Absence of low-frequency variability of sympathetic nerve activity in severe heart failure.
Absence of low-frequency variability of sympathetic nerve activity in severe heart failure.
复制标题
DOI：
10.1161/01.cir.95.6.1449
复制
发表时间：
1997-03
期刊：
影响因子：
37.8
通讯作者：
P. V. D. Borne;N. Montano;M. Pagani;R. Oren;V. Somers
中科院分区：
文献类型：
--
作者：
P. V. D. Borne;N. Montano;M. Pagani;R. Oren;V. Somers
在正常人中，血压、RR间隔和交感神经活动的变异性主要发生在低频（LF; 0.04 ~ 0.14 Hz）和高频（HF; +/-0.25 Hz）。在正常人交感神经激活增加的情况下，LF成分相对于HF成分增加。心力衰竭患者的交感神经活动水平很高。我们测试了交感神经活动变异性的LF成分在心力衰竭中增加的假设。方法与结果我们对21例慢性心力衰竭患者和12例年龄匹配的对照组的静息肌交感神经活动（MSNA）和RR间期同时记录进行了频谱分析。心衰患者的MSNA（每分钟62 +/- 4次）高于正常受试者（每分钟39 +/- 4次）；P < 0.01。心力衰竭患者的RR间期LF分量和MSNA变异性较对照组低（P < 0.01）。在心力衰竭中，至少部分地保留了RR间期和MSNA的HF变异性。RR间隔的变异模式与MSNA之间有密切的一致性。14例无MSNA变异性心衰患者与7例有MSNA变异性心衰患者相比，RR间期更短，RR间期方差更小，MSNA更高，呼吸速率更快，左室射血分数更低（均P < 0.05）。在中位随访12个月时，4例心力衰竭患者死亡，所有患者在MSNA和RR间期均无LF振荡。结论：重度心力衰竭患者交感神经活动不存在LF变异性。这种扰动型变异性与RR区间异常变异性密切相关。自主神经流出节律振荡的干扰，在RR间期和MSNA中都很明显，表明心力衰竭中存在中枢自主神经调节障碍，并可能具有重要的预后意义。
BACKGROUND In normal humans, variability of blood pressure, RR interval, and sympathetic activity occurs predominantly at a low frequency (LF; 0.04 to 0.14 Hz) and a high frequency (HF; +/-0.25 Hz). In conditions that increase sympathetic activation in normal humans, the LF component is increased relative to the HF component. Patients with heart failure have high levels of sympathetic activity. We tested the hypothesis that the LF component of sympathetic nerve activity variability is increased in heart failure. METHODS AND RESULTS We performed spectral analysis of simultaneous recordings of resting muscle sympathetic nerve activity (MSNA) and RR interval in 21 patients with chronic heart failure and 12 age-matched control subjects. MSNA was higher in patients with heart failure (62 +/- 4 bursts per minute) than in the normal subjects (39 +/- 4 bursts per minute; P < .01). LF components of RR interval and MSNA variability were lower in the heart failure patients versus the control subjects (P < .01). HF variability of RR interval and MSNA was preserved, at least in part, in heart failure. There was close coherence between variability patterns of RR interval and MSNA. Furthermore, in 14 heart failure patients who had no LF variability in MSNA compared with 7 heart failure patients who did manifest LF variability in MSNA, RR interval was shorter, the variance of RR interval was lower, MSNA was higher, respiratory rate was faster, and left ventricular ejection fraction was lower (all P < .05). At a median follow-up of 12 months, 4 heart failure patients had died, all of whom had had absent LF oscillations in MSNA and RR interval. CONCLUSIONS The LF variability of sympathetic nerve activity is absent in patients with severe heart failure. This disturbed pattern of variability is closely coherent with the abnormal variability of RR interval. These disturbances of rhythmic oscillations of autonomic outflow, evident in both RR interval and MSNA, suggest a central autonomic regulatory impairment in heart failure and may have important prognostic implications.