Mortara A, La Rovere M T, Pinna G D, Parziale P, Maestri R, Capomolla S, Opasich C, Cobelli F, Tavazzi L
Divisione di Cardiologia Centro Medico di Montescano, Fondazione S. Maugeri, Instituto di Ricovero e Cura a Carattere Scientifico, Pavia, Italy.
Am Heart J. 1997 Nov;134(5 Pt 1):879-88. doi: 10.1016/s0002-8703(97)80011-7.
In chronic heart failure (CHF) the contributing role of increased sympathetic activity and hemodynamic dysfunction in the genesis of ventricular arrhythmias has not been well established. To assess the relation between severe ventricular arrhythmias, hemodynamic impairment, and autonomic nervous system derangement, 142 patients with CHF in sinus rhythm underwent 24-hour electrocardiographic recording, right-sided heart catheterization, and evaluation of sympathovagal balance by heart rate variability (HRV) and baroreflex sensitivity (BRS). Patients were grouped according to the absence (without nonsustained ventricular tachycardia [NSVT]; n = 87) or presence (with NSVT; n = 55) of NSVT. Patients with NSVT had higher pulmonary artery and capillary pressures and more pronounced signs of sympathetic activation and parasympathetic withdrawal compared with those without NSVT. However, logistic regression analysis revealed that depressed BRS but not reduced HRV was significantly associated with the presence of NSVT, at both univariate analysis and after adjustment for clinical and hemodynamic variables. Moreover, it was found that when depressed BRS was associated with high pulmonary capillary pressure, the odds ratio for having NSVT rose markedly from 3.8 to 6.5. In conclusion, this study indicates that in stable CHF the assessment of arterial baroreflex function, but not HRV analysis, allows identification of patients at high risk of NSVT. It is suggested that the effect of depressed BRS is strengthened by the simultaneous presence of increased myocardial wall stress. These data support the hypothesis of a contributory role of autonomic nervous system dysfunction as expressed by the inability to activate effective vagal reflexes and an indirect index of ventricular stretch in the genesis of life-threatening arrhythmias.
在慢性心力衰竭（CHF）中，交感神经活动增加和血流动力学功能障碍在室性心律失常发生中的作用尚未完全明确。为了评估严重室性心律失常、血流动力学损害和自主神经系统紊乱之间的关系，对142例窦性心律的CHF患者进行了24小时心电图记录、右心导管检查，并通过心率变异性（HRV）和压力反射敏感性（BRS）评估交感迷走神经平衡。根据是否存在非持续性室性心动过速（NSVT）将患者分组（无NSVT组；n = 87）或有NSVT组（n = 55）。与无NSVT的患者相比，有NSVT的患者肺动脉和毛细血管压力更高，交感神经激活和副交感神经撤离的体征更明显。然而，逻辑回归分析显示，在单因素分析以及对临床和血流动力学变量进行调整后，BRS降低而非HRV降低与NSVT的存在显著相关。此外，研究发现，当BRS降低与高肺毛细血管压力相关时，发生NSVT的比值比从3.8显著升至6.5。总之，本研究表明，在稳定的CHF中，评估动脉压力反射功能而非HRV分析，可识别出有NSVT高风险的患者。提示心肌壁应力增加同时存在会增强BRS降低的影响。这些数据支持了自主神经系统功能障碍在危及生命的心律失常发生中起作用的假说，自主神经系统功能障碍表现为无法激活有效的迷走反射以及心室牵张的间接指标。
