自律神経系と突然の心臓発作による死. 発作後の心筋梗塞リスクの階層化に関する実験的根拠と臨床観察
P J Schwartz1, M T La Rovere, E Vanoli
1Dipartimento di Medicina, Università di Pavia, Italy.
Circulation
|January 1, 1992
まとめ
心拍数変動などの自律的制御マーカーの評価は,心筋梗塞後に突然の心臓死のリスクが高い患者を特定することができます. ヴァガスの活動は保護的であり,交感性の活性化は致命的な心律不整を誘発する可能性があります.
科学分野:
- 心臓病学 心臓病学
- 自律神経系の研究
- 心臓電気生理学 心臓電気生理学
背景:
- 自律神経系の不均衡は,心筋梗塞後の突然心臓死に関連しています.
- 交感性活性化により悪性不律が急激に発生し,陰道活性化により保護が提供されます.
- シンパト - ヴァガル相互作用を理解することは,心房細動のリスクを予測するために重要である.
研究 の 目的:
- 心筋梗塞後の高リスク患者を特定するために,自律的な制御の間接的なマーカーを調査する.
- 静脈動や生存などのアウトカムの決定における静脈動活動と交感性活性化の役割を調査する.
- 急性心臓死におけるバロレフレクスの感度と心拍の変動の予測値を評価する.
主な方法:
- 犬や猫の実験モデルでは,心筋小動脈不全時の自律的反応を分析した.
- 直接の神経記録と電気刺激により,管活動の役割が評価されました.
- 展望的な臨床試験では,心拍数の変動性と心筋梗塞後の患者におけるバロレフレクスの感受性を調査した.
- 現在進行中のATRAMI研究では,これらのマーカーを1200人の患者で評価する予定です.
主要な成果:
- 抑うつ反射クロノトロピック反応と心拍数変動の低下は,不律症のリスクが高い犬を特定しました.
- イシュケミア中の強烈な反射的ヴァガル活性化は,猫における心房細動からの保護と関連していた.
- 発心筋梗塞後の患者におけるバロレフレクスの感度低下または心拍数変動は,より高い心疾患による死亡率と相関しています.
結論:
- バロレフレクスの感度や心拍の変動など,心動脈の活動マーカーは,心筋梗塞後のリスクの階層化において有望であることが示されています.
- 大規模なATRAMI展望研究において,さらなる検証が進行中です.
- これらの発見は,突然の心臓死のリスクのある患者の特定を向上させる可能性がある.
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