Simultaneous Heart Rate Variability Monitoring Enhances the Predictive Value of Flow-Mediated Dilation in Ischemic Heart Disease

Shogo Watanabe; Eisuke Amiya; Masafumi Watanabe; Munenori Takata; Atsuko Ozeki; Aya Watanabe; Shuichi Kawarasaki; Tomoko Nakao; Yumiko Hosoya; Kazuko Omori; Koji Maemura; Issei Komuro; Ryozo Nagai

doi:10.1253/circj.CJ-12-1043

Ischemic Heart Disease

Simultaneous Heart Rate Variability Monitoring Enhances the Predictive Value of Flow-Mediated Dilation in Ischemic Heart Disease

Shogo Watanabe, Eisuke Amiya, Masafumi Watanabe, Munenori Takata, Atsuko Ozeki, Aya Watanabe, Shuichi Kawarasaki, Tomoko Nakao, Yumiko Hosoya, Kazuko Omori, Koji Maemura, Issei Komuro, Ryozo Nagai

Author information

Shogo Watanabe
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
Department of Laboratory Medicine, Teikyo University School of Medical Technology
Eisuke Amiya
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
Masafumi Watanabe
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
Munenori Takata
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
Atsuko Ozeki
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
Aya Watanabe
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
Shuichi Kawarasaki
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
Tomoko Nakao
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
Yumiko Hosoya
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
Kazuko Omori
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
Department of Laboratory Medicine, Teikyo University School of Medical Technology
Koji Maemura
Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
Issei Komuro
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
Ryozo Nagai
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
Jichi Medical University

Keywords: Autonomic nervous system, Endothelial function, Flow-mediated dilation, Ischemic heart disease

JOURNAL FREE ACCESS

2013 Volume 77 Issue 4 Pages 1018-1025

DOI https://doi.org/10.1253/circj.CJ-12-1043

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Abstract

Background: Endothelial dysfunction and autonomic nervous system imbalance are both risk markers of atherosclerotic vascular damage. The relationship between these 2 factors, however, has not been clarified concisely. Methods and Results: Flow-mediated dilation (FMD) was measured in 47 patients with ischemic heart disease (IHD; mean age, 68.1±7.1 years) using an ultrasound semi-automatic measuring system (UNEXEF18G), and autonomic nervous system activity was evaluated by simultaneous measurements of heart rate variability. FMD was significantly correlated with standard deviation of normal-to-normal beats (r=0.33, P=0.022) and the power ratio of low-frequency power to high-frequency power (LF/HF; r=–0.38, P=0.0087). Furthermore, multiple regression analysis indicated that LF/HF was the most important predictor of the magnitude of FMD. This interaction was severely blunted by β-blockers and the presence of diabetes. Moreover, standardized FMD according to autonomic nervous system activity was a better predictor of future cardiovascular events than FMD. Subjects with cardiovascular events had a significantly smaller corrected FMD (event (+), 3.62±0.41; event (–), 5.10±2.35; P=0.001), and the higher corrected FMD was associated with longer event-free survival. Conclusions: Autonomic nervous system activity is an important regulatory factor of FMD in subjects with IHD. Assessment of this interaction can help provide more accurate risk stratification of subjects with IHD. (Circ J 2013; 77: 1018–1025)

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