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

Authors Harris PRE, Stein PK, Fung GL, Drew BJ

Received 4 February 2013

Accepted for publication 17 April 2013

Published 12 August 2013 Volume 2013:9 Pages 465—473


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Patricia RE Harris,1 Phyllis K Stein,2 Gordon L Fung,3 Barbara J Drew4

1Electrocardiographic Monitoring Research Laboratory, School of Nursing, Department of Physiological Nursing, University of California, San Francisco, CA, USA; 2Heart Rate Variability Laboratory, School of Medicine, Division of Cardiology, Washington University, St Louis, MO, USA; 3Cardiology Services, Department of Medicine, 4School of Nursing, Department of Physiological Nursing, Division of Cardiology, University of California, San Francisco, CA, USA

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.

Keywords: acute coronary syndrome, electrocardiographic monitoring, heart rate turbulence, non-ST elevation myocardial infarction, outcomes, prognosis, unstable angina

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