Menuet Clément, Ben-Tal Alona, Linossier Ambre, Allen Andrew M, Machado Benedito H, Moraes Davi J A, Farmer David G S, Paterson David J, Mendelowitz David, Lakatta Edward G, Taylor Edwin W, Ackland Gareth L, Zucker Irving H, Fisher James P, Schwaber James S, Shanks Julia, Paton Julian F R, Buron Julie, Spyer K Michael, Shivkumar Kalyanam, Dutschmann Mathias, Joyner Michael J, Herring Neil, Grossman Paul, McAllen Robin M, Ramchandra Rohit, Yao Song T, Ritz Thomas, Gourine Alexander V
INMED, INSERM, Aix-Marseille University, Marseille, France.
Insightful Modelling, Auckland, New Zealand.
Nat Rev Cardiol. 2025 May 6. doi: 10.1038/s41569-025-01160-z.
The variation of heart rate in phase with breathing, known as 'respiratory sinus arrhythmia' (RSA), is a physiological phenomenon present in all air-breathing vertebrates. RSA arises from the interaction of several physiological mechanisms but is primarily mediated by rhythmic changes in cardiac parasympathetic (vagal) activity, increasing heart rate during inspiration and decreasing heart rate during expiration. RSA amplitude is an indicator of autonomic and cardiac health; RSA is diminished or absent in common pathological conditions such as chronic heart failure and hypertension. In this Expert Recommendation, we argue that the term 'RSA', although historically important, is semantically inaccurate and carries misleading pathological connotations, contributing to misunderstanding and misinterpretation of the origin and the physiological importance of the phenomenon. We propose replacing 'RSA' with the term 'respiratory heart rate variability' (RespHRV), which avoids pathological connotations and emphasizes the specific respiratory contribution to heart rate variability. We clarify that RespHRV encompasses respiratory-related heart rate variations in both the low-frequency and high-frequency bands traditionally defined in heart rate variability analysis, and that its amplitude should not be misconstrued as a measure of vagal tone. Adopting the proposed term 'RespHRV' is expected to unify understanding and stimulate further experimental and clinical research into the physiological mechanisms and functional importance of this phenomenon.
心率随呼吸同步变化，即所谓的“呼吸性窦性心律不齐”（RSA），是所有呼吸空气的脊椎动物都存在的一种生理现象。RSA由多种生理机制相互作用产生，但主要由心脏副交感神经（迷走神经）活动的节律性变化介导，吸气时心率增加，呼气时心率降低。RSA幅度是自主神经和心脏健康的一个指标；在慢性心力衰竭和高血压等常见病理状况下，RSA会减弱或消失。在本专家建议中，我们认为“RSA”这个术语虽然在历史上很重要，但在语义上不准确，且带有误导性的病理含义，这导致对该现象的起源和生理重要性产生误解和错误解读。我们建议用“呼吸性心率变异性”（RespHRV）一词取代“RSA”，该术语避免了病理含义，并强调了呼吸对心率变异性的特定贡献。我们明确指出，RespHRV涵盖了传统心率变异性分析中定义的低频和高频波段与呼吸相关的心率变化，并且其幅度不应被误解为迷走神经张力的度量。采用建议的术语“RespHRV”有望统一认识，并激发对该现象的生理机制和功能重要性的进一步实验和临床研究。
