The Autonomic Imbalance of Myocardial Ischemia during Exercise Stress Testing: Insight from Short-Term Heart Rate Variability Analysis

Ping-Yen Lin, Cheng-Ting Tsai, Chang Francis Hsu, Ying-Hsiang Lee, Han-Ping Huang, Chun-Che Huang, Lawrence Yu-Min Liu, Long Hsu, Ten-Fang Yang and Po-Lin Lin ()
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Ping-Yen Lin: Department of Electrophyics, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
Cheng-Ting Tsai: Cardiovascular Center, MacKay Memorial Hospital, Taipei 104217, Taiwan
Chang Francis Hsu: Labfront (Kiipo Co.), Boston, MA 02067, USA
Ying-Hsiang Lee: Cardiovascular Center, MacKay Memorial Hospital, Taipei 104217, Taiwan
Han-Ping Huang: Labfront (Kiipo Co.), Boston, MA 02067, USA
Chun-Che Huang: Department of Healthcare Administration, I-Shou University, Kaohsiung 82445, Taiwan
Lawrence Yu-Min Liu: Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan
Long Hsu: Department of Electrophyics, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
Ten-Fang Yang: Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
Po-Lin Lin: Division of Cardiology, Hsinchu MacKay Memorial Hospital, Hsinchu 30071, Taiwan

IJERPH, 2022, vol. 19, issue 22, 1-12

Abstract: Exercise stress testing (EST) has limited power in diagnosing obstructive coronary artery disease (CAD). The heart rate variability (HRV) analysis might increase the sensitivity of CAD detection. This study aimed to evaluate the correlation between short-term HRV and myocardial ischemia during EST, including the acceleration, maximum, and recovery stages of heart rate (HR). The HRV during EST from 19 healthy (RHC) subjects and 35 patients with CAD (25 patients with insignificant CAD (iCAD), and 10 patients with significant CAD (sCAD)) were compared. As a result, all HRV indices decreased at the maximum stage and no significant differences between iCAD and sCAD were found. The low-frequency power of heart rate signal (LF) of the RHC group recovered relatively quickly from the third to the sixth minutes after maximum HR, compared with that of the sCAD group. The relative changes of most HRV indices between maximum HR and recovery stage were lower in the sCAD group than in the RHC group, especially in LF, the standard deviation of all normal to normal intervals (SDNN), and the standard deviation in the long axis direction of the Poincaré plot analysis (SD2) indices ( p < 0.05). The recovery slope of LF was significantly smaller in the sCAD group than in the RHC group ( p = 0.02). The result suggests that monitoring short-term HRV during EST provides helpful insight into the cardiovascular autonomic imbalance in patients with significant CAD. The relative change of autonomic tone, especially the delayed sympathetic recovery, could be an additional marker for diagnosing myocardial ischemia.

Keywords: exercise stress testing; coronary artery disease; myocardial ischemia; heart rate variability; short-term HRV (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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