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Department of
Cardiology, Sahlgrenska University Hospital, S-41345 Göteborg, Sweden
Correspondence to: Dr Wennerblom email: maureen.jehler{at}hjl.gu.se
Accepted 4 October
1999
AIM
To investigate whether
uncomplicated chronic coronary artery disease causes changes in heart
rate variability and if so, whether the heart rate variability pattern
is different from that described in patients with acute myocardial infarction.
METHODSHeart rate variability was
studied in 65 patients with angina who had no previous myocardial
infarcts, no other diseases, and were on no drug that could influence
the sinus node. Results were compared with 33 age matched healthy
subjects. The diagnosis of coronary artery disease in angina patients
was established by coronary angiography in 58, by thallium scintigraphy
in six, and by exercise test only in one. Patients and controls were
Holter monitored 24 hours outside hospital, and heart rate variability was calculated in the frequency domain as global power (GP: 0.01-1.00 Hz), low frequency peak (LF: 0.04-0.15 Hz), high frequency peak (HF:
0.15-0.40 Hz), LF/HF in ms2, and in the time domain as
SDNN (SD of normal RR intervals), SDANN (SD of all five minute mean
normal RR intervals), SD (mean of all five minute SDs of mean RR
intervals), rMSSD (root mean square of differences of successive normal
RR intervals) (all in ms), and pNN50 (proportion of adjacent normal RR
intervals differing more than 50 ms from the preceding RR interval) as
per cent.
RESULTSThe mean age in patients and
controls was 60.4 (range 32-81) and 59.1 (32-77) years, respectively
(NS), the male/female ratio, 57/65 and 24/33 (NS), and the mean time of
Holter monitoring, 23.0 (18-24) and 22.8 (18-24) hours (NS).
Mortality in angina patients was 0% (0/65) at one year, 0% (0/56) at
two years, and 3% (1/33) at three years. Compared with healthy
subjects angina patients showed a reduction in GP (p = 0.007), HF
(p = 0.02), LF (p = 0.02), SD (p = 0.02), rMSSD (p = 0.01), and
pNN50 (p = 0.01). No significant difference was found in RR, LF/HF,
SDNN, or SDANN.
CONCLUSIONSUncomplicated coronary
artery disease without previous acute myocardial infarction was
associated with reduced high and low frequency heart rate variability,
including vagal tone. SDANN and SDNN, expressing ultra low and very low
frequencies which are known to reflect prognosis after acute myocardial
infarction, were less affected. This is in agreement with the good
prognosis in uncomplicated angina in this study.
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