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Influence of reversible segmental left ventricular dysfunction on heart period variability in patients with
D Bonaduce1, M Petretta, F Piscione
1Institute of Internal Medicine, Cardiology and Heart Surgery, University of Federico II, Naples, Italy.
Insights
Reversible left ventricular dysfunction in coronary artery disease patients is linked to reduced heart rate variability. Successful angioplasty improved both cardiac function and heart period power spectrum, suggesting improved autonomic control.
Area of Science:
- Cardiology
- Autonomic Nervous System Function
- Heart Period Variability Analysis
Background:
- Heart period variability is often reduced in coronary artery disease (CAD) patients.
- The underlying mechanisms for this reduction remain unclear.
- Investigating the link between cardiac dysfunction and autonomic imbalance is crucial.
Purpose of the Study:
- To evaluate the relationship between reversible segmental left ventricular dysfunction and frequency domain measures of heart period variability in CAD patients.
- To assess the impact of percutaneous transluminal coronary angioplasty (PTCA) on these parameters.
Main Methods:
- Echocardiography and frequency domain analysis of heart period variability were performed on 32 CAD patients before and after PTCA.
- Patients were categorized based on regional wall motion abnormalities (Group B) versus normal motion (Group A).
- A control group (Group C) of 15 healthy subjects was included for comparison.
Main Results:
- Patients with abnormal wall motion (Group B) had lower baseline low and high frequency power compared to normal (Group A) and control (Group C) groups.
- Following PTCA, Group B showed significant improvement in summed segment score and increased low and high frequency power.
- Post-PTCA, heart period variability measures in Group B became comparable to Groups A and C.
Conclusions:
- Segmental left ventricular dysfunction contributes to sympathovagal imbalance in CAD patients.
- Successful PTCA reverses left ventricular dysfunction and improves heart period power spectrum.
- Cardiac geometry alterations impact autonomic control of heart rate via afferent sympathetic mechanoreceptors.
Objectives:
This study evaluated the relation between reversible segmental left ventricular dysfunction and frequency domain measures of heart period variability in patients with coronary artery disease.
Background:
Heart period variability is frequently reduced in patients with coronary artery disease. However, the mechanisms of this reduction are still unclear.
Methods:
Echocardiographic left ventricular wall motion and frequency domain measures of heart period variability were evaluated in 32 patients with one-vessel coronary artery disease before and 16 to 24 days after successful percutaneous transluminal coronary angioplasty. Of these, 12 patients (Group A) had normal and 20 patients (Group B) had abnormal regional wall motion. A control group of 15 healthy subjects (Group C) underwent 24-h Holter recording twice at 2-week intervals to check for spontaneous variations.
Results:
At baseline, low and high frequency power were lower in Group B than in Groups A and C, whereas no difference was detectable in ultra low and very low frequency and total power. After coronary angioplasty, regional wall motion and frequency domain measures of heart period variability were unchanged in Group A. In Group B the mean (+/- SD) summed segment score improved from 17.1 +/- 3.6 to 12.8 +/- 2.0 (p < 0.01), and mean low and high frequency power (logarithmic units) increased from 6.14 +/- 0.23 to 6.35 +/- 0.34 (p < 0.01) and from 5.43 +/- 0.32 to 5.68 +/- 0.52 (p < 0.01), respectively. Furthermore, low and high frequency power, lower at baseline in Group B than in the other two groups, were comparable in the three groups after coronary angioplasty.
Conclusions:
This study demonstrates that segmental left ventricular dysfunction is involved in determining sympathovagal imbalance in patients with one-vessel coronary artery disease; the reversal of left ventricular dysfunction by successful coronary angioplasty improves the heart period power spectrum. Thus, alterations in cardiac geometry influence the discharge of afferent sympathetic mechanoreceptors, contributing to the derangement in autonomic control of heart rate.