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Relation of vascular dilator function and cardiac autonomic function with coronary angiography findings in patients
Gaetano Antonio Lanza1, Eleonora Ruscio1, Gessica Ingrasciotta1
1Fondazione Policlinico Universitario A Gemelli IRCCS, Università Cattolica del Sacro Cuore, Italy.
Insights
Patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) show similar vascular and cardiac autonomic function, regardless of obstructive or non-obstructive coronary artery disease. These findings suggest no functional difference in NSTE-ACS patients based on coronary artery disease severity.
Area of Science:
- Cardiology
- Vascular Biology
- Autonomic Nervous System
Background:
- A significant portion of patients diagnosed with non-ST segment elevation acute coronary syndrome (NSTE-ACS) present with non-obstructive coronary artery disease.
- Understanding the functional differences between NSTE-ACS patients with obstructive versus non-obstructive coronary artery disease is crucial for accurate diagnosis and treatment.
Purpose of the Study:
- To investigate potential differences in systemic vascular dilator function and cardiac autonomic function between NSTE-ACS patients with obstructive coronary artery disease (CAD) and those with non-obstructive CAD.
- To determine if vascular and heart rate variability parameters can predict adverse cardiovascular events in NSTE-ACS patients.
Main Methods:
- Assessed systemic endothelium-dependent and independent vascular dilator function using brachial artery flow-mediated dilation and nitrate-mediated dilation, respectively.
- Evaluated cardiac autonomic function through time-domain and frequency-domain heart rate variability parameters.
- Compared these functional assessments between 59 patients with obstructive CAD (≥50% stenosis) and 61 patients with non-obstructive CAD within a cohort of 120 NSTE-ACS patients.
Main Results:
- No statistically significant differences were observed in flow-mediated dilation (5.03±2.6% vs. 5.40±2.5%, P=0.37) or nitrate-mediated dilation (6.79±2.8% vs. 7.30±3.4%, P=0.37) between the obstructive and non-obstructive CAD groups.
- Cardiac autonomic function, assessed by heart rate variability, also showed no significant differences between the groups, although the triangular index trended lower in the obstructive CAD group (30.2±9.5 vs. 33.9±11.6, P=0.058).
- Neither vascular function nor heart rate variability parameters predicted the recurrence of angina or re-hospitalization during an 11.3-month follow-up period.
Conclusions:
- NSTE-ACS patients with obstructive CAD and those with non-obstructive CAD exhibit comparable systemic vascular dilator function and cardiac autonomic function.
- These findings indicate that the severity of coronary artery stenosis does not appear to differentiate key vascular and autonomic parameters in the NSTE-ACS population.
- Further research may be needed to identify other factors contributing to NSTE-ACS in patients with non-obstructive coronary artery disease.
Background:
A sizeable number of patients with a diagnosis of non-ST segment elevation acute coronary syndrome show non-obstructive coronary artery disease. In this study we assessed whether differences in vascular and cardiac autonomic function exist between non-ST segment elevation acute coronary syndrome patients with obstructive or non-obstructive coronary artery disease.
Methods And Results:
Systemic endothelium-dependent and independent vascular dilator function (assessed by flow-mediated dilation and nitrate-mediated dilation of the brachial artery, respectively) and cardiac autonomic function (assessed by time-domain and frequency-domain heart rate variability parameters) were assessed on admission in 120 patients with a diagnosis of non-ST segment elevation acute coronary syndrome. Patients were divided into two groups according to coronary angiography findings: (a) 59 (49.2%) with obstructive coronary artery disease (≥50% stenosis in any epicardial arteries); (b) 61 (50.8%) with non-obstructive coronary artery disease. No significant differences between the two groups were found in both flow-mediated dilation (5.03 ± 2.6 vs. 5.40 ± 2.5%, respectively; P = 0.37) and nitrate-mediated dilatation (6.79 ± 2.8 vs. 7.30 ± 3.4%, respectively; P = 0.37). No significant differences were also observed between the two groups both in time-domain and frequency-domain heart rate variability variables, although the triangular index tended to be lower in obstructive coronary artery disease patients (30.2 ± 9.5 vs. 33.9 ± 11.6, respectively; P = 0.058). Neither vascular nor heart rate variability variables predicted the recurrence of angina, requiring emergency room admission or re-hospitalisation, during 11.3 months of follow-up.
Conclusions:
Among patients admitted with a diagnosis of non-ST segment elevation acute coronary syndrome we found no significant differences in systemic vascular dilator function and cardiac autonomic function between those with obstructive coronary artery disease and those with non-obstructive coronary artery disease.
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