Time-dependent changes of heart rate variability after percutaneous transluminal angioplasty

doi:10.1016/S0002-8703(98)70033-X

American Heart Journal

Volume 135, Issue 5, May 1998, Pages 755-761

https://doi.org/10.1016/S0002-8703(98)70033-X Get rights and content

Abstract

Objectives It is not known whether the improvement of myocardial perfusion by percutaneous transluminal coronary angioplasty (PTCA) is followed by a response of the autonomic nervous system depending on the recovery of the myocardium. In this study we investigated changes of heart rate variability parameters in patients before and after PTCA at different time intervals. Methods In 42 patients with coronary artery disease documented on angiography, before and after PTCA 24-hour measurements of heart rate variability (HRV) were performed from Holter tapes. The time elapsed between the two measurements was 3 to 4 days in 26 patients and 6 to 8 months in 16 patients. Time domain parameters of HRV were calculated. Results Comparison of the two recordings showed that the parameters rMSSD, pNN50, and SDNN index decreased, whereas SDNN and SDANN increased. These changes were not statistically significant. A subgroup analysis revealed different results for patients with and without previous myocardial infarction: the parasympathetically and more sympathetically influenced parameters revealed different changes in these groups. Other variables such as ejection fraction or severity of coronary artery disease did not influence the HRV results. Although no statistically significant difference was seen on comparison of the patients with different recording intervals, patients with a longer interval between the two measurement periods showed higher values of all HRV parameters closer to normalized values. This observation may be explained by a delayed recovery of myocardial function after successful revascularization by PTCA. (Am Heart J 1998;135:755-61.)

Section snippets

Patients

In this prospective study 42 patients (10 women, 32 men) with coronary artery disease documented on angiography were investigated. The mean age of these patients was 58 years (SD ± 9 years), with a range of 44 to 72 years. Twenty patients had previous myocardial infarction: 12 anterior infarction and 8 inferior infarction. All patients had significant coronary artery disease with at least one stenotic lesion >70% of the vessel lumen. Sixteen patients had a single-vessel disease, 20 patients a

Comparison of all patients

All patients had a stable sinus rhythm without medication at the time of Holter monitoring for detection of HRV.

The values of time domain parameters measured were not statistically significantly different between the two measurements of the total patient group. The means of all parameters calculated decreased (decrease of SDNN index -0.8 not significant [NS], of rMSSD –1.6 NS, and of pNN50 –1.0 NS), except the parameters SDNN and SDANN, which increased (SDNN + 13.7 NS, SDANN + 15.5 NS).

Discussion

It has been known for many years that ischemia or infarction and reperfusion can trigger cardiac reflexes.4, 5, 6 Little information exists about the course of HRV after PTCA. Most authors could show that there is an immediate reaction of HRV parameters caused by coronary occlusion during PTCA. With PTCA used as a model to achieve ischemia, Airaksinen et al.¹⁴ could not predict the direction of HRV changes by the site of coronary occlusion. Depending on the type of ischemia such as transmural

Acknowledgements

We thank Mr. Samuel Garner for preparation of the article.

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Characterization of the nonlinear content of the heart rate dynamics during myocardial ischemia
2009, Medical Engineering and Physics
Citation Excerpt :
We might wonder whether the index returns to normal values during resting conditions within a certain time period after the PTCA procedure. Previous studies on cardiac ischemia induced by primary coronary angioplasty have addressed its long-term effects in the cardiac heart rhythm by means of standard linear techniques [4,5], particularly in relation to recovery stages [27,2,28,29]. A study of transient dynamics during ischemic stages, however, requires the analysis of short-term HRV data and to consider the intrinsic nonlinear behavior of the system.
We develop a method to quantify the changes in heart rate dynamics during local myocardial ischemia induced by a percutaneous transluminal coronary angioplasty procedure (PTCA). The method introduces an index measuring the nonlinear content of the beat-to-beat (RR) time series by using nonlinear time series techniques such as surrogate data analysis and average mutual information.
The index is applied to RR data from 67 subjects obtained before, during, and after the ischemic period and shows an increase in the nonlinearity of the cardiac control dynamics during ischemic and reperfusion stages. The nonlinear index is also used to characterize the effects of performing the coronary occlusion at different arteries and distances. We observe that the effect of ischemia becomes larger as the occlusion distance is reduced, and that most of the changes in the nonlinear content of the dynamics occur at long time scales typically related to sympathetic modulation of the cardiac rhythm (6–25 s).
Abnormal heart rate recovery immediately after treadmill testing: Correlation with clinical exercise testing, and myocardial perfusion parameters
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The increase in heart rate during exercise is considered to be attributed to sympathetic system activation combined with parasympathetic withdrawal. The prognostic importance of the chronotropic response to exercise and heart rate recovery 1 minute after exercise has already been established. The purpose of this study was to evaluate heart rate recovery as an index of myocardial ischemia, by correlating heart rate recovery with known parameters of myocardial ischemia.
Included in the study were 304 consecutive patients (73% men), aged 34 to 82 years. Patients whose heart rate recovery value or myocardial perfusion imaging could have been influenced by factors other than ischemic disease were excluded from the study. The patients underwent single photon emission computed tomography myocardial perfusion imaging combined with symptom-limited exercise testing with thallium 201 or technetium 99m tetrofosmin. The value for heart rate recovery was defined as the decrease in heart rate from peak exercise to 1 minute after termination of exercise. For semiquantitation of the scintigram, the uptake of the radiotracer was graded on a scale from 0 to 4. Twenty-one beats per minute was defined as the lowest normal value for heart rate recovery. We found 74 patients (24%) with an abnormal value. We also found a significant correlation between heart rate recovery 1 minute after exercise and stress myocardial perfusion score. In addition, there was a statistically significant relationship between heart rate recovery and chronotropic variables. Patients with an abnormal value of heart rate recovery were generally of an older age, were more likely men, had a higher frequency of risk factors for coronary artery disease, were mostly taking cardioactive medications, had lower efficiency during treadmill testing, and had more pathologic findings on the scintigram.
Myocardial ischemia, as assessed by myocardial perfusion imaging, is an important correlate of heart rate recovery. There is a significant correlation between chronotropic variables during exercise testing and heart rate recovery 1 minute after exercise. It seems that the heart rate recovery value 1 minute after peak exercise may be considered a reliable index of the severity of myocardial ischemia.
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Background: Growth hormone (GH) deficiency is associated with increased cardiovascular morbidity and mortality. Abnormalities in heart rate variability (HRV) (such as decreased cardiac sympathetic activity), which is a marker of cardiac autonomic tone, have been found in patients with GH deficiency.
Objective: The purpose of this study was to investigate the effects of GH therapy on HRV in adults with GH deficiency.
Methods: Adult patients with GH deficiency were eligible. HRV measurements were obtained by 24-hour measurements from Holter electrocardiography before and after 6 months of GH therapy in adult patients with GH deficiency. The following time domain parameters of HRV were calculated: the SD of the normal-to-normal (NN) interval (SDNN), the SD of the average NN interval (SDANN), the square root of the mean squared differences (RMSSD), and the proportion derived by dividing the number of interval differences of successive NN intervals >50 ms (NN50) by the total number of NN intervals (PNN50).
Results: A total of 21 patients (7 men, 14 women; mean age, 46.0 ± 11.2 years) were enrolled. Thirteen patients had panhypopituitarism and 8 had normal adrenocorticotropic hormone secretion. At the end of 6 months of GH therapy, the mean values of the sympathetically influenced parameters SDNN (before GH treatment, 134.5 ± 6.0 ms; after GH treatment, 118.5 ± 8.0 ms) and SDANN (before GH treatment, 121.2 ± 6.0 ms; after GH treatment, 96.2 ± 9.1 ms) decreased significantly (P < 0.05), but the parasympathetically influenced parameters RMSSD and PNN50 did not differ significantly from baseline. The mean heart rate and ventricular premature beats were not significantly different from baseline after GH therapy.
Conclusions: In this patient population, cardiac sympathetic tone was increased, without an obvious arrhythmogenic effect, after 6 months of GH therapy.
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^☆: From the Department of Internal Medicine—Cardiology, University of Ulm.

^☆☆: Reprint requests: Hans-H. Osterhues, MD, University of Ulm, Department of Internal Medicine II, Cardiology, Robert-Koch-Str. 8, D-89081 Ulm, Germany.

^★: 4/1/88875

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Time-dependent changes of heart rate variability after percutaneous transluminal angioplasty☆,☆☆,★

Abstract

Section snippets

Patients

Comparison of all patients

Discussion

Acknowledgements

Am J Cardiol

Am J Cardiol

Am J Cardiol

Am J Cardiol

Am J Cardiol

Am J Cardiol

Frequency domain measures of heart period variability and mortality after myocardial infarction

Circulation

Sympathetic reflex elicited by experimental coronary occlusion

Am J Physiol

Autonomic disturbance at onset of acute myocardial ischemia

Br Med J