Comparison of the Usefulness of Heart Rate Variability Versus Exercise Stress Testing for the Detection of Myocardial Ischemia in Patients Without Known Coronary Artery Disease
Comparison of the Usefulness of Heart Rate Variability Versus Exercise Stress Testing for the Detection of Myocardial Ischemia in Patients Without Known Coronary Artery Disease
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DOI：
10.1016/j.amjcard.2015.02.054
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发表时间：
2015-06-01
影响因子：
2.8
通讯作者：
Goldenberg, Ilan
中科院分区：
文献类型：
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作者：
Goldkorn, Ronen;Naimushin, Alexey;Goldenberg, Ilan
心率变异性(HRV)在冠心病(CAD)患者中已被证明是减弱的，因此，可能被用于早期检测心肌缺血。我们的目的是评估一种新的短期HRV算法在检测无已知CAD的受试者心肌缺血方面的诊断效果。我们前瞻性地招募了450名没有已知冠心病的受试者，他们被转诊到三级医学中心进行单光子发射计算机断层扫描心肌灌注成像(MPI)的运动负荷试验(EST)。所有受试者在使用MPI进行EST前都接受了1小时的Holier测试和随后的HRV分析。以MPI作为无创性检测心肌缺血的金标准，比较HRV分析与EST的诊断效率。所有受试者都有CAD的中间预测概率。平均年龄为62岁，其中38%为女性，51%患有高血压，25%患有糖尿病。HRV分析显示敏感性(77%)高于标准EST(27%)。经多因素校正后，心率变异性独立与8.4倍相关(p
Heart rate variability (HRV) has been shown to be attenuated in patients with coronary artery disease (CAD) and may, therefore, be possibly used for the early detection of myocardial ischemia. We aimed to evaluate the diagnostic yield of a novel short-term HRV algorithm for the detection of myocardial ischemia in subjects without known CAD. We prospectively enrolled 450 subjects without known CAD who were referred to tertiary medical centers for exercise stress testing (EST) with single-photon emission computed tomography myocardial perfusion imaging (MPI). All subjects underwent 1-hour Holier testing with subsequent HRV analysis before EST with MPI. The diagnostic yield of HRV analysis was compared with EST, using MPI as the gold standard for the noninvasive detection of myocardial ischemia. All subjects had intermediate pretest probability for CAD. Mean age was 62 years, 38% were Women, 51% had hypertension, and 25% diabetes mellitus. HRV analysis showed superior sensitivity (77%) compared with standard EST (27%). After multivariate adjustment, HRV was independently associated with an 8.4-fold (p