Antecedent autonomic symptoms predict contemporary autonomic symptom burden and reduced health-related quality of life after spontaneous coronary artery dissection

IntroductionSpontaneous coronary artery dissection (SCAD) is frequently accompanied by persistent symptoms of unknown pathogenesis after the index event. Autonomic dysfunction is a plausible mechanism for these but has not been systematically characterized. We quantified antecedent and contemporary autonomic symptoms in survivors of SCAD and examined their associations with cardiac and extra-cardiac symptoms and health-related quality of life. MethodsThis cross-sectional study recruited 227 volunteers from multiple countries with a self-reported history of SCAD. Participants completed validated patient-reported measures, including the Composite Autonomic Symptom Score-31 (COMPASS-31), Anxiety Sensitivity Index-3 (ASI-3), and EuroQol-5 Dimension-5L (EQ-5D-5L). They also completed an internally derived retrospective autonomic predisposition score assessing symptoms during adolescence and early adulthood. ResultsParticipants were predominantly female (97.8%), median age 53 (47-58) years, and were surveyed a median of 3 (1-5) years after their index SCAD event. 21.6% reported SCAD recurrence. Moderate autonomic symptom burden (COMPASS-31 [&ge;]20) was present in 56.4% and severe burden ([&ge;]40) in 16.3%. History of antecedent autonomic symptoms was the strongest independent predictor of contemporary autonomic symptom burden after adjustment for demographic and clinical covariates ({beta}=0.514; P <0.001). Greater autonomic symptom burden independently predicted lower EQ-5D health utility ({beta}=-0.150; P=0.029) and was associated with the ASI-3 physical concerns ({beta}=0.232; P <0.001), but not social concerns domain. Autonomic symptoms were not associated with SCAD recurrence. ConclusionSymptoms of autonomic dysregulation are common in survivors of SCAD and are associated with reduced quality of life. Their association with antecedent dysautonomic features during adolescence and early adulthood suggests a longstanding predisposition, the significance of which warrants further evaluation. Clinical PerspectiveO_ST_ABSWhat Is New?C_ST_ABSO_LISelf-reported antecedent and current autonomic symptoms are common in survivors of spontaneous coronary artery dissection and are associated with poorer health-related quality of life, greater fatigue, and greater psychological distress. C_LI What Are the Clinical Implications?O_LIAutonomic symptoms warrant clinical recognition in patients with prior spontaneous coronary artery dissection, not only as a post-event complaint but also as a potential marker of pre-existing autonomic vulnerability that may influence recovery experience. C_LIO_LIGreater awareness of autonomic symptom burden may support more personalized follow-up, patient counseling, and rehabilitation planning to help patients return more safely and confidently to daily activities, work, and family life. C_LI Graphical Abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=135 SRC="FIGDIR/small/26351434v1_ufig1.gif" ALT="Figure 1"> View larger version (53K): org.highwire.dtl.DTLVardef@1589559org.highwire.dtl.DTLVardef@b5423forg.highwire.dtl.DTLVardef@103b97org.highwire.dtl.DTLVardef@1b8378f_HPS_FORMAT_FIGEXP M_FIG C_FIG