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†
Background Detecting 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 o...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2019-12-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.119.014540 |
| _version_ | 1811334071848009728 |
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| author | Ilan Goldenberg Ronen Goldkorn Nir Shlomo Michal Einhorn Jacob Levitan Raphael Kuperstein Robert Klempfner Bruce Johnson |
| author_facet | Ilan Goldenberg Ronen Goldkorn Nir Shlomo Michal Einhorn Jacob Levitan Raphael Kuperstein Robert Klempfner Bruce Johnson |
| author_sort | Ilan Goldenberg |
| collection | DOAJ |
| description | Background Detecting 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 Results Between 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. Conclusions Our 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. Clinical Trial Registration URL: http://www.ClinicalTrials.gov. Unique identifiers: NCT01657006, NCT02201017). |
| first_indexed | 2024-04-13T17:02:17Z |
| format | Article |
| id | doaj.art-70b26fbe871047c588498aafd8116e02 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T17:02:17Z |
| publishDate | 2019-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-70b26fbe871047c588498aafd8116e022022-12-22T02:38:37ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802019-12-0182410.1161/JAHA.119.014540Heart 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†Ilan Goldenberg0Ronen GoldkornNir Shlomo1Michal Einhorn2Jacob Levitan3Raphael Kuperstein4Robert Klempfner5Bruce Johnson6Division of Cardiology University of Rochester Medical Center Rochester NYLeviev Heart Center and the Israeli Association for Cardiovascular Trials Sheba Medical Center Tel Hashomer IsraelLeviev Heart Center and the Israeli Association for Cardiovascular Trials Sheba Medical Center Tel Hashomer IsraelAriel University Ariel IsraelLeviev Heart Center and the Israeli Association for Cardiovascular Trials Sheba Medical Center Tel Hashomer IsraelLeviev Heart Center and the Israeli Association for Cardiovascular Trials Sheba Medical Center Tel Hashomer IsraelCardiac Rehabilitation Center Mayo Clinic Rochester MNBackground Detecting 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 Results Between 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. Conclusions Our 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. Clinical Trial Registration URL: http://www.ClinicalTrials.gov. Unique identifiers: NCT01657006, NCT02201017).https://www.ahajournals.org/doi/10.1161/JAHA.119.014540coronary artery diseaseheart rate variabilityrisk prediction |
| spellingShingle | Ilan Goldenberg Ronen Goldkorn Nir Shlomo Michal Einhorn Jacob Levitan Raphael Kuperstein Robert Klempfner Bruce Johnson 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† Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease coronary artery disease heart rate variability risk prediction |
| title | 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† |
| title_full | 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† |
| title_fullStr | 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† |
| title_full_unstemmed | 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† |
| title_short | 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† |
| title_sort | 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† |
| topic | coronary artery disease heart rate variability risk prediction |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.119.014540 |
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