The role of revascularization on short-term Heart Rate Variability (HRV) and Signal Averaged Electrocardiogram (SAECG) in Stable Coronary Artery Disease (CAD)

Janry Pangemanan; Agnes Lucia Panda; Victor Giovannie Xaverison Rooroh; Evan Jim Gunawan

doi:10.15562/bmj.v11i1.3147

The role of revascularization on short-term Heart Rate Variability (HRV) and Signal Averaged Electrocardiogram (SAECG) in Stable Coronary Artery Disease (CAD)

Janry Pangemanan ,

Agnes Lucia Panda ,

Victor Giovannie Xaverison Rooroh ,

Evan Jim Gunawan ,

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DOI: https://doi.org/10.15562/bmj.v11i1.3147 |
Published: 2022-04-30

Abstract

Background: Revascularization in patients with stable coronary artery disease (SCAD) can reduce myocardial ischemia and improves the autonomic nervous system, which can be measured by heart rate variability (HRV) and signal-averaged electrocardiogram (SAECG). This study aimed to investigate the effect of revascularization on HRV and SAECG in patients with SCAD.

Methods: This is a single-center prospective cohort study. Revascularization refers to percutaneous coronary intervention (PCI). The primary outcome of this study is the change in short-term HRV and SAECG from before revascularization to after revascularization. HRV and SAECG measurement was performed for 10 minutes before PCI and one-month post-PCI. Data were analyzed using SPSS version 23 for Windows.

Results: There are 30 patients included in this study, and 46.7% underwent incomplete PCI. There was no significant difference in HRV parameters in the time domain method. In the frequency domain, only the LF/HF ratio changed significantly from 3.5±2.6 before PCI to 2.16±1.9 after PCI, with a 1.33 decrease in LF/HF (p=0.007). Subgroup analysis was performed for patients receiving complete and incomplete revascularization. In patients who received complete revascularization, there was a significant difference in LF/HF ratio change of 1.6±2.28 (p=0.013). In patients that receive incomplete revascularization, there is a significant increase in HF 37.8±57.3 (p=0,028). In terms of SAECG parameters, there is no significant difference between before and after PCI in both primary and subgroup analysis.

Conclusion: Revascularization resulted in a significant reduction in LF/HF ratio assessed by short-term HRV. There was no benefit of revascularization in terms of SAECG parameters.

References

Hofmann T, Burmeister A, Meinertz T. Prognostic significance of the signal averaged electrocardiogram in patients with chronic stable coronary artery disease: Analysis in the time domain and by spectral temporal mapping. Z Kardiol. 2004;93(1):32–42.
Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019;40(2):87–165.
Acharya UR, Joseph KP, Kannathal N, Lim CM, Suri JS. Heart rate variability: A review. Med Biol Eng Comput. 2006;44(12):1031–1051.
Mironova T, Mironov V, Antufiev V, Safronova E, Mironov M, Davydova E. Heart rate variability analysis at coronary artery disease and angina pectoris. Recent Pat Cardiovasc Drug Discov. 2009;4(1):45–54.
Shaffer F, Ginsberg JP. An Overview of Heart Rate Variability Metrics and Norms. Front Public Health. 2017;5:258.
Voss A, Schroeder R, Vallverdú M, Schulz S, Cygankiewicz I, Vázquez R, et al. Short-term vs. long-term heart rate variability in ischemic cardiomyopathy risk stratification. Front Physiol. 2013;4:364.
Gatzoulis KA, Arsenos P, Trachanas K, Dilaveris P, Antoniou C, Tsiachris D, et al. Signal-averaged electrocardiography: Past, present, and future. J Arrhythmia. 2018;34(3):222–229.
Nunan D, Sandercock GRH, Brodie DA. A quantitative systematic review of normal values for short-term heart rate variability in healthy adults. PACE - Pacing Clin Electrophysiol. 2010;33(11):1407–1417.
Danford DA, Stelling JA, Kugler JD, Cheatham JP, Latson LA, Gumbiner CH, et al. Signal‐Averaged Electrocardiography of the Terminal QRS in Healthy Young Adults. Pacing Clin Electrophysiol. 1989;12(11):1712–1716.
Gomes ME, Aengevaeren WR, Lenders JW, Verheugt FW, Smits P, Tack CJ. Improving myocardial perfusion by percutaneous coronary intervention reduces central sympathetic activity in stable angina. Clin Cardiol. 2010;33(6):E16-E21.
Shaffer F, McCraty R, Zerr CL. A healthy heart is not a metronome: an integrative review of the heart's anatomy and heart rate variability. Front Psychol. 2014;5:1040.
Prabawa IPY, Lestari AAW, Muliarta IM, Mardhika PE, Pertiwi GAR, Bhargah A, et al. The Stromal Cell-derived Factor-1/CXCL12 3’A-gene Polymorphism is Related to the Increased Risk of Coronary Artery Disease: A Systematic Review and Meta-analysis. Open Access Macedonian Journal of Medical Sciences. 2020;8(F):197-202.
Aydinlar A, Sentürk T, Ozdemïr B, Kaderlï AA, Aydin O. Effect of percutaneous transluminal coronary angioplasty on QT dispersion and heart rate variability parameters. Cardiovasc J Afr. 2009;20(4):240-244
Abrootan S, Yazdankhah S, Payami B, Alasti M. Changes in Heart Rate Variability Parameters after Elective Percutaneous Coronary Intervention. J Tehran Heart Cent. 2015;10(2):80-84.
Berkalp B, Oral D, Caglar N, Omurlu K, Pamir G, Alpman A, et al. Effects of percutaneous transluminal coronary angioplasty on late potentials and high frequency mid-QRS potentials. Cardiology. 1994;85(3–4):216–221.
Sotomi Y, Okamura A, Iwakura K, Date M, Nagai H, Yamasaki T, et al. Impact of revascularization of coronary chronic total occlusion on left ventricular function and electrical stability: analysis by speckle tracking echocardiography and signal-averaged electrocardiogram. Int J Cardiovasc Imaging. 2017;33(6):815–823.
Shaw LJ, Berman DS, Maron DJ, Mancini GBJ, Hayes SW, Hartigan PM, et al. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation. 2008;117(10):1283–1291
Bernardi L, Valle F, Coco M, Calciati A, Sleight P. Physical activity influences heart rate variability and very-low-frequency components in Holter electrocardiograms. Cardiovasc Res. 1996;32(2):234–237.
Taylor JA, Carr DL, Myers CW, Eckberg DL. Mechanisms underlying very-low-frequency RR-interval oscillations in humans. Circulation. 1998;98(6):547–555.
Limbong M, Herry Y, Ardhianto P, Suhartono. Risk score of contrast-induced nephropathy in patients after percutaneous coronary intervention. Bali Medical Journal. 2021;10(1):400-404.

[1] Hofmann T, Burmeister A, Meinertz T. Prognostic significance of the signal averaged electrocardiogram in patients with chronic stable coronary artery disease: Analysis in the time domain and by spectral temporal mapping. Z Kardiol. 2004;93(1):32–42.

[2] Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019;40(2):87–165.

[3] Acharya UR, Joseph KP, Kannathal N, Lim CM, Suri JS. Heart rate variability: A review. Med Biol Eng Comput. 2006;44(12):1031–1051.

[4] Mironova T, Mironov V, Antufiev V, Safronova E, Mironov M, Davydova E. Heart rate variability analysis at coronary artery disease and angina pectoris. Recent Pat Cardiovasc Drug Discov. 2009;4(1):45–54.

[5] Shaffer F, Ginsberg JP. An Overview of Heart Rate Variability Metrics and Norms. Front Public Health. 2017;5:258.

[6] Voss A, Schroeder R, Vallverdú M, Schulz S, Cygankiewicz I, Vázquez R, et al. Short-term vs. long-term heart rate variability in ischemic cardiomyopathy risk stratification. Front Physiol. 2013;4:364.

[7] Gatzoulis KA, Arsenos P, Trachanas K, Dilaveris P, Antoniou C, Tsiachris D, et al. Signal-averaged electrocardiography: Past, present, and future. J Arrhythmia. 2018;34(3):222–229.

[8] Nunan D, Sandercock GRH, Brodie DA. A quantitative systematic review of normal values for short-term heart rate variability in healthy adults. PACE - Pacing Clin Electrophysiol. 2010;33(11):1407–1417.

[9] Danford DA, Stelling JA, Kugler JD, Cheatham JP, Latson LA, Gumbiner CH, et al. Signal‐Averaged Electrocardiography of the Terminal QRS in Healthy Young Adults. Pacing Clin Electrophysiol. 1989;12(11):1712–1716.

[10] Gomes ME, Aengevaeren WR, Lenders JW, Verheugt FW, Smits P, Tack CJ. Improving myocardial perfusion by percutaneous coronary intervention reduces central sympathetic activity in stable angina. Clin Cardiol. 2010;33(6):E16-E21.

[11] Shaffer F, McCraty R, Zerr CL. A healthy heart is not a metronome: an integrative review of the heart's anatomy and heart rate variability. Front Psychol. 2014;5:1040.

[12] Prabawa IPY, Lestari AAW, Muliarta IM, Mardhika PE, Pertiwi GAR, Bhargah A, et al. The Stromal Cell-derived Factor-1/CXCL12 3’A-gene Polymorphism is Related to the Increased Risk of Coronary Artery Disease: A Systematic Review and Meta-analysis. Open Access Macedonian Journal of Medical Sciences. 2020;8(F):197-202.

[13] Aydinlar A, Sentürk T, Ozdemïr B, Kaderlï AA, Aydin O. Effect of percutaneous transluminal coronary angioplasty on QT dispersion and heart rate variability parameters. Cardiovasc J Afr. 2009;20(4):240-244

[14] Abrootan S, Yazdankhah S, Payami B, Alasti M. Changes in Heart Rate Variability Parameters after Elective Percutaneous Coronary Intervention. J Tehran Heart Cent. 2015;10(2):80-84.

[15] Berkalp B, Oral D, Caglar N, Omurlu K, Pamir G, Alpman A, et al. Effects of percutaneous transluminal coronary angioplasty on late potentials and high frequency mid-QRS potentials. Cardiology. 1994;85(3–4):216–221.

[16] Sotomi Y, Okamura A, Iwakura K, Date M, Nagai H, Yamasaki T, et al. Impact of revascularization of coronary chronic total occlusion on left ventricular function and electrical stability: analysis by speckle tracking echocardiography and signal-averaged electrocardiogram. Int J Cardiovasc Imaging. 2017;33(6):815–823.

[17] Shaw LJ, Berman DS, Maron DJ, Mancini GBJ, Hayes SW, Hartigan PM, et al. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation. 2008;117(10):1283–1291

[18] Bernardi L, Valle F, Coco M, Calciati A, Sleight P. Physical activity influences heart rate variability and very-low-frequency components in Holter electrocardiograms. Cardiovasc Res. 1996;32(2):234–237.

[19] Taylor JA, Carr DL, Myers CW, Eckberg DL. Mechanisms underlying very-low-frequency RR-interval oscillations in humans. Circulation. 1998;98(6):547–555.

[20] Limbong M, Herry Y, Ardhianto P, Suhartono. Risk score of contrast-induced nephropathy in patients after percutaneous coronary intervention. Bali Medical Journal. 2021;10(1):400-404.

The role of revascularization on short-term Heart Rate Variability (HRV) and Signal Averaged Electrocardiogram (SAECG) in Stable Coronary Artery Disease (CAD)

Abstract

References

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