Relationship Between Autonomic Nervous Function And Coronary Heart Disease、Coronary Artery Lesions And Inflammatory Markers

Objective:the patients of Coronary heart disease is often associated with autonomic nervous system dysfunction, this study is mainly focused on the autonomic function of coronary heart disease in different clinical phenotypes, we used the index of heart rate variability measured by ambulatory electrocardiogram to quantify the autonomic nervous function, the main purpose of this study is:1. Whether the ANF between the different clinical phenotype of coronary heart disease are varying from each other.2.the relationship between the severity of coronary artery disease and autonomic nervous function 3. The relationship of inflammatory marker like C-reactive protein,fibrinogen and ANF.Methods:We collected 255 patients of CHD confirmed by the coronary angiography method who hospitalized in the Second Affiliated Hospital of Kunming Medical University Department of Cardiology, in March 2014 -- November 2015, which were defined as the experimental group, All these include 66 patients of stable angina (group B),107 of unstable angina (group C),82 patients of acute myocardial infarction (group D) and 69 cases of non-coronary heart disease (CAG shows stenosis of coronary artery<50%)with whom hospitalized due to the similar symptoms during the same period patients as the control group (a group). All the patients underwented the 24 hours Holter monitoring, and measured the HRV indexes. And estimating the Gensini score by Coronary angiography of Group B and Group C,and also weigh up the Inflammatory biomarkers indicators like CRP and FIB of patients in group C. The following research are:1. Analysis HRV indexs of the four groups of patients in A, B, C, D, to determine whether the HRV indexes between the control group and each clinical phenotype of CHD are different.2. Using Gensini score to quantify the Severity of coronary artery stenosis, estimating the Gensini score of Group B and Group C, and analysis the correlation between the HRV indexs and Gensini score of two groups.3. Measuring the CRP and FIB of group C, which is divided into C1 group (SDNN<100ms) and C2 group (SDNN> 100ms)according to SDNN values, compared the general clinical features of these two,and analysis the correlation between the inflammatory markers (IB) and HRV of UAP.Results:1. The results of HRV index and its relationship among each groups of coronary heart disease are as follows:SDNN values is lower in group B, C, D compared with group A (P<0.01, P<0.05), group D lower than group B (P<0.05). SDANN values in the group D was significantly than group A、B、C (P<0.01), group B and C is lower than group A (P<0.01, P<0.05), group C lower than B (P<0.05). RMSSD values is lower in group B、C、D compared with group A (P<0.01, P<0.05), and group C is lower than group B (P<0.05). Triangular index is lower in group D compared with group A (P<0.05). and for PNN50,there is no statistically significant differences between the four groups.Research shows that the HRV values is lower in all the clinical phenotype of CHD compared with the control group, There is a significant decreases in AMI group of the total autonomic nervous activity and sympathetic nervous related indicators, and for UAP group, the parasympathetic nervous index dropped the most significantly, all these suggest that sympathetic tone increased significantly significantly in patients with AMI,and for UAP patients, vagal tone decline the most significantly.2.There were dominantly negative correlation between the HRV indexs and Gensini score in group B and C, among which SDNN shows the strongest correlation (r=-0.476, P<0.001), The correlation indicate that for patients of angina,with the Coronary artery disease aggravated, HRV index decreased.3.The Correlation study of inflammatory markers and HRV indexs in group C indicate that:the number of women、diabetes、smoking and BMI index were all higher in group C1 compare with group C2, high-density lipoprotein cholesterol values was lower than group C2. without adjusting for confounding variables, HRV indexes were all negatively correlated with CRP, of which SDNN had the strongest correlation (r=-0.41, P=0.001) while the HRV index except for SDANN were negatively correlated with FIB, SDNN shows the strongest correlation (r=-0.40, P=0.001),Using the partial correlation analysis adjusted for the confounding variables of sex, diabetes, smoking, BMI, HDL, part of the HRV indicators changes for no correlation with FIB and CRP, The independent indexes were that,CRP and SDNN were negatively correlated (r=-0.39, P=0.002), and negative correlation with RMSSD (r=-0.25, P=0.044). FIB was negatively correlated with SDNN (r=-0.36, P=0.005), and negative correlation with the Triangle index(r=-0.35, P=0.007).Stepwise linear regression method showed that SDNN and CRP were negatively correlated (Beta=-0.406, P=0.001), FIB was negatively correlated with SDNN(Beta=-0.287.P=0.026), and negatively correlated triangle index (Beta=-0.254, P=-0.048). SDNN could predict CRP levels, SDNN、triangle index could predict FIB levels. The autonomic nervous system can reflect the systemic inflammatory response in UAP group, and the HRV related indexes can predict the level of inflammatory factors.Conclusions:1. The HRV values decreased among all the clinical phenotypes of CHD, Compared with group UAP and SAP, The Impairment of autonomic nervous function and the increase in sympathetic nerve activity are more obvious in group AMI than those of group SAP、UAP. The vagus nerve activity decreased significantly in UAP.2.Using the Gensini score quantified the severity of coronary artery lesions, angina pectoris group with Gensini score rises, the total activity of autonomic nervous index SDNN、triangular index, SNS activity index SDANN, PSNS activity index RMSSD and PNN50 gradually decreased. the sympathetic activity increased, parasympathetic activity decreasd. the severity of coronary artery lesions is negatively correlated with HRV, autonomic nerve function can evaluate the severity of coronary artery disease in patients with angina pectoris.3. There is a significant negative correlation between HRV indexes and CRP^ FIB in patients with Unstable angina pectoris of coronary heart disease, after controlling for gender, diabetes, smoking, BMI, HDL and other confounding variables, the total autonomic activity index SDNN,and parasympathetic nerve activity index RMSSD were negatively correlated with CRP, the total activity index SDNN, triangle index,and parasympathetic nerve activity index PNN50 were negatively correlated with FIB. Stepwise linear regression indicated that SDNN could predict CRP levels, SDNN、triangle index could predict FIB levels. Autonomic nerve function can reflect the systemic inflammatory reaction of UAP patients, Autonomic nervous function, especially in patients with the parasympathetic nervous system related indicators RMSSD, PNN50 severe declined may suggest seriously inflammatory reaction, timely evaluation of autonomic nerve function could guiding the clinical medication.