Relation of vascular dilator function and cardiac autonomic function with coronary angiography findings in patients with non-ST segment elevation acute coronary syndrome

Gaetano Antonio Lanza; Eleonora Ruscio; Gessica Ingrasciotta; Tamara Felici; Monica Filice; Antonio De Vita; Saverio Tremamunno; Angelo Villano; Filippo Crea

doi:10.1177/2048872620918714

Relation of vascular dilator function and cardiac autonomic function with coronary angiography findings in patients with non-ST segment elevation acute coronary syndrome

Eur Heart J Acute Cardiovasc Care. 2020 Apr 22:2048872620918714. doi: 10.1177/2048872620918714. Online ahead of print.

Authors

Gaetano Antonio Lanza¹, Eleonora Ruscio¹, Gessica Ingrasciotta¹, Tamara Felici¹, Monica Filice¹, Antonio De Vita¹, Saverio Tremamunno¹, Angelo Villano¹, Filippo Crea¹

Affiliation

¹ Fondazione Policlinico Universitario A Gemelli IRCCS, Università Cattolica del Sacro Cuore, Italy.

PMID: 32319310
DOI: 10.1177/2048872620918714

Abstract

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.

Keywords: Acute coronary syndrome; cardiac autonomic function; endothelial function; non-obstructive coronary artery disease.