Cardiac autonomic testing and treating heart disease. “A clinical perspective”
Heart Int 2014; 9(2): 45 – 52
Article Type: REVIEW
OPEN ACCESS ARTICLE
Nicholas L. DePace, Joy P. Mears, Michael Yayac, Joseph Colombo
Nicholas L. DePace
438 Ganttown Rd
Ste. 8 & 9
Sewell, NJ 08080, USA
Background – Coronary 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.
Methods – Therapies for treating cardiac mortality risks including cardiovascular autonomic neuropathy (CAN), are discussed.
Results – While 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.
Conclusions – P&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).
• Accepted on 8/1/2014
• Available online on 11/19/2014
• Publishedonline on 12/23/2014
Financial support: None.
Conflict of interest: Dr. DePace, Ms. Mears, and Mr. Yayac have no conflict of interest. Dr. Colombo is Medical Director, Executive Vice President, Board Member and part owner of ANSAR Medical Technologies, Inc., Philadelphia, PA, USA, a researcher, developer, manufacturer and distributor of autonomic function testing technology.