Heart rate variability before the occurrence of silent myocardial ischemia during ambulatory monitoring.

Thirty-three ischemic episodes in 19 patients with stable coronary artery disease were studied to clarify changing autonomic nervous system activity during daily life before the occurrence of myocardial ischemia. Nonischemic points were studied for comparison of control data with ischemic episodes. These were defined as (1) patient showing no ischemic ST-T change while having the same heart rate with onset of ischemic episodes, and (2) presence within 1 to 2 hours before or after onset of ischemic episodes in the same patient. We analyzed heart rate (HR) variability during the 30-minute period before the onset and after the end of ischemic episodes during 24-hour monitoring. The period of 30 to 40 minutes before ischemia was regarded as the baseline, and HR variability was analyzed at 10-minute intervals before each ischemic episode and nonischemic point. HR variability was quantified on the band of 2 components: low frequency (0.04 to 0.15 Hz; LF) and high frequency (0.15 to 0.40 Hz; HF). Of the 33 episodes, 24 (73%) had a greater LF/HF value during the 30-minute period before ischemia than that before the nonischemic points. Distribution of the number of the 24 episodes demonstrated circadian rhythm with a peak from 8 to 10 A.M. HF power began to decrease from the last 10 minutes before ischemia, compared with baseline. A significant decrease in HF power with a background of greater value of LF/HF may explain the reduced ischemic threshold for ischemia during daily life.