Watanabe Eiichi, Kodama Itsuo
Division of Cardiology, Department of Internal Medicine, Fujita Health University School of Medicine.
Nihon Rinsho. 2002 Jul;60(7):1299-307.
Autonomic nervous system plays a critical role in the regulation of cardiovascular system. We reviewed the autonomic nervous system examinations. Time and frequency domain analyses in heart rate variability is obtained from short- and long-term ECG and have predictive values of prognosis in various conditions of heart disease. Baroreflex testing evaluates autonomic modulation of arterial pressure. Baroreflex sensitivity is expressed by the(arterial blood pressure)/(RR interval in ECG) slope in response to infusion of nitroglycerine or phenylephrine. Decrease in baroreflex sensitivity is superior to heart rate variability in identifying patients with poor prognosis in post myocardial infarction. 123I-metaiodobenzylguanidine (MIBG) is an analogue of norepinephrine and hence cardiac 123I-MIBG imaging can visualize cardiac sympathetic nervous system. Defect area in the early phase(15 to 30 min after injection) indicates localization of ventricular denervation. MIBG uptake, measured as a heart to mediastinum activity ratio, had a high predictive vale for survival. Altered MIBG uptake may also play a significant role in the assessment of arrhythmogenic potential in patients with idiopathic ventricular fibrillation or congenital long QT syndrome.
自主神经系统在心血管系统的调节中起着关键作用。我们回顾了自主神经系统检查。心率变异性的时域和频域分析是通过短期和长期心电图获得的，并且在各种心脏病情况下对预后具有预测价值。压力反射测试评估动脉血压的自主调节。压力反射敏感性通过静脉输注硝酸甘油或去氧肾上腺素时的（动脉血压）/（心电图RR间期）斜率来表示。在识别心肌梗死后预后不良的患者方面，压力反射敏感性降低优于心率变异性。123I-间碘苄胍（MIBG）是去甲肾上腺素的类似物，因此心脏123I-MIBG成像可以显示心脏交感神经系统。早期（注射后15至30分钟）的缺损区域表明心室去神经支配的定位。以心脏与纵隔活性比测量的MIBG摄取对生存具有较高的预测价值。MIBG摄取改变在特发性室性心动过速或先天性长QT综合征患者的致心律失常潜力评估中也可能起重要作用。
