Gabriel Dias Rodrigues
Rubens Fazan Jr.
Nicola Montano- 1Department of Clinical Sciences and Community Health, Dipartimento di Eccellenza 2023–2027, University of Milan, Milan, Italy
- 2Department of Physiology and Pharmacology, Fluminense Federal University (UFF), Niterói, Brazil
- 3Department of Physiology, School of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirão Preto, Brazil
- 4Department of Internal Medicine, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
Editorial on the Research Topic
Updates on cardiovascular variability: underlying mechanisms and non-pharmacological therapeutic targets
The successful translation of heart rate variability (HRV) applications from bench to bedside is largely rooted in the pioneering studies led by Professor Alberto Malliani and his group (1). In essence, a reduction in HRV oscillatory patterns, or an overall loss of cardiovascular variability, reflects disfunction in the modulation of target organ function and serves as a robust prognostic marker (1). Advances in signal processing along with a growing understanding of brain–body interactions, have uncovered new connections between the autonomic nervous system and other biological systems thereby broadening the scope of HRV research.
This Research Topic brings together multidisciplinary contributions that advance our understanding of cardiovascular variability across experimental models, novel methodologies, and clinical applications. Our aim was to provide updated perspectives that bridge from basic physiological mechanisms and applied clinical research, ultimately fostering improved diagnostics, risk stratification, and therapeutic monitoring through the lens of cardiovascular variability assessment.
The studies included in this collection highlight recent advances in the application of cardiovascular variability assessment across a range of clinical and physiological contexts. Scatà et al. reported that postmenopausal women exibit significant reductions in HRV and baroreflex sensitivity compared to age-matched premenopausal controls, pointing to estrogen deficiency in the disruption of autonomic cardiovascular regulation (2). In another study, individuals with long COVID who reported persistent palpitations exhibited altered HRV and baroreflex sensitivity, suggesting that cardiac autonomic imbalance may contribute to the post-acute sequelae of SARS-CoV-2 infection (3).
Dos Santos and colleagues (4) demonstrated that HRV indices combined with machine learning techniques can effectively detect both the presence and severity of obstructive sleep apnea, supporting the development of rapid, non-invasive diagnostic tools. Also, in the field of sleep medicine, multifactorial analysis of HRV revealed altered complexity and scaling behavior in healthy pregnant women compared to non-pregnant controls, offering a sensitive method in capturing subtle autonomic changes during gestation (5).
Beyond clinical aspects, environmental and physiological stressors also modulate cardiovascular variability. Oliveira and colleagues (6) showed that men and women exhibit distinct autonomic responses to hypoxia: women preserved vagal activity and maintained stable baroreflex function, while men exhibited marked reductions in HRV, suggesting sex-specific autonomic adaptations. In the scenario of space medicine, a short-arm human centrifugation protocol delivering artificial gravity mitigated the decline in baroreflex function and HRV typically observed during prolonged bed rest, highlighting its potential as a countermeasure against cardiovascular deconditioning in microgravity simulations (7).
Together, these studies underscore the multifaceted relevance of cardiovascular variability as both a physiological marker and a clinical tool. They highlight the interplay between the autonomic nervous system, clinical features, and the environment influences. As new technologies and analytical frameworks continue to evolve, variability-based metrics are poised to play an increasingly prominent role in personalized medicine, enabling more precise diagnostics and targeted interventions. We hope this Research Topic will inspire continued interdisciplinary collaboration and innovation in the study of cardiovascular variability.
Author contributions
GD: Conceptualization, Validation, Visualization, Writing – original draft, Writing – review & editing. RF: Validation, Visualization, Writing – original draft, Writing – review & editing. NM: Supervision, Visualization, Writing – original draft, Writing – review & editing.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.
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References
1. Malliani A. Heart rate variability: from bench to bedside. Eur J Intern Med. (2005) 16(1):12–20. doi: 10.1016/j.ejim.2004.06.016
2. Scatà C, Ferreira FC, Padilha MCSV, Carandina A, Asnaghi R, Bellocchi C, et al. Blunted cardiac autonomic dynamics to active standing test in postmenopausal women. Front Cardiovasc Med. (2024) 11:1402086. doi: 10.3389/fcvm.2024.1402086
3. Jiang Y, Cheng Y, Xiao J, Wang Y, Chen G, Zhang Y. Analysis of the correlation between heart rate variability and palpitation symptoms in female patients with long COVID. Front Cardiovasc Med. (2023) 10:1273156. doi: 10.3389/fcvm.2023.1273156
4. Dos Santos RR, Marumo MB, Eckeli AL, Salgado HC, Silva LEV, Tinós R, et al. The use of heart rate variability, oxygen saturation, and anthropometric data with machine learning to predict the presence and severity of obstructive sleep apnea. Front Cardiovasc Med. (2025) 12:1389402. doi: 10.3389/fcvm.2025.1389402
5. Mendez MO, Bianchi AM, Recker F, Strizek B, Murguía JS, Reali P, et al. Multifractal analysis of heart rate variability in pregnancy during sleep. Front Cardiovasc Med. (2024) 11:1404055. doi: 10.3389/fcvm.2024.1404055
6. Oliveira ALMB, Rodrigues GD, Silva BM, Rohan PA, Soares PPDS. Sex differences in cardiorespiratory control under hypoxia: the roles of oxygen desaturation and hypoxic exposure time. Front Cardiovasc Med. (2025) 12:1473910. doi: 10.3389/fcvm.2025.1473910
Keywords: autonomic nerovus system, baroreflex sensitivity (BRS), machine learning (ML), microgravity, hypoxia, long covid, menopause
Citation: Dias Rodrigues G, Fazan Jr. R and Montano N (2025) Editorial: Updates on cardiovascular variability: underlying mechanisms and non-pharmacological therapeutic targets. Front. Cardiovasc. Med. 12:1670996. doi: 10.3389/fcvm.2025.1670996
Received: 22 July 2025; Accepted: 4 August 2025;
Published: 14 August 2025.
Edited and Reviewed by: Leonardo Roever, Brazilian Evidence-Based Health Network, Brazil
Copyright: © 2025 Dias Rodrigues, Fazan Jr. and Montano. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Gabriel Dias Rodrigues, ZGlhczVnYWJyaWVsQGdtYWlsLmNvbQ==