圧反射平衡線図を用いた心不全における交感神経性血圧調節の理解

抄録

The arterial baroreflex is an important negative feedback system to stabilize arterial pressure (AP). This system can be divided into neural and peripheral arc subsystems. When the neural and peripheral arcs are drawn on a pressure-sympathetic nerve activity (SNA) plane, the intersection yields a baroreflex operating point. We examined the abnormality of AP regulation in chronic heart failure (CHF) using the equilibrium diagram. The slope of the AP response to SNA in the peripheral arc became smaller in CHF. The maximum SNA suppression in the neural arc was attenuated in CHF, suggesting impaired baroreflex function. We examined the effect of chronic intermittent vagal nerve stimulation (VNS) on the baroreflex equilibrium diagram. While VNS significantly restored the magnitude of maximum SNA suppression, it did not affect the peripheral arc significantly. It is concluded that VNS improves the conditions of heart failure mainly by improving the baroreflex-mediated SNA suppression.