Disfungsi Autonom pada Pasien Penyakit Jantung Hipertensi Asimptomatik: Hasil Evaluasi Pemulihan Laju Jantung
AbstractBackground.Imbalance of the autonomic nervous system has been known to have an important role in the pathophysiology of chronic heart failure (CHF). How early this imbalance occurs in CHF patients has not much been studied. We hypothesized that imbalance of the autonomic function evaluated with heart rate recovery (HRR) already occur in asymptomatic hypertensive patients with left ventricular hypertrophy (LVH) as subset of an early stage of CHF patients .
Methods.Sixty two hypertensive patients (31 with LVH by echocardio-graphic criteria and 31 patients without LVH ) underwent treadmill exercise testing using the Bruce protocol and immediate supine on the recovery phase. Heart rate recovery was evaluated on minute 1 and 2 of the recov-ery phase and considered abnormal if = 18x/min in minute-1(HRR1) and = 42x/min in minute-2 (HRR2).
Results.The mean HRR was significantly lower in hypertensive patients with LVH then the ones without LVH (19,48 ± 7,21 vs 26,45 ± 8,03) in minute-1, and (38,35 ± 11,19 vs 45,35 ± 9,97) in minute-2. An abnormal-ity in HRR1 percentage was found in 48.4% in patients with HHD and in 12.9% in patients without HHD. An inverse weak correlation (r = 0.329, p = 0.009) was found between LV mass index and HRR1.
Conclusions.Abnormality of the HRR has already been found in hyper-tensive patients with LVH without signs or symptom of CHF suggesting an early occurrence of imbalance of the autonomic nervous system in early stage of CHF.
Sani A. Seluk beluk gagal jantung kongestif. Paper presented at: Heart Failure Symposium 15-16 Maret 2008, 2008; Jakarta.
ACC/AHA Guidelines for the evaluation and management of chronic heart failure in the adult: executive summarry. Journal of American College of Cardiology. 2001;38(7):2102-2107.
Jankowska E, Ponikowski P, Piepoli M, Banasiak W, Anker S, Poole-Wilson P. Autonomic imbalance and immune activation in chronic heart failure-patophysiological links. Cardiovascular Research. 2006;70:434-445.
Tjeerdsma G, Szabo B, Wijk Lv, Brouwer J, Tio R, Crijns H. Autonomic dysfuction in patients with mild heart failure and coronary artery disease and the effects of add-on B-blockade. European Journal of Heart Failure. 2001;3:33-39.
Folino A, Tokajuk B, Porta A, Romano S, Cerutti S, Dalla V. Autonomic modilation and clinical outcome in patients with chronic heart failure. International Journal of Cardiology. 2005;100:247-251.
Shehab A, MacFadyen R, McLaren M, Tavendale R, Belch J, Struthers A. Sudden unexpected death in heart failure may be proceeded by short term, intraindividual increase in inflamation and in autonomic dysfuction:a pilot study. Heart 2004;90:1263-1268.
Curtis B, O’Keefe J. Autonomic tone as a cardiovascular risk factor: The danger of chronic fight or flight. Mayo Clin Proc. 2002;77:45-54.
Froelicher V, Myers J, eds. Manual of exercise testing 3ed. Philadelphia: Mosby, Elsevier; 2007.
Arena R, Guazzi M, Myers J, Peberdy M. Prognostic value of heart rate recovery in patients with heart failure. American Heart Journal. 2006;151:851 e857-851 e813.
Lima R, Lorenzo AD, Soares A. Relation between postexercise abnormal heart rate recovery and myocardial damage evidenced by gated single-photo emission computed tomography. American Journal of Cardiology. 2006;97:1452-1454.
Alter P, Grimm W, Vollrath A, Czzerny F, Maisch B. Heart rate variability in patients with cardiac hypertophy-ralation to left ventricular mass and etiology. American Heart Journal. 2006;151:829-836.
Abraham W. The new standard of therapy for mild heart failure. Archive of Internal Medicine. 2000;160:1237-1247.
Anderson B, ed. Echocardiography: The Normal Examination and Echocardiographic Measurement. Brisbane: MGA Graphics; 2002: 110-113; No. 110-113.
Shetler K, Marcus R, Froelicher V, Vora S, Kalisetti D, Prakash M, Do D, Myers J. Heart rate recovery: validation and metodologic issues. Journal of American Collage of Cardiology. 2001;38:1980-1987.
Freeman J, Dewey F, Hadley D, Myers J, Froelicher V. Autonomic nervous system interaction with the cardiovascular system during exercise. Progress in Cardiovascular Diseases. 2006;48(5):32-36.
Watanabe J, Thamilarasan M, Blackstone E, Thomas J, Lauer M. Heart rate recovery immidiately after treadmill exercise and left ventricular systolic dysfunction as predictors of mortality.The case of stress echocardiography. Circulation. 2001;104:1911-1916.
Cole C, Blackstone E, Pashkow F, Snader C, Lauer M. Heart rate recovery immediately after exercise as a predictor of mortality. New England Journal of Medicine. 1999;341:1351-1357.
Nishime E, Cole C, Blackstone E, Pashkow F, Lauer M. Heart rate recovery and treadmill exercise score as predictors of mortality in patients reffered for exercise ECG. JAMA. 2000;284:1392-1398.
Buchheit M, Papelier Y, Laursen P, Ahmaidi S. Noninvasive assessment of cardiac parasympathetic function: postexercise heart rate recovery or heart rate variability. Am J Physiol Heart Circ Physiol. 2007;293:H8-H10.
Fortuno M, Gonzales A, Ravassa S, Lopez B, Diez J. Clinical implications of apoptosis in hypertensive heart disease. Am J Physiol Heart Circ Physiol. 2003;284:H1495-H1506.
Borlaug B, Melenovsky V, Russell S, Kessler K, Pacak K, Becker L, Kass D. Impaired chronotropic and vasodilator reserves limit exercise capacity in patients with heart failure and a preserved ejection fraction. Circulation. 2006;114:2138-2147.
Gonzales A, Fortuno M, Querejeta R, Ravassa S, Lopez B, Lopez N, Diez J. Caardiomyocyte apoptosis in hypertensive cardiomyopathy. Cardiovascular Research. 2003;59:549-562.
Javorka M, Zila I, Balharek T, Javorka K. Heart rate recovery after exercise: relation to heart rate variability and complexity. Brazilian Journal of Medicine and Biological Research. 2002;35(8):991-1000.
Imai K, Sato H, Hori M, Kusuoka H, Ozaki H, Yokoyama H, Takeda H, Inoue M, Kamada T. Vagally mediated heart rate recovery after exercise is accelerated in athletes but blunted in patients with chronic heart failure. Journal of American College of Cardiology. 1994;24:1529-1535.
Schlaich MP, Kaye DM, Lambert E, Sommerville M, Socratous F, Esler MD. Relation Between Cardiac Sympathetic Activity and Hypertensive Left Venticular Hypertrophy. Circulation. 2003;108(560-565).
PDF (Bahasa Indonesia) downloads: 5
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).