Assessment of the sympatho-vagal interaction in central serous chorioretinopathy measured by power spectral analysis of heart rate variability

Abstract

Purpose: It has been postulated that patients with central serous chorioretinopathy (CSCR) frequently have Type A behaviour with increased catecholamine release. The purpose of this study was to measure the activity of the sympathetic nervous system in patients with CSCR by a power spectral analysis (PSA) of heart rate (RR-interval) variability. PSA is a suitable noninvasive method to reflect the balance of the sympathovagal interaction. Methods: 24 eyes of 24 patients (23 males and 1 female) with a mean age of 44 y (range: 32-52) were evaluated and devided into 4 different groups: group 1 (n=8) with acute CSCR, group 2 (n=7) with acute recurrent CSCR, group 3 (n=2) with chronic persistent CSCR and group 4 (n=7) with complete remission after CSCR. The RR-interval measurement data of our 24 patients were compared with the data of 15 healthy age matched volunteers. Off-line analysis was performed with an autoregressive method (maximum entropy method). The resulting ratio of low frequency component (LF) and high frequency component (HF) of the power spectrum serves as a measure of sympathetic-vagal balance with LF representing mainly sympathetic activity and HF representing vagal activity. Results: When comparing the LF/HF ratios of CSCR patients with normal controls (LF/HF ratio of 1.1) significant differences were found for all but one subgroups: group 1: LF/HF ratio of 5.5 (p<0.01), group 2: LF/HF ratio of 5,4 (p<0.05), group 3: LF/HF ratio of 4.2 (p=0.1) and group 4: LF/HF ratio of 3.0 (p<0.05). Significant differences (p<0.05) were also found between active CSCR (group 1 and 2) and inactive CSCR (group 4). Conclusions: These results support the view that the pathogenesis of CSCR is related to an increased sympathetic activity of the autonomic nervous system. Furthermore the LF/HF ratios correlate well with the activity of the disease. PSA may be useful in assessing the changes of sympathetic activity in acute and chronic CSCR, yielding additional information for a rational therapy, e.g. β-blockade.