Autonomic Nervous System Testing in Cardiovascular Patients: From Research to Clinical Application

SAŽeTAK: Autonomni živčani sustav (ANS) ima ključnu ulogu u kardiovaskularnoj (KV) regulaciji kroz dinamičku interakciju svojih simpatičkih i parasimpatičkih dijelova.Disregulacija autonomne ravnoteže sve se više prepoznaje kao važan patofiziološki doprinos širokom rasponu KV poremećaja.Različite neinvazivne metode, poput varijabilnosti srčanog ritma, oporavka srčanog ritma, osjetljivosti barorefleksa, praćenja arterijskoga tlaka i testiranja nagibnim stolom, pokazale su znatnu dijagnostičku i prognostičku vrijednost u procjeni autonomne funkcije, dok komplementarni postupci poput testa aktivnoga stajanja, Valsalvina manevra i testa dubokog disanja mogu ponuditi dodatan uvid u autonomnu kontrolu, ali su i dalje nedovoljno iskorišteni u rutinskoj praksi.Unatoč rastućim dokazima koji podržavaju njihovu kliničku relevantnost, šira klinička primjena testiranja ANS-a ostaje ograničena metodološkom heterogenošću, nedostatkom jedinstvenih standarda i nedovoljnim konsenzusom o interpretaciji i kliničkim putevima odlučivanja.Ovaj članak pruža integrirani pregled uobičajeno primjenjivanih modaliteta testiranja ANS-a, sažimajući njihovu fiziološku osnovu i procjenjujući njihovu kliničku primjenjivost u kardiologiji.Osim tehnološkog napretka, uspostavljanje jedinstvenih međunarodnih smjernica, standardiziranih protokola i okvira za interpretaciju temeljenih na konsenzusu bit će ključno za osiguranje dosljednosti, poboljšanje usporedivosti između istraživanja i olakšavanje integracije testiranja ANS-a u rutinsku kardiološku praksu.Zahvaljujući takvim zajedničkim naporima procjena ANS-a ima potencijal da se razvije od istraživačkog instrumenta do komponente personalizirane KV medicine.SUMMARY: The autonomic nervous system (ANS) plays a pivotal role in cardiovascular (CV) regulation through the dynamic interplay of its sympathetic and parasympathetic divisions.Dysregulation of autonomic balance is increasingly recognized as an important pathophysiological contributor to a broad range of CV disorders.A variety of non-invasive methods, such as heart rate variability, heart rate recovery, baroreflex sensitivity, blood pressure monitoring, and tilt-table testing, have demonstrated substantial diagnostic and prognostic value in assessing autonomic function across CV disorders, while complementary procedures such as the active standing test, Valsalva maneuver, and deepbreathing test may offer additional insight on autonomic control but remain underutilized in routine cardiology.Despite growing evidence supporting their clinical relevance, the broader clinical adoption of ANS testing remains limited by methodological heterogeneity, absence of unified standards, and insufficient consensus on interpretation and clinical decision pathways.This article provides an integrated overview of commonly used ANS testing modalities, summarizing their physiological basis and evaluating their clinical applicability in cardiology.In addition to technological advances, establishing unified international guidelines, standardized protocols, and consensus-based interpretation frameworks will be crucial to ensure consistency, improve comparability between studies, and facilitate the integration of ANS testing into routine cardiological practice.Through such collaborative efforts, ANS assessment has the potential to evolve from a research instrument into a component of personalized CV medicine.