Markers of inflammation in acute coronary syndromes: Association with increased heart rate and reductions in heart rate variability

Hamaad, Ali; Sosin, Michael; Blann, Andrew D.; Patel, Jeetesh V.; Lip, Gregory Y.H.; MacFadyen, Robert J.

doi:10.1002/clc.4960281207

Cited by 43 publications

(37 citation statements)

References 34 publications

(38 reference statements)

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“…Decreased HRV has been reported in a variety of clinical settings associated with increased production of inflammatory cytokines (6,(22)(23)(24)31). Circulating levels of inflammatory cytokines are increased in patient with cirrhosis (19,55) and positively correlate with the severity of hepatic encephalopathy in this patient population (19,43,44).…”

Section: Discussionmentioning

confidence: 92%

“…Contrary to the predictions of the classical concept of homeostasis, the output of a wide variety of physiological systems, such as the normal heart beat, fluctuates in a complex manner, even under resting conditions (1,21). Deceased variability or increased regularity of the cardiac rhythm has been reported in different clinical settings associated with systemic inflammation and increased production of inflammatory cytokines, such as sepsis, diabetes mellitus, ischemic heart disease, congestive heart failure, and hepatic failure; in these contexts, it is a negative predictor of outcome (5,6,(22)(23)(24)31).…”

mentioning

confidence: 99%

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Decreased heart rate variability in patients with cirrhosis relates to the presence and degree of hepatic encephalopathy

Mani¹,

Montagnese²,

Jackson³

et al. 2009

American Journal of Physiology-Gastrointestinal and Liver Physi

111

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Mani AR, Montagnese S, Jackson CD, Jenkins CW, Head IM, Stephens RC, Moore KP, Morgan MY. Decreased heart rate variability in patients with cirrhosis relates to the presence and degree of hepatic encephalopathy. Am J Physiol Gastrointest Liver Physiol 296: G330 -G338, 2009. First published November 20, 2008 doi:10.1152/ajpgi.90488.2008.-Heart rate variability (HRV) is reduced in several clinical settings associated with either systemic inflammation or neuropsychiatric impairment. The possibility that the changes in HRV observed in patients with neuropsychiatric impairment might relate to the overproduction of inflammatory cytokines does not seem to have been considered in the studies undertaken to date. HRV is decreased in patients with liver cirrhosis but its relationship to the impairment of neuropsychiatric performance, commonly observed in these patients, is unknown. The aim of this study was to investigate the relationship between HRV, hepatic encephalopathy, and production of inflammatory cytokines in patients with cirrhosis. Eighty patients with cirrhosis [53 men, 27 women; mean (Ϯ1SD) age 54 Ϯ 10 yr], classified as neuropsychiatrically unimpaired or as having minimal or overt hepatic encephalopathy, and 11 healthy subjects were studied. HRV was assessed by applying Poincaré plot analysis to the R-R interval series on a 5-min ECG. Inflammatory cytokines (TNF-␣, IL-6, IL-10, and IL-12) were measured in a subgroup of patients. Long-term R-R variability was significantly decreased in the patients with cirrhosis, in parallel with the degree of neuropsychiatric impairment (P Ͻ 0.01) and independently of the degree of hepatic dysfunction (P ϭ 0.011). The relative risk of death increased by 7.7% for every 1-ms drop in this variable. Plasma levels of IL-6 significantly correlated with indexes of both HRV and neuropsychiatric performance. The changes observed in HRV and in neuropsychiatric status in patients with cirrhosis are significantly correlated, most likely reflecting a common pathogenic mechanism mediated by inflammatory cytokines.

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Section: Discussionmentioning

confidence: 92%

mentioning

confidence: 99%

Decreased heart rate variability in patients with cirrhosis relates to the presence and degree of hepatic encephalopathy

Mani¹,

Montagnese²,

Jackson³

et al. 2009

American Journal of Physiology-Gastrointestinal and Liver Physi

111

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“…6,29 There is indirect support for association of cardiac autonomic function and thrombosis. Physical exercise and psychological stress influence markers of fibrinolysis in healthy individuals.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, any apparent relationship between RR interval and CD 40 -L in the recovery phase might reflect of previously documented associations between generalized vascular inflammation and HRV. 6,29 Why the association is not evident during acute events might reflect low sensitivity in the acute phase.…”

Section: Discussionmentioning

confidence: 99%

Markers of Thrombosis and Hemostasis in Acute Coronary Syndromes: Relationship to Increased Heart Rate and Reduced Heart‐Rate Variability

Hamaad

Sosin

Blann

et al. 2009

Clinical Cardiology

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Background: Acute coronary syndromes (ACS) are characterized by abnormal heart-rate variability (HRV) and biomarkers of endothelial damage and thrombosis. Hypothesis: We hypothesized an association between these factors in patients with ACS. Methods: We studied 99 patients with ACS measuring HRV and plasma markers of endothelial damage/dysfunction (von Willebrand factor, vWF) and thrombosis/hemostasis (soluble P-selectin (s-Psel); CD 40 -ligand (CD 40 -L); D-dimer). HRV and plasma indices were compared to age-and gender-matched controls. Measures were repeated at 4 months in a subset. vWF, s-Psel and D-Dimer levels were raised compared to control. Results: HRV indices were reduced (mean RR, SDNN, SDNNi, RMSSD, Triangular index, LF and HF). There were weak correlations between mean RR and s-Psel (R = −0.234, p = 0.023) and D-dimer (R = −0.219, p = 0.041). At 4-month follow-up, significant correlations were between mean RR and CD 40 L (R = −0.414, p = 0.008) and D-dimer (R = −0.363, p = 0.012). On multivariate logistic regression analysis statin use (p = 0.046) was the only independent predictor of acute s-Psel levels. Age (p = 0.004) and mean RR interval (p = 0.01) were independent predictors of D-dimer levels at follow-up. Conclusions: Abnormal HRV is associated with markers of hemostasis and thrombosis in ACS, and present both in the acute and rehabilitation phases.

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“…The SAA level is sometimes increased in hyperglycemic subjects (11,12). Several prior studies have indicated a positive correlation between the HRs and C-reactive protein (CRP), another inflammatory marker (13,14). However, these studies did not focus on hyperglycemia, and there has been an observation that SAA is closer to CVD-related pathologies than other markers, such as CRP (15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

Possible relationship between the heart rates and serum amyloid A in a hyperglycemic population

Kotani

Uurtuya

Taniguchi

et al. 2015

BST

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Markers of inflammation in acute coronary syndromes: Association with increased heart rate and reductions in heart rate variability

Abstract: These observational data, while limited, are the first to link autonomic tone and in particular sympathetic tone (as indicated by HRV), to the process of acute leukocytosis and systemic inflammation common in acute coronary syndromes.

Cited by 43 publications

References 34 publications

Decreased heart rate variability in patients with cirrhosis relates to the presence and degree of hepatic encephalopathy

Decreased heart rate variability in patients with cirrhosis relates to the presence and degree of hepatic encephalopathy

Markers of Thrombosis and Hemostasis in Acute Coronary Syndromes: Relationship to Increased Heart Rate and Reduced Heart‐Rate Variability

Possible relationship between the heart rates and serum amyloid A in a hyperglycemic population

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