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. 1999 Jul;82(1):75–81. doi: 10.1136/hrt.82.1.75

Alterations of autonomic nervous activity in recurrence of variant angina

M Takusagawa 1, S Komori 1, K Umetani 1, T Ishihara 1, T Sawanobori 1, I Kohno 1, S Sano 1, D Yin 1, H Ijiri 1, K Tamura 1
PMCID: PMC1729100  PMID: 10377313

Abstract

OBJECTIVE—To investigate whether autonomic nervous activity is involved in the recurrence of spontaneous coronary spasm in variant angina.
DESIGN—Retrospective analysis.
SETTING—Cardiology department of a university hospital.
PATIENTS—18 patients with variant angina were divided into single attack group (SA; nine patients) and multiple attack group (MA; nine patients) according to the frequency of ischaemic episodes with ST segment elevation during 24 hour Holter monitoring.
METHODS—Heart rate variability indices were calculated using MemCalc method, which is a combination of the maximum entropy method for spectral analysis and the non-linear least squares method for fitting analysis, at 30 second intervals for 30 second periods, from 40 minutes before the attack to 30 minutes after the attack. High frequency (HF; 0.04-0.15 Hz) was defined as a marker of parasympathetic activity, and the ratio of low frequency (LF; 0.15-0.40 Hz) to high frequency (LF/HF) as an indicator of sympathetic activity. The averaged value during the 40 to 30 minute period before an attack was defined as the baseline.
RESULTS—Compared with baseline, the HF component decreased in both groups at two minutes before the attack (p < 0.01), and the LF/HF ratio decreased at three minutes before the attack (p < 0.01). The baseline LF/HF was lower in the MA group than in the SA group (p < 0.01).
CONCLUSIONS—A reduction of sympathetic activity may play a key role in determining the recurrence of transient ischaemic events caused by spontaneous coronary spasm in patients with variant angina.


Keywords: sympathetic activity; recurrence of coronary spasm; MemCalc method; variant angina

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Figure 1  .

Figure 1  

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Graphs showing RR interval (A), LF (B), HF (C) and LF/HF ratio (D) in the single attack (SA) group (∘) and the multiple attack (MA) group (•) from 40 minutes before an attack to 30 minutes after an attack. For clarity, SD bars are not shown. Baseline = averaged value during the 40 to 30 minute period before an attack. The averaged RR interval in the MA group was significantly higher than in the SA group (p < 0.01). In both groups, HF significantly decreased compared with baseline at two minutes before an attack, while LF and LF/HF were significantly reduced compared with baseline at three minutes before an attack. For LF and LF/HF, the MA group showed significantly lower values than the SA group before and after the attack (p < 0.01, respectively). *p < 0.05 v MA group; †p < 0.01 v MA group; §p < 0.05 v baseline; ¶p < 0.01 v baseline. LF, low frequency component (0.04-0.15 Hz); HF, high frequency component (0.15-0.40 Hz).

Figure 2  .

Figure 2  

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Graphs showing RR interval (E), LF (F), HF (G), and LF/HF ratio (H) in the single attack (SA) group (∘) and the multiple attack (MA) group (•) with ST segment elevation in the modified lead II of the Holter ECG from 40 minutes before an attack to 30 minutes after an attack. For clarity, SD bars are not shown. Baseline = averaged value during the 40 to 30 minute period before an attack. The results are similar to those of fig 1. *p < 0.05 v MA group; †p < 0.01 v MA group; §p < 0.05 v baseline; ¶p < 0.01 v baseline. LF, low frequency component (0.04-0.15 Hz); HF, high frequency component (0.15-0.40 Hz).

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