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The relationship between heart rate variability and heart rate turbulence dynamics after primary coronary angioplasty
Małgorzata Kurpesa1, Ewa Trzos, Tomasz Rechciński
1II Chair and Department of Cardiology, Medical University of Lodz, Bieganski Hospital, Poland. kurpesa@ptkardio.pl
Insights
Heart rate turbulence (HRT) dynamics after myocardial infarction (MI) treated with primary angioplasty show significant changes over time. Early heart rate variability (HRV) analysis can predict these long-term HRT dynamics and identify patients needing further monitoring.
Area of Science:
- Cardiology
- Autonomic Nervous System Research
- Medical Diagnostics
Background:
- Heart rate turbulence (HRT) analysis is established for risk stratification post-myocardial infarction (MI) treated with medication.
- Primary percutaneous coronary angioplasty (PTCA) is a common treatment for MI.
- Understanding long-term HRT dynamics after PTCA is crucial for patient management.
Purpose of the Study:
- To evaluate the long-term dynamics of HRT changes in patients with MI treated with primary PTCA.
- To assess the predictive value of early post-infarction heart rate variability (HRV) analysis for HRT dynamics.
Main Methods:
- The study included 96 patients with MI treated with primary PTCA.
- Holter monitoring for HRV and HRT analysis was conducted 3 days and 1 year post-procedure.
- Statistical analysis identified predictors of HRT dynamics.
Main Results:
- Over 12 months, 51 patients showed improved HRT (Type I), 34 worsened (Type II), and 14 had mixed changes (Type III).
- Early HRV parameters, particularly Delta LF/HF, predicted Type II HRT dynamics.
- SDNN and Triangular Index improved in all patients during follow-up.
Conclusions:
- HRT exhibits significant, distinct dynamics compared to HRV after primary PTCA for MI.
- Abnormal circadian autonomic activity patterns predict long-term HRT changes towards unfavorable values.
- Identifying patients with abnormal autonomic patterns is key for repeat HRT analysis during follow-up.
Background:
The application of heart rate turbulence (HRT) analysis for risk assessment after pharmacologically treated myocardial infarction (MI) was described in 1999. The aim of the present study was to evaluate the dynamics of HRT changes in long-term observation after MI treated with primary coronary angioplasty (PTCA). Moreover, the usefulness was assessed of early postinfarction heart rate variability (HRV) analysis for predicting HRT dynamics.
Methods:
The study group consisted of 96 patients with MI treated with primary PTCA. Holter monitoring with HRV and HRT analysis was performed 3 days after the procedure and 1 year later.
Results:
Twelve months after primary PTCA, an improvement (Type I HRT dynamics) was noted in 51 patients, and the worsening of both the HRT parameters (Type II HRT dynamics) in 34 patients. Fourteen patients showed the worsening of only one HRT parameter (Type III HRT dynamics). The following HRV parameters recorded in early postinfarction Holter monitoring had a significant influence on the risk of Type II HRT dynamics: SDNN, RMSSD, Triangle Index and Delta LF/HF (mean day-time LF/HF - mean night-time LF/HF). Only the latter was found in the multivariate analysis as significantly connected with worsened HRT. During the follow-up, SDNN and Triangular Index improved in all the patients.
Conclusions:
HRT after myocardial infarction treated with primary PTCA presents a significant dynamics, which is different than dynamics of HRV. An abnormal circadian pattern of autonomic activity is a finding that helps identify patients who need to have HRT analysis repeated during a long-term follow-up, due to the tendency for HRT to change with time toward the prognostically unfavorable values.
