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© 2021 Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Introduction

Incomplete cardiac revascularisation (ICR) assessed by residual SYNTAX score (rSs) is associated with increased 5-year mortality. Furthermore, in the general population, our group has demonstrated that impaired autonomic function determined by heart rate recovery time between 10 and 20 s (HRR10–20) following an active stand is associated with increased all-cause mortality.

Purpose

We hypothesised that ICR would be associated with impaired autonomic function determined by HRR10–20.

Methods

After ethical approval and informed consent, consecutive patients attending cardiac rehabilitation in a tertiary referral centre were enrolled. All patients had percutaneous coronary revascularisation. During an active stand, real-time heart rate, blood pressure and ECG recordings were taken using non-invasive digital photoplethysmography and HRR10–20 determined. Assessment of autonomic function was performed by determining speed of HRR10–20 post-orthostatic challenge.

Patients with an rSs >0 were considered incompletely revascularised and those with an rSs of 0 fully revascularised. Demographic data were recorded and statistical analysis performed.

Results

Patients (n=53) comprised those with complete revascularisation (CR) (n=37) and ICR (n=16). In the ICR group, mean rSs was 9.4.

HRR10–20 was impaired in the ICR group (−3±0.60) compared with the CR cohort (−6.56±0.52) (p<0.0001). Completeness of revascularisation was strongly associated with HRR10–20 (Pearson’s correlation coefficient 0.529; p<0.0001). Baseline demographics did not differ significantly. Use of rate-limiting medication was similar between cohorts (beta blockers, calcium channel blockers, ivabradine).

Conclusions

Our data confirm significant correlation between ICR and impaired autonomic function determined by speed of heart rate recovery. Thus, determining autonomic dysfunction post-ICR may identify those at increased mortality risk.

Details

Title
Impaired autonomic function after incomplete revascularisation
Author
Armstrong, Richard 1   VIAFID ORCID Logo  ; Wheen, Peter 2   VIAFID ORCID Logo  ; Brandon, Lisa 2 ; Finucane, Ciarán 3 ; Kenny, Rose Anne 3 ; Maree, Andrew 2 

 Cardiology, Belfast Health and Social Care Trust, Belfast, UK 
 Department of Cardiology, St James Hospital, Dublin, Ireland 
 TILDA Medical Gerontology, Trinity College, Dublin, Ireland 
First page
e001835
Section
Coronary artery disease
Publication year
2021
Publication date
2021
Publisher
BMJ Publishing Group LTD
ISSN
2398595X
e-ISSN
20533624
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
3146993943
Copyright
© 2021 Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.