HRV in a bit more detail: Part 2

Part 1 of this series provided information on heart function, ECG basics, HRV basics and how the Autonomic nervous system influences heart rate. For Part 2, I’ll discuss and display basic HRV analysis concepts to try and enhance your understanding of HRV.  I’ll relate as much of this discussion as possible to smart-phone based HRV tools as it is unlikely that most readers of this site have access to an ECG.

Athlete vs. Non-Athlete

Fit individuals generally have lower resting heart rates and greater parasympathetic activity at rest. These adaptations to training may be a result of both intrinsic heart adaptations (SA node remodeling, increase in ventricle capacity) and autonomic adaptations (greater vagal activity).

Below is an ECG segment from a collegiate male endurance athlete. This sample is likely capturing the normal fluctuation in heart rate that occurs in response to respiration (breathing). Heart rate tends to speed up on inspiration and slow down on expiration. The technical term used to describe this phenomenon is “Respiratory Sinus Arrhythmia”.

athlete ECG RSA1

Endurance Athlete ECG

For comparison, below is a screen shot of a healthy non-athlete ECG. Here, you can clearly see a higher resting heart rate and less variability.

Non-athlete ECG

Non-athlete ECG

The Excel snap shot below is what R-R interval data looks like once exported from the ECG software (Acqknowledge in this case) to a workbook. Though specialized HRV software is much more functional, it’s certainly possible to perform some time series (statistical) analysis on the R-R interval data with basic excel functions (i.e. Standard Deviation, Mean R-R Interval, RMSSD, etc.). Today, we’ll focus primarily on RMSSD as this parameter appears to be the preferred HRV index for athlete monitoring (See Plews et al. 2013 and this for more on RMSSD).

R-R Intervals

R-R Intervals

Tachogram

With HRV software analysis, ECG recordings are converted to a tachogram, which plot the successive R-R intervals on the y-axis and the number of beats within the ECG segment on the x-axis. This provides a nice visual representation of heart rate variability over a given time and makes for easy software analysis.

Below is a 5 minute ECG segment from an endurance athlete converted to a tachogram with our Nevrokard HRV software. Notice how the R-R intervals vary considerably over a broad range. The time domain values follow.

Endurance Athlete Tachogram

Endurance Athlete Tachogram

EAstats1

In contrast, below is the tachogram and time domain analysis of an age matched non-endurance athlete for comparison. Note how the R-R intervals are relatively stable and within a narrow range, demonstrating less variability.

Non-athlete Tachogram

Non-athlete Tachogram

NAstats1

To put this in perspective for the good folks using ithlete or BioForce, I’ll convert the raw RMSSD values (displayed in the “Summary Statistics” screen shots above) to ithlete/BioForce values. To do this, we simply log transform the raw RMSSD and multiply it by 20 (lnRMSSDx20). Keep in mind that the ithlete uses a 55-sec test and BioForce uses 2.5-min test. The values shown here are from 5-min ECG samples, but you get the idea.

rmssd conversion

Ectopic Beats and Artifacts

Last post, I discussed “normal” beats originating from the SA node. Any beats originating from outside the SA node disturb cardiac rhythm and can therefore impact HRV. These are called ectopic beats. Electrical interference, or excessive noise or movement can create “artifacts” which can also affect the data. It’s important to manually inspect ECG data for ectopic beats or artifacts and correct them (replace with the adjacent “normal” cycle) or discard the ECG sample entirely if there are excessive disturbances. Most smart-phone HRV tools do not provide R-R interval data and therefore manual inspection for ectopic beats is impossible. Conveniently, devices such as ithlete and BioForce are designed to automatically detect and correct irregular beats. For example, the application will detect and replace R-R intervals that are unlikely to occur in healthy, resting individuals (e.g., R-R intervals below 500ms or above 1800ms). I’d assume OmegaWave Pro, SweetBeat and other devices also have this feature.

Below is an example of an ectopic beat from an ECG which appears to be a premature atrial contraction. You’ll see this again in a moment on the tachogram as well.

ectopic1

Measurement Protocol

For athlete monitoring, HRV data is ideally collected as soon after waking in the morning as possible after bladder emptying.  We want as close to resting conditions as possible. It would be wise to avoid checking e-mails, text messages and anything else that can alter mood, excite you, upset you, etc. Even water consumption will have an acute impact on HRV. Consistency of measurement protocol and time of measurement are important for longitudinal monitoring. In addition, being as motionless as possible and undisturbed is equally as important.

In the screen shot below towards the right hand side, we can clearly see when the individual gets restless and moves or adjusts his position. We can also see the ectopic beat that occurs toward the start of the measure (same ectopic beat shown above in the ECG). Slight and subtle movements can clearly impact heart rate so be as still as possible when you perform your measures at home.

ectopic_disturbed tachogram

In the tachogram below, notice how heart rate changes considerably at around the 10 minute mark. This is a result of a researcher entering the exam room where the subject was resting during an ECG recording. Clearly, the resting condition was disturbed as the subject was excited/stressed from the person entering the room. Thus, do your best to remain as undisturbed as possible when performing a measure at home.

disturbed measure 10min

All data shown today were from supine ECG recordings. Next post I’ll discuss and show HRV changes in response to postural change (i.e., from supine to standing).