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

Objective: To review our studies of the ease and importance of Parasympathetic and Sympathetic (P&S) measures in managing cardiovascular patients. Background: The autonomic nervous system is responsible for the development or progression of Hypertension (HTN), orthostasis, Coronary Disease (CAD), Congestive Heart Failure (CHF) and arrhythmias. Finally, new technology provides us with rapid, accurate P and S measures critically needed to manage these patients much more successfully. Methods: Using the ANX 3.0 autonomic monitor, P&S activity was recorded in 4 studies: 163 heart failure patients in total, mean follow-up (f/u) 12-24.5 months; 109 orthostasis patients, f/u 2.28 years and 483 patients with risk factors or known HTN, CAD or CHF, f/u 4.92 yrs. All were on guideline-driven therapy. Results: 59% of CHF patients had dangerously high Sympathovagal Balance (SB) or Cardiac Autonomic Neuropathy (CAN) and Ranolazine markedly improved 90% of these, improved left ventricular ejection fraction in 70% of patients on average 11.3 units, and reduced Major Adverse Cardiac Event (MACE) [Acute Coronary Syndromes (ACS), death, acute CHF, Ventricular Tachycardia/Ventricular Fibrillation (VT/VF)] 40%. 66% of orthostatic patients corrected with (r) Alpha Lipoic Acid ([r]ALA); non-responders had the lowest S-tone. In the 483 patient study, SB>2.5 best predicted MACE when compared to nuclear stress and echocardiography (sensitivity 0.59 or 7.03 [CI (Confidence Interval) 4.59-10.78], specificity 0.83, positive predictive value 0.64 and negative predictive value 0.80). Conclusion: Parasympathetic and sympathetic measures significantly improve care of cardiovascular patients.