Carotid Artery Revascularization Improves Cardiac Sympathetic Nerve Activity in Patients With Carotid Artery Stenosis

Tsukasa Kato; Wakana Sato; Teruki Sato; Hiroaki Shimizu; Hiroyuki Watanabe

doi:10.14740/cr1402

Carotid Artery Revascularization Improves Cardiac Sympathetic Nerve Activity in Patients With Carotid Artery Stenosis

Cardiol Res. 2022 Oct;13(5):289-296. doi: 10.14740/cr1402. Epub 2022 Oct 25.

Authors

Tsukasa Kato¹, Wakana Sato¹, Teruki Sato¹, Hiroaki Shimizu², Hiroyuki Watanabe¹

Affiliations

¹ Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Akita, Japan.
² Department of Neurosurgery, Akita University Graduate School of Medicine, Akita, Japan.

PMID: 36405230
PMCID: PMC9635777
DOI: 10.14740/cr1402

Abstract

Background: The carotid sinus baroreceptor reflex controls the neural regulation of blood pressure. Baroreceptor disorders due to carotid sinus atherosclerosis have detrimental cardiovascular effects. This study investigated the medium-term effects of carotid artery revascularization (CAR) on sympathetic and cardiac function and systemic blood pressure variability in patients with carotid artery stenosis.

Methods: This study included 21 consecutive patients (median age 70 years, 18 men) with carotid artery stenosis scheduled for CAR. ¹²³I metaiodobenzylguanidine (MIBG) scintigraphy, echocardiography, brain natriuretic peptide levels, 24-h Holter electrocardiography (ECG), and ambulatory blood pressure monitoring assessed approximately 3 months postoperatively were compared to preoperative data.

Results: All 21 enrolled patients underwent CAR. Carotid artery stenting was done in three patients with cardiovascular risk or anatomical difficult for carotid endarterectomy. The mean common carotid artery end-diastolic velocity improved significantly (P < 0.01) by 1.6-fold, from 10.8 ± 3.2 to 16.1 ± 7.1 cm/s. In ¹²³I-MIBG scintigraphy, the heart-to-mediastinum (H/M) count ratio was significantly higher than preoperatively (from 2.66 ± 0.48 to 2.86 ± 0.56, P = 0.03). Holter ECG analysis revealed a significant decrease in the low-frequency/high-frequency (LF/HF) ratio compared to preoperatively (from 2.17 ± 1.20 to 1.62 ± 0.68, P = 0.04). These findings suggest decreased myocardial sympathetic activation. In echocardiography, the tissue Doppler-derived e' increased, and E/e' decreased significantly (P < 0.05) from 11.7 ± 5.1 to 10.1 ± 4.0, suggesting an improved left ventricular diastolic capacity. The mean 24-h and nighttime blood pressures were unchanged.

Conclusions: CAR in patients with carotid stenosis may provide medium-term improvement in cardiac sympathetic nerve activity and left ventricular diastolic dysfunction.

Keywords: 123I-MIBG scintigraphy; Cardiac sympathetic nerve activity; Carotid artery stenosis; Carotid artery stenting; Carotid endarterectomy; Carotid sinus baroreceptor; Echocardiography; HFpEF.