Beat to beat variability in cardiovascular variables: Noise or music?,☆☆

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Abstract

Cardiovascular variables such as heart rate, arterial blood pressure, stroke volume and the shape of electrocardiographic complexes all fluctuate on a beat to beat basis. These fluctuations have traditionally been ignored or, at best, treated as noise to be averaged out. The variability in cardiovascular signals reflects the homeodynamicinterplay between perturbations to cardiovascular function and the dynamic response of the cardiovascular regulatory systems. Modern signal processing techniques provide a means of analyzing beat to beat fluctuations in cardiovascular signals, so as to permit a quantitative, noninvasive or minimally invasive method of assessing closed loop hemodynamic regulation and cardiac electrical stability. This method promises to provide a new approach to the clinical diagnosis and management of alterations in cardiovascular regulation and stability.

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This work was supported by Grant 1ROI-HL39291-01, from the National Institutes of Health, Bethesda, Maryland, Grant NAGW-988, from the National Aeronautics and Space Administration of Washington, D.C., a grant from the Whitaker Foundation, Mechanicsburg, Pennsylvania; a grant from the Johnson and Johnson HST Research Fund, Cambridge, Massachusetts and a grant from the Colin Medical Instrument Co., South Plainfield, New Jersey. M. Appel is grateful for support from the Fannie and John Hertz Foundation, Livermore, California.

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This article is part of a series of articles celebrating the 40th anniversary of the American College of Cardiology. The series attempts to set the stage for the future by describing current state of the art management of selected major cardiovascular problems and the basic knowledge that will provide directions for advances in diagnosis and therapy.