The LF/HF ratio does not accurately measure cardiac sympatho-vagal balance

By G. Billman. Front. Physio., 2013

1,297 citations recorded by the source corpus.

Power spectral analysis of the beat-to-beat variations of heart rate or the heart period (R–R interval) has become widely used to quantify cardiac autonomic regulation (Appel et al., 1989; Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology, 1996; Berntson et al., 1997; Denver et al., 2007; Thayler et al., 2010; Billman, 2011). This technique partitions the total variance (the “power”) of a continuous series of beats into its frequency components, typically identifying two or three main peaks: Very Low Frequency (VLF) <0.04 Hz, Low Frequency (LF), 0.04–0.15 Hz, and High Frequency (HF) 0.15–0.4 Hz. It should be noted that the HF peak is shifted to a higher range (typically 0.24–1.04 Hz) in infants and during exercise (Berntson et al., 1997). The HF peak is widely believed to reflect cardiac parasympathetic nerve activity while the LF, although more complex, is often assumed to have a dominant sympathetic component (Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology, 1996; Berntson et al., 1997; Billman, 2011). Based upon these assumptions, Pagani and co-workers proposed that the ratio of LF to HF (LF/HF) could be used to quantify the changing relationship between sympathetic and parasympathetic nerve activities (i.e., the sympatho-vagal balance) (Pagani et al., 1984, 1986; Malliani et al., 1991) in both health and disease. However, this concept has been challenged (Kingwell et al., 1994; Koh et al., 1994; Hopf et al., 1995; Eckberg, 1997; Houle and Billman, 1999; Billman, 2011). Despite serious and largely under-appreciated limitations, the LF/HF ratio has gained wide acceptance as a tool to assess cardiovascular autonomic regulation where increases in LF/HF are assumed to reflect a shift to “sympathetic dominance” and decreases in this index correspond to a “parasympathetic dominance.” Therefore, it is vital to provide a critical assessment of the assumptions upon which this concept is based.

Subfields: Biomedical Engineering, Cardiology and Cardiovascular Medicine, Surgery

View Paper: https://www.semanticscholar.org/paper/955165fe262470b27ef6ed2f71001aa3e658b271

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Citations in the corpus

Anxiety Disorders are Associated with Reduced Heart Rate Variability: A Meta-Analysis (2014, background): “There is an ongoing debate as to the interpretation of LF HRV (85, 87), and consequently there are sound arguments against the utility and meaningfulness of the oft reported measure LF/HF ratio (88, 89).”
Heart Rate Variability and Cardiac Vagal Tone in Psychophysiological Research – Recommendations for Experiment Planning, Data Analysis, and Data Reporting (2017, background): “However, this view has been highly criticized (Eckberg, 1997; Billman, 2013).”
A healthy heart is not a metronome: an integrative review of the heart's anatomy and heart rate variability (2014, methodology): “It is calculated by first dividing the 24-h record into 288 5-min segments and then calculating the standard deviation of all NN intervals contained within each segment.”
Heart Rate Variability (HRV) Analysis: A Methodology for Organizational Neuroscience (2019, background): “Notwithstanding ongoing debates (Billman, 2013; Malliani, Pagani, Lombardi, & Cerutti, 1991; Parati et al., 2006; Task Force, 1996), researchers have argued that the ratio of LF to HF power (LF/HF) can possibly represent an informative index of the sympathovagal balance.”
An Overview of Heart Rate Variability Metrics and Norms (2017, background): “” The complex relationship between SNS and PNS nerve activity means that the ratio between LF and HF power will not always index autonomic balance (21).”