Prognostic Value of Heart Rate Turbulence for Risk Assessment in Patients with Unstable Angina and Non-ST Elevation Myocardial Infarction

Authors

Patricia R.E. Harris, Electrocardiographic Monitoring Research Laboratory, School of Nursing, Department of Physiological Nursing, University of California, San FranciscoFollow
Phyllis K. Stein, Heart Rate Variability Laboratory, School of Medicine, Division of Cardiology, Washington UniversityFollow
Gordon L. Fung, Cardiology Services, Department of MedicineFollow
Barbara J. Drew, School of Nursing, Department of Physiological Nursing, Division of Cardiology, University of California, San FranciscoFollow

Document Type

Article

Source

Vascular Health and Risk Management

ISSN

1178-2048

Volume

9

First Page

465

Last Page

473

Publication Date

8-2013

Department

Nursing

Abstract

Background: We sought to examine the prognostic value of heart rate turbulence derived from electrocardiographic recordings initiated in the emergency department for patients with non-ST elevation myocardial infarction (NSTEMI) or unstable angina.

Methods: Twenty-four-hour Holter recordings were started in patients with cardiac symptoms approximately 45 minutes after arrival in the emergency department. Patients subsequently diagnosed with NSTEMI or unstable angina who had recordings with ≥18 hours of sinus rhythm and sufficient data to compute Thrombolysis In Myocardial Infarction (TIMI) risk scores were chosen for analysis (n = 166). Endpoints were emergent re-entry to the cardiac emergency department and/or death at 30 days and one year.

Results: In Cox regression models, heart rate turbulence and TIMI risk scores together were significant predictors of 30-day (model chi square 13.200, P = 0.001, C-statistic 0.725) and one-year (model chi square 31.160, P < 0.001, C-statistic 0.695) endpoints, outperforming either measure alone.

Conclusion: Measurement of heart rate turbulence, initiated upon arrival at the emergency department, may provide additional incremental value in the risk assessment for patients with NSTEMI or unstable angina.

Rights

Copyright © 2013 Dovepress.

PubMed ID

23976860

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License