Wensel R, Jilek C, Dörr M, Francis D P, Stadler H, Lange T, Blumberg F, Opitz C, Pfeifer M, Ewert R
Dept of Internal Medicine II, Universtätsklinikum Regensburg, Regensburg, Germany.
Eur Respir J. 2009 Oct;34(4):895-901. doi: 10.1183/09031936.00145708. Epub 2009 May 14.
Pulmonary arterial hypertension (PAH) results in chronic right heart failure, which is associated with an increase in sympathetic tone. This may adversely affect cardiac autonomic control. We investigated the changes in cardiac autonomic nervous activity in relation to disease severity in patients with PAH. In 48 patients with PAH (median World Health Organization class III, pulmonary artery pressure 52+/-14 mmHg, pulmonary vascular resistance 1,202+/-718 dyn x s x cm(-5), cardiac index 2.0+/-0.8 L x min(-1) x m(-2)) and 41 controls, cardiac autonomic nervous activity was evaluated by measurement of heart rate variability (HRV) and baroreflex sensitivity. All patients underwent cardiopulmonary exercise testing (peak oxygen uptake 13.2+/-5.1 mL x kg(-1) x min(-1), minute ventilation/carbon dioxide production slope 47+/-16). In patients with PAH, spectral power of HRV was reduced in the high-frequency (239+/-64 versus 563+/-167 ms2), low-frequency (245+/-58 versus 599+/-219 ms2) and very low-frequency bands (510+/-149 versus 1106+/-598 ms2; all p<0.05). Baroreflex sensitivity was also blunted (5.8+/-0.6 versus 13.9+/-1.2 ms x mmHg(-1); p<0.01). The reduction in high-frequency (r = 0.3, p = 0.04) and low-frequency (r = 0.33, p = 0.02) spectral power and baroreflex sensitivity (r = 0.46, p<0.01) was related to the reduction in peak oxygen uptake. Patients with PAH have a marked alteration in cardiac autonomic control that is related to exercise capacity and may, therefore, serve as an additional marker of disease severity.
肺动脉高压（PAH）会导致慢性右心衰竭，这与交感神经张力增加有关。这可能会对心脏自主神经控制产生不利影响。我们研究了PAH患者心脏自主神经活动与疾病严重程度的关系。在48例PAH患者（世界卫生组织心功能分级中位数为III级，肺动脉压52±14 mmHg，肺血管阻力1202±718 dyn·s·cm⁻⁵，心脏指数2.0±0.8 L·min⁻¹·m⁻²）和41例对照组中，通过测量心率变异性（HRV）和压力反射敏感性来评估心脏自主神经活动。所有患者均进行了心肺运动试验（峰值摄氧量13.2±5.1 mL·kg⁻¹·min⁻¹，分钟通气量/二氧化碳产生斜率47±16）。在PAH患者中，HRV的高频（239±64对563±167 ms²）、低频（245±58对599±219 ms²）和极低频波段（510±149对1106±598 ms²；均p<0.05）的频谱功率降低。压力反射敏感性也减弱（5.8±0.6对13.9±1.2 ms·mmHg⁻¹；p<0.01）。高频（r = 0.3，p = 0.04）和低频（r = 0.33，p = 0.02）频谱功率以及压力反射敏感性（r = 0.46，p<0.01）的降低与峰值摄氧量的降低有关。PAH患者的心脏自主神经控制有明显改变，这与运动能力有关，因此可能作为疾病严重程度的一个额外标志物。
