Five-minute heart rate variability can predict obstructive angiographic coronary disease
Five-minute heart rate variability can predict obstructive angiographic coronary disease
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DOI：
10.1136/heartjnl-2011-300033
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发表时间：
2012-03-01
期刊：
影响因子：
5.7
通讯作者：
Krum, H.
中科院分区：
文献类型：
--
作者：
Kotecha, D.;New, G.;Krum, H.
目的：阻塞性冠状动脉疾病（CAD）在诊断性血管造影的患者中仅占一半。五分钟心率变异性（HRV）是血管自主控制的非侵入性标志，本研究假设它可以对心脏病患者进行风险分层并减少不必要的血管造影。设计（冠状动脉疾病的替代风险标志物（ARM-CAD）研究）。设置墨尔本的三个心脏中心，澳大利亚。患者470例接受择期血管造影术的连续患者（心律基本正常），主要观察指标：梗阻性CAD的存在结果阻塞性CAD患者HRV显著降低，尤其是在低频（LF）范围（中位数180 vs 267 ms（2）无CAD; p < 0.001）。冠状动脉病变的严重程度呈线性趋势;正常冠状动脉患者的中位LF功率（IQR）为275（612）ms，轻微冠状动脉不规则为255（400）ms，单支冠状动脉病变为212（396）ms，更严重的疾病为170（327）ms（2）;趋势p值为0.003。无论冠状动脉狭窄的解剖位置如何，LF功率都有类似的降低。比较LF小于250和250 ms（2）或更大的患者，使用多变量回归分析，阻塞性CAD的校正OR为2.42，95% CI 1.33至4.38（p=0.004）。在亚组分析中没有发现相互作用，HRV增加了风险预测，而与基线房颤风险无关（p < 0.0001）。结论低HRV是血管造影冠状动脉疾病的强预测因子，而与其他合并症无关，在临床上可用作窦性心律患者的风险预测因子。www.armcad.com http://clinicaltrials.gov/ct2/show/NCT00403351
Objective Obstructive coronary artery disease (CAD) is evident in only half of patients referred for diagnostic angiography. Five-minute heart rate variability (HRV) is a non-invasive marker for autonomic control of the vasculature, which this study hypothesised could risk-stratify cardiac patients and reduce unnecessary angiograms.Design A prospective observational study (the Alternative Risk Markers in Coronary Artery Disease (ARM-CAD) study).Setting Three cardiac centres in Melbourne, Australia.Patients 470 consecutive patients undergoing elective angiography (with predominantly normal cardiac rhythm), regardless of co-morbidity.Main outcome measures The presence of obstructive CAD (>= 50% stenosis) on angiography.Results Patients with obstructive CAD had significantly reduced HRV, particularly in the low frequency (LF) range (median 180 vs 267 ms(2) without CAD; p < 0.001). There was a linear trend with the severity of CAD; 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) ms(2); p value for trend 0.003. There was a similar reduction in LF power regardless of the anatomical location of coronary stenoses. Comparing patients with LF less than 250 and 250 ms(2) or greater, the adjusted OR for obstructive CAD using multivariate regression was 2.42, 95% CI 1.33 to 4.38 (p=0.004). No interactions were noted in subgroup analysis and HRV added to risk prediction irrespective of the baseline Framingham risk (p < 0.0001).Conclusion Low HRV is strongly predictive of angiographic coronary disease regardless of other co-morbidities and is clinically useful as a risk predictor in patients with sinus rhythm.Clinical trial registration information http://clinicaltrials.gov/ct2/show/NCT00403351 www.armcad.com