Cardiac Resynchronization Therapy Modulates Peripheral Sympathetic Activity.
Cardiac Resynchronization Therapy Modulates Peripheral Sympathetic Activity.
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DOI：
10.1016/j.hrthm.2020.02.022
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发表时间：
2020-02
期刊：
影响因子：
5.5
通讯作者：
P. Xiao;Cheng Cai;Pei Zhang;C. DeSimone;Dereen Ernst;Y. Yin;Peng-Sheng Chen;Y. Cha
中科院分区：
文献类型：
--
作者：
P. Xiao;Cheng Cai;Pei Zhang;C. DeSimone;Dereen Ernst;Y. Yin;Peng-Sheng Chen;Y. Cha
研究背景交感神经活性增高与左室收缩功能减退患者预后不良有关（即射血分数降低的心力衰竭[HFrEF]）。本研究的目的是研究心脏起搏治疗（CRT）对交感神经活动的影响，通过平均皮肤交感神经活性（aSKNA）测量。10例接受植入式心律转复除颤器作为一级预防的患者作为对照。患者的临床数据，超声心动图变量，和aSKNA在基线和3个月follow-up.ResultsCRT患者表现出较宽的QRS持续时间有较高的aSKNA（1.52 ± 0.65 μV比0.97 ± 0.49 μV;P= 0.027）相比，对照组在基线。在CRT组中，QRS时限≥150 ms的患者aSKNA高于QRS时限<150 ms的患者（1.67 ± 0.63 μV vs 1.19 ± 0.51 μV;P= 0.039）。CRT后，左心室射血分数（LVEF）从29.6%改善至35.4%（P= .001）。aSKNA显著降低（1.52 ± 0.65 μV vs 1.31 ± 0.63 μV;P= 0.018）。36例CRT患者中有17例为CRT应答者，3个月随访时LVEF改善≥5%。CRT应答者的aSKNA从1.47 μ V显著降低至1.15 μV（P= 0.003），但无应答者无变化（1.44 ± 0.69至1.37 ± 0.70;P= 0.61）。CRT后，aSKNA的显着减少与LVEF的改善（r = 0.638;P= .001）。结论CRT降低HFrEF患者交感神经活性升高，伴随着短期随访收缩功能的改善。交感神经活动的减少主要见于CRT应答者。
BackgroundHeightened sympathetic nerve activity has been associated with poorer prognosis in patients with reduced left ventricular systolic function (ie, heart failure with reduced ejection fraction [HFrEF]).ObjectiveThe purpose of this study was to investigate the effects of cardiac resynchronization therapy (CRT) on sympathetic nerve activity, measured by average skin sympathetic nerve activity (aSKNA).MethodsThis prospective study enrolled 36 patients with HFrEF who received CRT. Ten patients who received an implantable cardioverter–defibrillator for primary prevention served as controls. Patient clinical data, echocardiographic variables, and aSKNA at baseline and 3-month follow-up were collected.ResultsCRT patients who exhibited wider QRS duration had higher aSKNA (1.52 ± 0.65 μV vs 0.97 ± 0.49 μV;P= .027) compared to the control group at baseline. In the CRT group, patients with QRS duration ≥150 ms had higher aSKNA than those with QRS duration <150 ms (1.67 ± 0.63 μV vs 1.19 ± 0.51 μV;P=.039). After CRT, left ventricular ejection fraction (LVEF) improved from 29.6% to 35.4% (P= .001). aSKNA decreased significantly (1.52 ± 0.65 μV vs 1.31 ± 0.63 μV;P= .018). Seventeen of the 36 CRT patients were CRT responders, with LVEF improvement ≥5% at 3-month follow-up. aSKNA significantly decreased from 1.47 to 1.15 μV (P= .003) in CRT responders but was unchanged in nonresponders (1.44 ± 0.69 to 1.37 ± 0.70;P= .61). After CRT, a significant reduction in aSKNA was associated with improvement in LVEF (r = 0.638;P= .001).ConclusionCRT reduces elevated sympathetic activity in HFrEF patients, accompanied by improvement in systolic function at short-term follow-up. The reduction of sympathetic activity is mainly seen in CRT responders.