Spontaneous indices are inconsistent with arterial baroreflex gain
Spontaneous indices are inconsistent with arterial baroreflex gain
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DOI：
10.1161/01.hyp.0000091370.83602.e6
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发表时间：
2003-10-01
期刊：
影响因子：
8.3
通讯作者：
Taylor, JA
中科院分区：
文献类型：
--
作者：
Lipman, RD;Salisbury, JK;Taylor, JA
动脉压和心跳周期自发发生的平行波动经常被用作压力感受反射功能的指标。尽管自发指数很方便，但它们与动脉压力反射的关系仍不清楚。因此，我们在 97 名志愿者中推导了 5 个提议的指数（序列法、α 指数、传递函数、低频传递函数和脉冲响应函数），将它们与动脉压力反射增益（通过改良的牛津药理学技术）进行比较，并检查它们与颈动脉扩张和呼吸性窦性心律失常的关系。受试者包括年龄 25 至 86 岁的男性和女性 (n = 41)，其中 30% 患有冠状动脉疾病。一般来说，这些指数彼此相关（α指数和低频传递函数除外）并与压力反射增益相关。然而，布兰德-奥特曼方法表明，自发指数的一致性限制与压力反射增益本身一样大。即使在压力反射增益最低三分位数内的个体中，压力反射增益似乎与临床最相关，自发指数也未能与压力反射增益相关。事实上，对于这些人来说，任何指数和压力反射增益之间都没有相关性。向前逐步线性回归显示，所有自发指数和压力反射增益均与呼吸性窦性心律失常相关，但只有压力反射增益与颈动脉扩张相关。因此，这些数据表明自发指数对增益的估计不充分，并且与动脉压力感受反射功能不一致。
Spontaneously occurring, parallel fluctuations in arterial pressure and heart period are frequently used as indices of baroreflex function. Despite the convenience of spontaneous indices, their relation to the arterial baroreflex remains unclear. Therefore, in 97 volunteers, we derived 5 proposed indices (sequence method, alpha-index, transfer function, low-frequency transfer function, and impulse response function), compared them with arterial baroreflex gain (by the modified Oxford pharmacologic technique), and examined their relation to carotid distensibility and respiratory sinus arrhythmia. The subjects comprised men and women (n = 41) aged 25 to 86 years, 30% of whom had established coronary artery disease. Generally, the indices were correlated with each other (except alpha-index and low-frequency transfer function) and with baroreflex gain. However, the Bland-Altman method demonstrated that the spontaneous indices had limits of agreement as large as the baroreflex gain itself. Even in individuals within the lowest tertile of baroreflex gain for whom baroreflex gain appears to be the most clinically relevant, spontaneous indices failed to relate to baroreflex gain. In fact, for these individuals, there was no correlation between any index and baroreflex gain. Forward stepwise linear regression showed that all spontaneous indices and baroreflex gain were related to respiratory sinus arrhythmia, but only baroreflex gain was related to carotid distensibility. Therefore, these data suggest that spontaneous indices are inadequate estimates of gain and are inconsistent with arterial baroreflex function.