Heart rate variability depression in patients with unstable angina

doi:10.1016/0002-8703(95)90076-4

American Heart Journal

Volume 130, Issue 4, October 1995, Pages 772-779

https://doi.org/10.1016/0002-8703(95)90076-4 Get rights and content

Abstract

The degree of reduction in heart rate variability (HRV) after myocardial infarction has been shown to have prognostic significance, but HRV has not been studied extensively in patients with unstable angina. We assessed spectral and nonspectral measurements of HRV in 52 patients with unstable angina, 52 patients with acute myocardial infarction, and 41 normal subjects. The spectral bands of 0.04 to 0.15 Hz (low frequency), 0.15 to 0.4 (high frequency), and nonspectral parameters SDNN, SDANN, SDNN index, rMSSD, and pNN50 were calculated from continuous 24-hour ECGs. All measures of HRV were reduced in patients with acute coronary syndromes compared to normal controls (p < 0.001), and there was no significant difference in measure of HRV between unstable angina and myocardial infarction patients. In patients with unstable angina who stabilized after admission, HRV had increased by the second 24 hours of monitoring. In contrast, HRV was further depressed in patients who had episodes of chest pain or transient ST-segment depression during the second 24 hours. rMSSD, pNN50, and SDNN index were lower in patients with unstable angina who had transient silent ischemia compared to those without silent ischemia. Of the patients with unstable angina, 4 died and 1 had nonfatal acute myocardial infarction within 11 months. HRV was lower in these patients than in patients without further cardiac events.

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Cited by (46)

Associations between affective factors and high-frequency heart rate variability in primary care patients with depression
2022, Journal of Psychosomatic Research
Citation Excerpt :
Current smoking status was assessed by a Behavioral Risk Factor Surveillance System measure (Nelson et al., 2001) and was coded as 0 = no current smoking and 1 = current smoking. Some behavioral factors (e.g., smoking) and medical comorbidities (e.g., diabetes) known to affect HF HRV have been exclusion criteria in some prior HRV studies [63,64]. However, because elevated CVD risk was an inclusion criterion in the eIMPACT trial and depression is associated with elevated rates of CVD risk factors [65–71], we examined these factors as covariates rather than used them as exclusion criteria to help ensure our sample is representative and our findings are generalizable to primary care patients with depression.
Depression is a risk factor for cardiovascular disease (CVD), and subgroups of people with depression may be at particularly elevated CVD risk. Lower high-frequency heart rate variability (HF HRV), which reflects diminished parasympathetic activation, is a candidate mechanism underlying the depression-CVD relationship and predicts cardiovascular events. Few studies have examined whether certain depression subgroups – such as those with co-occurring affective factors – exhibit lower HF HRV. The present study sought to assess associations between co-occurring affective factors and HF HRV in people with depression.
Utilizing baseline data from the 216 primary care patients with depression in the eIMPACT trial, we examined cross-sectional associations of depression's co-occurring affective factors (i.e., anxiety symptoms, hostility/anger, and trait positive affect) with HF HRV. HF HRV estimates were derived by spectral analysis from electrocardiographic data obtained during a supine rest period.
Individual regression models adjusted for demographics and depressive symptoms revealed that anxiety symptoms (standardized regression coefficient β = −0.24, p = .002) were negatively associated with HF HRV; however, hostility/anger (β = 0.02, p = .78) and trait positive affect (β = −0.05, p = .49) were not. In a model further adjusted for hypercholesterolemia, hypertension, diabetes, body mass index, current smoking, CVD prevention medication use, and antidepressant medication use, anxiety symptoms remained negatively associated with HF HRV (β = −0.19, p = .02).
Our findings suggest that, in adults with depression, those with comorbid anxiety symptoms have lower HF HRV than those without. Co-occurring anxiety may indicate a depression subgroup at elevated CVD risk on account of diminished parasympathetic activation.
Sleep heart rate variability assists the automatic prediction of long-term cardiovascular outcomes
2020, Sleep Medicine
Citation Excerpt :
Since first was proposed, HRV has been rapidly adopted as a non-invasive method to study the cardiac autonomic modulation [3]. Evidences of an association between HRV and CVD, such as myocardial infarction [4,5], stroke [6], angina [7,8], coronary heart disease [9], coronary artery disease [10–12] and sudden cardiac death [13], have been reported. Furthermore, studies have put forward that HRV has predictive value for CVD outcomes [14–16].
We aimed to investigate the association between sleep HRV and long-term cardiovascular disease (CVD) outcomes, and further explore whether HRV features can assist the automatic CVD prediction.
We retrospectively analyzed polysomnography (PSG) data obtained from 2111 participants in the Sleep Heart Health Study, who were followed up for a median of 11.8 years after PSG acquisition. During follow-up, 1252 participants suffered CVD events (CVD group) and 859 participants remained CVD-free (non-CVD group). HRV measures, derived from time-domain and frequency-domain, were calculated. Regression models were created to determine the independent predictor for long-term CVD outcomes, and to explore the association between HRV and CVD latency. Furthermore, based on HRV and other clinical features, a model was trained to automatically predict CVD outcomes using the eXtreme Gradient Boosting algorithm.
Compared with the non-CVD group, decreased HRV during sleep was found in the CVD group. HRV, particularly its component of high frequency (HF), was demonstrated to be independent predictor of CVD outcomes. Moreover, normalized HF was positively correlated with CVD latency. The proposed prediction model achieved a total accuracy of 75.3%, in which sleep HRV features served as a supplement to the well-recognized CVD risk factors, such as aging, adiposity and sleep disorders.
Association between sleep HRV and long-term CVD outcomes was demonstrated here, suggesting that altered HRV during sleep might occur many years prior to the onset of CVD. Machine learning models, combining sleep HRV and other clinical characteristics, should be promising in the early prediction of CVD outcomes.
Myocardial infarction - Sailing on to new horizons
2012, Deutsche Zeitschrift fur Akupunktur
Die Erfahrung zeigt, dass Akupunktur bei Patienten mit Angina pectoris und Zustand nach Herzinfarkt wirksam und hilfreich ist. Dennoch macht die Akupunktur einen großen Bogen um diese Patienten. Man will sich nicht blamieren, scheint der Hauptgrund zu sein. An einem derart organisch determinierten Prozess wie den koronaren Stenosen kann eine Nadeltherapie nichts ausrichten, also vergisst man seine guten Erfahrungen bei diesen Patienten.
In diesem Artikel wird die Allgemeingültigkeit der „KHK” als pathogenetische Basis von Angina pectoris und Herzinfarkt in Zweifel gezogen. Es werden die Thesen vertreten:
Dass die koronaren Stenosen in ihrer Bedeutung hochgradig überschätzt werden, dass ein Herzinfarkt aus verschiedenen, sehr unterschiedlichen Gründen entstehen kann, dass unter den verschiedenen Ursachen der Gefäßfaktor eine eher untergeordnete Rolle spielt und dass ein Defekt in der autonomen Steuerung der Herztätigkeit eine wichtige Ursache von Angina pectoris und Herzinfarkt darstellt.
Der Defekt in der autonomen Steuerung besteht im Wesentlichen in einer Abschwächung der parasympathisch-vagalen Einflüsse auf die Herztätigkeit. Bei Patienten mit ischämischer Herzkrankheit besteht eine pathognomonische Schwäche der parasympathischen Herzaktivität. Dieser Defekt in der autonomen Regulation korrespondiert mit psychosomatischen Charakteristika, die das leib-seelische Geschehen bei diesen Patienten als Yin-Schwäche deutlich werden lassen.
Eine Therapie des Yin-Defekts gelingt mit Empathie und Liebe, mit Entspannungsübungen und allen „vegetativ-harmonisierenden” Behandlungsmaßnahmen wie auch der Akupunktur. Die Akupunktur ist bei Angina pectoris und Zustand nach Herzinfarkt als kausal wirksame Methode einzuschätzen.
Practical knowledge shows that acupuncture treatment of patients with angina pectoris and after myocardial infarction is efficient and helpful. Nevertheless, most acupuncturists avoid treating these patients. The main reason seems to be not to make oneself ridiculous in the eyes of conventional medicine, which holds that an organically determinated process like coronary stenoses cannot be influenced by acupuncture needles. Therefore, acupuncturists have chosen to collectively “forget” their good experiences in treating these patients.
In this article, “coronary heart disease”, the generally accepted cause of angina pectoris and myocardial infarction, is being questioned. The following statements are supported:
The importance of coronary stenoses is by far overestimated. The genesis of myocardial infarction has different reasons. Coronary stenoses are of minor significance. A defective autonomic heart control is of major importance.
The defective autonomic activity is based on a significant reduction of vagal heart control. This reduction of parasympathetic heart activity is a pathognomonic attribute of patients with ischemic heart disease. It corresponds to some psychosomatic characteristics, so that the body-mind process of these patients can be understood as a failure of “yin”.
A treatment of this “yin-failure” is possible with empathy and loving care, relaxation practices, and all treatments harmonizing the inner balance, such as acupuncture. Acupuncture for angina pectoris, and after myocardial infarction, should therefore be considered a causal method of treatment.
HDL-cholesterol level provides additional prognosis in acute coronary syndromes
2009, International Journal of Cardiology
In the setting of acute coronary syndromes, plasma lipids have not been defined as prognostic variables, however little research has been dedicated to this specific issue. In order to test the independent predictive value for in-hospital events of low-density lipoprotein (LDL)-cholesterol, high-density lipoprotein (HDL)-cholesterol and triglycerides measured at hospital admission, 97 individuals with unstable angina or non-ST-elevation acute myocardial infarction were evaluated. In-hospital events, defined as death, non-fatal myocardial infarction or recurrent unstable angina, were significantly predicted by HDL-cholesterol (C-statistics = 0.69; 95% CI = 0.55–0.83, P = 0.018), contrary to LDL-cholesterol (C-statistics = 0.40; 95% CI = 0.24–0.56, P = 0.23) and triglycerides (C-statistics = 0.48; 95% CI = 0.31–0.65, P = 0.83). The best HDL-cholesterol cut-off point was 32 mg/dl, with a 33% incidence of events in patients with HDL-cholesterol ≤ 32 mg/dl, compared with only 9% in those with HDL-cholesterol > 32 mg/dl (P = 0.003). Logistic regression analysis showed HDL-cholesterol ≤ 32 mg/dl (OR = 3.6; 95% CI = 1.0–14; P = 0.05) and TIMI Risk Score (OR = 2.3; 95% CI = 1.4–2.9, P = 0.001) as the independent predictors of events. Furthermore, the addition of HDL-cholesterol to TIMI Risk Score improved its C-statistic from 0.81 to 0.85. In conclusion, as opposed to LDL-cholesterol and triglycerides, HDL-cholesterol level adds prognostic value to the prediction of in-hospital recurrent events during non-ST-elevation acute coronary syndromes.
An observational, prospective study exploring the use of heart rate variability as a predictor of clinical outcomes in pre-hospital ambulance patients
2008, Resuscitation
Citation Excerpt :
Decreased HRV has been found to be a predictor of increased mortality in the elderly,6 for coronary artery disease,7,8 postmyocardial infarction,9 congestive heart failure 10 and dilated cardiomyopathy.11 Altered spectral HRV analysis has been found to be an indicator of severity in congestive heart failure,12 hypertension,13 coronary artery disease,14 angina,15 myocardial infarction,15 hypoxia,16 chronic renal failure17 and diabetes mellitus.18 Decreased HRV has also been found in intensive care unit (ICU) patients following head trauma,19 sepsis20 and septic shock.21
To explore the use of pre-hospital heart rate variability (HRV) as a predictor of clinical outcomes such as hospital admission, intensive care unit (ICU) admission and mortality. We also implemented an automated pre-analysis signal processing algorithm and multiple principal component analysis (PCA) for outcomes.
We conducted a prospective observational clinical study at an emergency medical services (EMS) system in a medium sized urban setting in the United States. Electrocardiogram (ECG) data was obtained from a sample of 45 ambulance patients conveyed to a tertiary hospital, monitored with a LIFEPAK12 defibrillator/monitor. After extracting the data, filtering for noise reduction and isolating non-sinus beats, various HRV parameters were computed. These included time domain, frequency domain and geometric parameters. PCA was performed on the hospital outcomes for these patients.
We used a combination of HRV parameters, age and vital signs such as respiratory rate, SpO₂ and Glasgow coma score (GCS) in a PCA analysis. For predicting admission to ICU, sensitivity was 100%, specificity was 48.6%, and negative predictive value (NPV) was 100%; for predicting admission to hospital, sensitivity was 78.9%, specificity was 85.7%, and NPV was 75.0%; for predicting death, sensitivity was 50.0%, specificity was 100%, and NPV was 97.4%. There was also a significant correlation of several HRV parameters with length of hospital stay.
With signal processing techniques, it is feasible to filter and analyze ambulance ECG data for HRV. We found a combination of HRV parameters and traditional ‘vital signs’ to have an association with clinical outcomes in pre-hospital patients. This may have potential as a triage tool for ambulance patients.
The Electrocardiogram as a Prognostic Tool for Predicting Major Cardiac Events
2007, Progress in Cardiovascular Diseases
Citation Excerpt :
Despite the demonstrated prognostic value in patients with AMI, the possible clinical utility for risk stratification of HRV in non–ST-elevation acute coronary syndromes was previously investigated only in few studies, which included only limited numbers of patients with a diagnosis of unstable angina. Although these reports showed some association between depressed HRV and cardiac events, they were not powered enough to assess its predictive value for fatal events.94-97 However, in our recent study, depressed LF amplitude (bottom quartile values) was a significant independent predictor of 6-month total and cardiac mortality.69
Among patients with cardiac disease, the identification of those who are at low risk and those who are at high risk for major cardiac events is crucial for a rational clinical management of individual patients. A correct noninvasive risk stratification of cardiac patients, in particular, has relevant clinical implications because it would avoid unnecessary exposure to potentially risky invasive diagnostic or interventional procedures in low-risk patients, whereas it would allow an appropriate aggressive diagnostic and therapeutic approach in high-risk patients. Furthermore, the appropriate identification of low- and high-risk patients would also have social and economic implications by favoring optimization of resource distribution and costs. A large number of studies in previous decades provided evidence that several methods and variables derived from the analysis of the electrocardiogram (ECG) are powerful predictors of major cardiac events in several clinical conditions. Despite that, there has been limited attention about how several of these findings can be used in clinical practice. Furthermore, in recent years, most studies about risk stratification of cardiac patients have mainly been focused on the use of a number of serum/plasma biomarkers with reduced attention to ECG variables. Surprisingly, however, there have been few attempts to establish whether the various proposed risk markers add any significant information to that obtainable from ECG methods. In this article, the evidence for the prognostic value of variables derived from the assessment of the ECG signal by several methods and techniques will be briefly reviewed. Because of the largeness of the topic, this review will be necessarily incomplete. Because most of the clinical research in this field concerned risk stratification of patients with coronary artery disease, the article will be largely focused on this population of patients. The role of ECG methods in specific cardiac diseases and, in particular, in the general population of asymptomatic subjects will be briefly discussed when believed appropriate and helpful. Furthermore, only major clinical events (ie, cardiac death, arrhythmic events, acute myocardial infarction) will be taken into account as end points in this article. Minor clinical events (eg, coronary revascularization procedures, coronary artery restenosis, recurrences of symptoms) are indeed less robust as end points because they are widely biased by subjective judgments.

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^a: Drs. Sopher, Leatham, and Redwood were supported by research fellowships from the British Heart Foundation.

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Clinical investigationHeart rate variability depression in patients with unstable angina

Abstract

Am J Cardiol

Am J Cardiol

Am Heart J

Am Heart J

J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

Am J Cardiol

Am Heart J

Int J Biomed Comput

J Am Coll Cardiol

Am J Cardiol

Am J Cardiol

J Auton Nerv Syst

Am J Cardiol

Am J Cardiol

Am Heart J

Analysis of heart rate variability

Ergonomics

Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat-to-beat cardiovascular control

Science

Assessment of autonomic function in humans by heart rate spectral analysis

Am J Physiol

Clinical investigation
Heart rate variability depression in patients with unstable angina