Sympathetic nervous activity in patients with acute coronary syndrome: a comparative study of inflammatory biomarkers

Abstract

Previous studies have shown that both sympathetic hyperactivity and enhanced inflammatory responses are associated with poor outcomes in patients with acute coronary syndrome (ACS). Whether there is a correlation between these two characteristics remains unclear. Thirty-four patients with uncomplicated ACS were evaluated; their mean age was 51.7±7.0 years, 79.4% were male, and 94.1% had myocardial infarction (MI). On the fourth day of hospitalization, they underwent muscle sympathetic nerve activity (MSNA) analysis (microneurography), as well as ultrasensitive C-reactive protein (usCRP), interleukin-6 (IL-6), and lipoprotein-associated phospholipase A (Lp-PLA) activity measurements. These evaluations were repeated at 1, 3, and 6 months after hospitalization. Both MSNA and inflammatory biomarkers were elevated during the acute phase of ACS and then decreased over time. At hospitalization, the median usCRP level was 17.75 (IQR 8.57; 40.15) mg/l, the median IL-6 level was 6.65 (IQR 4.45; 8.20), the mean Lp-PLA activity level was 185.8 ±52.2 nmol/min per ml, and mean MSNA was 64.2±19.3 bursts/100 heart beats. All of these variables decreased significantly over 6 months compared with the in-hospital levels. MSNA was independently associated with the peak level of creatine kinase isoenzyme MB (CKMB) in the acute phase (=0.027) and with left ventricular ejection fraction (LVEF) at 6 months (=0.026). Despite the increased levels of inflammatory biomarkers and sympathetic hyperactivity in the initial phase of ACS, no significant correlations between them were observed in any of the analyzed phases. Our data suggest that although both sympathetic hyperactivity and inflammation are concomitantly present during the early phase of ACS, these characteristics manifest via distinct pathological pathways.

COVID‐19 is getting on our nerves: sympathetic neural activity and haemodynamics in young adults recovering from SARS‐CoV‐2

“…SARS-CoV-2 infection is also associated with inflammatory cytokine storms, which can have sweeping implications to the respiratory system, vasculature, and nervous system (Paybast et al, 2020). While inflammatory cytokine storms can be life-threatening, even relatively mild increases in inflammatory biomarkers result in oxidative stress (Tank et al, 2011;Moreira et al, 2017). These proinflammatory mediators can subsequently cross the blood brain barrier, ultimately increasing activation of the sympathetic nervous system (SNS) (Pongratz & Straub, 2014).…”

“…Increases in resting and reactive sympathetic activity can have detrimental effects on several physiological systems, including alterations in cardiac contraction (Moreira et al . 2017), impairments in vascular function (Thijssen et al . 2006) and reductions in exercising blood flow capacity (Stuckless & Pyke, 2015); accordingly, sympathetic overdrive has been identified as an independent predictor of mortality in a number of diseases (Grassi et al .…”

The association between 24-h blood pressure variability and major adverse cardiac events (MACE) in hospitalized patients with acute myocardial infarction: a retrospective cohort study

“…In the ischemic area, oxidative stress builds up, and myocardial cell’s ability to produce vasodilator substances decreases. Mechanically, some injured cardiomyocytes leading to a decrease in myocardial contractility, which is compensated by an increase in sympathetic activity and the secretion of catecholamines as well as angiotensinogen, which aims to maintain peripheral hemostasis function [ 1 – 3 ].…”

Predictive Value of Increased Perioperative Heart Rate for All-Cause Mortality After Cardiac Surgery: A Systematic Review and Meta-Analysis

“…Second, studies have indicated that a shorter lifespan is associated with elevated heart rate (Zhang & Zhang, 2009). An increased heart rate could cause a subsequent elevation of reactive oxygen species (Luo et al, 2020), inflammatory cytokines, glucose-lipid metabolism disturbance (Saladini & Palatini, 2018), and abnormal activation of the immune system (Moreira et al, 2017). These physiological dysfunctions could easily contribute to the impairment of organ function and lead to an adverse outcome, including death.…”