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The value of Holter monitoring with heart rate variability assessment in predicting restenosis after successful percutaneous transluminal coronary angioplasty of isolated stenosis of left anterior descending artery
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Abstract
Methods: 56 consecutive patients were studied - 41 men and 15 women (mean age: 56.2 ± 8.3 years) with left anterior descending artery stenosis who underwent successful PTCA. All patients underwent 24 hour Holter monitoring with HRV assessment within 1 week after PTCA and then again before repeated follow-up angiography.
Results: Repeated coronary angiography revealed restenosis in 15 patients and no signs of significant stenosis in the remaining 41 patients. The sensitivity of standard ST-segment depression criteria for the prediction of restenosis was low (ranging from 7% to 27%), with quite high specificity (80–93%) and very low diagnostic accuracy (17–36%). However, the presence of ventricular extrasystoles (≥ 50 during 24 h registration) was statistically significantly associated with quite a high likelihood of the presence of restenosis - sensitivity (53% and 47%), specificity (76% and 85%) and diagnostic accuracy (44% and 54%), respectively. In baseline recordings the significantly higher values of rMSSD (p < 0.05) and pNN50 (p = 0.61) had been found among patients who later developed restenosis, compared to those that did not. The sensitivity of rMSSD ≥ 30 ms for the prediction of restenosis was 60%, specificity 76%, diagnostic accuracy 47%. Also the sensitivity of pNN50 ≥ 8% for prediction of restenosis was high and equalled 60%, specificity 78% and diagnostic accuracy 50%.
Conclusions: The value of a 24 hour Holter ST-segment monitoring in the prediction of restenosis seems to be limited. The possible correlation between frequent ventricular extrasystoles and the presence of restenosis needs further studies. The value of heart rate variability in the prediction of restenosis remains to be defined.
Abstract
Methods: 56 consecutive patients were studied - 41 men and 15 women (mean age: 56.2 ± 8.3 years) with left anterior descending artery stenosis who underwent successful PTCA. All patients underwent 24 hour Holter monitoring with HRV assessment within 1 week after PTCA and then again before repeated follow-up angiography.
Results: Repeated coronary angiography revealed restenosis in 15 patients and no signs of significant stenosis in the remaining 41 patients. The sensitivity of standard ST-segment depression criteria for the prediction of restenosis was low (ranging from 7% to 27%), with quite high specificity (80–93%) and very low diagnostic accuracy (17–36%). However, the presence of ventricular extrasystoles (≥ 50 during 24 h registration) was statistically significantly associated with quite a high likelihood of the presence of restenosis - sensitivity (53% and 47%), specificity (76% and 85%) and diagnostic accuracy (44% and 54%), respectively. In baseline recordings the significantly higher values of rMSSD (p < 0.05) and pNN50 (p = 0.61) had been found among patients who later developed restenosis, compared to those that did not. The sensitivity of rMSSD ≥ 30 ms for the prediction of restenosis was 60%, specificity 76%, diagnostic accuracy 47%. Also the sensitivity of pNN50 ≥ 8% for prediction of restenosis was high and equalled 60%, specificity 78% and diagnostic accuracy 50%.
Conclusions: The value of a 24 hour Holter ST-segment monitoring in the prediction of restenosis seems to be limited. The possible correlation between frequent ventricular extrasystoles and the presence of restenosis needs further studies. The value of heart rate variability in the prediction of restenosis remains to be defined.
Keywords
percutaneous transluminal coronary angioplasty; restenosis; Holter monitoring; heart rate variability
About this articleTitle
The value of Holter monitoring with heart rate variability assessment in predicting restenosis after successful percutaneous transluminal coronary angioplasty of isolated stenosis of left anterior descending artery
Journal
Issue
Vol 13, No 5 (2006): Folia Cardiologica
Pages
404-413
Published online
2006-05-25
Page views
734
Article views/downloads
936
Bibliographic record
Folia Cardiol 2006;13(5):404-413.
Keywords
percutaneous transluminal coronary angioplasty
restenosis
Holter monitoring
heart rate variability
Authors
Marek Grygier
Przemysław Mitkowski
Romuald Ochotny
Maciej Lesiak
Jadwiga Kowal
Małgorzata Pyda
Włodzimierz Skorupski
Stefan Grajek
Andrzej Cieśliński
