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European Heart Journal 1999 20(1):38-50; doi:10.1053/euhj.1998.1272
Copyright © 1999 by the European Society of Cardiology.
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Heart rate variability and ischaemia in patients with coronary heart disease and stable angina pectoris

Influence of drug therapy and prognostic value

F. Webera,f1, H. Schneidera, T. von Arnimb and W. Urbaszeka

a Clinic for Internal Medicine, Cardiology Department, University of Rostock, Rostock, Germany
b Ludwig Maximilian University, Munich Red Cross Hospital, Munich, Germany

accepted July 29, 1998

Abstract

Aims

Determination of the influence of therapy with bisoprolol and nifedipine on the heart rate variability of patients from the Total Ischemic Burden Bisoprolol Study and examination of the prognostic value.

Methods and Results

Four hundred and twenty-two patients with stable angina were included. The heart rate variability was determined over a period of 24h. Parameters determined: standard deviation of the mean of all corrected RR intervals, standard deviation of all 5min mean cycle lengths, square root of the mean of the squared differences of successive corrected RR intervals. Nifedipine reduced the mean values of all heart rate variability parameters tested. Square root of the mean of the square differences of successive corrected RR intervals increased under bisoprolol. Standard deviation of the mean of all corrected RR intervals and standard deviation of all 5min mean cycle lengths increased from low baseline values and declined from higher baseline values. The increase in heart rate variability under therapy was accompanied by a tendency towards a better prognosis. Patients with an increase in heart rate variability and simultaneous complete suppression of ischaemia under therapy displayed no serious events in the course of one year.

Conclusions

The increase in the heart rate variability, which can be regarded as prognostically favourable, was predominantly observed under bisoprolol. The parameter constellation of an increase in heart rate variability and complete ischaemia suppression on the 48-h Holter ECG was associated with the greatest benefit.

Key Words: Heart rate variability • beta-blockers • calcium antagonists • coronary heart disease

f1 Correspondence: Dr Frank Weber, Universität Rostock, Klinik für Innere Medizin, Abteilung Kardiologie, Postfach 10 08 88, D-18055 Rostock, Germany.

Malik, MCamm, AJ

References

  1. Kleiger RE, Miller JP, Bigger JT, Moss AJ. Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol. 1987;59:256–262[CrossRef][Web of Science][Medline]
  2. Farrel TG, Bashir Y, Crippes T. Risk stratification for arrhythmic events in postinfarction patients based on heart rate variability, ambulatory electrocardiographic variables and the signal-averaged electrocardiogram. J Am Coll Cardiol. 1992;18:687–697
  3. Bigger JT, Fleiss JL, Rolnitzky LM, Steinmann RC. Frequency domain measures of heart period variability to assess risk late after myocardial infarction. J Am Coll Cardiol. 1993;21:729–736[Abstract]
  4. Tsuji H, Venditti FJ, Manders ES. Reduced heart rate variability and mortality risk in an elderly cohort. The Framingham Heart Study. Circulation. 1994;90:878–883[Abstract/Free Full Text]
  5. Valkama JO, Huikuri HV, Koistinen MJ, Sinikka Y-M, Airaksinen KEJ, Myerburgh RJ. Relation between heart rate variability and spontaneous and induced ventricular arrhythmias in patients with coronary artery disease. J Am Coll Cardiol. 1995;25:437–443[Abstract]
  6. von Arnim T. Medical treatment to reduce total ischemic burden. Total ischemic burden bisoprolol study (TIBBS), a multicenter trial comparing bisoprolol and nifedipine. J Am Coll Cardiol. 1995;25:231–238[Abstract]
  7. von Arnim T. Prognostic significance of transient ischemic episodes: response to treatment shows improved prognosis. Results of the Total Ischemic Burden Bisoprolol Study (TIBBS) follow-up. J Am Coll Cardiol. 1996;28:20–24[Abstract]
  8. Elfner R, Buss J, Heene DL, Kraatz J. Beat-by-beat validation of the Oxford Medilog 4500, a 24-h ambulatory ECG system with real-time analysis. J Ambul Monit. 1988;1:17–31
  9. Pinna GD, Maestri R, Cesare AD, Colombo R, Minuco G. The accuracy of power-spectrum analysis of heart-rate vari-ability from annotated RR lists generated by Holter systems. Physiol Meas. 1994;15:163–179[CrossRef][Web of Science][Medline]
  10. Algra A, Tijssen JG, Roelandt JR, Pool J, Lubsen J. Heart rate variability from 24-hour electrocardiography and the 2-year risk for sudden death. Circulation. 1993;88:180–185[Abstract/Free Full Text]
  11. Cook JR, Bigger JT, Kleiger RE, Fleiss JL, Steinmann RC, Rolnitzky LM. Effect of atenolol and diltiazem on heart period variability in normal persons. J Am Coll Cardiol. 1991;17:480–484[Abstract]
  12. Bigger JT, Fleiss JL, Steinmann RC, Rolnitzky LM, Scheider WJ, Stein PK. RR variability in healthy, middle-aged persons compared with patients with chronic coronary heart disease or recent acute myocardial infarction. Circulation. 1995;91:1936–1943[Abstract/Free Full Text]
  13. Adamson PB, Huang MH, Vanoli E, Foreman RD, Schwartz PJ, Hull SS. Unexpected interaction between beta-adrenergic blockade and heart rate variability before and after myocardial infarction. Circulation. 1994;90:976–982[Abstract/Free Full Text]
  14. Kleiger RE, Bigger JT, Bosner MS. Stability over time of variables measuring heart rate variability in normal subjects. Am J Cardiol. 1991;68:626–630[CrossRef][Web of Science][Medline]
  15. van Hoogenuyce DK, Weinstein H, Martin GJ. Reproducibility and relation to mean heart rate of heart rate variability in normal subjects and in patients with congestive heart failure secondary to coronary heart disease. Am J Cardiol. 1991;68:1668–1676[CrossRef][Web of Science][Medline]
  16. Zuanetti G, Latini R, Neilson JMM, Schwartz PJ, Ewing DJ. Heart rate variability in patients with ventricular arrhythmias: effect of antiarrhythmic drugs. J Am Coll Cardiol. 1991;17:604–612[Abstract]
  17. Bigger JT, Fleiss JL, Rolnitzky LM, Steinmann RC. Stability over time of heart period variability in patients with previous myocardial infarction and ventricular arrhythmias. Am J Cardiol. 1992;69:718–723[CrossRef][Web of Science][Medline]
  18. Hohnloser SH, Klingenheben T, Zabel M, Schröder F, Just H. Intraindividual reproducibility of heart rate variability. PACE. 1992;15:2211–2214
  19. Kautzner J. Reproducibility of heart rate variability measurement. Heart Rate Variability. Armonk: Futura; 1995. p. 165–71
  20. Bigger T, Rolnitzky LM, Steinmann RC, Fleiss JL. Predicting mortality after myocardial infarction from the response of RR variability to arrhythmic drug therapy. J Am Coll Cardiol. 1994;23:733–740[Abstract]
  21. Gottlieb SO, Weisfeldt ML, Ouyang P, Mellils ED, Gerstenblith G. Silent ischemia predicts infarction and death during 2-year follow-up of instable angina. J Am Coll Cardiol. 1987;10:756–760[Abstract]
  22. von Arnim T, Gerbig HW, Krawietz W, Höfling B. Prognostic implications of transient predominantly silent ischemia in patients with unstable angina pectoris. Eur Heart J. 1988;9:435–440[Abstract/Free Full Text]
  23. Tzivioni D, Weisz G, Gavish A, Zin D, Keren A, Stren S. Comparison of mortality and myocardial infarction rates in angina pectoris with and without ischemic episodes during daily activities. Am J Cardiol. 1989;63:273–276[CrossRef][Web of Science][Medline]
  24. Deedwania P, Carbajal EV. Silent ischemia during daily life is an independent predictor of mortality in stable angina. Circulation. 1990;81:748–756[Abstract/Free Full Text]
  25. von Arnim T, Szeimies-Seebach U, Erath A, Schreiber MA, Möfling B. Ischemia detected on ambulatory monitoring: Has it prognostic implications? Adv Cardiol. 1990;37:236–243[Medline]
  26. Yeung AC, Barry J, Orav J, Bonassin E, Rabyu KE, Selwyn AP. Effects of asymptomatic ischemia on long-term prognosis in chronic stable coronary disease. Circulation. 1991;83:1598–1604[Abstract/Free Full Text]
  27. Van Boven AJ, Jukema JW, Crijns HJ, Lie KI. Heart rate variability profiles in symptomatic coronary artery disease and preserved left ventricular function: relation to ventricular tachycardia and transient myocardial ischemia: Regression Growth Evaluation Statin Study (REGRESS). Am Heart J. 1995;130:1020–1025[CrossRef][Web of Science][Medline]
  28. Pozzati A, Poncaldi LG, Di Pasquale G, Bugiardini R. Transient sympathovagal imbalance triggers ‘ischemic’ sudden death in patients undergoing electrocardiographic Holter monitoring. J Am Coll Cardiol. 1996;27:847–852[Abstract]
  29. Vardas PE, Kochiakis GE, Manios EG, Kanoupakis EM, Zouridakis EG, Chlouverakis GI. Spectral analysis of heart rate variability before and during episodes of nocturnal ischaemia in patients with extensive coronary heart disease. Eur Heart J. 1996;17:331–333[Free Full Text]
  30. Cerati D, Nador F, Maestri R. Influence of residual ischaemia on heart rate variability after myocardial infarction. Eur Heart J. 1997;18:78–81[Abstract/Free Full Text]
  31. Sroka K, Peimann CJ, Seevers H. Heart rate variability in myocardial ischemia during daily life. J Elektrcardiol. 1997;30:45–56
  32. Deanfield JE, Shea M, Riberio P. Transient ST segment depression as a marker of myocardial ischemia during daily life. Am J Cardiol. 1984;54:1195–1200[CrossRef][Web of Science][Medline]
  33. Tzivoni D, Gavish A, Benkonin J, Banai S, Keren A, Stern SI. Day to day variability of myocardial ischemic episodes in coronary heart disease. Am J Cardiol. 1987;60:1003–1005[CrossRef][Web of Science][Medline]
  34. Pardo Y, Merz CN, Paul-Labrador M. Heart rate variability, reproducibility and stability using commercially available equipment in coronary artery disease with daily life myocardial ischemia. Am J Cardiol. 1996;78:866–870[CrossRef][Web of Science][Medline]
  35. Kamath MV, Fallen EL. Diurnal variations of neurocardiac rhythms in acute myocardial infarction. Am J Cardiol. 1991;68:155–160[CrossRef][Web of Science][Medline]
  36. Lombardi F, Torzillo D, Sandrone G. Beta-blocking effect of propafenone based on spectral analysis of heart rate variability. Am J Cardiol. 1992;70:1028–1034[CrossRef][Web of Science][Medline]
  37. Hohnloser SH, Klingenheben T, Zabel M, Just H. Effect of sotalol on heart rate variability assessed by Holter monitoring in patients with ventricular arrhythmias. Am J Cardiol. 1993;72:67A–71A[CrossRef][Medline]
  38. Niemela MJ, Airaksinen KEJ, Huikuri HV. Effect of beta-blockade on heart rate variability in patients with coronary heart disease. J Am Coll Cardiol. 1994;23:1370–1377[Abstract]
  39. Sandrone G, Mortara A, Torzillo D, La Rovere MT, Malliani A, Lombardi F. Effects of beta blockers (Atenolol or Metoprolol) on heart rate variability after acute myocardial infarction. Am J Cardiol. 1994;74:340–345[CrossRef][Web of Science][Medline]
  40. Schweizer MW, Brachmann J, Kirchner U. Heart rate variability in time and frequency domains: effects of gallopamil, nifedipine, metoprolol compared with placebo. Br Heart J. 1993;70:252–258[Abstract/Free Full Text]
  41. Lombardi F, Sandrone G, Pernpruner S. Heart rate variability as an index of sympatho-vagal interaction in patients after myocardial infarction. Am J Cardiol. 1987;60:1239–1245[CrossRef][Web of Science][Medline]
  42. Bigger TJ, Fleiss JL, Rolnitzky LM, Steinman RC, Schneider WJ. Time course of recovery of heart period variability after myocardial infarction. J Am Coll Cardiol. 1991;18:1643–1649[Abstract]
  43. Huikuri HV. Heart rate variability in coronary heart disease. J Intern Med. 1995;237:349–357[Web of Science][Medline]
  44. Odemuyiwa O, Malik M, Farrel T, Bashir Y, Poloniecki J, Camm J. Comparison of the predictive characteristic of heart rate variability index and left ventricular ejection fraction for all-cause mortality, arrhythmic events and sudden death after acute myocardial infarction. Am J Cardiol. 1991;68:434–439[CrossRef][Web of Science][Medline]
  45. Camm AJ, Fei L. Risk stratification following myocardial infarction: heart rate variability and other risk factors. Malik M, Camm AJ. Heart Rate Variability. Armonk: Futura; 1995. p. 369–392
  46. Hartikainen JEK, Malik M, Staunton A, Poloniecki J, Camm J. Distinction between arrhythmic and nonarrhythmic death after acute myocardial infarction based on heart rate vari-ability, signal-averaged electrocardiogram, ventricular arrhythmias and left ventricular ejection fraction. J Am Coll Cardiol. 1996;28:296–304[Abstract]

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