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61 Five-min heart rate variability can predict obstructive angiographic coronary disease
  1. D Kotecha1,
  2. G New2,
  3. M Flather1,
  4. D Eccleston3,
  5. H Krum3
  1. 1Royal Brompton Hospital, London, UK
  2. 2Box Hill Hospital, Melbourne, UK
  3. 3Monash University, Melbourne, UK

Abstract

Background Obstructive coronary artery disease (CAD) is evident in only half of patients referred for diagnostic coronary angiography. Five-minute heart rate variability (HRV) is a marker for autonomic control of the vasculature, which we hypothesised could be used to risk-stratify cardiac patients (the Alternative Risk Markers in Coronary Artery Disease (ARM-CAD) study.

Methods Resting HRV prior to elective coronary angiography was analysed in 470 participants with predominantly normal cardiac rhythm, regardless of comorbidity. The presence of obstructive CAD (≥50% stenosis) was regressed in a multivariate model including risk factors, ECG variables and medications.

Results Mean age was 65 years (SD 11), 67% were male, 21% had diabetes, mean blood pressure was 144/79 mm Hg (SD 21/10) and 16% had impaired left-ventricular function. Patients with obstructive CAD had significantly reduced HRV, particularly in the low frequency (LF) range (median 180 vs 267 ms2 without CAD; p<0.001). There was a linear trend according to the severity of CAD; the 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) ms2; p-value for trend=0.003. There was a similar reduction in LF power regardless of the anatomical location of coronary stenoses (see Abstract 61 figure 1). Comparing patients with LF<250 and ≥250 ms2, the OR for obstructive CAD was 2.42, 95% CI 1.33 to 4.38 (p=0.004) after adjusting for risk factors, medications and heart rate. No interactions were noted in sub-group analysis of age, gender, diabetes, prior cardiovascular disease or high-sensitivity CRP. In addition, HRV added to risk prediction irrespective of baseline Framingham risk (p<0.0001).

Conclusion Low HRV is strongly predictive of angiographic coronary disease regardless of other comorbidities and is clinically useful as a risk predictor in patients with sinus rhythm.

  • Coronary artery disease
  • heart rate variability
  • coronary angiography

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