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Heart rate variability derived from exercise ECG in the detection of coronary artery disease

Matti Virtanen1, Mika Kähönen, Tuomo Nieminen

  • 1Ragnar Granit Institute, Tampere University of Technology, PO Box 692, FI-33101, Finland.

Physiological Measurement
|October 2, 2007
PubMed

Insights

Heart rate variability (HRV) analysis during exercise ECG is not effective for detecting coronary artery disease (CAD). Traditional ST-segment analysis showed better diagnostic performance than HRV in this study.

Area of Science:

  • Cardiology
  • Medical Diagnostics
  • Biomedical Engineering

Background:

  • Coronary artery disease (CAD) diagnosis often relies on exercise electrocardiography (ECG).
  • The utility of heart rate variability (HRV) analysis during exercise ECG for CAD detection remains unclear.
  • Previous studies have not established HRV's diagnostic performance in this context.

Purpose of the Study:

  • To evaluate the diagnostic performance of HRV parameters derived from exercise ECG for detecting coronary artery disease (CAD).
  • To compare the efficacy of HRV analysis with traditional ST-segment analysis in CAD detection.
  • To assess the impact of heart rate (HR) correction on HRV's diagnostic capabilities.

Main Methods:

  • Analysis of exercise ECG recordings from the Finnish Cardiovascular Study (FINCAVAS).
  • Inclusion of patients with proven CAD (n=112) and a low likelihood of CAD (n=114).
  • Calculation of HRV parameters (SDNN, RMSSD, Poincaré SD1/SD2) and ST-segment depression from 1-minute ECG segments (pre-exercise, during, and post-exercise).
  • Evaluation of diagnostic performance using receiver operating characteristic (ROC) curve analysis.
  • Comparison of uncorrected and HR-corrected HRV parameters.

Main Results:

  • Uncorrected HRV parameters demonstrated the best diagnostic performance during the recovery phase, but showed high correlation with heart rate (HR).
  • HR correction reduced both the correlation with HR and the diagnostic performance of HRV parameters in the recovery phase.
  • ST-segment analysis exhibited superior diagnostic performance compared to all analyzed HRV parameters (Area under ROC: 0.795 for ST-level vs. <0.795 for HRV).
  • HR correction negatively impacted the diagnostic performance of HRV during the recovery phase.

Conclusions:

  • HRV analysis from exercise or recovery ECG segments is currently inadequate for detecting coronary artery disease (CAD).
  • Traditional ST-segment analysis remains a more capable diagnostic tool for CAD detection compared to HRV analysis from exercise ECG.
  • The findings suggest that HR correction may diminish the diagnostic utility of HRV in the recovery phase for CAD assessment.

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