Assessing baroreflex gain from spontaneous variability in conscious dogs: role of causality and respiration

Baroreflex sensitivity assessment and heart rate variability: relation to maneuver and technique

In the present study, we examined two baroreflex sensitivity (BRS) issues that remain uncertain: the differences among diverse BRS assessment techniques and the association between BRS and vagal outflow. Accordingly, the electrocardiogram and non-invasive arterial pressure were recorded in 27 healthy subjects, during supine with and without controlled breathing, standing, exercise, and recovery conditions. Vagal outflow was estimated by heart rate variability indexes, whereas BRS was computed by alpha-coefficient, transfer function, complex demodulation in low- and high-frequency bands, and by sequence technique. Our results indicated that only supine maneuvers showed significantly greater BRS values over the high frequency than in the low-frequency band. For maneuvers at the same frequency region, supine conditions presented a larger number of significant differences among techniques. The plots between BRS and vagal measures depicted a funnel-shaped relationship with significant log-log correlations (r=0.880-0.958). Very short latencies between systolic pressure and RR interval series in high-frequency band and strong log-log correlations between frequency bands were found. Higher variability among different baroreflex measurements was associated with higher level of vagal outflow. Methodological assumptions for each technique seem affected by non-baroreflex variation sources, and a modified responsiveness of vagal motoneurons due to distinct stimulation levels for each maneuver was suggested. Thus, highest vagal outflows corresponded to greatest BRS values, with maximum respiratory effect for the high-frequency band values. In conclusion, BRS values and differences across the tested techniques were strongly related to the vagal outflow induced by the maneuvers.

System identification: a multi-signal approach for probing neural cardiovascular regulation

Short-term, beat-to-beat cardiovascular variability reflects the dynamic interplay between ongoing perturbations to the circulation and the compensatory response of neurally mediated regulatory mechanisms. This physiologic information may be deciphered from the subtle, beat-to-beat variations by using digital signal processing techniques. While single signal analysis techniques (e.g., power spectral analysis) may be employed to quantify the variability itself, the multi-signal approach of system identification permits the dynamic characterization of the neural regulatory mechanisms responsible for coupling the variability between signals. In this review, we provide an overview of applications of system identification to beat-to-beat variability for the quantitative characterization of cardiovascular regulatory mechanisms. After briefly summarizing the history of the field and basic principles, we take a didactic approach to describe the practice of system identification in the context of probing neural cardiovascular regulation. We then review studies in the literature over the past two decades that have applied system identification for characterizing the dynamical properties of the sinoatrial node, respiratory sinus arrhythmia, and the baroreflex control of sympathetic nerve activity, heart rate and total peripheral resistance. Based on this literature review, we conclude by advocating specific methods of practice and that future research should focus on nonlinear and time-varying behaviors, validation of identification methods, and less understood neural regulatory mechanisms. Ultimately, we hope that this review stimulates such future investigations by both new and experienced system identification researchers.

Exploring directionality in spontaneous heart period and systolic pressure variability interactions in humans: implications in the evaluation of baroreflex gain

Although in physiological conditions RR interval and systolic arterial pressure (SAP) are likely to interact in a closed loop, the traditional cross-spectral analysis cannot distinguish feedback (FB) from feedforward (FF) influences. In this study, a causal approach was applied for calculating the coherence from SAP to RR (K(s-r)) and from RR to SAP (K(r-s)) and the gain and phase of the baroreflex transfer function. The method was applied, compared with the noncausal one, to RR and SAP series taken from 15 healthy young subjects in the supine position and after passive head-up tilt. For the low frequency (0.04-0.15 Hz) spectral component, the enhanced FF coupling (K(r-s) = 0.59 +/- 0.21, significant in 14 subjects) and the blunted FB coupling (K(s-r) = 0.17 +/- 0.17, significant in 4 subjects) found at rest indicated the prevalence of nonbaroreflex mechanisms. The tilt maneuver recovered FB influences (K(s-r) = 0.47 +/- 0.16, significant in 14 subjects), which were stronger than FF interactions (K(s-r) = 0.34 +/- 0.19, significant in 9 subjects). At the respiratory frequency, the RR-SAP regulation was balanced at rest (K(s-r) = 0.30 +/- 0.18 and K(r-s) = 0.29 +/- 0.20, significant in 11 and 8 subjects) and shifted toward FB mechanisms after tilt (K(s-r) = 0.35 +/- 0.19 and K(r-s) = 0.19 +/- 0.11, significant in 14 and 8 subjects). The causal baroreflex gain estimates were always lower than the corresponding noncausal values and decreased significantly from rest to tilt in both frequency bands. The tilt-induced increase of the phase lag from SAP to RR suggested a shift from vagal to sympathetic modulation. Thus the importance of nonbaroreflex interactions pointed out the necessity of accounting for causality in the cross-spectral analysis of the interactions between cardiovascular variables in healthy humans.

Oncogenic and activated wild-type ras-p21 proteins induce different isoforms of protein kinase C in mitogenic signal transduction

We have previously found that the protein kinase C (PKC) inhibitor, CGP 41 251, blocks oncogenic ras-p21 protein- and beta-PKC-induced oocyte maturation, but only weakly inhibits insulin-induced oocyte maturation (which requires activation of wild-type endogenous ras-p21). Because the dose-response curves for inhibition of oncogenic p21- and beta-PKC-induced oocyte maturation by CGP 41 251 superimpose and because the ras-p21-inactivating antibody, Y13-259, does not inhibit beta-PKC-induced oocyte maturation, we concluded that the oncogenic, but not wild-type, protein requires beta-PKC as a downstream target. Because multiple isoforms of PKC exist and several of these, such as epsilon-PKC, have been found to be important on ras signal transduction pathways, we have investigated which PKC isoforms are critical to each ras protein. For this purpose, we used PKC-isoform-specific inhibitors, which have been shown to inhibit selectively the function and translocation of PKC isoforms in vitro and in vivo. Specifically, the peptides KLFIMN, QEVIRN, and EAVSLKPT each inhibit beta-1, beta-2, and epsilon-PKC, respectively, but do not cross-inhibit other PKC isoforms. We find that the epsilon-PKC inhibitory peptide strongly blocks insulin- but not oncogenic ras-p21-induced oocyte maturation whereas the beta-2 inhibitory peptide more strongly inhibits oncogenic ras-p21-induced oocyte maturation, corroborating our previous studies. The beta-1 inhibitory peptide has little effect on either protein. We conclude that selective inhibition of individual PKC isoforms permits the distinction between signal transduction initiated by oncogenic and activated wild-type p21 proteins and implicate different specific PKC isoforms in mitogenic signal transduction by each of these proteins. The ability to dissect the role of individual PKC isozymes in this regulation is of therapeutic significance.

Comparison of various techniques used to estimate spontaneous baroreflex sensitivity (the EuroBaVar study)

This study compared spontaneous baroreflex sensitivity (BRS) estimates obtained from an identical set of data by 11 European centers using different methods and procedures. Noninvasive blood pressure (BP) and ECG recordings were obtained in 21 subjects, including 2 subjects with established baroreflex failure. Twenty-one estimates of BRS were obtained by methods including the two main techniques of BRS estimates, i.e., the spectral analysis (11 procedures) and the sequence method (7 procedures) but also one trigonometric regressive spectral analysis method (TRS), one exogenous model with autoregressive input method (X-AR), and one Z method. With subjects in a supine position, BRS estimates obtained with calculations of alpha-coefficient or gain of the transfer function in both the low-frequency band or high-frequency band, TRS, and sequence methods gave strongly related results. Conversely, weighted gain, X-AR, and Z exhibited lower agreement with all the other techniques. In addition, the use of mean BP instead of systolic BP in the sequence method decreased the relationships with the other estimates. Some procedures were unable to provide results when BRS estimates were expected to be very low in data sets (in patients with established baroreflex failure). The failure to provide BRS values was due to setting of algorithmic parameters too strictly. The discrepancies between procedures show that the choice of parameters and data handling should be considered before BRS estimation. These data are available on the web site (http://www.cbi.polimi.it/glossary/eurobavar.html) to allow the comparison of new techniques with this set of results.

Non-invasive model-based estimation of the sinus node dynamic properties from spontaneous cardiovascular variability series

A non-invasive model-based approach to the estimation of sinus node dynamic properties is proposed. The model exploits the spontaneous beat-to-beat variability of heart period and systolic arterial pressure and the sampled respiration, thus surrogating the information from direct measures of neural activity. The residual heart period variability not related to baroreflex, to direct effects of respiration and to low frequency influences independent of baroreflex, is interpreted as the effect of the dynamic properties of the sinus node and modelled as a regression of the RR interval over its previous value. Therefore the sinus node transfer function is modelled by means of a filter with a real pole z = mu (and a zero in the origin). It was found that: first, in young healthy subjects the nodal tissue responded as a low-pass filter with mu = 0.76 +/- 0.12 (mean +/- SD); secondly, ageing did not significantly modify either its shape or gain at 0 Hz; thirdly, in heart transplant recipients, the dynamic transduction properties were lost (all-pass filter, p = 0.06 +/- 0.16, p < 0.001); fourthly, low-dose atropine left the sinus node dynamic properties unmodified; fifthly, high-dose atropine affected the dynamic transduction properties by increasing the gain at 0 Hz and rendering steeper its roll-off (the percent increase of mu with respect to baseline was 18.3 +/- 22.3, p < 0.05).

Arterial baroreflex function and cardiovascular variability: interactions and implications

The arterial baroreflex contributes importantly to the short-term regulation of blood pressure and cardiovascular variability. A number of factors (including reflex, humoral, behavioral, and environmental) may influence gain and effectiveness of the baroreflex, as well as cardiovascular variability. Many central neural structures are also involved in the regulation of the cardiovascular system and contribute to the integrity of the baroreflex. Consequently, brain injuries or ischemia may induce baroreflex impairment and deranged cardiovascular variability. Baroreflex dysfunction and deranged cardiovascular variability are also common findings in cardiovascular disease. A blunted baroreflex gain and impaired heart rate variability are predictive of poor outcome in patients with heart failure and myocardial infarction and may represent an early index of autonomic activation in left ventricular dysfunction. The mechanisms mediating these relationships are not well understood and may in part be the result of cardiac structural changes and/or altered central neural processing of baroreflex signals.

Noninvasive quantification of respiratory modulation on left ventricular size and stroke volume

To noninvasively explore the complex interactions between heart rate, left ventricular (LV) stroke volume (SV) and respiration, different techniques were proposed and applied to the beat-to-beat measurements of end-diastolic (ED), end-systolic (ES) volumes and SV, obtained from echocardiographic acoustic quantification LV volume signal. Data were obtained from eight patients with dilated cardiomyopathy (DCM, age 60 +/- 2, mean +/- SE), and from 11 age-matched healthy volunteers (N, age 63 +/- 2). Spectral analysis showed an increase in HF power in DCM, both in ED (in ml2, 58 +/- 18 versus 19 +/- 5 in N) and in SV (in ml2, 55 +/- 12 versus 17 +/- 5 in N), together with an increase in total power (in ml2, ED: 119 +/- 31 in DCM versus 48 +/- 9 in N; SV: 88 +/- 17 in DCM versus 31 +/- 8 in N). Folded scattergrams evidenced higher amplitude oscillations in DCM (in ml, ES: 7.93 +/- 1.29; ED: 7.94 +/- 1.59; SV: 7.27 +/- 0.91) compared to N (in ml, ES: 4.08 +/- 0.64; ED: 3.56 +/- 0.65; SV: 3.63 +/- 0.43). Moreover, the prevalent effect of increased afterload generating SV reduction during inspiration was pointed out in N, while an intersubject dispersion in the relation between respiratory phase and LV dimension changes was found in DCM. Black-box model identification summarized these mechanisms by means of a few quantitative parameters.

Hypertension-related hypoalgesia, autonomic function and spontaneous baroreflex sensitivity

OBJECTIVE

The mechanisms involved in the relationship between pain perception and hypertension are poorly understood. This study has sought to investigate whether the spontaneous baroreflex sensitivity and the autonomic nervous system balance are related to hypertension-associated hypoalgesia.

METHODS

In the morning, 73 untreated male subjects (45 hypertensives, 28 normotensives) were submitted to a simultaneous recording of electrocardiographic and blood pressure signals in resting condition. The tracings were analysed off-line to evaluate the spectral components of the low frequency (LF) and high frequency (HF) powers (autoregressive algorithm; LF/HF ratio used in subsequent analysis as an index of sympathovagal balance), and the alphaLF (alphaLF), an index of baroreflex sensitivity. After the rest period, the subjects underwent dental pain perception evaluation (pulpar tester: test current increasing from 0 to 0.03 mA, expressed in relative Units) to determine the dental pain threshold and tolerance. Afterwards, a 24-h ambulatory blood pressure monitoring was performed.

RESULTS

A significant relationship was observed between alphaLF and pain threshold (r = -0.34; p = 0.003). When a multivariate analysis was computed to control for age, 24-h systolic pressure and LF/HF ratio, alphaLF was a predictive independent factor associated with pain threshold (model p = 0.019; r = -0.31; p = 0.025). Moreover, the 24-h systolic pressure was independently associated with pain threshold (model p = 0.019; r = 0.30, p = 0.031). The relationship between alphaLF and relative tolerance was not statistically significant. When the association between the LF/HF ratio and pain sensitivity was assessed as a secondary endpoint, no significant relationship was observed. Since no significant interaction was found, the effect of alphaLF and LF/HF ratio on pain perception was assumed to be similar in normotensive and hypertensive subjects.

CONCLUSIONS

The relationship found between unstimulated baroreflex sensitivity and pain threshold suggests a modulation of pain perception by baroreflex pathways in hypertension-associated hypoalgesia. In a baseline condition, the autonomic nervous system balance does not seem to influence pain sensitivity.

Effects of cardiac rehabilitation and exercise training on autonomic regulation in patients with coronary artery disease

BACKGROUND

Although cardiovascular rehabilitation and exercise training have substantial benefits in various ischemic heart disease (IHD) risk factors and subsequent prognosis after major IHD events, there is a paucity of information about its effects on autonomic regulation (such as heart rate variability [HRV] and baroreflex gain), particularly considering its arterial and cardiopulmonary components.

METHODS

We studied 40 patients (aged 60 +/- 6 y) after major IHD events, including 29 who underwent a comprehensive phase II cardiac rehabilitation and exercise training program and 11 controls who did not attend cardiac rehabilitation. Specifically, we determined whether active training improves prognostic indices of autonomic regulation of the SA node and whether changes in baroreflex gain could be ascribed to the arterial or to the cardiopulmonary component of the overall arterial pressure/heart period baroreflex.

RESULTS

Only patients with IHD undergoing active rehabilitation demonstrated a significant increase in R-R interval, in its variance, in overall gain of arterial pressure/heart period baroreflex (7.44 +/- 1.20 ms/mm Hg to 12.12 +/- 1.48 ms/mm Hg, P <.001) and in peak oxygen consumption (Delta = 2.45 mL/kg/min, P <.001). Separate examination of the selective arterial and cardiopulmonary components showed that only the latter increased significantly (6.17 +/- 1.09 ms/mm Hg to 10.62 +/- 1.56 ms/mm Hg; P <.01).

CONCLUSIONS

Cardiac rehabilitation is associated with significant improvements in autonomic markers of neural regulation of the SA node, such as increases in R-R variance and the gain of the overall spontaneous baroreflex, with specific improvements in the cardiopulmonary component as opposed to the arterial baroreflex component of this system. These improvements may further explain the reduction in morbidity and mortality noted after formal cardiac rehabilitation and exercise training programs.

Sequential modulation of cardiac autonomic control induced by cardiopulmonary and arterial baroreflex mechanisms

BACKGROUND

Nonhypotensive lower body negative pressure (LBNP) induces a reflex increase in forearm vascular resistance and muscle sympathetic neural discharge without affecting mean heart rate. We tested the hypothesis that a reflex change of the autonomic modulation of heartbeat might arise during low intensity LBNP without changes of mean heart rate.

METHODS AND RESULTS

Ten healthy volunteers underwent plasma catecholamine evaluation and a continuous recording of ECG, finger blood pressure, respiratory activity, and central venous pressure (CVP) during increasing levels of LBNP up to -40 mm Hg. Spectrum and cross-spectrum analyses assessed the changes in the spontaneous variability of R-R interval, respiration, systolic arterial pressure (SAP), and CVP and in the gain (alpha(LF)) of arterial baroreflex control of heart rate. Baroreceptor sensitivity was also evaluated by the SAP/R-R spontaneous sequences technique. LBNP began decreasing significantly: CVP at -10, R-R interval at -20, SAP at -40, and the indexes alpha(LF) and baroreceptor sensitivity at -30 and -20 mm Hg, compared with baseline conditions. Plasma norepinephrine increased significantly at -20 mm Hg. The normalized low-frequency component of R-R variability (LF(R-R)) progressively increased and was significantly higher than in the control condition at -15 mm Hg.

CONCLUSIONS

Nonhypotensive LBNP elicits a reflex increase of cardiac sympathetic modulation, as evaluated by LF(R-R), which precedes the changes in the hemodynamics and in the indexes of arterial baroreflex control.