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Five-minute heart rate variability can predict obstructive angiographic coronary disease
D Kotecha1, G New, M D Flather
1Monash Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Australia. dipak.kotecha@monash.edu
Insights
Low heart rate variability (HRV) strongly predicts obstructive coronary artery disease (CAD) in patients undergoing angiography. This non-invasive marker can aid in risk stratification and potentially reduce unnecessary cardiac procedures.
Area of Science:
- Cardiology
- Autonomic Nervous System Function
- Non-invasive Cardiac Diagnostics
Background:
- Obstructive coronary artery disease (CAD) is diagnosed in only half of patients referred for angiography.
- Five-minute heart rate variability (HRV) serves as a non-invasive marker for autonomic control of the vasculature.
- HRV may help risk-stratify cardiac patients and decrease unnecessary angiograms.
Purpose of the Study:
- To investigate the hypothesis that five-minute heart rate variability (HRV) can risk-stratify cardiac patients.
- To determine if HRV can reduce the number of unnecessary coronary angiograms performed.
- To assess the predictive value of HRV for obstructive coronary artery disease.
Main Methods:
- Prospective observational study (Alternative Risk Markers in Coronary Artery Disease (ARM-CAD) study).
- 470 consecutive patients with predominantly normal cardiac rhythm undergoing elective angiography across three Australian cardiac centres.
- Obstructive CAD defined as ≥50% stenosis on angiography.
Main Results:
- Patients with obstructive CAD exhibited significantly reduced HRV, particularly in the low frequency (LF) range (median 180 vs 267 ms²; p<0.001).
- A linear trend was observed between decreasing LF power and increasing CAD severity (p=0.003).
- Reduced LF power was independent of stenosis location, and HRV added to risk prediction irrespective of Framingham risk score (p<0.0001).
Conclusions:
- Low HRV is a strong predictor of angiographic coronary artery disease.
- HRV is clinically useful for risk prediction in patients with sinus rhythm.
- HRV can aid in identifying patients with obstructive CAD, potentially reducing the need for invasive procedures.
Objective:
Obstructive coronary artery disease (CAD) is evident in only half of patients referred for diagnostic angiography. Five-minute heart rate variability (HRV) is a non-invasive marker for autonomic control of the vasculature, which this study hypothesised could risk-stratify cardiac patients and reduce unnecessary angiograms.
Design:
A prospective observational study (the Alternative Risk Markers in Coronary Artery Disease (ARM-CAD) study).
Setting:
Three cardiac centres in Melbourne, Australia.
Patients:
470 consecutive patients undergoing elective angiography (with predominantly normal cardiac rhythm), regardless of co-morbidity.
Main Outcome Measures:
The presence of obstructive CAD (≥50% stenosis) on angiography.
Results:
Patients with obstructive CAD had significantly reduced HRV, particularly in the low frequency (LF) range (median 180 vs 267 ms(2) without CAD; p<0.001). There was a linear trend with the severity of CAD; median LF power (IQR) in patients with normal coronaries was 275 (612), with minor coronary irregularities 255 (400), single-vessel CAD 212 (396) and more severe disease 170 (327) ms(2); p value for trend 0.003. There was a similar reduction in LF power regardless of the anatomical location of coronary stenoses. Comparing patients with LF less than 250 and 250 ms(2) or greater, the adjusted OR for obstructive CAD using multivariate regression was 2.42, 95% CI 1.33 to 4.38 (p=0.004). No interactions were noted in subgroup analysis and HRV added to risk prediction irrespective of the baseline Framingham risk (p<0.0001).
Conclusion:
Low HRV is strongly predictive of angiographic coronary disease regardless of other co-morbidities and is clinically useful as a risk predictor in patients with sinus rhythm.
Clinical Trial Registration Information:
http://clinicaltrials.gov/ct2/show/NCT00403351 www.armcad.com.
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