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

Author

Listed:
  • 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
    Department of Cosmetic Applications and Management, MacKay Junior College of Medicine, Nursing and Management, Taipei 25245, Taiwan)

  • Chang Francis Hsu

    (Labfront (Kiipo Co.), Boston, MA 02067, USA)

  • Ying-Hsiang Lee

    (Cardiovascular Center, MacKay Memorial Hospital, Taipei 104217, Taiwan
    Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan
    Department of Artificial Intelligence and Medical Application, MacKay Junior College of Medicine, Nursing and Management, Taipei 25245, 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
    Division of Cardiology, Hsinchu MacKay Memorial Hospital, Hsinchu 30071, 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
    Graduate Institute of Medical Informatics, Taipei Medical University Hospital, Taipei 110301, Taiwan)

  • Po-Lin Lin

    (Division of Cardiology, Hsinchu MacKay Memorial Hospital, Hsinchu 30071, Taiwan
    Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan)

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.

Suggested Citation

  • 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 & Po-Lin Lin, 2022. "The Autonomic Imbalance of Myocardial Ischemia during Exercise Stress Testing: Insight from Short-Term Heart Rate Variability Analysis," IJERPH, MDPI, vol. 19(22), pages 1-12, November.
    • Handle: RePEc:gam:jijerp:v:19:y:2022:i:22:p:15096-:d:974359
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    References listed on IDEAS

    as
    1. Giovanna Zimatore & Maria Chiara Gallotta & Matteo Campanella & Piotr H. Skarzynski & Giuseppe Maulucci & Cassandra Serantoni & Marco De Spirito & Davide Curzi & Laura Guidetti & Carlo Baldari & Stavr, 2022. "Detecting Metabolic Thresholds from Nonlinear Analysis of Heart Rate Time Series: A Review," IJERPH, MDPI, vol. 19(19), pages 1-24, October.
    2. Giovanna Zimatore & Lavinia Falcioni & Maria Chiara Gallotta & Valerio Bonavolontà & Matteo Campanella & Marco De Spirito & Laura Guidetti & Carlo Baldari, 2021. "Recurrence quantification analysis of heart rate variability to detect both ventilatory thresholds," PLOS ONE, Public Library of Science, vol. 16(10), pages 1-15, October.
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