Cardiac autonomic testing and diagnosing heart disease. “A clinical perspective”
Abstract
Overview
Background. Coronary heart disease (CHD) is a major health concern, affecting nearly half the middle-age population
and responsible for nearly one-third of all deaths. Clinicians have responsibilities beyond diagnosing CHD,
including risk stratification of patients for major adverse cardiac events (MACE), modifying the risks and treating the
patient. In this first of a two-part review, identifying risk factors is reviewed, including more potential benefit from
autonomic testing.
Methods. Traditional and non-traditional, and modifiable and non-modifiable risk factors for MACE where compared,
including newer risk factors, such as inflammation, carotid intimal thickening, ankle-brachial index, CT
calcium scoring, and autonomic function testing, specifically independent measurement of parasympathetic and
sympathetic (P&S) activity.
Results. The Framingham Heart Study, and others, have identified traditional risk factors for the development of
CHD. These factors effectively target high-risk patients, but a large number of individuals who will develop CHD
and MACE are not identified. Many patients with CHD who appear to be well-managed by traditional therapies
still experience MACE. In order to identify these patients, other possible risk factors have been explored. Advanced
autonomic dysfunction, and its more severe form, cardiac autonomic neuropathy, have been strongly
associated with an elevated risk of cardiac mortality and are diagnosable through P&S testing.
Conclusions. Independent measures of P&S activity, provides additional information and has the potential to incrementally
add to risk assessment. This additional information enables physicians to (1) specifically target more
high-risk patients and (2) titrate therapies, with autonomic testing guidance, in order to minimize risk of cardiac
mortality and morbidity.
Keywords
Cardiac autonomic neuropathy, Cardiovascular risk factors, Heart disease, Mortality
Article Information
Disclosure
Financial support: No grants or funding have been received for this
study.
Correspondence
Nicholas L. DePace, Sr. M.D. 438 Ganttown Rd., Ste. 8 & 9 Sewell, NJ 08080, USA dovetech@erols.com
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