Markers of thrombosis and hemostasis in acute coronary syndromes: relationship to increased heart rate and reduced heart-rate variability.
BACKGROUND
Acute coronary syndromes (ACS) are characterized by abnormal heart-rate variability (HRV) and biomarkers of endothelial damage and thrombosis.


OBJECTIVE
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.
University Department of Medicine, City Hospital, Birmingham, England.
Ali
A
Hamaad
Michael D
MD
Sosin
Andrew D
AD
Blann
Gregory Y H
GY
Lip
Robert J
RJ
MacFadyen
D054058:Acute Coronary Syndrome / Q000097:blood / Q000503:physiopathology*; D001145:Arrhythmias, Cardiac / Q000503:physiopathology; D016022:Case-Control Studies; D003328:Coronary Thrombosis / Q000503:physiopathology; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019007:P-Selectin / Q000097:blood; D011446:Prospective Studies; D014841:von Willebrand Factor / Q000032:analysis*
D019007:P-Selectin; D014841:von Willebrand Factor