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Effect of primary coronary intervention on heart rate variability and left ventricular function in patients with
P Santangeli1, P Lamendola, C Larosa
1Department of Cardiology, Sacro Cuore Catholic University, Rome, Italy.
Insights
Heart rate variability (HRV) significantly improves after acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention (PCI), irrespective of left ventricular ejection fraction (LVEF) changes. This suggests HRV is a valuable indicator of recovery post-PCI.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Interventional Cardiology
Background:
- Primary percutaneous coronary intervention (PCI) is a standard treatment for acute myocardial infarction (AMI).
- Previous studies indicate PCI positively impacts left ventricular remodeling and heart rate variability (HRV) in AMI patients.
- The relationship between left ventricular remodeling and HRV changes post-PCI in AMI patients remains under-investigated.
Purpose of the Study:
- To investigate the relationship between left ventricular remodeling and HRV changes during follow-up in AMI patients treated with primary PCI.
- To assess the impact of primary PCI on HRV and left ventricular ejection fraction (LVEF) in AMI patients.
Main Methods:
- A cohort of 28 AMI patients treated with primary PCI within 12 hours of symptom onset was studied.
- 24-hour ECG Holter recordings and echocardiographic assessments of LVEF were performed before discharge, and at 1- and 6-month follow-up.
- HRV was analyzed in both time- and frequency-domains.
Main Results:
- Significant improvements in time- and frequency-domain HRV variables were observed at 1 and 6 months post-PCI (P<0.001).
- Left ventricular ejection fraction (LVEF) remained substantially unchanged throughout the follow-up period (P=0.25).
- HRV improved similarly in patients with and without LVEF improvement, indicating an independent effect.
Conclusions:
- In AMI patients treated with primary PCI, HRV improves over time, independent of LVEF changes.
- These findings highlight HRV as a potential marker for recovery after AMI treated with primary PCI.
- Further research is warranted to explore the clinical implications of these HRV changes.
Aim:
Several studies showed that primary percutaneous coronary interventions (PCI) have a favourable impact on left ventricular remodeling and heart rate variability (HRV) both at short- and long-term follow-up in patients suffering an acute myocardial infarction (AMI). However, no previous study investigated the relationship between left ventricular remodeling and changes in HRV during follow-up in AMI patients treated by primary PCI.
Methods:
We studied 28 patients with AMI (57+/-8 years, 27 men), treated by PCI within 12 hours of symptom onset. Patients underwent a 24-hour ECG Holter recording and left ventricular ejection fraction (LVEF) echocardiographic assessment before discharge, and at 1-month and 6-month follow-up. HRV was measured in the time- and frequency-domain.
Results:
A significant improvement of both time- and frequency-domain HRV variables was observed at 1-month and at 6-month follow-up with the most significant changes being found for standard deviation of normal-normal beat intervals (SDNN) in the time-domain (95.5+/-26.1 ms vs 125.5+/-29.8 ms vs 142.8+/-28.8 ms, respectively; P<0.001) and for very low frequency (VLF) amplitude in the frequency-domain (36.7+/-9.8 ms vs 44.1+/-11.1 vs 48.9+/-12.2 ms, respectively; P<0.001). In contrast, compared to basal values, LVEF was substantially unchanged at 1-month and 6-month follow-up (48.8+/-8.5% vs 50.8+/-10% vs 49.6+/-9%, respectively; P=0.25). At 6-month follow-up 11 patients showed an improvement of >or= 5% of LVEF, whereas 17 patients did not show any improvement of LVEF. HRV variables significantly improved in a similar way in these two subgroups both at 1-month and at 6-month follow-up.
Conclusion:
Our data demonstrate that, in AMI patients treated by primary PCI, HRV improves over time, independent of changes in LVEF. The clinical implications of these findings deserve to be addressed in future studies.
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