Clinical Study Of Autonomic Nervous Function In Coronary Heart Disease

Coronary artery disease(CAD)is one of the cardiovascular diseases that threaten human health seriously.Continuous chronic myocardial ischemia and hypoxia make autonomic nervous function imbalance and dysfunction,which is manifested by decreased vagal tension and enhanced sympathetic nerve activity.Eventually,severe cardiovascular events such as malignant arrhythmia,sudden cardiac death,etc were happened.Heart rate variability(HRV),heart rate turbulence(HRT)and heart rate recovery(HRR)became widely used methods to assess cardiac autonomic nervous function.But there was few research to assess the status of autonomic nervous regulation combined with HRR,HRV and HRT,and observe their relationship between the parameters and the severity of coronary lesions in stable coronary artery disease(SCAD)patients.The purpose of this study was to explore cardiac autonomic nervous function by above three methods in CAD and demonstrate their relationship with the severity of coronary lesions in SCAD.In order to achieve the above objectives,main contents and conclusions of this study are listed as follows:1.A total of 80 consecutive patients with chest pain diagnosed CAD(n=40)and non-coronary artery disease(NCAD,n=40)according to coronary artery angiography(CAG),who were hospitalized in our department during May 2016 to March 2017,were included in this study.HRV,HRT and heart rate HRR were measured in all subjects.The results showed that the HRR(HRR1-HRR5)values,HRV(RMSSD,pNN50 and HF)values were significantly lower in the CAD group compared to the NCAD group.Results of multivariate logistic regression analysis showed that delayed HRR1 was a risk factor of CAD after adjusting for gender,age,hypertension,diabetes mellitus and beta-blockers use.The present results demonstrated that vagus nerve function was impaired in CAD patients.There was a correlation between HRR delay,HRV decrease and CAD.Delayed HRR1 was a significant predictor of autonomic nervous injury in CAD patients.2.A total of 128 consecutive hospitalized patients without CAD(Control,n=65)and SCAD(n=63)were included in this study.SCAD patients were further divided into single or two/three vessel disease as well as <70% or ?70% stenosis subgroups.HRR and HRV parameters as well as CAG were performed.The Gensini score for each patient were calculated.The results showed that HRR1-HRR5 and HRV values were significantly lower,and Gensini scores,percentages of abnormal HRR1 and HRR2 were significantly higher in the SCAD group compared to the Control group.Results of multivariate logistic regression analysis showed that HRR1?24bpm,delayed HRR2 and HRR3,reduced HRV,high Gensini score were risk factors of SCAD;High Gensini score,HRR2?42bpm,delayed HRR5 were risk factors of multiple coronary artery lesions in SCAD patients and high Gensini score,delayed HRR5 were risk factors of severe coronary artery stenosis in SCAD patients after adjusting for gender,age and beta-blockers use.Our results demonstrated that the autonomic function was impaired in SCAD patients and higher Gensini score and lower HRR were closely related to the severity of coronary lesions in this patient cohort.