Good reproducibility of heart rate variability after orthostatic challenge in patients with a history of acute coronary syndrome

- We found comparable SEMs and ICCs in supine position and after an orthostatic challenge test in patients with a history of ACS.
- All ICCs of HRV parameters associated with mortality risk were good to excellent (ICCs between 0.636 and 0.869).
- Ectopic beats had no systematic effect on any of the measured HRV parameters when corrected with commercially available software.

BackgroundSeveral parameters of heart rate variability (HRV) have been shown to predict the risk of sudden cardiac death (SCD) in cardiac patients. There is consensus that risk prediction is increased when measuring HRV during specific provocations such as orthostatic challenge. For the first time, we provide data on reproducibility of such a test in patients with a history of acute coronary syndrome.MethodsSixty male patients (65 ± 8 years) with a history of acute coronary syndrome on stable medication were included. HRV was measured in supine (5 min) and standing (5 min) position on 2 occasions separated by two weeks. For risk assessment relevant time-domain [standard deviation of all R-R intervals (SDNN) and root mean squared standard differences between adjacent R-R intervals (RMSSD)], frequency domain [low-frequency power (LF), high-frequency power (HF) and LF/HF power ratio] and short-term fractal scaling component (DF1) were computed. Absolute reproducibility was assessed with the standard errors of the mean (SEM) and 95% limits of random variation, and relative reproducibility by the intraclass correlation coefficient (ICC).ResultsWe found comparable SEMs and ICCs in supine position and after an orthostatic challenge test. All ICCs were good to excellent (ICCs between 0.636 and 0.869).ConclusionsReproducibility of HRV parameters during orthostatic challenge is good and comparable with supine position.