| Title: | CLINICAL APPLICATION OF BRS (BAROREFLEX SENSITIVITY) FOR RISK STRATIFICATION OF SUDDEN CARDIAC DEATH AND CHF |
| DOI No: | 10.1142/9789812702234_0052 |
| Source: | ADVANCES IN ELECTROCARDIOLOGY 2004 (pp 192-198)
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| Author(s): | RYUJI NOHARA
Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Osaka, Japan
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| Abstract: | BRS is applicable to estimate cardiac parasympathetic nerve function. It is reported that sympathetic nerve augmentation is due to decreased function of BRS in patients with congestive heart failure, and that angiotensin II or NO is closely related to this abnormality. In international ATRAMI study, it was reported that sudden cardiac death was closely related to low value of BRS after myocardial infarction. Subanalysis of this study also showed patency of infarct artery modified the BRS, and that BRS and non-sustained VT were the good marker to estimate cardiac events and select treatment including ICD. Subanalysis of the Japanese patients enrolled in ATRAMI also showed that BRS less than 3.5 revealed high cardiac death rate in 3 years (3/21=14.3%) compared to those more than 3.5 (1/87=1.1%), suggesting BRS being the good prognostic marker in Japan too. Our recent study showed that normal BRS was the good marker of event free prognosis as well as BNP, and combination of BNP and BRS contributed much more for CHF patients. BRS is determined by several factors including carotid arterial sclerosis. Our study revealed that poor pWV using carotid artery related to the worsening of BRS with non-linear manner, suggesting some threshold of arterial stiffness in the worsening of BRS. Smoking habit in the young is reported to be the risk factors of cardiac events. We investigated the smoking cessation and re-smoking in relation to BRS and sympathetic nerve function. Only one week cessation of smoking significantly improved both BRS and resultant sympathetic nerve function. It strongly suggests the smoking habit of the young partly contributes to the cardiac events including sudden cardiac death. Thus, quantitative evaluation of BRS abnormality with or without sympathetic nerve function calculated by MIBG or RR interval analysis might be the important clinical tool for both estimation of prognosis and determination of treatment strategy. |
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