine – PUBMED (Database linked to the publisher Elsevier – SCIENCEDIRECT, Database linked to Elsevier - SCOPUS, WEB OF SCIENCE (site that allows access to a database linked to the Clarivate Analytics) in the period between December 2023 and February 2024, published between 2018 and 2023, which resulted in 2804 articles found. Of these, 14 articles were selected for this publication. The criteria adopted for the inclusion of articles in this study were: randomized clinical trials (Original articles), published in the last five years, available in full text, resulting from clinical studies on changes in vascular hemodynamics due to stenosis, obstruction, dilation or stiffening of the arterial wall in adult patients (age group > 30 years) with hypertension; and that have human beings as participants in the research. Studies with samples composed of animals, texts whose theme dealt with obstructive sleep apnea or other dysfunctions that were not related to vascular hemodynamic changes and/or heart rate variability were excluded, whose variables analyzed were the variables in the time and frequency domain. Figure 1 – Revision flowchart. Source – Adapted from Page, et al , 2022 [10] . 3 Results The studies achieved by this review dealt with heart rate variability and: arterial stiffness and autonomic modulation (Germano-Soares , et al, 2019; Serra, et al , 2022; Zhang, et al, 2023; Araújo, et al , 2023; Kase, et al , 2023); peripheral arterial disease (Andrade-Lima, et al , 2019; Santini, et al , 2020); Risk factors for heart disease (Jerkjok, et al , 2019; Wang, et al , 2021); hemodynamic disorders (Shah, et al , 2020; Fathieh, et al , 2021; Tikhonova, et al , 2023); Atherosclerosis and venous thromboembolism (Rupprecht, et al, 2020; Awotoye, et al , 2020). Germano-Soares, et al (2019) [11] analyzed the association between cardiac autonomic modulation and arterial stiffness in patients with peripheral arterial disease. They demonstrated with the study that the increase in arterial stiffness has a significant relationship with heart rate variability and autonomic dysfunction in subjects with peripheral arterial disease. Peripheric arterial disease was also the subject of the study by Andrade-Lima, et al (2019) [12] , who investigated heart rate variability in patients with peripheral arterial disease and intermittent claudication. The key findings were that in participants with peripheral artery disease and intermittent claudication, hemodynamics, cardiac autonomic modulation, and baseline estimates of forearm and calf blood flow showed excellent reproducibility. The reproducibility of the vasodilator response was moderate for the calf and decreased for the forearm. In the research of Jerkjok, et al (2019) [13] Heart rate was recorded beat-by-beat while the patients performed their routine tasks (work, leisure, sleep) day and night. The findings indicate that a single RMSSD value may be associated with increased risk in cardiovascular risk factors, including inflammatory markers, blood lipids and glucose, as well as blood pressure. However, the authors suggest future research to establish the prospective value of a cutoff point for RMSSD in relation to cardiovascular disease risk. Shah, et al (2020) [14] reported that vascular ischemic dysfunctions can induce autonomic alterations and that there is a higher risk of cardiac disorders in the first hours of the day. Based on their knowledge on the subject, they hypothesized that the imbalance of the autonomic system, considering the decrease in heart rate variability, and poor myocardial perfusion are associated. Guided by this hypothesis, the main findings were the changes in the morning variability of the heart rate (exposed in a nonlinear mode through the Poincaré graph ) that are understood to be associated with changes in the regulation of coronary blood flow. They also clarify that myocardial hemodynamic disorder induces sympathetic imbalance and causes sudden dysregulation in the cardiac rhythm. Rupprecht, et al , 2020 [15] correlated systemic inflammation, carotid arteriosclerosis, and autonomic dysfunction, since arteriosclerosis present in the carotid artery alters the function of baroceptors and chemoceptors in that vascular structure, generating autonomic dysfunction (sympathetic hyperactivity and reduced vagal tone). With the study, the authors demonstrated that low-grade systemic inflammation is associated with the severity of the carotid arteriosclerotic process. Systemic inflammation, according to the authors, may be a specific carotid arteriosclerotic condition and not a consequence of the generic arteriosclerotic process. Autonomic dysfunction was induced by a reduction in specific (and non-generalized) carotid stenosis, high frequency (HF), heart rate variability, leading to a reduction in vagal tone, without other components being altered. With the research, the authors concluded that carotid arteriosclerotic disease leads to autonomic dysfunction, with carotid baroreceptors and chemoreceptors as mediators. While Rupprecht, et al studied inflammation, carotid arteriosclerosis, and autonomic dysfunction, Santini, et al , 2020 [16] analyzed the impact of interarm blood pressure difference on functional and cardiovascular parameters in patients with peripheral arterial disease. The authors used ninety-eight patients with peripheral arterial obstructive disease. They were separated into two groups: those with a pressure difference between the right and left upper limbs of 10 mmHg or greater (34 patients) and the others (blood pressure less than 10 mmHg) (64 patients). A difference in interarm blood pressure is frequently observed in systemic atherosclerotic individuals, which is generically associated with increased arterial stiffness and reduced cardiac autonomic control. Systemic cardiovascular parameters were considered: arterial stiffness and heart rate variability. Arterial stiffness indices were obtained in both arms and the arm with the highest systolic blood pressure was used for analysis. With the study, the authors considered that no changes in heart rate variability were observed, which suggests that the difference in interarm blood pressure is not associated with changes in cardiac autonomic control. Awotoye, et al , 2020 [17] studied the association between resting heart rate and venous thromboembolism in patients without cardiovascular disease and venous thrombosis and its association with the individual’s gender. The sample involved in the research was six thousand four hundred and seventy nine men and women in the average age group of 62 years and resting heart rate equal to 63 bpm, without atherosclerotic cardiovascular disease, heart failure, atrial fibrillation or cancer. Patients with venous thromboembolism were found to have a higher medical resting heart rate than those who did not have venous thromboembolism. Among individuals whose resting heart rate and inflammatory and coagulation factors were measured, the authors found resting heart rate significantly (and positively) associated with inflammatory and coagulation factors after adjusting for age, gender, race, and ethnicity. The authors suggest that women who were more predisposed to having a higher resting heart rate had lower mean physical activity and higher levels of inflammatory markers. At rest, the parasympathetic system is predominant. Thus, an elevated heart rate can be a consequence of decreased parasympathetic tone and increased sympathetic stimulation and changes in the sympathetic nervous system can lead to the risk of thrombosis. The authors conclude by considering that resting heart rate is related to a higher risk of venous thromboembolism and to high levels of inflammatory and coagulation factors. Fathieh, et al , 2021 [18] studied coronary artery disease with the participation of symptomatic individuals and asymptomatic healthy controls. The cardiac electrical signals were captured through two time series simultaneously, resulting in a nonlinear dynamic represented by the Poincaré graph. Heart rate variability through linear and nonlinear methods helps in the early identification of acute myocardial infarction and other ischemic manifestations of healthy subjects. The authors used nonlinear dynamics to assess coronary artery disease through plestymography and Poincaré plotting, managing to distinguish participants positive for coronary artery disease from healthy patients. WANG, et al , 2021 [19] surveyed patients with essential hypertension through ambulatory blood pressure monitoring. Regarding myocardial ischemia, the authors reported that there were no significant changes in relation to age, gender, blood pressure, myocardial ischemia, and standard deviation of the sinus intervals SDNN, PNN50. However, they observe that there were differences in the RMSSD variable and one explanation in vogue is that heart rate variability is linked to autonomic nerve function, since both the circadian rhythm of blood pressure and heart rate variability are a reflection of autonomic nerve function. In this sense, autonomic nerve dysfunction should affect heart rate variability. The authors show that gender and blood pressure are reflected in myocardial ischemia and the circadian rhythm of blood pressure is impacted by heart rate variability. Serra, et al , 2022 [20] , aimed to characterize the differences between the sexes in relation to the impact of heart rate variability on arterial stiffness and whether they differ according to the presence of diabetes, studied the relationship between heart rate variability and arterial stiffness specifically by gender. The researchers assessed the stiffness of the aorta artery by carotid-femoral pulse wave velocity. They measured heart rate variability to assess sympathetic/parasympathetic autonomic function. The time domain of heart rate variability was evaluated using the vagal index variable RMSSD (in m/s). The frequency domain of heart rate variability is related to the spectral analysis of a series of RR intervals to quantify the sympathetic and vagal impact on the heart. The authors evaluated the parameters of the power spectral density in the high-frequency range (HF – 0.15–0.4 Hz), the low-frequency spectral density (LF – 0.04–0.15 Hz) and the LF/HF ratio. With the research, the authors revealed that age, blood pressure, diabetes, and cardiac autonomic dysfunction assessed by heart rate variability was related to changes in pulse wave velocity. And high sympathetic activity has been related to arterial stiffness in patients with and without diabetes, but the significant relationship between lower LF activity and arterial stiffness was not related to heart rate, although in other studies this has been attributed to an increase in heart rate. They demonstrated that smoking, dyslipidemia, and comorbidities are factors that impact heart rate variability in arterial stiffness and that the difference in autonomic regulation of mean heart rate over pulse wave velocity is not the same between males and females. Tikhonova, et al , 2023 [21] carried out a research that evaluated the spectral components of the oscillations of heart rate variability and cutaneous blood flow of the forearm and foot and analyzed the interferences between their regulation processes through the correlation and analysis of the coherence of phases under postural stress in patients with arterial hypertension and type 2 diabetes mellitus, in addition to revealing the most effective methods and significant quantitative parameters to distinguish patients with hypertension patients with hypertension, type 2 diabetes mellitus and healthy individuals, and blood pressure, echocardiogram, fundus estimation and renal function status were evaluated. Electrocardiogram and cutaneous blood flow of the forearm and foot of two skin sites were measured and recorded simultaneously for each participant at rest (supine – 15 min) and seated with forearms in the position 10-15 cm below the cardiac level and knees at 90º for 15 minutes. The electrocardiogram signals were transformed into RR interval sequences to analyze heart rate variability. Cutaneous blood flow from the forearm and foot was recorded on a two-channel Doppler laser analyzer. Cutaneous blood flow from the forearm and foot was captured from the outer surface of the right forearm near the wrist (and from the dorsum of the right foot between the heads of the 1st and 2nd metatarsals. Cutaneous blood perfusion was recorded to estimate red blood cell flow per unit time. The researchers performed spectral analysis for all recorded signals using adaptive wavelets . With the results of the study, the authors suggest that the external and internal variations between the regulatory processes of heart rate variability and cutaneous blood flow in the extremities of healthy individuals and patients demonstrate sensitivity to changes in hemodynamic status caused by pathological disorders and can be suggested as non-invasive physiological markers for the early diagnosis of vascular dysfunctions to prevent severe diseases. Zhang, et al , 2023 [22] recruited individuals with and without carotid plaques to measure arterial stiffness and endothelial dysfunction to predict the relationship between them and carotid plaques. The researchers used the following variables: SDNN, RMSSD, NN50, PNN50, triangular index, LF, HF, LF/HF. As a result, the authors reported that no significant differences were found in heart rate, heart rate increase index at 75 beats per minute, in SDNN, RMSSD, NN50, PNN50, HF (0.15-0.4hz) or LF/HF. However, significant differences were found between the two groups in the distribution of age, sex, alcoholism, smoking, hypertension, diabetes, and the history of cardiovascular and cerebrovascular diseases, in addition, the mean value of the reactive hyperemia index was significantly different between the two groups. Similarly, there was a significant difference in the triangular index and LF in both groups. Araújo, et al , 2023 [23] studied endothelial function, stiffness, and heart rate variability of patients with cardiovascular disease hospitalized for COVID-19. As a result of the research, the authors found that patients with endothelial dysfunction had an increase in the HF component of heart rate variability; however, other components did not differ between the groups. In addition, FH showed a negative and moderate correlation with LnRHI (Natural logarithm of the reactive hyperemia index) and AIx@75 (Normalized increase index for a heart rate of 75 beats per minute). HF, SDNN, RMSSD, and PNN50 represent parasympathetic activity, while LF represents sympathetic and parasympathetic activities. Thus, patients with COVID-19 and endothelial dysfunction may have unbalanced autonomic responses with parasympathetic predominance. Kase, et al , 2023 [24] investigated the relationship between heart rate variability and arterial stiffness in patients with type 2 diabetes. The patients were divided into three groups: no diabetic retinopathy, simple nonproliferative diabetic retinopathy and proliferative diabetic retinopathy. To assess heart rate variability, the authors examined patients who were in the supine position. The authors present as results that the coefficient of variation of 100 RR intervals at rest and deep breathing was lower in patients with arterial stiffening than in those without arterial stiffening, both at rest and during deep breathing, and the difference was smaller in patients with arterial stiffening than in those without artery stiffening. The researchers also found that the low heart rate variability estimated by the coefficient of variation of 100 RR intervals at rest and deep breathing during the RR interval is closely associated with arterial stiffness in patients with type 2 diabetes and reflects a state of sympathetic hyperstimulation that indicates an early sign of cardiac autonomic neuropathy. With the present study, they demonstrated that the heart rate variability estimated by the coefficient of variation of 100 RR intervals at rest and deep breathing was more strongly associated with the presence of diabetic kidney disease and arterial stiffness than with the coefficient of variation of 100 RR intervals at rest and deep breathing in patients with type 2 diabetes. Thus, several studies have associated heart rate variability and vascular hemodynamics. Chart 1 below shows syntheses of the studies and their findings, considering peripheral arterial disease. Author(s)/Year Population Sample Equipment(s) used Structure(s) evaluated Protocol HRV Indices Denouement n Gender Age group Germano-Soares; et al; 2019 Symptomatic peripheral artery disease 114 Men ≥ 65 heart rate monitor (POLAR, RS 800CX)/Polar ProTrainer 5 software Tonometer Heart Carotid artery Femoral artery The variability of the measured heart rate in relation to the time and frequency domain. Arterial stiffness assessed by carotid-femoral pulse wave velocity RMSSD SDNN pNN50 LF HF LF/HF The increase in arterial stiffness is related to heart rate variability and autonomic dysfunction in subjects with peripheral arterial disease Andrade-Lima; et al; 2019 Peripheral arterial disease and intermittent claudication 29 Men ≥ 50 Mercury column sphygmomanometer Electrocardiograph Plethysmograph Heart Blood pressure Electrocardiogram recorded between 10 and 20 minutes / Heart rate between 20 and 25 minutes LF HF LF/HF The mean values of all heart rate variability variables were not significantly different between tests Jerczok, et al , 2019 Workers 9550 Men/ Women ≥ 41,7 Electrocardiograph Heart Blood pressure Electrocardiography – 100 Hz – 24 hours RMSSD A single RMSSD value may be associated with cardiovascular risk factors Shah; et al; 2020 War veterans (hypertensive?) without known ischemic heart disease 276 Men ≥ 55 Electrocardiograph (ECG)(Holter) positron emission tomography (coronary) Heart/Coronary Arteries Holter for 24 hours HF, LF, VLF Changes in morning heart rate variability associated with changes in coronary blood flow regulation. Myocardial hemodynamic disorder induces sympathetic imbalance and causes sudden dysregulation in the heart rhythm. Rupprecht; et al, 2020 Asymptomatic extracranial carotid stenosis 105 Men/ Women ≥ 66 Duplex sonograph Electrocardiograph Heart Carotid arteries electrocardiogram recorded between 8:00 a.m. and 10:00 a.m. for 15 minutes at rest in the supine position after 30 minutes HF LF VLF LF/HF Carotid arteriosclerotic disease leads to autonomic dysfunction with carotid baroreceptors and chemoreceptors as mediators. Santini ; et al, 2020 Peripheral arterial disease and blood pressure difference between arms 98 Men/ Women ≥ 67 Heart rate monitor (RS 800CX, Polar Electro, Finland) Heart Blood pressure Carotid artery Femoral artery Arterial stiffness through carotid pulse wave velocity (tonometry)/heart rate (electrocardiograph) SDNN RMSSD pNN50 LF HF The difference in interarm blood pressure is not associated with changes in cardiac autonomic control Awotoye; et al, 2020 No venous thromboembolism 6479 Men/ Women ≥ 62 Electrocardiograph Heart Resting heart rate recording by 12-lead electrocardiograph - Resting heart rate related to increased risk of venous thromboembolism and elevated levels of inflammatory and coagulation factors Fathieh; et al, 2021 Coronary artery disease and heart failure/Healthy (control) 200 Men/ Women ≥ 66 Photopletismógrafo Catheterization Angiography Heart Coronary arteries Cardiac electrical signals captured by orthogonal three-dimensional voltage gradient – OVG/Blood volume variations perfusing tissue – PPG (sampling rate 8 khz) - Nonlinear features of simultaneously acquired signals can assess coronary artery disease Wang; et al, 2021 Essential hypertension 492 Men/ Women ≥ 63 Electrocardiograph Heart The dynamic ECG (basal ST segment amplitude greater than 0.1mV and duration greater than 1min) SDNN PNN50 RMSSD Gender and blood pressure are closely related to the occurrence of myocardial ischemia/type of circadian rhythm blood pressure is affected by heart rate variability Serra; et al, 2022 Hypertension/ Healthy 422 Men/ Women ≥ 61 Electrocardiograph Heart Aorta artery Aortic stiffness assessed by carotid-femoral pulse wave velocity/Heart rate variability by 2-minute electrocardiogram/Patient in supine position PNN50 RMSDD LF HF LF/HF Age, blood pressure, and diabetes, and impaired cardiac autonomic function were associated with arterial stiffness Tikhonova; et al, 2023 Hypertensive Diabetics Healthy (controls) 64 Men/ Women ≥ 63 Electrocardiograph/ two-channel Doppler laser analyzer Heart Right forearm Ceiling height Skin (skin blood perfusion) Evaluated: blood pressure, blood flow, fundus and kidney function VLF LF HF Heart rate and blood flow variability demonstrated sensitivity to changes in hemodynamics Zhang; et al, 2023 With and without atheromatous plates 991 Men/ Women ≥ 62 EndoPAT pressure sensor probe Doppler ultrassonógraph Heart and arteries Carotid, femoral and aorta Measurement of aortic hemodynamic parameters and carotid-femoral artery pulse wave velocity SDNN RMSSD NN50 PNN50 LF HF LF/HF There were differences between the two groups (with and without atheromatous plaques) in relation to age, gender, alcoholism, smoking, hypertension, diabetes, and history of cardiovascular and cerebrovascular diseases, and differences in the triangular index. Araújo; et al, 2023 Cardiovascular diseases and those diagnosed with COVID-19 27 Men/ Women ≥ 40 Plestimograph EndoPAT-2000 Heart Blood pressure Endothelial function, arterial stiffness, and heart rate variability were assessed using peripheral arterial tonometry LF HF LF/HF SDNN PNN50 RMSSD Patients with endothelial dysfunction showed an increase in the HF component of heart rate variability Kase; et al, 2023 Type 2 diabetes 313 Men/ Women 58 Electrocardiograph Phonocardiography Heart Aorta and tibial arteries Evaluation of heart rate variability in the supine position. ECG recording obtained for 2 to 3 minutes at rest and for 2 to 3 minutes during deep breathing at a rate of 6 breaths per minute (5 seconds of inhalation and 5 seconds of exhalation) - Heart rate variability is associated with arterial stiffness ECG: electrocardiogram; SDNN – standard deviation of all normal RR intervals; SNNi – Mean of the standard deviations of normal RR intervals calculated at 5-minute intervals; SDANN – Standard deviation of the means of normal RR intervals calculated in 5-minute intervals; pNN50 – percentage of normal RR intervals that differ more than 50 milliseconds from their adjacent one; RMSSD – Square root of the mean of the square of the differences between adjacent normal RR intervals in 24h recording, HF – High frequency; LF – Low frequency; ULF – ultra-low frequency; VLF – Very low frequency Source – The authors, 2024. Of the fourteen studies described here, eight studies related arterial dysfunction and low heart rate variability; one article deals with hemodynamic disorders as a source of changes in heart rate variability and sympathetic imbalance; Two articles show that vascular obstructive disorders can induce cardiac autonomic dysfunction. Other results were presented that clarify that endothelial dysfunction and blood pressure also have an impact on autonomic dysfunction. However, it was identified by an article that the difference in interarm pressure is not associated with dysfunction in cardiac autonomic control. Regarding the limitations, we consider that the studies that went into the development of this study were in small quantity compared to the number of texts collected for the initial analysis. 4 Conclusion The results bring with them the understanding that changes in sympathovagal balance detected through the evaluation of heart rate variability can be a predictor of changes in vascular dynamics, helping in the prevention of cardiovascular diseases. However, further studies must be carried out to prove this possibility. not-yet-known not-yet-known not-yet-known unknown REFERENCES [1] Teston, Elen F.; Cecilio, Hellen P. M.; Santos, Aliny L.; Arruda, Guilherme O. de; Radovanovic, Cremilde A. T.; Marcon, Sonia S. Fatores associados às doenças cardiovasculares em adultos. Medicina, Ribeirão Preto, v. 49, n. 2, p.: 95-102, 2016. [2] Massa, Kaio Henrique Correa; Duarte, Yeda Aparecida Oliveira; Chiavegatto Filho, Alexandre Dias Porto. 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Keywords clinical: electrophysiology – autonomic nervous system clinical: non-invasive techniques – heart rate variability clinical: non-invasive techniques – holter/event recorders Authors Affiliations Luís Aparecido de Oliveira Freitas 0000-0003-1909-3764 [email protected] Universidade de Brasilia View all articles by this author Vera Regina Fernandes da Silva Marães Universidade de Brasilia View all articles by this author Metrics & Citations Metrics Article Usage 229 views 126 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Luís Aparecido de Oliveira Freitas, Vera Regina Fernandes da Silva Marães. VASCULAR HEMODYNAMIC DYSFUNCTION AND ITS INTERFERENCE IN HEART RATE VARIABILITY: A REVIEW. Authorea . 04 February 2025. DOI: https://doi.org/10.22541/au.173867988.83085892/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. 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