Blunted heart rate recovery is associated with coronary artery spasm in patients with suspected vasospastic angina

• Published in: Clinical hypertension Vol. 23; no. 1; p. 24
• Main Authors: Kim, Hyunsu, Cho, Sang-Hoon, Cho, Kyoung-Im, Kim, Bong-Joon, Im, Sung-Il, Heo, Jung-Ho
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 12.12.2017; BioMed Central; BMC
• Subjects: Analysis; Angina pectoris; Cardiac autonomic function; Cardiac patients; Care and treatment; Coronary artery spasm; Ergonovine; Exercise tests; Health aspects; Heart rate; Heart rate recovery; Cardiac autonomic function; Heart rate recovery; Coronary artery spasm
• ISSN: 2056-5909; 2056-5909
• DOI: 10.1186/s40885-017-0080-2

Autonomic nervous system activity has been shown to be altered in patients with vasospastic angina (VA). Heart rate recovery (HRR) is a simple, non-invasive measurement of autonomic nervous system dysfunction. We aimed to investigate whether HRR is related to VA, as established by an ergonovine test. A total of 976 consecutive patients (47.5% male, mean age 55 years) without significant coronary artery disease who underwent both an ergonovine provocation test and a treadmill exercise test were enrolled. The relationship between VA and HRR was evaluated. A total of 30.7% (300/976) of patients were diagnosed with VA, as documented by the ergonovine provocation test. HRR was significantly reduced in patients with VA compared to patients without VA (24.6 ± 18.0 vs. 30.5 ± 22.2,  < 0.001), and HRR was lowest in patients with multi-vessel spasm (21.9 ± 17.3). The proportion of blunted HRR, which was defined as HRR less than 12 beats, was significantly higher in patients with VA than in those without coronary artery spasm (26.6% vs. 39.3%,  < 0.001). In multivariable regression analyses, age (odds ratio (OR) = 1.03; 95% confidence interval (CI): 1.01-1.04;  = 0.001), blunted HRR (OR = 1.71; 95% CI: 1.26-2.31;  < 0.001), current smoking status (OR = 2.11; 95% CI: 1.50-2.98;  < 0.001), and male gender (OR = 2.00; 95% CI: 1.43-2.78;  < 0.001) were significant independent predictors of VA presence. Blunted HRR was an independent predictor of VA presence, which suggests a link between coronary artery spasm and autonomic dysregulation.