Monash Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Australia.
Heart. 2012 Mar;98(5):395-401. doi: 10.1136/heartjnl-2011-300033. Epub 2011 Nov 25.
Obstructive coronary artery disease (CAD) is evident in only half of patients referred for diagnostic angiography. Five-minute heart rate variability (HRV) is a non-invasive marker for autonomic control of the vasculature, which this study hypothesised could risk-stratify cardiac patients and reduce unnecessary angiograms.
A prospective observational study (the Alternative Risk Markers in Coronary Artery Disease (ARM-CAD) study).
Three cardiac centres in Melbourne, Australia.
470 consecutive patients undergoing elective angiography (with predominantly normal cardiac rhythm), regardless of co-morbidity.
The presence of obstructive CAD (≥50% stenosis) on angiography.
Patients with obstructive CAD had significantly reduced HRV, particularly in the low frequency (LF) range (median 180 vs 267 ms(2) without CAD; p<0.001). There was a linear trend with the severity of CAD; median LF power (IQR) in patients with normal coronaries was 275 (612), with minor coronary irregularities 255 (400), single-vessel CAD 212 (396) and more severe disease 170 (327) ms(2); p value for trend 0.003. There was a similar reduction in LF power regardless of the anatomical location of coronary stenoses. Comparing patients with LF less than 250 and 250 ms(2) or greater, the adjusted OR for obstructive CAD using multivariate regression was 2.42, 95% CI 1.33 to 4.38 (p=0.004). No interactions were noted in subgroup analysis and HRV added to risk prediction irrespective of the baseline Framingham risk (p<0.0001).
Low HRV is strongly predictive of angiographic coronary disease regardless of other co-morbidities and is clinically useful as a risk predictor in patients with sinus rhythm.
http://clinicaltrials.gov/ct2/show/NCT00403351 www.armcad.com.
只有一半的经诊断性血管造影术转诊的患者存在阻塞性冠状动脉疾病（CAD）。5 分钟心率变异性（HRV）是血管自主控制的一种非侵入性标志物，本研究假设它可以对心脏患者进行风险分层，并减少不必要的血管造影术。
前瞻性观察性研究（替代风险标志物在冠状动脉疾病（ARM-CAD）研究）。
澳大利亚墨尔本的三个心脏中心。
470 例连续接受选择性血管造影术（主要为正常心律）的患者，无论合并症如何。
血管造影术上是否存在阻塞性 CAD（≥50%狭窄）。
阻塞性 CAD 患者的 HRV 明显降低，尤其是在低频（LF）范围（中位数为 180 与无 CAD 患者的 267 ms(2)；p<0.001）。CAD 严重程度呈线性趋势；正常冠状动脉患者的 LF 功率（IQR）中位数为 275（612），轻度冠状动脉不规则为 255（400），单支血管 CAD 为 212（396），更严重的疾病为 170（327）ms(2)；p 值为趋势 0.003。无论冠状动脉狭窄的解剖位置如何，LF 功率均有类似降低。比较 LF 小于 250 和 250 ms(2)或更高的患者，多变量回归分析显示，使用 LF 进行阻塞性 CAD 的调整 OR 为 2.42，95%CI 为 1.33 至 4.38（p=0.004）。亚组分析中未发现交互作用，并且 HRV 增加了风险预测，无论基础Framingham 风险如何（p<0.0001）。
无论其他合并症如何，HRV 降低均强烈预测血管造影冠状动脉疾病，并且作为窦性节律患者的风险预测指标具有临床意义。
http://clinicaltrials.gov/ct2/show/NCT00403351www.armcad.com。
