Cardiology Department, Erasme Hospital, 808 Route de Lennik, 1070 Brussels, Belgium.
Am J Respir Crit Care Med. 2010 Jun 1;181(11):1269-75. doi: 10.1164/rccm.200912-1856OC. Epub 2010 Mar 1.
The sympathetic nervous system has been reported to be activated in pulmonary arterial hypertension (PAH).
We investigated the prognostic significance of muscle sympathetic nervous system activity (MSNA) in PAH.
Thirty-two patients with PAH were included in the study and underwent a measurement of MSNA over a 6-year period of time. They had undergone a concomitant evaluation of New York Heart Association (NYHA) functional class, a 6-minute walk distance (6MWD), an echocardiographic examination, and a right heart catheterization for diagnostic or reevaluation purposes. The median follow-up time was 20.6 months (interquartile range, 45.8 mo). Clinical deterioration was defined by listing for transplantation or death.
Seventeen patients presented with clinical deterioration. As compared with the 15 others, they had an increased MSNA (80 +/- 12 vs. 52 +/- 18 bursts/min; P < 0.001) and heart rate (88 +/- 17 vs. 74 +/- 12 bpm; P = 0.01), a lower 6MWD (324 +/- 119 vs. 434 +/- 88 m; P < 0.01) and a deteriorated NYHA functional class (3.6 +/- 0.5 vs. 2.9 +/- 0.8; P < 0.001). The hemodynamic variables were not different. MSNA was directly related to heart rate and inversely to 6MWD. A univariate analysis revealed that increased MSNA and heart rate, NYHA class IV, lower 6MWD, and pericardial effusion were associated with subsequent clinical deterioration. A multivariate analysis showed that MSNA was an independent predictor of clinical deterioration. For every increase of 1 burst/minute, the risk of clinical deterioration during follow-up increased by 6%.
Sympathetic nervous system activation is an independent predictor of clinical deterioration in pulmonary arterial hypertension.
已报道在肺动脉高压（PAH）中交感神经系统被激活。
我们研究了 PAH 中肌肉交感神经活动（MSNA）的预后意义。
32 例 PAH 患者参与了这项研究，并在 6 年的时间内对 MSNA 进行了测量。他们同时接受了纽约心脏协会（NYHA）功能分级、6 分钟步行距离（6MWD）、超声心动图检查和右心导管检查，以进行诊断或重新评估。中位随访时间为 20.6 个月（四分位间距，45.8mo）。临床恶化定义为列出移植或死亡。
17 例患者出现临床恶化。与另外 15 例患者相比，他们的 MSNA（80±12 比 52±18 爆发/分钟；P<0.001）和心率（88±17 比 74±12 bpm；P=0.01）更高，6MWD（324±119 比 434±88 m；P<0.01）和 NYHA 功能分级（3.6±0.5 比 2.9±0.8；P<0.001）恶化。血流动力学变量没有差异。MSNA 与心率直接相关，与 6MWD 呈负相关。单变量分析显示，MSNA 增加、心率增加、NYHA 分级 IV、6MWD 降低和心包积液与随后的临床恶化相关。多变量分析显示 MSNA 是临床恶化的独立预测因子。MSNA 每增加 1 次/分钟，随访期间临床恶化的风险增加 6%。
交感神经系统的激活是 PAH 临床恶化的独立预测因子。
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