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Altered autonomic cardiac control predicts restenosis after percutaneous coronary intervention
Matthias Goernig1, Matthias Gramsch, Vico Baier
1Department of Cardiology, Clinic of Internal Medicine I, University of Jena, Jena, Germany. matthias.goernig@med.uni-jena.de
Insights
Heart rate and blood pressure variability analysis can identify restenosis after percutaneous coronary intervention (PCI). This noninvasive approach aids in predicting restenosis risk in patients with a history of PCI.
Area of Science:
- Cardiology
- Autonomic Nervous System Function
- Medical Diagnostics
Background:
- Restenosis after percutaneous coronary intervention (PCI) affects up to 30% of patients, impacting long-term success.
- Drug-eluting stents reduce restenosis but incur higher costs.
- Current noninvasive tests for restenosis lack sufficient diagnostic power.
Purpose of the Study:
- To develop a novel noninvasive method for identifying patients at high risk for restenosis after PCI.
- To combine heart rate variability (HRV) and blood pressure variability (BPV) analyses for improved restenosis detection.
Main Methods:
- Evaluated cardiovagal autonomic regulation in 52 patients with suspected restenosis post-PCI.
- Assessed parameters including HRV, BPV, baroreflex sensitivity (BRS), and heart rate turbulence.
- Compared patients with restenosis (CAD+R) to those without (CAD-R).
Main Results:
- Significant differences between groups observed in BPV (diastolic LF/P, systolic/diastolic UVLF) and BRS (tachycardic slope).
- Heart rate turbulence onset (HRTO) and systolic blood pressure potentiation (SBPP) also differed significantly.
- A combination of diastolic LF/P and HRTO predicted restenosis with 83.4% accuracy.
Conclusions:
- Indicators of sympathetic activation or vagal depression are associated with restenosis post-PCI.
- This approach offers a promising noninvasive monitoring strategy for patients after PCI.
Background:
Early and late restenosis in up to 30% remains a major problem for long-term success after percutaneous coronary intervention (PCI). Compared to bare metal stents, the use of drug-eluting stents reduces restenosis below 10%, but implant coasts have to be considered. In restenosis noninvasive testing lacks diagnostic power. We applied a new approach to identify patients with a high risk for restenosis after PCI by combining heart rate (HR) and blood pressure variability (BPV) analyses.
Methods:
In 52 patients with clinical suspicion of restenosis and history of PCI, we investigated patterns of cardiovagal autonomic regulation prior to cardiac catheterization. The patients were separated in (i) patients with restenosis (CAD+R) and (ii) patients without restenosis (CAD-R), where restenosis is defined as a stenosis greater than 75% of luminal diameter in at least one main vessel. The following parameters/methods were evaluated: Canadian Cardiovascular Society grade (CCS-grade), vessel disease score (CAD-level), left ventricular ejection fraction (LVEF), heart rate variability (HRV), BPV, baroreflex sensitivity (BRS), as well as HR turbulence and blood pressure (BP) potentiation caused by premature ventricular complexes.
Results:
Whereas age, LVEF, CAD-level, CCS-grade, and mean BP did not differ between CAD+R and CAD-R, significant differences were found in (i) BPV: diastolic LF/P, systolic, and diastolic UVLF, (ii) in BRS: slope of tachycardic sequences, and (iii) in extrasystolic parameters: heart rate turbulence onset (HRTO) and potentiation of systolic BP (SBPP). Standard HRV parameters did not show significant differences between the groups. Using the two parameters diastolic LF/P (threshold >0.2) and HRTO (threshold >0) restenosis were predicted in 83.4%.
Conclusions:
These results demonstrate that indicators of sympathetic activation or vagal depression identify restenosis in patients after PCI, thus opening a perspective for a new noninvasive monitoring.
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