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Cardioinhibitory response to carotid sinus massage in patients with coronary artery disease
1Department of Cardiology, University of Ankara, Faculty of Medicine, Turkey.
Insights
Carotid sinus massage reveals a link between heart rate changes and left ventricular dysfunction in coronary artery disease patients. This response is associated with wall motion abnormalities, not lesion severity.
Area of Science:
- Cardiology
- Cardiovascular Physiology
- Diagnostic Medicine
Background:
- Coronary artery disease (CAD) affects left ventricular function.
- Carotid sinus massage (CSM) elicits a cardioinhibitory response.
- The link between CSM response and cardiac impairment in CAD is not fully understood.
Purpose of the Study:
- To investigate the relationship between the cardioinhibitory response to CSM and coronary artery lesions.
- To explore the association between CSM response and left ventricular impairment in CAD patients.
Main Methods:
- Coronary angiography performed on 86 patients (63 with CAD, 23 controls).
- Carotid sinus massage (right and left) and measurement of maximal change in RR interval (%).
- Echocardiography to assess left ventricular function (segment scores, fractional shortening).
Main Results:
- No significant relationship found between coronary lesion severity and CSM response.
- Positive correlation between total left ventricular segment scores and maximal RR interval change during right CSM (r = 0.478, P < 0.01).
- Maximal RR interval change was significantly higher in patients with segmental wall motion abnormalities (83.0% vs. 32.9%, P < 0.01).
- Negative correlation between fractional shortening and maximal RR interval change during CSM (right: r = -0.482, P < 0.01; left: r = -0.334, P < 0.05).
Conclusions:
- Cardioinhibitory response to CSM is significantly related to left ventricular impairment in CAD.
- CSM response correlates with the presence and severity of segmental wall motion abnormalities.
- CSM may serve as a non-invasive indicator of left ventricular dysfunction in coronary artery disease.
Abstract:
The relationship between cardioinhibitory response to the carotid sinus massage and the severity of coronary artery lesions and left ventricular impairment was investigated in 86 patients who underwent coronary angiography. The study group (Group 1) comprised 63 patients who had coronary lesions and the control group (Group 2) comprised 23 patients who had normal coronary arteries. There was no significant relationship between the severity of coronary artery lesions and the cardioinhibitory response to the carotid sinus massage in the study group. However, there was a positive correlation (r = 0.478, P < 0.01) between total left ventricular segment scores and the maximal change in RR interval (%) during the right carotid sinus massage in the study group. During the right carotid sinus massage, maximal change of RR interval (%) was significantly higher in patients who had segmental wall motion abnormalities than in patients who did not (83.0 +/- 72.4% vs. 32.9 +/- 42.5%, P < 0.01, respectively). In the patients who could have echocardiographic measurements there was negative correlation between fractional shortening value and maximal change of RR interval (%) (right massage; r = -0.482, P < 0.01, left massage; r = -0.334, P < 0.05). In conclusion, we found a significant relationship between the cardioinhibitory response to carotid sinus massage and the presence and severity of the segmental wall motion abnormalities and left ventricular impairment in patients with coronary artery disease.