title: 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.
abstract: 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 Holter 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 <0.001) increased likelihood for the detection of myocardial ischemia by MPI, whereas EST did not show a statistically significant association with a positive MPI (odds ratio 2.1; p = 0.12). Of subjects who were referred for subsequent coronary angiography, the respective sensitivities of HRV and EST for the detection of significant CAD were 73% versus 26%. Our data suggest that HRV can be used as an important noninvasive technique for the detection of myocardial ischemia in subjects without known CAD, providing superior sensitivity to conventional EST in this population.
authors: Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel. Electronic address: Ronen.Goldkorn@sheba.health.gov.il.
authors: Ronen
authors: R
authors: Goldkorn
authors: Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.
authors: Alexey
authors: A
authors: Naimushin
authors: Israeli Association for Cardiovascular Trials, Sheba Medical Center, Tel Hashomer, Israel.
authors: Nir
authors: N
authors: Shlomo
authors: Israeli Association for Cardiovascular Trials, Sheba Medical Center, Tel Hashomer, Israel.
authors: Ariella
authors: A
authors: Dan
authors: Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.
authors: Dan
authors: D
authors: Oieru
authors: Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.
authors: Israel
authors: I
authors: Moalem
authors: Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.
authors: Eli
authors: E
authors: Rozen
authors: Israeli Association for Cardiovascular Trials, Sheba Medical Center, Tel Hashomer, Israel.
authors: Ilan
authors: I
authors: Gur
authors: Ariel University, Ariel, Israel.
authors: Jacob
authors: J
authors: Levitan
authors: The Heart Institute, Shaarei Zeddek Medical Center, Jerusalem, Israel.
authors: David
authors: D
authors: Rosenmann
authors: The Heart Institute, Shaarei Zeddek Medical Center, Jerusalem, Israel.
authors: Yakov
authors: Y
authors: Mogilewsky
authors: Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel; Israeli Association for Cardiovascular Trials, Sheba Medical Center, Tel Hashomer, Israel.
authors: Robert
authors: R
authors: Klempfner
authors: Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel; Israeli Association for Cardiovascular Trials, Sheba Medical Center, Tel Hashomer, Israel; Tel Aviv University, Tel Aviv, Israel.
authors: Ilan
authors: I
authors: Goldenberg
mesh_terms: D000465:Algorithms; D003324:Coronary Artery Disease; D005080:Exercise Test; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000503:physiopathology*; D011446:Prospective Studies