Xiao Pei-Lin, Cai Cheng, Zhang Pei, DeSimone Christopher V, Ernst Dereen K, Yin Yue-Hui, Chen Peng-Sheng, Cha Yong-Mei
Department of Cardiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Heart Rhythm. 2020 Jul;17(7):1139-1146. doi: 10.1016/j.hrthm.2020.02.022. Epub 2020 Feb 27.
Heightened sympathetic nerve activity has been associated with poorer prognosis in patients with reduced left ventricular systolic function (ie, heart failure with reduced ejection fraction [HFrEF]).
The purpose of this study was to investigate the effects of cardiac resynchronization therapy (CRT) on sympathetic nerve activity, measured by average skin sympathetic nerve activity (aSKNA).
This prospective study enrolled 36 patients with HFrEF who received CRT. Ten patients who received an implantable cardioverter-defibrillator for primary prevention served as controls. Patient clinical data, echocardiographic variables, and aSKNA at baseline and 3-month follow-up were collected.
CRT patients who exhibited wider QRS duration had higher aSKNA (1.52 ± 0.65 μV vs 0.97 ± 0.49 μV; P = .027) compared to the control group at baseline. In the CRT group, patients with QRS duration ≥150 ms had higher aSKNA than those with QRS duration <150 ms (1.67 ± 0.63 μV vs 1.19 ± 0.51 μV; P =.039). After CRT, left ventricular ejection fraction (LVEF) improved from 29.6% to 35.4% (P = .001). aSKNA decreased significantly (1.52 ± 0.65 μV vs 1.31 ± 0.63 μV; P = .018). Seventeen of the 36 CRT patients were CRT responders, with LVEF improvement ≥5% at 3-month follow-up. aSKNA significantly decreased from 1.47 to 1.15 μV (P = .003) in CRT responders but was unchanged in nonresponders (1.44 ± 0.69 to 1.37 ± 0.70; P = .61). After CRT, a significant reduction in aSKNA was associated with improvement in LVEF (r = 0.638; P = .001).
CRT reduces elevated sympathetic activity in HFrEF patients, accompanied by improvement in systolic function at short-term follow-up. The reduction of sympathetic activity is mainly seen in CRT responders.
交感神经活动增强与左心室收缩功能降低的患者（即射血分数降低的心力衰竭[HFrEF]）预后较差有关。
本研究旨在探讨心脏再同步治疗（CRT）对交感神经活动的影响，通过平均皮肤交感神经活动（aSKNA）进行测量。
这项前瞻性研究纳入了36例接受CRT的HFrEF患者。10例接受植入式心律转复除颤器进行一级预防的患者作为对照。收集患者的临床数据、超声心动图变量以及基线和3个月随访时的aSKNA。
与对照组相比，基线时QRS时限更宽的CRT患者aSKNA更高（1.52±0.65μV对0.97±0.49μV；P = 0.027）。在CRT组中，QRS时限≥150 ms的患者aSKNA高于QRS时限<150 ms的患者（1.67±0.63μV对1.19±0.51μV；P = 0.039）。CRT后，左心室射血分数（LVEF）从29.6%提高到35.4%（P = 0.001）。aSKNA显著降低（1.52±0.65μV对1.31±0.63μV；P = 0.018）。36例CRT患者中有17例为CRT反应者，在3个月随访时LVEF改善≥5%。CRT反应者的aSKNA从1.47显著降低至1.15μV（P = 0.003），而非反应者则无变化（1.44±0.69至1.37±0.70；P = 0.61）。CRT后，aSKNA的显著降低与LVEF的改善相关（r = 0.638；P = 0.001）。
CRT可降低HFrEF患者升高的交感神经活动，并在短期随访中伴有收缩功能的改善。交感神经活动的降低主要见于CRT反应者。
