Baroreflex sensitivity: methods, mechanisms, and prognostic value.
A large bulk of data collected over the last 25 years links reflex autonomic activation during acute myocardial ischemia with risk of developing lethal arrhythmias. Specifically, evidence obtained in an experimental preparation in chronically infarcted dogs supported (he concept that sympathetic hyp...
| Publicado en: | Pacing & Clinical Electrophysiology Vol. 17; no. 3; pp. 434 - 446 |
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| Autores principales: | , |
| Formato: | Journal Article |
| Publicado: |
Wiley-Blackwell
Mar1994
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106037622&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 106037622 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 01478389 4F8 jtl: Pacing & Clinical Electrophysiology issn: 01478389 maglogo: Y pubinfo: dt: Mar1994 vid: 17 iid: 3 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 106037622 2009412989 NLM7513871 106037622 ppf: 434 ppct: 12 formats: fmt: @attributes: type: P tig: atl: Baroreflex sensitivity: methods, mechanisms, and prognostic value. aug: au: Vanoli E Adamson PB sug: ab: A large bulk of data collected over the last 25 years links reflex autonomic activation during acute myocardial ischemia with risk of developing lethal arrhythmias. Specifically, evidence obtained in an experimental preparation in chronically infarcted dogs supported (he concept that sympathetic hyperactivity enhances likelihood for ventricular tachyarrhythmias. vagal activation exerts protective effects. Based on this knowledge, it was first proposed by our group that analysis of autonomic control of heart rate could provide information relevant to risk stratification in post-myocardial infarction individuals. Among several possibilities, baroreflex sensitivity was evaluated by correlating blood pressure rise induced by bolus injections of phenylephrine with the consequent beat to beat R-R interval lengthening. Experimental studies involving direct recordings from single neural vagal fibers directed to the heart documented that baroreflex sensitivity closely reproduces cardiac vagal activity. In a large group of conscious dogs it was shown that a depressed baroreflex sensitivity was highly predictive of the risk for ventricular fibrillation during acute myocardial ischemia. The clinical prognostic value of baroreflex sensitivity has already been confirmed in pilot studies conducted by different groups of investigators. Overall, the phenylephrine test has been performed in several hundred patients with no reports of side effects. An ongoing multicenter study, the ATRAMl (Autonomic Tone and Reflexes After Myocardial Infarction) is aimed to definitively assess the predictive value of baroreflex sensitivity and heart rate variability in patients with a prior myocardial infarction, While the enrollment is still ongoing, this study has already provided an important methodological information about the possibility of using non invasive technique lo record blood pressure by means of FIN APRES. to evaluate baroreflex sensitivity. Comparison among 142 tests performed with simultaneous recording from an intraarterial line and from FINAPRES indicated a strong cor relation (r = 0.9) between the two methods. ATRAMl is expected to close the enrollment in the near future. To date, baroreflex sensitivity appears to be a safe and non-invasive test likely to provide meaningful information on autonomic balance and consequently on risk profile of patients with a prior myocardial infarction. pubtype: Academic Journal doctype: Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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