Carotid arterial distensibility is an important determinant of improvementin autonomic balance after successful coronary angioplasty

Objective To determine whether arterial distensibility influences improveme nt of autonomic imbalance after left ventricular wall motion (LVWM) abnorma lity has been improved by percutaneous transluminal angioplasty (PTCA) in p atients with ischemic heart disease (IHD). Methods and Results The following variables were assessed before end 3 mont hs after PTCA in 63 patients with IHD who had a successful PTCA: heart rate variability (standard deviation of all normal R-R intervals [SDNN] measure d from 24 h Holter electrocardiograms), baroreceptor sensitivity (determine d by the phenylephrine injection method), and carotid artery distensibility (determined by ultrasonography). Abnormalities of LVWM were assessed by ci neventriculography. In a multivariate analysis, carotid artery distensibili ty before PTCA and changes in LVWM abnormality before and after PTCA were i ndependently associated with changes in baroreceptor sensitivity and SDNN ( P<0.05). Patients were divided into two groups: one with impaired and one g roup with unimpaired initial carotid artery distensibility. After PTCA, LVW M was improved significantly in both groups, but baroreceptor sensitivity a nd SDNN were improved significantly (respectively from 5.0 +/- 3.3 to 5.9 /- 3.9 ms/mmHg, P<0.01 and from 111 +/- 47 to 128 +/- 54 ms, P<0.01) only i n patients with well-preserved carotid artery distensibility. Conclusions The beneficial effect of PTCA on autonomic balance was greater in patients with well-preserved carotid artery distensibility than in those with impaired carotid artery distensibility. These results suggest that th e pathophysiological state of arterial distensibility may modify the autono mic balance even after myocardial ischemia-related LVWM abnormalities are i mproved. I Hypertens 18:1621-1628 (C) 2000 Lippincott Williams & Wilkins.