View More View Less
  • 1 Debreceni Egyetem, Általános Orvostudományi Kar, Kardiológiai és Szívsebészeti Klinika, Debrecen
  • 2 Debreceni Egyetem, Általános Orvostudományi Kar, Neurológiai Klinika, Debrecen
  • 3 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Aneszteziológiai és Intenzív Terápiás Intézet, Szeged, Semmelweis u. 6., 6725

Összefoglaló. Bevezetés: Az artériás baroreflex-érzékenységi (BRS-) indexek egységnyi nyomásváltozásra adott élettani válaszokat írnak le. Az RR-intervallum gyors válaszait a cardiovagalis BRS-indexekkel, a vasomotorválaszokat az izom szimpatikus idegi aktivitás (MSNA) válaszain alapuló szimpatikus-BRS-indexekkel jellemezzük. Szívelégtelenségben kórosan csökkent értékeik kedvezőtlen kimenetelt jeleznek. Betegek és módszerek: A BRS-indexek meghatározhatóságát 52, szívelégtelenségben szenvedő betegben (kor: 59 ± 10 év; EF: 37 ± 11%) és 11, kor szerint illesztett egészséges önkéntesben vizsgáltuk. EKG- és vérnyomásfelvételekből három cardiovagalis BRS-indexet számítottunk; a növekvő, illetve csökkenő spontán szekvenciák módszerén alapuló up-BRS-t és down-BRS-t, továbbá az alacsony frekvenciatartomány-beli ’cross-spectralis ’ indexet, az LF-alfát. Egy perifériás ideg (nervus peroneus) perkután punkciójával detektáltuk az MSNA szimpatikus csúcs incidenciáját (csúcs/100 szívciklus), s ezt korreláltattuk a diastolés nyomás 3 Hgmm sávokba rendezett értékeivel. Így nyertük a szimpatikus BRS jellemzőit, a BRSSY-incidencia-értékeket. Eredmények: Az up- és down-BRS-szekvenciák csak a betegek 19%-ában voltak meghatározhatók, az LF-alfa a 69%-ukban. Azok, akiknél cardiovagalis BRS nem volt meghatározható, szignifikánsan csökkent RR-intervallum-ingadozást és magasabb NT-proBNP-értékeket mutattak. A meghatározható cardiovagalis BRS-indexek nem különítették el a betegeket és a kontrollszemélyeket. A BRSSY-incidencia-érték 58%-ban állt rendelkezésre, s csakúgy, mint maga a „csúcs” incidencia, jól elkülönítette a betegeket és az önkénteseket. A hiányzó baroreflexérték a magas „csúcs” incidenciával állt összefüggésben. Következtetés: A cardiovagalis BRS-értékek csak korlátozottan alkalmasak egészséges önkéntesek és szívelégtelen betegek elkülönítésére, a meghatározhatatlan értékek súlyosabb betegségre utalnak. A BRSSY-incidencia elkülöníti az egészséges és a beteg csoportokat; a hiányzó érték a fokozott szimpatikus aktivitással áll összefüggésben. Orv Hetil. 2021; 162(3): 91–98.

Summary. Introduction: Arterial baroreflex sensitivity (BRS) is characterized by the magnitude of physiological responses to arterial pressure changes. Rapid RR interval responses are quantified by cardiovagal BRS parameters, sympathetic responses could be assessed by changes in muscle sympathetic nerve activity (MSNA). Abnormal indices in heart failure are associated with poor outcome. Patients and methods: 52, heart failure patients (age 59 ± 10 years, EF 37 ± 11%), and 11, age-matched healthy volunteers were studied. From ECG and arterial pressure recordings up-BRS and down-BRS values were determined using the method of spontaneous sequences. The low frequency cross-spectral gain, the LF alpha was also determined. Percutaneous puncture of the peroneal nerves allowed determination of MSNA burst incidence (burst/100 cycles), which was correlated to corresponding diastolic pressure bins of 3 mmHg, yielding a sympathetic BRS, the BRSSY-incidence. Results: Up- and down-BRS could be calculated in 19% of the patients, LF alpha was determined in 69%. Those with missing cardiovagal BRS values showed diminished RR interval variation, and higher levels of NT-proBNP. The measurable cardiovagal BRS indices did not separate patients and healthy volunteers. BRSSY-incidence could be determined in 58% of the patients. The sympathetic gain as well as the burst incidence differed significantly between patients and healthy volunteers. Missing BRSSY-incidence was associated with higher burst incidence. Conclusion: Cardiovagal BRS indices have limited value in differentiating healthy and heart failure subjects. Incalculable values among patients indicate more severe disease state. BRSSY-incidence does separate healthy and diseased population, the missing BRSSY-incidence values are related to increased sympathetic activity. Orv Hetil. 2021; 162(3): 91–98.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1

    Rudas L, Crossman AA, Morillo CA, et al. Human sympathetic and vagal baroreflex responses to sequential nitroprusside and phenylephrine. Am J Physiol. 1999; 276: H1691–H1698.

  • 2

    Parati G, Frattola A, Di Rienzo M, et al. Effects of aging on 24-h dynamic baroreceptor control of heart rate in ambulant subjects. Am J Physiol. 1995; 268: H1606–H1612.

  • 3

    Hughson RL, Quintin L, Annat G, et al. Spontaneous baroreflex by sequence and power spectral methods in humans. Clin Physiol. 1993; 13: 663–676.

  • 4

    Zöllei É, Gingl Z, Kardos A, et al. Comparison between different non-invasive indices of baroreflex gain. [A baroreflexek neminvazív jellemzőinek összehasonlító vizsgálata.] Cardiol Hung. 1996; 28: 269–272. [Hungarian]

  • 5

    Laude D, Elghozi JL, Girard A, et al. Comparison of various techniques used to estimate spontaneous baroreflex sensitivity (the EuroBaVar study). Am J Physiol Regul Integr Comp Physiol. 2004, 286: R226–R231.

  • 6

    Sundlöf G, Wallin BG. Human muscle nerve sympathetic activity at rest. Relationship to blood pressure and age. J Physiol. 1978; 274: 621–637.

  • 7

    Kienbaum P, Karlsson T, Sverrisdottir YB, et al. Two sites for modulation of human sympathetic activity by arterial baroreceptors? J Physiol. 2001; 531: 861–869.

  • 8

    Hart EC, Joyner MJ, Wallin BG, et al. Baroreflex control of muscle sympathetic nerve activity: a nonpharmacological measure of baroreflex sensitivity. Am J Physiol Heart Circ Physiol. 2010; 298: H816–H822.

  • 9

    Taylor CE, Witter T, El Sayed K, et al. Relationship between spontaneous sympathetic baroreflex sensitivity and cardiac baroreflex sensitivity in healthy young individuals. Physiol Rep. 2015; 3: e12536.

  • 10

    Hissen SL, El Sayed K, Macefield VG, et al. The stability and repeatability of spontaneous sympathetic baroreflex sensitivity in healthy young individuals. Front Neurosci. 2018; 12: 403.

  • 11

    Lambert EA, Thompson J, Schlaich M, et al. Sympathetic and cardiac baroreflex function in panic disorder. J Hypertens. 2002; 20: 2445–2451.

  • 12

    Keller DM, Cui J, Davis SL, et al. Heat stress enhances arterial baroreflex control of muscle sympathetic nerve activity via increased sensitivity of burst gating, not burst area in humans. J Physiol. 2006; 573: 445–451.

  • 13

    Carter JR, Durocher JJ, Larson RA, et al. Sympathetic neural responses to 24-hour sleep deprivation in humans: sex differences. Am J Physiol Heart Circ Physiol. 2012; 302: H1991–H1997.

  • 14

    Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016; 37: 2129–2200.

  • 15

    Eckberg DL, Drabinsky M, Braunwald E. Defective cardiac parasympathetic control in patients with heart disease. N Engl J Med. 1971; 285: 877–883.

  • 16

    La Rovere MT, Specchia G, Mortara A, et al. Baroreflex sensitivity, clinical correlates, and cardiovascular mortality among patients with a first myocardial infarction. A prospective study. Circulation 1988; 78: 816–824.

  • 17

    Mortara A, La Rovere MT, Pinna GD, et al. Arterial baroreflex modulation of heart rate in chronic heart failure. Clinical and hemodynamic correlates and prognostic implications. Circulation 1997; 96: 3450–3458.

  • 18

    Pinna GD, Maestri R, Capomolla S, et al. Applicability and clinical relevance of the transfer function method in the assessment of baroreflex sensitivity in heart failure patients. J Am Coll Cardiol. 2005; 46: 1314–1321.

  • 19

    La Rovere MT, Maestri R, Robbi E, et al. Comparison of the prognostic values of invasive and noninvasive assessment of baroreflex sensitivity in heart failure. J Hypertens. 2011; 29: 1546–1552.

  • 20

    Cohn JN, Levine TB, Olivari MT, et al. Plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure. N Engl J Med. 1984; 311: 819–823.

  • 21

    Leimbach WN Jr, Wallin BG, Victor RG, et al. Direct evidence from intraneural recordings for increased central sympathetic outflow in patients with heart failure. Circulation 1986; 73: 913–919.

  • 22

    Floras JS. Sympathetic nervous system activation in human heart failure: clinical implications of an updated model. J Am Coll Cardiol. 2009; 54: 375–385.

  • 23

    Barretto AC, Santos AC, Munhoz R, et al. Increased muscle sympathetic nerve activity predicts mortality in heart failure patients. Int J Cardiol. 2009; 135: 302–307.

  • 24

    Ferguson DS, Berg WJ, Roach PJ, et al. Effects of heart failure on baroreflex control of sympathetic neural activity. Am J Cardiol. 1992; 69: 523–531.

  • 25

    Grassi G, Seravalle G, Cattaneo BM, et al. Sympathetic activation and loss of reflex sympathetic control in mild congestive heart failure. Circulation 1995; 92: 3206–3211.

  • 26

    Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation 1996; 93: 1043–1065.

  • 27

    Kardos A, Watterich G, de Menezes R, et al. Determinants of spontaneous baroreflex sensitivity in a healthy working population. Hypertension 2001; 37: 911–916.

  • 28

    Hinojosa-Laborde C, Ryan KL, Rickards CA, et al. Resting sympathetic baroreflex sensitivity is subjects with low and high tolerance to central hypovolemia induced by lower body negative pressure. Front Physiol. 2014; 5: 241.

  • 29

    Mortara A, Sleight P, Pinna GD, et al. Abnormal awake respiratory patterns are common in chronic heart failure and may prevent evaluation of autonomic tone by measures of heart rate variability. Circulation 1997; 96: 246–252.