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
Key result
Low heart rate variability was independently associated with a 2-fold increased likelihood for myocardial ischemia (OR 2.00; 95% CI 1.41-2.89; P=0.01) in patients without known CAD.
Why the study?
Detecting significant CAD in the general population is complex, prompting investigation into whether a CAD-specific HRV algorithm could improve detection of subclinical or early ischemia in patients without known CAD.
Does a CAD-specific heart rate variability algorithm improve the detection of myocardial ischemia in patients with low to intermediate pretest probability for CAD without known CAD?
Population
1043 patients with low to intermediate pretest probability for CAD without known CAD
Comparison
1-hour Holter HRV analysis using HeartTrends DyDx algorithm vs exercise stress testing
Design
Prospective international multicenter cohort study
Authors
Discussion
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Implication
May aid ischemia risk stratification without known CAD; hypothesis-generating and requires prospective validation before clinical use.
Study Design
Type
Observational (n=1,043)
Multicenter
Yes
Structured PICO
Does a CAD-specific heart rate variability algorithm improve the detection of myocardial ischemia in patients with low to intermediate pretest probability for CAD without known CAD?
P
Population
1043 patients with low to intermediate pretest probability for CAD without known CAD, mean age 61 years, 38% women, screened in tertiary medical centers in the United States and Israel.
I
Intervention
1-hour Holter testing with immediate heart rate variability (HRV) analysis using the HeartTrends DyDx algorithm
C
Comparator
Traditional CAD risk factors
O
Outcome
Presence of myocardial ischemia detected by exercise stress echocardiography or exercise myocardial perfusion imagingsurrogate
Main Result
Effect estimate: OR 2.00 (95% CI 1.41-2.89)
p-value: p=0.01
Short-term heart rate variability testing using a specific algorithm significantly improves the detection of myocardial ischemia when added to traditional risk factors in patients without known CAD.
Cite This Study
Goldenberg et al. (2019) conducted an observational in Myocardial ischemia in patients without known CAD (n=1,043). Heart rate variability (HRV) analysis using the HeartTrends DyDx algorithm was evaluated on Presence of myocardial ischemia detected by exercise stress echocardiography or exercise myocardial perfusion imaging (OR 2.00, 95% CI 1.41-2.89, p=0.01). Low heart rate variability was independently associated with a 2-fold increased likelihood for myocardial ischemia (OR 2.00; 95% CI 1.41-2.89; P=0.01) in patients without known CAD.