Relation between Sympathetic Overactivity and Left Atrial Spontaneous Echo Contrast in Patients with Mitral Stenosis and Sinus Rhythm

• Published in: Heart, lung & circulation lung & circulation, 2006-08, Vol.15 (4), p.242-247
• Main Authors: Ozdemir, Ozcan, Alyan, Omer, Soylu, Mustafa, Topaloglu, Serkan, Aras, Dursun, Metin, Fatma, Geyik, Bilal, Ozbakir, Cemal, Demir, Ahmet Duran
• Format: Article
• Language: English
• Subjects: Adult; Autonomic Nervous System - physiopathology; Autonomic nervous system activity; Case-Control Studies; Echocardiography; Female; Gene Expression Regulation; Heart Atria - physiopathology; Heart Rate - physiology; Heart rate variability; Humans; Male; Mitral stenosis; Mitral Valve Stenosis - etiology; Mitral Valve Stenosis - genetics; Mitral Valve Stenosis - metabolism; Mitral Valve Stenosis - physiopathology; P-Selectin - genetics; P-Selectin - metabolism; Periodicity; Platelet Activation - genetics; Platelet Activation - physiology; Risk Factors; Sensitivity and Specificity; Sinoatrial Node - physiopathology; Spontaneous echo contrast; Sympathetic Nervous System - physiopathology
• ISSN: 1443-9506; 1444-2892
• DOI: 10.1016/j.hlc.2006.03.009

Spontaneous echo contrast (SEC) is common in patients with mitral stenosis (MS) and presence of SEC in left atrium (LA) is associated with a higher risk of thromboembolism. Recently, an increase in activation of platelets was demonstrated in patients with SEC raising the hypothesis that palatelets are involved in the pathogenesis of SEC. In this study, we evaluated effects of autonomic nervous system activity on SEC formation in patients with rheumatic MS and sinus rhythm by heart rate variability analysis. Twenty-six patients with LASEC were compared with 28 patients without LASEC. Mean heart rate, low frequency (LF) and low frequency/high frequency (LF/HF) ratio were significantly higher, standard deviation of all NN (SDNN), root mean square of successive differences (RMSSD), number of NN intervals that differed by more than 50 ms from adjacent interval divided by the total number of all NN intervals (PNN50) and high frequency (HF) values were lower in the patients with LASEC. A standard deviation of all NN intervals 79.5 with a sensitivity of 92% and specificity of 90; a low frequency/high frequency ratio >3.7 with a sensitivity of 96% and specificity of 90%. A left atrial diameter >4.3 cm increased the LASEC formation by 3.0 folds, HR >78 beats/min by 6.4 folds, standard deviation of all NN intervals 3.7 by 6.4 folds, sP-selectin>142 by 5.8 folds. Variables affecting sP-selectin levels were LA diameter, mitral valve area, transmitral mean gradient, left ventricular ejection fraction, the presence of mitral regurgitation, HR, standard deviation of all NN intervals, low frequency, high frequency and low frequency/high frequency ratio. Sympathetic overactivity and reduced heart rate variability are important determinants for LASEC formation and increased s-P selectin levels. Therefore, platelet activation via increased sympathetic activity may play an important role in pathogenesis of LASEC.