Hautvast R W, Brouwer J, DeJongste M J, Lie K I
Department of Cardiology, University Hospital, Groningen, The Netherlands.
Clin Cardiol. 1998 Jan;21(1):33-8. doi: 10.1002/clc.4960210107.
Spinal cord stimulation is an effective treatment for chronic refractory angina pectoris. Its efficacy is related to an anti-ischemic action, possibly as a result of modulation of the autonomic nervous system. Therefore, the influence of spinal cord stimulation on the autonomic nervous system and myocardial ischemia was prospectively studied in 19 consecutive patients with intractable angina pectoris.
Patients were included when demonstrating > 0.1 mV STsegment depression on the exercise electrocardiogram (ECG) during two separate treadmill tests. After enrollment, heart rate variability together with ischemic indices were studied with 48 h ambulatory ECG monitoring. Assessments were made at baseline and after 6 weeks of spinal cord stimulation therapy.
After 6 weeks, no significant changes in heart rate variability were detected. However, ischemic indices on the ambulatory ECG, as well as anginal attacks and consumption of sublingual nitrate tablets, were significantly decreased.
Autonomic modulation assessable with heart rate variability analysis may not be the explanatory mechanism of action for the decrease of anginal attacks and ischemia, exerted by spinal cord stimulation used as an adjuvant therapy in patients with chronic intractable angina pectoris.
脊髓刺激是治疗慢性顽固性心绞痛的一种有效方法。其疗效与抗缺血作用有关,这可能是自主神经系统调节的结果。因此,我们对19例顽固性心绞痛患者进行了前瞻性研究,以探讨脊髓刺激对自主神经系统和心肌缺血的影响。
入选标准为在两次独立的平板运动试验中,运动心电图(ECG)显示ST段压低>0.1 mV。入选后,通过48小时动态心电图监测研究心率变异性和缺血指标。在基线和脊髓刺激治疗6周后进行评估。
6周后,未检测到心率变异性有显著变化。然而,动态心电图上的缺血指标以及心绞痛发作次数和硝酸甘油含片的消耗量均显著减少。
对于慢性顽固性心绞痛患者,使用脊髓刺激作为辅助治疗时,通过心率变异性分析评估的自主神经调节可能不是心绞痛发作和缺血减少的作用机制。