Second Department of Internal Medicine and Cardiology Centre, University of Szeged, Korányi Fasor 6, 6720 Szeged, Hungary.
Europace. 2010 Apr;12(4):574-8. doi: 10.1093/europace/euq032. Epub 2010 Feb 25.
Abnormalities of the sympathetic baroreflex regulation are documented in various diseases. The recording of sympathetic nerve activity allows for the calculation of baroreflex gain but this is not available in practice. A non-invasive method based on blood pressure during the late phases of Valsalva manoeuvre (VM) was proposed. Sympathetic gain could be calculated from the pressure fluctuations following ventricular extrasystole or non-sustained ventricular tachycardia (NSVT).
We assessed both indices in 25 subjects with no significant cardiovascular disease. VM was performed at 40 mmHg for 12 s. Paced NSVT consisted of five to six cycles. The sympathetic gains were determined based on the recovery of mean arterial pressure (MAP, mmHg/s). The maximum slope of five consecutive MAP elevations occurring within a 15-cycle period after NSVT was calculated. This MAP turbulence slope (MAP(TS)) was expressed in mmHg/cycle. Five patients were excluded because of unacceptable VM. VM-derived sympathetic gain (SBRS(vals)) and the NSVT-derived gain (SBRS(NSVT)) correlated closely (R = 0.86, P < 0.001). Their mean difference was 3.2 +/- 4.8 mmHg. Both SBRS(vals) and SBRS(NSVT) correlated closely with MAP(TS) (R = 0.77, P < 0.001 and R = 0.86, P < 0.001, respectively).
The sympathetically mediated arterial pressure recovery is an analogous process following both VM and NSVT. SBRS(NSVT) or MAP(TS) may be useful in the assessment of patients with implanted antiarrhythmic devices.
在各种疾病中都记录到交感神经压力反射调节的异常。交感神经活动的记录可以计算出压力反射增益，但在实践中无法实现。本文提出了一种基于瓦尔萨尔瓦动作（Valsalva maneuver，VM）后期血压的非侵入性方法。可以通过室性期前收缩或非持续性室性心动过速（non-sustained ventricular tachycardia，NSVT）后的血压波动来计算交感神经增益。
我们在 25 名无明显心血管疾病的受试者中评估了这两个指标。VM 持续 12 秒，压力为 40mmHg。起搏 NSVT 由五到六个周期组成。根据平均动脉压（mean arterial pressure，MAP，mmHg/s）的恢复来确定交感神经增益。计算 NSVT 后 15 个周期内连续 5 次 MAP 升高的最大斜率。该 MAP 湍流斜率（MAP turbulence slope，MAP(TS)）以 mmHg/周期表示。由于 VM 不可接受，有 5 名患者被排除在外。VM 衍生的交感神经增益（sympathetic baroreflex reserve derived from VM，SBRS(vals)）和 NSVT 衍生的增益（sympathetic baroreflex reserve derived from NSVT，SBRS(NSVT)）密切相关（R = 0.86，P < 0.001）。两者的平均差值为 3.2 ± 4.8mmHg。SBRS(vals)和 SBRS(NSVT)均与 MAP(TS)密切相关（R = 0.77，P < 0.001 和 R = 0.86，P < 0.001）。
VM 和 NSVT 后动脉血压恢复的交感神经介导过程类似。SBRS(NSVT)或 MAP(TS)可能有助于评估植入抗心律失常装置的患者。
