Prognostic value of heart rate turbulence for risk assessment in patients with unstable angina and non-ST elevation myocardial infarction

Patricia R.E. Harris, Phyllis K. Stein, Gordon L. Fung, Barbara J. Drew

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

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.

Original languageEnglish
Pages (from-to)465-473
Number of pages9
JournalVascular Health and Risk Management
Volume9
Issue number1
DOIs
StatePublished - 2013

Keywords

  • Acute coronary syndrome
  • Electrocardiographic monitoring
  • Heart rate turbulence
  • Non-ST elevation myocardial infarction
  • Outcomes
  • Prognosis
  • Unstable angina

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