Learning Objectives
Handout (Prepared by Dr. Gianaros) 
Seminar Outline
Reference Resources for HRV (Compiled by Drs. Gianaros & Bleil)

Learning Objectives
(1) To understand the autonomic & non-autonomic origins of heart rate variability; 
(2) To understand the appropriate measurement & interpretation of HRV; 
(3) To gain practical experience in the use of available HRV scoring programs; and
(4) To discuss appropriate and inappropriate inferences researchers can make with HRV.

Day 2:
Research Design and Interpretation, Ambulatory and sleep settings, HRV and
biobehavioral health; Appropriate and inappropriate inferences.
A. Stating the Research Question about HRV
a.  State vs. trait effects
b.  Resting HRV vs. HRV reactivity 
c.  Different assessments appropriate to answering clinical questions
relative to physiological mechanism questions
d.  Examples from the literature: HRV and CV risk, Task engagement,
HRV and negative affect
B. Short-term vs. long-term measurement of HRV
a.  What is the adequate length of a recording period?
b.  Adequate collection, editing, scoring intervals of long-term (e.g., 24 hr)
recordings 
C. Threats to inference
a.  Respiration
b.  Physical activity
c.  Movement artifacts, missed, and extra heartbeats, and arrhythmias
d.  Task pacing
e.  Alternative physiological explanations of experimental effects.
D. Converging indices
a.  Resting heart rate
b.  Pre-ejection period 
c.  Verbal report
d.  Autonomic space
E. Concepts of possible relevance
a.  Relaxation
b.  Health
c.  Inflammation
d.  Recovery
e.  Bliss
F. Practicum: Critical review of 3 representative papers (small groups)

Reference Resources for HRV
Compiled by Peter Gianaros, Ph.D. and Maria Bleil, Ph.D., December 2004
Overviews and Guidelines
Akselrod S et al: Power spectrum analysis of heart rate fluctuations: A quantitative probe
of beat to beat cardiovascular control. Science 213:220-222, 1981.
Berntson GG et al:  Heart rate variability: Origins, methods, and interpretive caveats.
Psychophysiology 34:623-648, 1997.
Task Force: Heart rate variability: Standards of measurement, physiological interpretation,
and clinical use. Circulation 93:1043-1065, 1996.
Inferences about Autonomic Function
Berntson GG et al: Respiratory sinus arrhythmia: Autonomic origins, physiological
mechanisms, and psychophysiological implications. Psychophysiology 30:183-196, 1993.
Eckberg DL: Human sinus arrhythmia as an index of vagal cardiac outflow.
J Appl Physiol 54: 961-966, 1983.
Katoona PG, Jih F: Respiratory sinus arrhythmia: Noninvasive measure of parasympathetic
cardiac control. J Appl Physiol 39:801-805, 1975.
Taylor JA et al: Sympathetic restraint of respiratory sinus arrhythmia: implications for
vagal-cardiac tone assessment in humans. Am J Physiol: Heart Circulatory Physiol
280:H2804-2814, 2001.
Influence of Aging and Other Risk Factors (gender, obesity, smoking, alcohol)
Antelmi I et al: Influence of age, gender, body mass index, and functional capacity on heart
rate variability in a cohort of subjects without heart disease. Am J Cardiol 93:381-385, 2004.
Fagard RH et al: Influence of demographic, anthropometric and lifestyle characteristics on
heart rate and its variability in the population. J Hypertension 17:1589-1599, 1999.
Kageyama T et al: Effects of obesity, current smoking status, and alcohol consumption
on heart rate variability in male white-collar workers. Int Arch Occupat Environ Health
69:447-454, 1997.
Tsuji H et al.: Determinants of heart rate variability. J Am Coll Cardiol 28:1539-1546, 1996.
Relationships with Psychosocial Factors
DEPRESSION: Psychiatric samples
Agelink MW et al: Relationship between major depression and heart rate variability.
Clinical consequences and implications for antidepressive treatment. Psychiatry
Res 113(1-2):139-149, 2002.
Thayer JF et al:  Heart period variability and depressive symptoms: gender differences.
Biol Psychiatr 44:304-306, 1998.
DEPRESSION: Cardiac samples
Carney RM et al:  Depression, heart rate variability, and acute myocardial infarction.
Circulation 104:2024-2028, 2001.
Stein PK et al: Severe depression is associated with markedly reduced heart rate variability
in patients with stable coronary heart disease. J Psychosom Res 48:493-500; comment
317-320, 2000.
Prediction of Cardiovascular Health
Population-based studies:
Dekker JM et al.  Low heart rate variability in a 2-minute rhythm strip predicts risk of
coronary heart disease and mortality from several causes: the ARIC Study. Atherosclerosis
Risk In Communities. Circulation 102:1239-1244, 2000.
Huikuri HV et al. (1999). Heart rate variability and progression of coronary atherosclerosis.
Arteriosclerosis Thromb Vasc Biol 19:1979-1985, 1999.
Tsuji H et al: Impact of reduced heart rate variability on risk for cardiac events: the
Framingham Heart Study. Circulation 94:2850-2855, 1996a.
MI patients:
Bigger JT et al:  The ability of several short-term measures of RR variability to predict
mortality after myocardial infarction. Circulation 88:927-934, 1993.
Bigger JT Jr. et al:  Frequency domain measures of heart period variability to assess risk
late after myocardial infarction. J Am Coll Cardiol 21:729-736, 1993.
CAD patients:
Hayano J et al: Severity of coronary atherosclerosis correlates with the respiratory
component of heart rate variability. Am Heart J 121:1070-1078, 1991.
Huikuri HV et al: Heart rate variability and progression of coronary atherosclerosis.
Arteriosclerosis Thromb Vasc Biol 19:1979-1985, 1999.
Use as a Reactivity Measure
Cacioppo JT et al: Individual differences in the autonomic origins of heart rate reactivity:
the psychometrics of respiratory sinus arrhythmia and preejection period. Psychophysiology
31:412-419, 1994.
Sloan RP et al:  Hostility, gender, and cardiac autonomic control. Psychosom Med
63:434-440, 2001.
Hughes JW, Stoney CM: Depressed mood is related to high-frequency heart rate variability
during stressors. Psychosom Med 62:796-803, 2000.
Quantification
Berntson GG, Stowell JR:  ECG artifacts and heart period variability: don't miss a beat!
Psychophysiology 35:127-132, 1998.
Grossman et al:  A comparison of three quantification methods for estimation of respiratory
sinus arrhythmia. Psychophysiology 27:702-714, 1990.
Riniolo T, Porges SW:  Inferential and descriptive influences on measures of respiratory
sinus arrhythmia: sampling rate, R-wave trigger accuracy, and variance estimates.
Psychophysiology 34:613-621, 1997.
Control of Breathing
Grossman P et al:  Respiratory sinus arrhythmia, cardiac vagal control, and daily activity.
Am J Physiol: Heart Circulatory Physiol 287:H728-H734, 2004.
Grossman P et al: Prediction of tonic parasympathetic cardiac control using respiratory
sinus arrhythmia: the need for respiratory control. Psychophysiology 28:201-216, 1991.
Ritz T et al:  Modulation of respiratory sinus arrhythmia by respiration rate and volume:
Stability across posture and volume variations. Psychophysiology 38:858-862, 2001.
Theoretical Perspectives
Berntson GG et al: Autonomic space and psychophysiological response.
Psychophysiology 31:44-61, 1994.
Berntson GG et al: Cardiac psychophysiology and autonomic space in humans: empirical
perspectives and conceptual implications. Psychol Bull 114:296-322, 1993.
Porges SW:  The Polyvagal Theory: phylogenetic contributions to social behavior.
Physiol Behav 79:503-513, 2003.
Beauchaine T: Vagal tone, development, and Gray's motivational theory: toward an
integrated model of autonomic nervous system functioning in psychopathology.
Dev Psychopathol 13:183-214, 2001.

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