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CLINICAL STUDY: HEART FAILURE

Effects of posture on cardiac autonomic nervous activity in patients with congestive heart failure

Shoichi Miyamoto, MD^*, Masatoshi Fujita, MD, FACC, Hiroyuki Sekiguchi, PhD, Yoshiaki Okano, MD, Noritoshi Nagaya, MD^||, Kinzo Ueda, MD^*, Shun-ichi Tamaki, MD^*, Ryuji Nohara, MD^¶, Shigeru Eiho, PhD and Shigetake Sasayama, MD, FACC^¶

^* Division of Cardiology, Takeda Hospital, Kyoto, Japan
College of Medical Technology, Kyoto University, Kyoto, Japan
Department of Systems Science, Graduate School of Informatics, Kyoto University, Kyoto, Japan
Clinical Laboratory Medicine, Kyoto University Hospital, Kyoto, Japan
^|| Division of Cardiology, National Cardiovascular Center, Osaka, Japan
^¶ Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan

Manuscript received August 31, 2000; revised manuscript received February 9, 2001, accepted February 15, 2001.

Reprint requests and correspondence: Professor Masatoshi Fujita, College of Medical Technology, Kyoto University, 53 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
mfujita{at}kuhp.kyoto-u.ac.jp

OBJECTIVES

We aimed to clarify which recumbent position is preferred by patients with congestive heart failure (CHF) and to evaluate whether cardiac autonomic nervous activity is different among three recumbent positions (supine, left lateral decubitus, right lateral decubitus) in patients with CHF.

BACKGROUND

It remains unclear whether cardiac autonomic nervous activity is different among three recumbent positions in patients with CHF.

METHODS

We studied 17 male CHF patients (66 ± 7 years) and 17 age- and gender-matched healthy subjects (66 ± 7 years). Each subject underwent 24-h ambulatory electrocardiographic monitoring. A channel was used to record the CM₅ lead, and another to record the signal of the patient’s posture with use of a newly developed small-sized detector (3.2 cm x 3.2 cm). By using spectral analysis of heart rate variability, frequency-domain measures were calculated and compared among the three recumbent positions. Normalized high-frequency (HF: 0.15 to 0.40 Hz) power was used as an index of vagal activity and the low frequency (0.04 to 0.15 Hz)/HF power ratio was used as an index of sympathovagal balance.

RESULTS

In patients with CHF, the time for the right lateral decubitus position was two-fold longer than that for the supine and left lateral decubitus positions. The increased cardiac sympathetic activity and decreased vagal tone in CHF patients were normalized in the right lateral decubitus position.

CONCLUSIONS

The right lateral decubitus position in patients with CHF may be a self-protecting mechanism of attenuating the imbalance of cardiac autonomic nervous activity.

Abbreviations and Acronyms   CAD = coronary artery disease   CHF = congestive heart failure   ECG = electrocardiogram, electrocardiographic   HRV = heart rate variability   REM = rapid eye movement

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