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Additive Value of Heart Rate Variability in Predicting Obstructive Coronary Artery Disease Beyond Framingham Risk
Hsin-Ru Li1, Tse-Min Lu, Hao-Min Cheng
1Department of Medicine, Shuang Ho Hospital, Taipei Medical University.
Insights
Reduced heart rate variability (HRV) predicts coronary artery disease (CAD) in stable angina patients, independent of traditional risk factors. HRV may be most relevant for individuals with high cardiovascular risk or diabetes.
Area of Science:
- Cardiology
- Medical Diagnostics
Background:
- Heart rate variability (HRV) is often diminished in patients diagnosed with coronary artery disease (CAD).
- Investigated the predictive capability of reduced HRV for angiographic CAD in stable angina patients, beyond established Framingham risk factors.
Purpose of the Study:
- To determine if reduced HRV is an independent predictor of angiographic CAD in patients with stable angina.
- To assess the added value of HRV in predicting CAD compared to the Framingham risk score.
Main Methods:
- Enrolled 514 patients with stable angina, performing 24-hour Holter ECG before coronary angiography.
- Analyzed HRV in both frequency (VLF, LF, HF, total power) and time domains (SDNN, SDANN, RMSSD, pNN20).
- Defined angiographic CAD as ≥ 50% diameter reduction in coronary arteries.
Main Results:
- 203 patients (39.6%) had angiographic CAD, with higher Framingham risk and lower HRV in this group.
- Reduced HRV indices (LF, HF, SDNN, RMSSD, pNN20) remained significant predictors of CAD after adjusting for clinical variables and Framingham risk.
- HRV was predictive of CAD primarily in patients with high Framingham risk or diabetes.
Conclusions:
- Diminished HRV is a significant predictor of CAD in stable angina patients, independent of conventional risk factors.
- The predictive utility of HRV appears most pronounced in individuals with high Framingham risk scores or diabetes mellitus.
Background:
Heart rate variability (HRV) is usually reduced in patients with CAD. We therefore investigated whether reduced HRV is predictive of angiographic CAD beyond Framingham risk in patients with stable angina.
Methods And Results:
A total of 514 patients (age, 66.1 ± 14.3 years, 358 men) were enrolled. Holter ECG was performed before catheterization, and 24-h HRV was analyzed in both the frequency domain (VLF, LF, HF and total power) and the time domain (SDNN, SDANN, RMSSD and pNN20). Angiographic CAD was defined as ≥ 50% diameter reduction of 1 or more coronary arteries. On coronary angiography 203 patients (39.6%) had angiographic CAD. Patients with CAD had significantly higher Framingham risk and lower HRV according to both frequency and time domain parameters. After controlling for age, gender, heart rate, SBP, renal function, lipids and Framingham risk, reduced HRV indices remained predictors of CAD (OR, 95% CI for LF, HF, SDNN, RMSSD and pNN20: 0.81, 0.66-0.99; 0.77, 0.63-0.94; 0.75, 0.59-0.96; 0.72, 0.58-0.88; and 0.76, 0.62-0.94, respectively). On subgroup analysis, HRV parameters appeared to be predictive of CAD only in subjects with high Framingham risk or diabetes.
Conclusions:
Reduced HRV is predictive of CAD in patients with stable angina, independent of traditional risk factors and Framingham risk. The predictive value of HRV may be relevant only in subjects with high Framingham risk or diabetes.
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