Abstract
Background: Heart rate variability (HRV) was proposed as a noninvasive biomarker to stratify the risk of cardiovascular disease. However, it remains to be determined if HRV can be used as a surrogate for coronary artery physiology as analyzed by quantitative flow ratio (QFR) in patients with new-onset unstable angina pectoris (UAP).Methods: A total of 129 consecutive patients with new-onset UAP who underwent 24-h long-range 12-channel electrocardiography from June 2020 to December 2020 were included in this study. HRV, coronary angiography, and QFR information was retrieved from patient medical records, the severity of coronary lesions was evaluated using the Gensini score (GS), and total atherosclerotic burden was assessed using the three-vessel contrast QFR (3V-cQFR) calculated as the sum of cQFR in three vessels.Results: Multivariate logistic analysis showed that low-frequency power (LF) and high-sensitivity C-reactive protein (hs-CRP) were directly correlated with functional ischemia of target vessel, which were inversely correlated with total atherosclerotic burden as assessed by 3V-cQFR. Moreover, incorporation of the increase in LF into the existing model that uses clinical risk factors, GS, and hs-CRP significantly increased the discriminatory ability for evaluating coronary artery physiology of target vessel.Conclusions: LF and hs-CRP are independently associated with functional ischemia in patients with new-onset UAP. The relative increase of LF and hs-CRP could add value to the use of classical cardiovascular risk factors to predict the functional severity of coronary artery stenosis. Our results suggest a potential association between the autonomic nervous system, inflammation, and coronary artery physiology.
Highlights
Traditional cardiovascular risk factors, such as age, family history of premature heart disease, diabetes, cigarette smoking, hypertension, and dyslipidemia, have been demonstrated to be linked to the incidence of acute cardiovascular events and the increased risks of morbidity, mortality, and disability in patients with acute coronary syndrome (ACS) [1]
Identifying hidden risk factors correlated with functional severity of coronary artery stenosis and total atherosclerotic burden would be important for predicting acute coronary events in patients with ACS, in those with unstable angina pectoris (UAP)
For patients with new-onset UAP, we found that [1] plasma hsCRP and low-frequency power (LF) were independently associated with the functional severity of coronary artery stenosis of target vessel, as well as the total atherosclerotic burden, as determined by cQFR, and LF was positively correlated with hs-CRP; [2] higher plasma hsCRP at baseline was independently correlated with the severity of coronary artery lesion as evaluated by Gensini Score (GS), while LF was not heart rate variability (HRV) and cQFR Measurement
Summary
Traditional cardiovascular risk factors, such as age, family history of premature heart disease, diabetes, cigarette smoking, hypertension, and dyslipidemia, have been demonstrated to be linked to the incidence of acute cardiovascular events and the increased risks of morbidity, mortality, and disability in patients with acute coronary syndrome (ACS) [1]. Identifying hidden risk factors correlated with functional severity of coronary artery stenosis and total atherosclerotic burden would be important for predicting acute coronary events in patients with ACS, in those with unstable angina pectoris (UAP). Heart rate variability (HRV) was proposed as a noninvasive biomarker to stratify the risk of cardiovascular disease It remains to be determined if HRV can be used as a surrogate for coronary artery physiology as analyzed by quantitative flow ratio (QFR) in patients with new-onset unstable angina pectoris (UAP)
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