Analysis of clinical and heart rate variability parameters associated with single-vessel and multivessel coronary artery disease: A retrospective study

Objectives: To compare heart rate variability (HRV) parameters and cardiac biomarkers between patients with single-vessel and multivessel coronary artery disease (CAD) and assess their associations with multivessel involvement. Methodology: This retrospective study included 196 patients with angiographically confirmed CAD admitted between September 2022 and May 2025 at Ningguo People's Hospital. Patients were classified as having single-vessel (n=55) or multivessel (n=141) disease. Group differences were assessed, and logistic regression was used to examine associations of SDNN, deceleration capacity (DC), high-sensitivity cardiac troponin T (hs-TnT), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) with multivessel disease. Restricted cubic spline analysis explored potential nonlinear relationships. Results: The multivessel group had lower SDNN, SDANN, SDNN index, and DC and higher hs-TnT and NT-proBNP levels than the single-vessel group (all P<0.05). After adjustment for age, sex, hypertension, and diabetes, higher SDNN was associated with lower odds of multivessel disease (OR=0.68, 95% CI: 0.49-0.94), whereas higher hs-TnT (OR=2.43, 95% CI: 1.35-4.37) and NT-proBNP (OR=3.51, 95% CI: 1.28-9.62) were associated with higher odds. DC was not significantly associated with multivessel disease. Spline analyses suggested possible nonlinear patterns for SDNN and DC, but these findings were exploratory. Conclusion: Lower SDNN and higher hs-TnT and NT-proBNP were associated with multivessel CAD. The hs-TnT finding should be interpreted in the context of myocardial injury burden and limited control of confounding.