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[Heart rate variability in patients treated with percutaneous transluminal coronary angioplasty]
Ewa Sedziwy1, Maria Olszowska, Wiesława Tracz
1Klinika Chorób Serca i Naczyń Instytut Kardiologii Collegium Medicum Uniwersytet Jagielloński, Kraków.
Insights
Successful percutaneous transluminal coronary angioplasty (PTCA) improves heart rate variability (HRV) in patients with coronary artery disease. Autonomic modulation of heart rate shows significant improvement within three months post-PTCA, persisting for one year.
Area of Science:
- Cardiology
- Autonomic Nervous System Function
- Heart Rate Variability Analysis
Context:
- Decreased heart rate variability (HRV) is a risk factor for sudden cardiac death in coronary artery disease (CAD) patients.
- The impact of myocardial revascularization on HRV is under investigation, with limited data on percutaneous transluminal coronary angioplasty (PTCA).
Purpose:
- To evaluate changes in HRV parameters following successful PTCA in patients with CAD.
- To assess HRV behavior before and up to one year after PTCA.
Summary:
- This study analyzed HRV in 65 patients undergoing successful PTCA, measuring parameters like pNN50, SDNN, and SDANN via 24-hour Holter monitoring.
- A significant increase in pNN50, SDNN, and SDANN was observed within three months post-PTCA, with sustained improvements at 6 and 12 months.
- The parameter rMSSD did not show significant changes throughout the one-year follow-up period.
Impact:
- Successful PTCA enhances autonomic modulation of heart rate in CAD patients.
- Improvements in parasympathetic control are evident as early as two weeks post-PTCA.
- The beneficial effects of PTCA on heart rate autonomic regulation persist for at least 12 months.
Unlabelled:
Decreased heart rate variability (HRV) is an independent risk factor for sudden cardiac death in patients with coronary artery disease (CAD) and previous myocardial infarction. The influence of myocardial revascularization on HRV parameters has been investigated for the past few years. However, little is known about HRV behaviour in patients with CAD treated with percutaneous transluminal coronary angioplasty (PTCA). The purpose of this study was to estimate HRV parameters before PTCA and during a one year follow-up. We examined 65 patients (47 men, 18 women; mean age 51.2 +/- 7.6), who underwent successful and uncomplicated PTCA. Thirty eight patients had a prior myocardial infarction. The mean left ventricular ejection fraction was 59.8 +/- 8.1%. Thirty-nine patients had a single-vessel disease, 25 patients had a double-vessel disease and one patient had a triple-vessel disease. Serial 24-hour Holter monitoring (before PTCA, 14 days, 3, 6, 12 months after PTCA) was performed in all patients. The following time domain measures of HRV were calculated from each recording, for 24-hours: pNN50, SDNN, SDANN and rMSSD. During the one year follow-up, a significant increase of pNN50, SDNN and SDANN was observed. We noted, that the statistically significant increase of the above-mentioned parameters occurred during the first 3 month follow-up. The results of the next serial recordings (6 and 12 months after PTCA) demonstrated no additional changes in HRV values, however they were still significantly higher than before procedure. Mean values of HRV parameters before PTCA and 3 months after were as follows: pNN50: 8.8 +/- 6.8%, vs 11.7 +/- 9.4% (p < 0.05), SDNN: 121.2 +/- 33.5 ms vs 148.2 +/- 29.3 ms (p < 0.05), SDANN: 113.6 +/- 16.2 ms vs 125.1 +/- 22.3 ms (p < 0.05). Parameter rMSSD did not change significantly during the whole observation.
Conclusions:
1. Myocardial revascularisation with successful PTCA leads to an improvement in the autonomic modulation of heart rate. 2. The increase in parasympathetic control of the heart rate is already being observed 2 weeks after successful PTCA. 3. Beneficial increased influence of both parts of the autonomic nervous system on heart rate persists for 12 months after coronary angioplasty.