Cardiac Autonomic Testing and Treating Heart Disease. “A Clinical Perspective”

Abstract

BackgroundCoronary heart disease (CHD) is a major health concern, affecting nearly half the middle-age population and responsible for nearly one-third of all deaths. Clinicians have several major responsibilities beyond diagnosing CHD, such as risk stratification of patients for major adverse cardiac events (MACE) and treating risks, as well as the patient. This second of a two-part review series discusses treating risk factors, including autonomic dysfunction, and expected outcomes.MethodsTherapies for treating cardiac mortality risks including cardiovascular autonomic neuropathy (CAN), are discussed.ResultsWhile risk factors effectively target high-risk patients, a large number of individuals who will develop complications from heart disease are not identified by current scoring systems. Many patients with heart conditions, who appear to be well-managed by traditional therapies, experience MACE. Parasympathetic and Sympathetic (P&S) function testing provides more information and has the potential to further aid doctors in individualizing and titrating therapy to minimize risk. Advanced autonomic dysfunction (AAD) and its more severe form cardiovascular autonomic neuropathy have been strongly associated with an elevated risk of cardiac mortality and are diagnosable through autonomic testing. This additional information includes patient-specific physiologic measures, such as sympathovagal balance (SB). Studies have shown that establishing and maintaining proper SB minimizes morbidity and mortality risk.ConclusionsP&S testing promotes primary prevention, treating subclinical disease states, as well as secondary prevention, thereby improving patient outcomes through (1) maintaining wellness, (2) preventing symptoms and disorder and (3) treating subclinical manifestations (autonomic dysfunction), as well as (4) disease and symptoms (autonomic neuropathy).

Endothelial and Autonomic Dysfunction at Early Stages of Glucose Intolerance and in Metabolic Syndrome

“…The results of the present study confirm the data from our previous study in a different cohort, showing a high prevalence of CAN at early stages of glucose intolerance and in the presence of MetS [27,28] and largely overlap with literature data [29][30][31]. According to Vinik classification of CAN, based on the high-sensitive ANX-3.0 method, applied in the current study, our data meet the criteria for early CAN with parasympathetic tone weakness and relative SNS hyperactivity [32], manifested by increased heart rate, which we recorded.…”

Routine Measurements of Cardiac Parasympathetic and Sympathetic Nervous Systems Assists in Primary and Secondary Risk Stratification and Management of Cardiovascular Clinic Patients

“…CAN is associated with other risk factors including:  Low ejection fraction  Poor cardiac output  Arrhythmias  Cardiomyopathies including chronic heart failure  Poor circulation, coronary artery disease with or without angina  Greater mortality and  Greater morbidity including silent myocardial infarction and early cardiac death. Often, very low P-activity (CAN) leads to the need for an implanted cardiac device [1,[31][32][33][34][35][36][37][38][39][40][41][42][43][44].…”

Cardiac Autonomic Testing and Diagnosing Heart Disease. “A Clinical Perspective”

“…Another risk factor which predisposes patients to adverse cardiac events is autonomic neuropathy, specifically cardiovascular autonomic neuropathy (CAN) ( 23 - 24 - 25 - 26 - 27 - 28 - 29 - 30 - 31 - 32 - 33 - 34 - 35 - 36 - 37 - 38 ). CAN is associated with other risk factors ( 39 ), including 1) low ejection fraction ( 25 , 26 ); 2) poor cardiac output ( 40 ); 3) arrhythmias ( 27 , 28 ); 4) cardiomyopathies ( 29 , 30 ), including chronic heart failure ( 31 ); 5) poor circulation ( 32 ), including poor cardiac circulation (angina or CAD) ( 33 ); 6) greater mortality ( 24 ) and 7) greater morbidity ( 41 ), including silent MI and early cardiac death ( 24 , 34 ). Often, very low parasympathetic activity leads to the need for cardiac intervention or an implanted cardiac device.…”

“…Subsequent studies demonstrate the association with multivariant analyses ( 58 , 60 , 61 ). Some of these researchers find that CAN is treatable with more information from P&S monitoring ( 39 , 42 ).…”