Vol 13, No 5 (2006): Folia Cardiologica
Original articles
Published online: 2006-05-25
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
Folia Cardiol 2006;13(5):404-413.
Abstract
Background: The aim of our study was to examine the value of Holter monitoring and
changes of heart rate variability (HRV) parameters in patients undergoing percutaneous
transluminal coronary angioplasty (PTCA) and to assess their value for detection of restenosis
after the elective PTCA of single-vessel coronary artery disease.
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.
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 angioplastyrestenosisHolter monitoringheart rate variability
