La Rovere Maria Teresa, Porta Alberto, Schwartz Peter J
Department of Cardiology, IRCCS Istituti Clinici Scientifici Maugeri, Montescano (Pavia), Italy.
Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
Front Physiol. 2020 Jun 12;11:582. doi: 10.3389/fphys.2020.00582. eCollection 2020.
This essay covers several aspects of the autonomic control of the heart, all relevant to cardiovascular pathophysiology with a direct impact on clinical outcomes. Ischemic heart disease, heart failure, channelopathies, and life-threatening arrhythmias are in the picture. Beginning with an overview on some of the events that marked the oscillations in the medical interest for the autonomic nervous system, our text explores specific areas, including experimental and clinical work focused on understanding the different roles of tonic and reflex sympathetic and vagal activity. The role of the baroreceptors, not just for the direct control of circulation but also because of the clinical value of interpreting alterations (spontaneous or induced) in their function, is discussed. The importance of the autonomic nervous system for gaining insights on risk stratification and for providing specific antiarrhythmic protection is also considered. Examples are the interventions to decrease sympathetic activity and/or to increase vagal activity. The non-invasive analysis of the RR and QT intervals provides additional information. The three of us have collaborated in several studies and each of us contributes with very specific and independent areas of expertise. Here, we have focused on those areas to which we have directly contributed and hence speak with personal experience. This is not an attempt to provide a neutral and general overview on the autonomic nervous system; rather, it represents our effort to share and provide the readers with our own personal views matured after many years of research in this field.
本文涵盖了心脏自主控制的几个方面，所有这些方面都与心血管病理生理学相关，并直接影响临床结果。缺血性心脏病、心力衰竭、离子通道病和危及生命的心律失常都在讨论范围内。本文首先概述了一些标志着医学对自主神经系统兴趣波动的事件，接着探讨了特定领域，包括专注于理解紧张性和反射性交感神经及迷走神经活动不同作用的实验和临床研究。文中讨论了压力感受器的作用，不仅因其对循环的直接控制，还因其在解释其功能改变（自发或诱发）方面的临床价值。自主神经系统在风险分层和提供特定抗心律失常保护方面的重要性也得到了考虑。例如降低交感神经活动和/或增加迷走神经活动的干预措施。RR和QT间期的无创分析提供了额外信息。我们三人在多项研究中进行了合作，每个人都在非常特定且独立的专业领域做出了贡献。在此，我们专注于我们直接做出贡献的领域，因此是基于个人经验进行阐述。这并非试图对自主神经系统进行中立和全面的概述；相反，它代表了我们在该领域多年研究后，努力与读者分享并提供我们自己的个人观点。
