Heart Rate Variability for Risk Assessment of Myocardial Ischemia in Patients Without Known Coronary Artery Disease: The HRV-DETECT (Heart Rate Variability for the Detection of Myocardial Ischemia) Study†
Heart Rate Variability for Risk Assessment of Myocardial Ischemia in Patients Without Known Coronary Artery Disease: The HRV-DETECT (Heart Rate Variability for the Detection of Myocardial Ischemia) Study†
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DOI：
10.1161/jaha.119.014540
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发表时间：
2019-12-17
影响因子：
5.4
通讯作者：
Johnson, Bruce
中科院分区：
文献类型：
--
作者：
Goldenberg, Ilan;Goldkorn, Ronen;Johnson, Bruce
背景检测普通人群中的严重冠状动脉疾病 (CAD) 非常复杂，并且依赖于传统 CAD 危险因素和无创检测的综合评估。我们假设 CAD 特异性心率变异性 (HRV) 算法可用于改善对不知道 CAD 的患者的亚临床或早期缺血的检测。方法和结果在 2014 年至 2018 年期间，我们前瞻性地招募了 1043 名 CAD 预测试概率低至中等的患者，他们在美国和以色列的三级医疗中心接受了心肌缺血筛查。患者接受了 1 小时动态心电图测试，使用 HeartTrends DyDx 算法立即进行 HRV 分析，然后进行运动负荷超声心动图 (n=612) 或运动心肌灌注成像 (n=431)。使用基于敏感性和特异性的接受者操作特征分析来确定低 HRV 的阈值。主要终点是通过运动负荷超声心动图或运动心肌灌注成像检测到心肌缺血的存在。患者的平均年龄为 61 岁，其中 38% 为女性。 66 名 (6.3%) 患者检测到心肌缺血。调整 CAD 危险因素和运动压力测试结果后，低 HRV 与心肌缺血的可能性显着增加 2 倍独立相关（比值比，2.00；95% CI，1.41-2.89 [P=0.01]）。将 HRV 添加到传统 CAD 危险因素中，显着提高了心肌缺血的预测概率。结论我们从一项大型前瞻性国际临床研究中获得的数据表明，短期 HRV 测试可作为一种新型数字健康方式，用于增强对不了解 CAD 的低至中风险个体的风险评估。
BackgroundDetecting significant coronary artery disease (CAD) in the general population is complex and relies on combined assessment of traditional CAD risk factors and noninvasive testing. We hypothesized that a CAD-specific heart rate variability (HRV) algorithm can be used to improve detection of subclinical or early ischemia in patients without known CAD.Methods and ResultsBetween 2014 and 2018 we prospectively enrolled 1043 patients with low to intermediate pretest probability for CAD who were screened for myocardial ischemia in tertiary medical centers in the United States and Israel. Patients underwent 1-hour Holter testing, with immediate HRV analysis using the HeartTrends DyDx algorithm, followed by exercise stress echocardiography (n=612) or exercise myocardial perfusion imaging (n=431). The threshold for low HRV was identified using receiver operating characteristic analysis based on sensitivity and specificity. The primary end point was the presence of myocardial ischemia detected by exercise stress echocardiography or exercise myocardial perfusion imaging. The mean age of patients was 61 years and 38% were women. Myocardial ischemia was detected in 66 (6.3%) patients. After adjustment for CAD risk factors and exercise stress testing results, low HRV was independently associated with a significant 2-fold increased likelihood for myocardial ischemia (odds ratio, 2.00; 95% CI, 1.41-2.89 [P=0.01]). Adding HRV to traditional CAD risk factors significantly improved the pretest probability for myocardial ischemia.ConclusionsOur data from a large prospective international clinical study show that short-term HRV testing can be used as a novel digital-health modality for enhanced risk assessment in low- to intermediate-risk individuals without known CAD.