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Cardiac and peripheral autonomic control in restrictive cardiomyopathy

机译：限制性心肌病的心脏和外周自主神经控制

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Abstract Aims Autonomic dysfunction determines the advance of dilated cardiomyopathy (DCM) and is related to poor outcomes. However, this autonomic imbalance is unknown in patients with restrictive cardiomyopathy (RCM) even though they have similar symptoms and poor quality of life as DCM patients have. The aim of this study was to evaluate if autonomic and neurovascular controls were altered in RCM patients. Methods and results Fifteen RCM patients, 10 DCM patients, and 10 healthy subjects were evaluated. Heart rate and blood pressure (BP) were recorded. Peripheral sympathetic activity [muscle sympathetic nerve activity (MSNA)] by microneurography and cardiac sympathetic activity by power spectrum analysis of heart rate variability. Spontaneous baroreflex sensitivity (BRS) was evaluated by the sequence method and forearm blood flow by venous occlusion plethysmography. Both cardiomyopathy groups had higher MSNA frequency ( P < 0.001) and MSNA incidence ( P < 0.001), higher cardiac sympathovagal balance ( P < 0.02), reduced BRS for increase ( P = 0.002) and for decrease in BP ( P = 0.002), and lower forearm blood flow ( P < 0.001) compared with healthy subjects. We found an inverse correlation between BRS for increase and decrease in BP and peripheral sympathetic activity ( r = ?￠????0.609, P = 0.001 and r = ?￠????0.648, P < 0.001, respectively) and between BRS for increase and decrease in BP and cardiac sympathetic activity ( r = ?￠????0.503, P = 0.03 and r = ?￠????0.487, P = 0.04, respectively). Conclusions The RCM patients had cardiac and peripheral autonomic dysfunctions associated with peripheral vasoconstriction. Nonetheless, the presence of normal ejection fraction underestimates the evolution of the disease and makes clinical treatment difficult. These alterations could lead to a similar cardiovascular risk as that observed in DCM patients.
机译：摘要目的自主神经功能障碍决定了扩张型心肌病（DCM）的进展，并与不良预后相关。但是，即使局限性心肌病（RCM）患者的症状和生活质量与DCM患者相似，但这种自主神经失调仍是未知的。这项研究的目的是评估RCM患者的自主神经血管控制是否发生改变。方法和结果对15例RCM患者，10例DCM患者和10例健康受试者进行了评估。记录心率和血压（BP）。通过微神经造影检查进行周围交感活动[肌肉交感神经活动（MSNA）]，通过心率变异性的功率谱分析对心脏进行交感活动。通过测序方法评估自发性压力反射敏感性（BRS），并通过静脉阻塞体积描记法评估前臂血流。两组心肌病均具有较高的MSNA频率（P <0.001）和MSNA发生率（P <0.001），较高的心脏交感神经平衡（P <0.02），BRS降低以增加（P = 0.002）和BP降低（P = 0.002） ，与健康受试者相比，前臂的血流更低（P <0.001）。我们发现BRS与BP的升高和降低和周围交感神经活动之间呈负相关（r =≥0.609，P = 0.001和r =≥0.648，P <0.001），并且BRS用于增加和减少血压和心脏交感神经活动（r分别为r = 0.503，P = 0.03和r =Δ0.487，P = 0.04）。结论RCM患者伴有心脏和周围植物自主神经功能障碍，并伴有周围血管收缩。然而，正常射血分数的存在低估了疾病的发展，并使得临床治疗困难。这些改变可能导致与DCM患者相似的心血管风险。

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