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The Autonomic Imbalance of Myocardial Ischemia during Exercise Stress Testing: Insight from Short-Term Heart Rate

Ping-Yen Lin1, Cheng-Ting Tsai2,3, Chang Francis Hsu4

  • 1Department of Electrophyics, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan.

International Journal of Environmental Research and Public Health
|November 26, 2022
PubMed

Insights

Short-term heart rate variability (HRV) analysis during exercise stress testing (EST) can improve coronary artery disease (CAD) detection. Delayed sympathetic recovery in significant CAD patients suggests autonomic imbalance.

Area of Science:

  • Cardiology
  • Physiology
  • Biomedical Engineering

Background:

  • Exercise stress testing (EST) has limitations in diagnosing obstructive coronary artery disease (CAD).
  • Heart rate variability (HRV) analysis may enhance the sensitivity of CAD detection during EST.
  • Autonomic dysfunction is implicated in cardiovascular diseases.

Purpose of the Study:

  • To evaluate the correlation between short-term HRV and myocardial ischemia during the acceleration, maximum, and recovery phases of EST.
  • To compare HRV patterns during EST in healthy individuals and patients with varying degrees of CAD.
  • To identify potential HRV-based markers for diagnosing significant CAD.

Main Methods:

  • Collected HRV data during EST from 19 healthy controls (RHC) and 35 CAD patients (25 iCAD, 10 sCAD).
  • Analyzed HRV indices including low-frequency power (LF), standard deviation of normal-to-normal intervals (SDNN), and Poincaré plot parameters (SD2).
  • Compared HRV changes across acceleration, maximum, and recovery stages of heart rate (HR).

Main Results:

  • All HRV indices decreased at maximum HR, with no significant differences between iCAD and sCAD groups.
  • The low-frequency power (LF) in healthy controls recovered faster post-maximum HR compared to the significant CAD (sCAD) group.
  • Relative changes in most HRV indices (LF, SDNN, SD2) between maximum HR and recovery were lower in the sCAD group than in RHC (p < 0.05).
  • The recovery slope of LF was significantly smaller in the sCAD group (p = 0.02), indicating delayed sympathetic recovery.

Conclusions:

  • Short-term HRV monitoring during EST offers valuable insights into cardiovascular autonomic imbalance in significant CAD.
  • Delayed sympathetic recovery, reflected in HRV changes, may serve as an additional diagnostic marker for myocardial ischemia.
  • HRV analysis during EST can potentially augment traditional diagnostic methods for obstructive CAD.

Keywords:
coronary artery diseaseexercise stress testingheart rate variabilitymyocardial ischemiashort-term HRV

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