Markers of inflammation in acute coronary syndromes: association with increased heart rate and reductions in heart rate variability.
BACKGROUND
Systemic and vascular inflammation is at the heart of the thrombotic occlusion of coronary arteries.


OBJECTIVE
The study was undertaken to determine the relationship between established inflammatory markers (interleukin-6 [IL-6] and high-sensitivity C-reactive protein [hs-CRP]), neutrophil or white cell count, and concomitant autonomic tone in patients with coronary artery disease soon after occlusive events.


METHODS
We tested the linkage between autonomic tone (as defined using both time domain and frequency domain estimates of heart rate variability [HRV]) and circulating markers of inflammation (white cell counts, hs-CRP, and IL-6) in a sample of 100 patients with proven acute coronary syndrome and compared these with healthy controls (n = 49) and the relationships on repeated measures at 4 months in recovery (n = 51).


RESULTS
We demonstrated predictable depressed HRV in acute patients who tended to show recovery by 4 months. The acute changes in HRV indices (e.g., triangular index) showed modest negative correlation (r = -0.2-0.3) with the acute elevation of white cell count, IL-6, and hs-CRP. These associations did not persist on multivariate analysis of data gathered at 4 months post event.


CONCLUSIONS
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.
Hamaad
Ali
A
Haemostasis, Thrombosis and Vascular Biology Unit, University Department of Medicine City Hospital, Birmingham, United Kingdom.
Sosin
Michael
M
Blann
Andrew D
AD
Patel
Jeetesh
J
Lip
Gregory Y H
GY
MacFadyen
Robert J
RJ
D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D016022:Case-Control Studies; D003327:Coronary Disease / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D004562:Electrocardiography; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006339:Heart Rate; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology; D009504:Neutrophils / Q000473:pathology; D011446:Prospective Studies
D015415:Biomarkers; D015850:Interleukin-6; D002097:C-Reactive Protein