Prognostic value of heart rate variability in acute coronary syndrome

Smitha Pernaje Seetharam; Vinutha Shankar MS; Kaviraja Udupa; Raveesha A.; Niranjan Reddy

doi:10.1515/jbcpp-2022-0134

Article

Prognostic value of heart rate variability in acute coronary syndrome

Smitha Pernaje Seetharam , Vinutha Shankar MS , Kaviraja Udupa , Raveesha A. and Niranjan Reddy

Published/Copyright: October 4, 2022

Published by

Become an author with De Gruyter Brill

Submit Manuscript Author Information Explore this Subject

From the journal Journal of Basic and Clinical Physiology and Pharmacology Volume 34 Issue 3

Abstract

Objectives

To assess the predictive value of pre-discharge heart rate variability (HRV) parameters in patients with acute coronary syndrome (ACS) treated by percutaneous coronary intervention (PCI).

Methods

145 consecutive male patients with ACS (aged 57.12 ± 10.81 years) were included in this study. Fifteen minutes electrocardiogram recording was done to measure time-domain [standard deviation of N–N intervals (SDNN), root-mean square differences of successive R–R intervals (rMSSD)] and frequency-domain [low-frequency (LF) power, high-frequency (HF) power and total power (TP)] HRV parameters before and after PCI. The primary end point was the occurrence of major clinical events (MCE) defined as death, sudden death or re-acute myocardial infarction at the end of 3 months follow-up.

Results

At a follow-up of 3 months, MCE occurred in 06 patients (4.14%) (Cardiac death was 3.01%, while that of sudden death was 1.13%). Out of six-MCE, four deaths and two re-AMIs occurred. Pre-discharge HRV values (SDNN, rMSSD, TP, LF and HF) were significantly lower in patients with ACS without MCE. Only total power HRV index (AUC=0.748; p=0.040) showed greater prognostic accuracy.

Conclusions

In conclusion, study showed an increase in SDNN, rMSSD, LF, HF and TP after successful revascularization with PCI in patients who had MCE. The resultant sensitivity, specificity of HRV is still limited in the present study. Particularly, its sensitivity is higher (33–83%) with a modest specificity (61–72%).

Keywords: acute coronary syndrome; heart rate variability; myocardial infarction; prognostic value; ROC curve

Corresponding author: Vinutha Shankar MS, MD, Prof and Head, Department of Physiology, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar 563103, Karnataka, India, Phone: +919845065374, 08152 243003, Fax: +91 (8152) 243008, E-mail: vinutha.shankar@gmail.com

Acknowledgments

The authors would immensely thank the statistical help given by Mr. Ravishankar, Biostatistician, Department of Community Medicine, Sri Devaraj Urs Medical College, Kolar.

Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: The study was approved by the Central Ethics Committee (CEC No. SDUAHER/KLR/R & I/91/2021-22 dated 9-3-2021).

References

1. Amsterdam, EA, Wenger, NK, Brindis, RG, Casey, DE, Ganiats, TG, Holmes, DR, et al.. AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American heart association task force on practice guidelines. J Am Coll Cardiol 2014;64:e139–228. https://doi.org/10.1016/j.jacc.2014.09.017.Search in Google Scholar PubMed

2. Hyun, KK, Essue, BM, Woodward, M, Jan, S, Brieger, D, Chew, D, et al.. The household economic burden for acute coronary syndrome survivors in Australia. BMC Health Serv Res 2016;16:636. https://doi.org/10.1186/s12913-016-1887-3.Search in Google Scholar PubMed PubMed Central

3. Torres, M, Moayedi, S. Evaluation of the acutely dyspneic elderly patient. Clin Geriatr Med 2007;23:307–25. https://doi.org/10.1016/j.cger.2007.01.007.Search in Google Scholar PubMed

4. Brateanu, A. Heart rate variability after myocardial infarction. What we know and what we still need to find out. Curr Med Res Opin 2015;31:1855–60. https://doi.org/10.1185/03007995.2015.1086992.Search in Google Scholar PubMed

5. Coviello, I, Pinnacchio, G, Laurito, M, Stazi, A, Battipaglia, I, Barone, L, et al.. Prognostic role of heart rate variability in patients with ST-segment elevation acute myocardial infarction treated by primary angioplasty. Cardiology 2013;124:63–70. https://doi.org/10.1159/000345779.Search in Google Scholar PubMed

6. Abrootan, S, Yazdankhah, S, Payami, B, Alasti, M. Changes in heart rate variability parameters after elective percutaneous coronary intervention. J Tehran Heart Cent 2015;10:80–4.Search in Google Scholar

7. Gulati, M, Levy, PD, Mukherjee, D, Amsterdam, E, Bhatt, DL, Birtcher, KK, et al.. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: a report of the American College of Cardiology/American heart association joint committee on clinical practice Guidelines. Circulation 2021;144:e368–454, Erratum in: Circulation 2021;144:e455. https://doi.org/10.1161/CIR.0000000000001029.Search in Google Scholar PubMed

8. Collet, JP, Thiele, H, Barbato, E, Barthe´le´my, O, Bauersachs, J, Bhatt, DL, et al.. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. The Task Force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2021;42:12891367. https://doi.org/10.1093/eurheartj/ehaa575.Search in Google Scholar PubMed

9. U.S. Department of Health and Human Services. The health consequences of Smoking-50 years of progress: a report of the surgeon general. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2014. Available from: https://www.ncbi.nlm.nih.gov/books/NBK179276/ [Accessed 22 Mar 2018].Search in Google Scholar

10. Hackshaw, A, Morris, JK, Boniface, S, Tang, JL, Milenković, D. Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports. BMJ 2018;363:k5035. https://doi.org/10.1136%2Fbmj.j5855.10.1136/bmj.j5855Search in Google Scholar PubMed PubMed Central

11. Tomiyama, H, Nakayama, T, Watanabe, G, Shiojim, K, Sakuma, Y, Yamamoto, A. Effects of short-acting and long-acting loop diuretics on heart rate variability in patients with chronic compensated congestive heart failure. Am Heart J 1999;137:543–8. https://doi.org/10.1016/S0002-8703(99)70504-1.Search in Google Scholar

12. Pivatelli, FC, Santos, MA, Fernandes, GB, Gatti, M, Abreu, LC, Valenti, VE, et al.. Sensitivity, specificity and predictive values of linear and nonlinear indices of heart rate variability in stable angina patients. Int Arch Med 2012;5:31. https://doi.org/10.1186/1755-7682-5-31.Search in Google Scholar PubMed PubMed Central

13. Harris, PR, Stein, PK, Fung, GL, Drew, BJ. Heart rate variability measured early in patients with evolving acute coronary syndrome and 1-year outcomes of rehospitalization and mortality. Vasc Health Risk Manag 2014;10:451–64. https://doi.org/10.2147/VHRM.S57524.Search in Google Scholar PubMed PubMed Central

14. Exner, DV, Kavanagh, KM, Slawnych, MP, Mitchell, LB, Ramadan, D, Aggarwal, SG, et al.. Noninvasive risk assessment early after a myocardial infarction: the REFINE study. J Am Coll Cardiol 2007;50:2275–84.10.1016/j.jacc.2007.08.042Search in Google Scholar PubMed

15. Balanescu, S, Corlan, AD, Dorobantu, M, Gherasim, L. Prognostic value of heart rate variability after acute myocardial infarction. Med Sci Monit 2004;10:307–15.Search in Google Scholar

16. Erdogan, A, Coch, M, Bilgin, M, Parahuleva, M, Tillmanns, H, Waldecker, B, et al.. Prognostic value of heart rate variability after acute myocardial infarction in the era of immediate reperfusion. Herzschr Elektrophys 2008;19:161–8. https://doi.org/10.1007/s00399-008-0024-3.Search in Google Scholar PubMed

17. Airaksinen, KE, Ikäheimo, MJ, Linnaluoto, MK, Niemelä, M, Takkunen, JT. Impaired vagal heart rate control in coronary artery disease. Br Heart J 1987;58:592–7. https://doi.org/10.1136/hrt.58.6.592.Search in Google Scholar PubMed PubMed Central

18. Lindenfeld, J, Schrier, RW. Blood urea nitrogen a marker for adverse effects of loop diuretics? J Am Coll Cardiol 2011;58:383–5. https://doi.org/10.1016/j.jacc.2011.01.054.Search in Google Scholar PubMed

19. Jujo, K, Minami, Y, Haruki, S, Matsue, Y, Shimazaki, K, Kadowaki, H, et al.. Persistent high blood urea nitrogen level is associated with increased risk of cardiovascular events in patients with acute heart failure. ESC Heart Fail 2017;4:545–53. https://doi.org/10.1002/ehf2.12188.Search in Google Scholar PubMed PubMed Central

20. Hsin, HT, Yang, CY, Yeih, DF, Shieh, JS, Li, AH. The detrended fluctuation analysis of acute-phase heart-rate variability in acute coronary syndromes – a pilot study. Int J Cardiol 2010;140:252–5. https://doi.org/10.1016/j.ijcard.2008.11.044.Search in Google Scholar PubMed

21. Saito, K, Saito, Y, Kitahara, H, Nakayama, T, Fujimoto, Y, Kobayashi, Y. In-hospital blood pressure variability: a novel prognostic marker of renal function decline and cardiovascular events in patients with coronary artery disease. Kidney Blood Press Res 2020;45:748–57. https://doi.org/10.1159/000509291.Search in Google Scholar PubMed

22. Mäkikallio, TH, Huikuri, HV, Hintze, U, Videbaek, J, Mitrani, RD, Castellanos, A, et al.. Fractal analysis and time and frequency-domain measures of heart rate variability as predictors of mortality in patients with heart failure. Am J Cardiol 2001;87:178–82. https://doi.org/10.1016/s0002-9149(00)01312-6.Search in Google Scholar PubMed

23. Huikuri, HV, Mäkikallio, TH, Peng, CK, Goldberger, AL, Hintze, U, Moller, M. Fractal correlation properties of R–R interval dynamics and mortality in patients with depressed left ventricular function after an acute myocardial infarction. Circulation 2000;101:47–53. https://doi.org/10.1161/01.cir.101.1.47.Search in Google Scholar PubMed

24. Tapanainen, JM, Thomsen, PEB, Køber, L, Torp-Pedersen, C, Mäkikallio, TH, Still, AM, et al.. Fractal analysis of heart rate variability and mortality after an acute myocardial infarction. Am J Cardiol 2002;90:347–52. https://doi.org/10.1016/s0002-9149(02)02488-8.Search in Google Scholar PubMed

Received: 2022-05-12

Accepted: 2022-09-05

Published Online: 2022-10-04

You are currently not able to access this content.

Articles in the same Issue

https://doi.org/10.1515/jbcpp-2022-0134

Keywords for this article

acute coronary syndrome; heart rate variability; myocardial infarction; prognostic value; ROC curve