The use of heart rate variability (HRV) testing in addition to assessment of risk factors for coronary artery disease (CAD) was found to improve the identification of myocardial ischemia in individuals with low to intermediate risk for CAD, according to a study published in the Journal of the American Heart Association.

Individuals with low to intermediate pretest probability for CAD who were screened for myocardial ischemia (n=1043; mean age, 61 years) were prospectively enrolled in this study. Participants underwent a 1-hour Holter testing, which was analyzed using the HeartTrends DyDx algorithm. Patients then underwent an exercise stress echocardiography (n=612) or exercise myocardial perfusion imaging (n=431) to detect myocardial ischemia (primary endpoint).

In this cohort, 66 patients (6.3%) had myocardial ischemia, which was more common in participants with low vs high HRV (11% vs 3%, respectively; P =.002). Low HRV was found to be an independent predictor of myocardial ischemia (odds ratio [OR], 2.00; 95% CI, 1.41-2.89; P =.01) in a multivariable analysis. A single unit reduction in HRV was found to be associated with a 52% increased likelihood for myocardial ischemia (OR, 1.52; 95% CI, 1.11-2.13; P =.02).

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A study limitation was the sole inclusion of patients with a low to intermediate pretest probability for CAD.

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“In the era of wearable digital monitoring devices and increased interest in personalized approaches to risk assessment, HRV may provide useful information to direct lifestyle change and monitor general health status,” noted the study authors.


Goldenberg I, Goldkorn R, Shlomo N, et al. Heart rate variability for risk assessment of myocardial ischemia in patients without known coronary artery disease: the HRV-DETECT (heart rate variability for the detection of myocardial ischemia) study. J Am Heart Assoc. 2019;8(24):e014540.