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Heart Rate Fragmentation, Ambulatory Blood Pressure, and Coronary Artery Calcification: A Population-Based Study
Yuichi Sawayama1, Yuichiro Yano2, Takashi Hisamatsu2,3
1Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan.
Insights
Higher heart rate fragmentation (HRF) and systolic blood pressure (SBP) during sleep are linked to coronary artery calcification (CAC) in men. This suggests HRF may be an early indicator of cardiovascular risk.
Area of Science:
- Cardiology
- Biomedical Engineering
- Public Health
Background:
- Ultra-rapid heart rate variability patterns, such as heart rate fragmentation (HRF), are not well understood in relation to coronary artery calcification (CAC) in the general population.
- Subclinical atherosclerosis, indicated by CAC, is a significant risk factor for cardiovascular events.
Purpose of the Study:
- To investigate the association between HRF and CAC in a general population.
- To determine if this association is independent of systolic blood pressure (SBP) levels.
Main Methods:
- Utilized data from the Shiga Epidemiological Study of Subclinical Atherosclerosis (SESSA).
- Assessed 24-hour ambulatory blood pressure monitoring for awake and asleep SBP.
- Quantified HRF using the percentage of inflection points (PIP) from 24-hour Holter monitoring.
- Measured CAC using the Agatston score from computed tomography scans.
- Employed multivariable logistic regression to analyze associations.
Main Results:
- The study included 508 participants (mean age 66.5 years), with 64% having CAC.
- Higher awake SBP (OR 1.40, 95% CI: 1.11-1.77) and asleep SBP (OR 1.28, 95% CI: 1.02-1.60) were associated with prevalent CAC.
- Higher awake PIP (OR 1.23, 95% CI: 0.99-1.54) and asleep PIP (OR 1.31, 95% CI: 1.05-1.62) were also associated with CAC.
- No significant interaction was found between PIP and ambulatory SBP regarding CAC presence.
Conclusions:
- Elevated HRF and SBP levels during sleep are independently associated with the presence of CAC in a general male population.
- HRF, particularly during sleep, may serve as a novel biomarker for subclinical coronary atherosclerosis.
Background:
Little is known regarding whether ultra-rapid patterns of heart rate variability (eg, heart rate fragmentation [HRF]) are associated with coronary artery calcification (CAC) in a general population.
Objectives:
This study aimed to assess the association between HRF and CAC, and whether these associations are independent of systolic blood pressure (SBP) levels.
Methods:
From SESSA (the Shiga Epidemiological Study of Subclinical Atherosclerosis), we used data from 24-hour ambulatory blood pressure monitoring to identify awake and asleep SBP levels, and data from concurrent 24-hour Holter monitoring to quantify HRF using the awake and asleep percentage of inflection points (PIP). CAC on computed tomography scanning was quantified using an Agatston score. We used multivariable binomial logistic regression to assess the associations of PIP and ambulatory SBP with the presence of CAC, as defined by Agatston score >0.
Results:
Of the 508 participants in this study (mean age: 66.5 ± 7.3 years), 325 (64%) had CAC and 183 (36%) did not. In fully adjusted models of prevalent CAC that also included office SBP, the ORs with 95% CIs for awake PIP, awake SBP, asleep PIP, and asleep SBP were 1.23 (95% CI: 0.99-1.54), 1.40 (95% CI: 1.11-1.77), 1.31 (95% CI: 1.05-1.62), and 1.28 (95% CI: 1.02-1.60), respectively. There was no evidence of interaction between PIP and ambulatory SBP in association with CAC. Results were similar when other HRF indices instead of PIP were used.
Conclusions:
Higher HRF and SBP levels during sleep are each associated with the presence of CAC in a general male population.
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