The effect of chronically occluded coronary artery recanalisation on baroreflex sensitivity and left ventricular systolic function

Abstract

Recanalisation of chronic total occlusion (CTO) of a coronary artery can be reflected by improvements in various clinical parameters. Revealing increased parasympathetic activity would constitute an additional argument for performing this procedure. To assess the effect of CTO recanalisation on baroreflex sensitivity (BRS) and left ventricular ejection fraction (LVEF) in stable symptomatic patients with coronary artery disease. BRS (spectral analysis, transfer function, Blackman-Tukey algorithm, 0.03 Hz bandwidth Parzen window) and LVEF (echocardiography, Simpson's method) were analysed in 23 patients: one day (R1) before, one day (R2) after, and three months (R3) after CTO recanalisation. Patients were divided into two groups: those with depressed (≤ 3 ms/mm Hg) or preserved(> 3 ms/mm Hg) BRS. Significant BRS changes were observed in the study group compared to baseline values (p = 0.016). In the patients with a depressed reflex, BRS in R2 was similar to R1 and almost doubled in R3 (p = 0.018). In the patients with a preserved reflex, BRS significantly decreased in R2 (p = 0.024) and returned to the baseline value in R3. The behaviour of LVEF was homogenous in the groups, showing an increase from R1 to R3. The improvement in autonomic nervous system activity after successful CTO recanalisation is reflected by an increase in BRS, and the changes are dependent on the baseline value of the measurement: patients with a depressed BRS before recanalisation present a greater BRS improvement than patients with a preserved BRS. The CTO recanalisation leads to the improvement of LVEF in both groups.