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Related Experiment Video

Updated: May 27, 2026

Oxygenation-sensitive Cardiac MRI with Vasoactive Breathing Maneuvers for the Non-invasive Assessment of Coronary Microvascular Dysfunction
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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

Heart (British Cardiac Society)
|November 29, 2011
PubMed
Summary

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.

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Oxygenation-sensitive Cardiac MRI with Vasoactive Breathing Maneuvers for the Non-invasive Assessment of Coronary Microvascular Dysfunction
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Evaluation of Coronary Flow Reserve After Myocardial Ischemia Reperfusion in Rats
06:32

Evaluation of Coronary Flow Reserve After Myocardial Ischemia Reperfusion in Rats

Published on: June 28, 2019

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.