Original Investigation

Heart Rate Variability Biofeedback and Mental Stress Myocardial Flow Reserve

JAMA Network Open 10.1001/jamanetworkopen.2025.38416

October 21, 2025 at 11:00 AM EDT

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Is heart rate variability biofeedback (HRVB) an effective intervention for reducing the effects of acute psychological stress on myocardial blood flow?In this single-center pilot randomized clinical trial of 21 participants, 6 weeks of HRVB training was associated with an increase in mental stress myocardial flow reserve, which was measured as the ratio of myocardial blood flow during mental stress to the flow at rest.These findings suggest that 6 weeks of HRVB training is an effective intervention for increasing myocardial blood flow during an acute mental stress challenge.

Corresponding Author: Amit J. Shah, MD, MSCR, Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Room 4045, Atlanta, GA 30322 (ajshah3@emory.edu).

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