Baroreflex Sensitivity in Patients with Coronary Artery Disease Who Underwent Percuteous Coronary Intervention
Abstract
Background.Autonomic dysfunction contributes to incidence of ventricular arrhythmias and sudden cardiac death in patients with coronary artery disease (CAD). Revascularization, for example percutaneous coronary intervention (PCI), is intended to improve myocardial perfusion. Besides that, PCI is considered to improve autonomic dysfunction. This study is aimed at assessing baroreflex sensitivity (BRS) in patients with CAD before and after PCI.Methods. Patients with angiographically having coronary stenoses = 50% who underwent coronary angioplasty at the catheterization laboratorium of National Cardiovascular Center Harapan Kita, Jakarta, were included in this study. Baroreflex sensitivity was calculated by administering nitroglycerin 300 µg intra aortic before and after PCI.
Results.Subjects comprise of 8 (42%) male and 11 (58%) female, aged 57.5 ± 9.3 year old. Most of subjects had dyslipidemia (57%), were smoker (42%), had hypertension (42%) and only 3 (16%) had diabetes mellitus. Nine (47%) of subjects had previous history of myocardial infarction. Medications suspected affecting baroreflex sensitivity, which were used by the time of study included nitrate (63%), beta-blockade (58%), and calcium antagonist (32%). Mean value of baroreflex sensitivity pre-PCI and post-PCI were 2,51+3,23 ms/mmHg and 1,96+1,61 ms/mmHg (p=0,412), subsequently. Multivariate analysis with logistic regression showed that nitrate has significant effect on decreased BRS soon after PCI (p=0,023; CI 95% 1,496-216,62;OR 18,00).
Conclusion. In patients with Coronary Artery Disease, immediately after percutaneous coronary intervention, barorefelex sensitivity was decreased. Nitrate has significant effect on alteration of barorefelex sensitivity.
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References
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Schwartz PJ. The autonomic nervous system and sudden death. Eur Heart J. 1998;19(suppl F):F72-F80.
Schwartz PJ, Vanoli E, Stramba Badiale M, et al. Autonomic mechanism and sudden death. New insights from analysis of baroreceptor reflexes in conscious dogs with and without a myocardial infarction. Circulation. 1988;78:969-979.
La Rovere MT, Mortara A, Specchia G, et al. Baroreflex sensitivity, clinical correlates and cardiovascular mortality among patients with a first myocardial infarction: a prospective study. Circulation. 1988;78:816-824.
Farrel TG, Odemuyiwa O, Bashir Y, et al. Prognostic value of baroreflex sensitivity testing after acute myocardial infarction. Br Heart J. 1992;67:129-137.
Schwartz PJ, La Rovere MT, Vanoli E, Autonomic nervous system and sudden cardiac death: experimental basis and clinical obsevation for post-myocardial infarction risk stratification. Circulation. 1992;85(supp I):I77-I91.
Maria Teresa La Rovere,MD; Gian Domenico Pinna, MS; Stefan H. Hohnloser, MD;Frank I Marcus, MD; Andrea Mortara, MD; Ryuji Nohara, MD; J. Thomas Bigger Jr, MD; A John Camm, MD; Peter J Schwartz, MD; on behalf of the Autonomic Tone and Reflexes After Myocardial Infarction (ATRAMI) Investigators. Baroreflex Sensitivity and Heart Rate Variability in the Identification of Patients at Risk for Life-Threatening Arrhythmias Implication for Clinical Trials. Circulation. 2001;103:2072-2077.
Stein PK, Kleiger RE. Insight from the study of heart rate variability. Annu Rev Med. 1999;50:249-61
Mrowka R, person P, Theres H, Patzak A. Blunted arterial baroreflex causes ‘pathological’ heart rate turbulence. Am J Physiol regulatory Integrative Comp Physiol. 2000; 279: R1171-5.
Douglas P Zipes, MD. Influence of Myocardial Ischemia and Infarction on Autonomic Innervation of Heart. Circulation. 1990;82:1095-1105.
Bonnemeier H, Wiegand U, Friedlbinder J, et al. Reflex cardiac activity in Ischemia and reperfusion: Heart rate turbulence in patients undergoingdirect percutaneous coronary intervention for acute myocardial infarction. Circulation. 2003; 108:958-964.
Parati G, Di Rienzo M, Mancia G. How to measure baroreflex sensitivity: from the cardiovascular laboratory to daily life. Journal of Hypertension 2000;18(1):7-19.
Bashore T, Bates E, Berger P, et al. American College of Cardiology / Society for Cardiac Angiography and Interventional Clinical Expert Consensus Document and Cardiac Laboratory Standards. A Report of the American College of Cardiology Task Force on Clinical Expert Consensus Document. JACC 2001;37(8):2170-2214.
Bastaman Basuki, Regresi Logistik. Dalam: Aplikasi metode kasus-kontrol. Bagian Kedokteran Komunitas, FK UI, tahun 2000: hal 132-169.
Smyth HS, Sleight P, Pickering GW. Reflex regulation of arterial pressure during sleep in man: a quantitative method of assessing baroreflex sensitivity. Circ Res 1969;24:109-121.
Watkins,L.L.; Fainman,C.; Dimsdale,J.; Ziegler,M.G.Assessment of baroreflex control from beat-to-beat blood pressure and heart rate changes: a validation study. Psychophysiology 1995. 32; 4:411-414.
Bauernschmitt, R. Malberg, H. Kopp, B. Schmidt, T. Lang e,R. Alteration of baroreflex sensitivity early after cardiac surgery. (Abstract) Computers in Cardiology 2000, 57-59.
Gori T, Floras JS, Parker JD. MD Effects of nitroglycerin treatment on baroreflex sensitivity and short-term heart rate variability. J Am Coll Cardiol 2002;40:2000 –5.
Venardos MK, Kaye MD. Myocardial ischemia-reperfusion injury, antioxidant enzyme systems and selenium: review. Curr Med Chem 2007;14(14):1539-49.
Brockmann G, Wessel N, Malberg H, Lange R, Bauernschmitt R. Recovery of Heart rate variability and baroreflex sensitivity following open heart surgery. Computers in Cardiology 2006;33:865-868.
Schwartz PJ. The autonomic nervous system and sudden death. Eur Heart J. 1998;19(suppl F):F72-F80.
Schwartz PJ, Vanoli E, Stramba Badiale M, et al. Autonomic mechanism and sudden death. New insights from analysis of baroreceptor reflexes in conscious dogs with and without a myocardial infarction. Circulation. 1988;78:969-979.
La Rovere MT, Mortara A, Specchia G, et al. Baroreflex sensitivity, clinical correlates and cardiovascular mortality among patients with a first myocardial infarction: a prospective study. Circulation. 1988;78:816-824.
Farrel TG, Odemuyiwa O, Bashir Y, et al. Prognostic value of baroreflex sensitivity testing after acute myocardial infarction. Br Heart J. 1992;67:129-137.
Schwartz PJ, La Rovere MT, Vanoli E, Autonomic nervous system and sudden cardiac death: experimental basis and clinical obsevation for post-myocardial infarction risk stratification. Circulation. 1992;85(supp I):I77-I91.
Maria Teresa La Rovere,MD; Gian Domenico Pinna, MS; Stefan H. Hohnloser, MD;Frank I Marcus, MD; Andrea Mortara, MD; Ryuji Nohara, MD; J. Thomas Bigger Jr, MD; A John Camm, MD; Peter J Schwartz, MD; on behalf of the Autonomic Tone and Reflexes After Myocardial Infarction (ATRAMI) Investigators. Baroreflex Sensitivity and Heart Rate Variability in the Identification of Patients at Risk for Life-Threatening Arrhythmias Implication for Clinical Trials. Circulation. 2001;103:2072-2077.
Stein PK, Kleiger RE. Insight from the study of heart rate variability. Annu Rev Med. 1999;50:249-61
Mrowka R, person P, Theres H, Patzak A. Blunted arterial baroreflex causes ‘pathological’ heart rate turbulence. Am J Physiol regulatory Integrative Comp Physiol. 2000; 279: R1171-5.
Douglas P Zipes, MD. Influence of Myocardial Ischemia and Infarction on Autonomic Innervation of Heart. Circulation. 1990;82:1095-1105.
Bonnemeier H, Wiegand U, Friedlbinder J, et al. Reflex cardiac activity in Ischemia and reperfusion: Heart rate turbulence in patients undergoingdirect percutaneous coronary intervention for acute myocardial infarction. Circulation. 2003; 108:958-964.
Parati G, Di Rienzo M, Mancia G. How to measure baroreflex sensitivity: from the cardiovascular laboratory to daily life. Journal of Hypertension 2000;18(1):7-19.
Bashore T, Bates E, Berger P, et al. American College of Cardiology / Society for Cardiac Angiography and Interventional Clinical Expert Consensus Document and Cardiac Laboratory Standards. A Report of the American College of Cardiology Task Force on Clinical Expert Consensus Document. JACC 2001;37(8):2170-2214.
Bastaman Basuki, Regresi Logistik. Dalam: Aplikasi metode kasus-kontrol. Bagian Kedokteran Komunitas, FK UI, tahun 2000: hal 132-169.
Smyth HS, Sleight P, Pickering GW. Reflex regulation of arterial pressure during sleep in man: a quantitative method of assessing baroreflex sensitivity. Circ Res 1969;24:109-121.
Watkins,L.L.; Fainman,C.; Dimsdale,J.; Ziegler,M.G.Assessment of baroreflex control from beat-to-beat blood pressure and heart rate changes: a validation study. Psychophysiology 1995. 32; 4:411-414.
Bauernschmitt, R. Malberg, H. Kopp, B. Schmidt, T. Lang e,R. Alteration of baroreflex sensitivity early after cardiac surgery. (Abstract) Computers in Cardiology 2000, 57-59.
Gori T, Floras JS, Parker JD. MD Effects of nitroglycerin treatment on baroreflex sensitivity and short-term heart rate variability. J Am Coll Cardiol 2002;40:2000 –5.
Venardos MK, Kaye MD. Myocardial ischemia-reperfusion injury, antioxidant enzyme systems and selenium: review. Curr Med Chem 2007;14(14):1539-49.
Brockmann G, Wessel N, Malberg H, Lange R, Bauernschmitt R. Recovery of Heart rate variability and baroreflex sensitivity following open heart surgery. Computers in Cardiology 2006;33:865-868.
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How to Cite
Tjahjono, C., Munawar, M., Kaligis, R., & Idham, I. (1). Baroreflex Sensitivity in Patients with Coronary Artery Disease Who Underwent Percuteous Coronary Intervention. Indonesian Journal of Cardiology, 28(6), 415-423. https://doi.org/10.30701/ijc.v28i6.207
Section
Clinical Research
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