Coronary calcium associated with changes in instrumental and humoral markers of sympathetic activity in patients with non-obstructive coronary atherosclerosis

Aim. To study the associations between sequential factors of the 10-year coronary heart disease (CHD) risk index MESA, heart rate variability (HRV), molecular markers of sympathetic activity and the presence or absence of calcium in the coronary arteries (CA) in patients with non-occlusive coronary atherosclerosis. Materials and methods. A total of 30 patients with suspected CHD, as a result of which at least one CA stenosis < 70% with a left ventricular ejection fraction ≥ 50% according to transthoracic echocardiography was identified using coronary computed tomography angiography. HRV was studied by means of daily monitoring of electrocardiograms, analyzing the parameters of time and spectral analysis. All patients had blood samples taken to measure copeptin, catestatin, high-sensitivity C-reactive protein (hsCRP) and amino-terminal pro-brain natriuretic peptide (NT-proBNP). Statistical analysis was performed after dividing the distribution into two subgroups depending on the value of the coronary calcium index (coronary calcium Agatston score; CCI): group 1 (CCI 0, n = 11) and group 2 (CCI > 0, n = 19). Results. Statistically significant ( p < 0.05) correlations of CCI with lipid damage indices were established regarding total cholesterol and low-density lipoprotein cholesterol (LDL-C) ( r = –0.36 and r = –0.40, respectively), coronary artery age ( r = 0.77), 10-year coronary heart disease risk index MESA ( r = 0.78) and 10-year prognosis of adverse cardiovascular events ( r = 0.39). Multivariate regression analysis showed that the presence of coronary artery indices (CCI > 0) in patients with non-obstructive coronary artery lesions is independently associated with a family history of coronary heart disease [odds ratio (OR) 1.92, p = 0.0011]; HRV indices [NN (OR 1.75, p = 0.0001); SDANN (OR 1.43, p = 0.0136); pNN50 (OR 1.34; p = 0.0153); rMSSD (OR 1.88; p = 0.0793)] and high-density lipoprotein cholesterol (OR 1.09; p = 0.0111) were determined. The study determined threshold values of LDL-C (≤ 1.82 mmol/L; AUC = 0.72; p = 0.002) and copeptin (≤ 0.485 ngm/L; AUS = 0.672; p = 0.021) and hsCRP with catestatin (hsCRP ≤ 1.21 g/L and catestatin ≤ 138.1 μg/ml; AUC = 0.674; sensitivity 56.2%; p = 0.021), which in such patients can be used as markers associated with the presence of coronary calcium. Conclusion. The presence of calcium in the coronary arteries in patients with non-obstructive lesions of the coronary arteries associated with an aggravated family history of CHD, disintegration of the autonomic heart regulation, which is expressed in the suppression of the activity of the parasympathetic division of the autonomic nervous system and the levels of reduction of LDL-C.