151
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Rousselet L, Le Rolle V, Ojeda D, Guiraud D, Hagége A, Bel A, Bonnet JL, Mabo P, Carrault G, Hernández AI. Influence of Vagus Nerve Stimulation parameters on chronotropism and inotropism in heart failure. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2014:526-9. [PMID: 25570012 DOI: 10.1109/embc.2014.6943644] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Vagus Nerve Stimulation (VNS) has been shown to be useful in heart failure patients, including antiarrhythmic effects, improvement of cardiac function and reduction of the mortality. However, the optimal configuration of VNS can be a difficult task, since there are several adjustable parameters, such as current amplitude (mA), pulse width (ms), burst frequency (Hz), number of pulses and, in the case of cardiac-triggered VNS, the delay (ms) between the R-wave and the beginning of the stimulation. The objective of this paper is to analyse the effect of these parameters, and their interaction, on the chronotropic and inotropic responses to vagal stimulation. 306 VNS sequences were tested on 12 sheep with induced heart failure. Autonomic markers of the chronotropic (changes in RR interval) and inotropic (changes in dP/dtmax) effects were extracted from the observed data. In order to analyse the influence of stimulation parameters on these markers, a sensitivity analysis method was applied. Results illustrate the strong interaction between the delay and the others parameters. The number of pulses, the current and the frequency seem to be particularly influent on chronotropism and inotropism although the effect of the frequency is highly non-linear or it depends on other parameters.
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152
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Abstract
It has been known for many decades that multiple abnormalities of the autonomic nervous system (ANS) are present in heart failure (HF). Moreover, many of the effective therapies currently used to treat HF have either direct or indirect effects on the ANS. While therapies that block over-activity of the sympathetic nervous system are now standard of care, much less well studied are therapies aimed at augmenting the parasympathetic nervous system. This review will cover recent and ongoing investigations targeting modulation of the ANS, especially highlighting new and ongoing studies directed toward augmenting parasympathetic mechanisms.
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Affiliation(s)
- Mark E Dunlap
- MetroHealth Campus of Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA.
| | - Anju Bhardwaj
- MetroHealth Campus of Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA
| | - Paul J Hauptman
- Saint Louis University School of Medicine, St. Louis, MO, USA
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153
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Quintana DS, Alvares GA, Heathers JAJ. Guidelines for Reporting Articles on Psychiatry and Heart rate variability (GRAPH): recommendations to advance research communication. Transl Psychiatry 2016; 6:e803. [PMID: 27163204 PMCID: PMC5070064 DOI: 10.1038/tp.2016.73] [Citation(s) in RCA: 232] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 03/18/2016] [Accepted: 03/23/2016] [Indexed: 12/11/2022] Open
Abstract
The number of publications investigating heart rate variability (HRV) in psychiatry and the behavioral sciences has increased markedly in the last decade. In addition to the significant debates surrounding ideal methods to collect and interpret measures of HRV, standardized reporting of methodology in this field is lacking. Commonly cited recommendations were designed well before recent calls to improve research communication and reproducibility across disciplines. In an effort to standardize reporting, we propose the Guidelines for Reporting Articles on Psychiatry and Heart rate variability (GRAPH), a checklist with four domains: participant selection, interbeat interval collection, data preparation and HRV calculation. This paper provides an overview of these four domains and why their standardized reporting is necessary to suitably evaluate HRV research in psychiatry and related disciplines. Adherence to these communication guidelines will help expedite the translation of HRV research into a potential psychiatric biomarker by improving interpretation, reproducibility and future meta-analyses.
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Affiliation(s)
- D S Quintana
- Division of Mental Health and Addiction, NORMENT, KG Jebsen Centre for Psychosis Research, University of Oslo, Oslo University Hospital, Oslo, Norway,Division of Mental Health and Addiction, NORMENT, KG Jebsen Centre for Psychosis Research, University of Oslo, Oslo University Hospital, Building 49, Oslo University Hospital, Ullevål, Kirkeveien 166, PO Box 4956, Nydalen, Oslo N-0424, Norway. E-mail:
| | - G A Alvares
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia,Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, QLD, Australia
| | - J A J Heathers
- School of Psychology, University of Sydney, Sydney, NSW, Australia,Department of Cardiology and Intensive Therapy, Poznań University of Medical Sciences, Poznań, Poland
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154
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Puente de la Vega Costa K, Gómez Perez MA, Roqueta C, Fischer L. Effects on hemodynamic variables and echocardiographic parameters after a stellate ganglion block in 15 healthy volunteers. Auton Neurosci 2016; 197:46-55. [PMID: 27143533 DOI: 10.1016/j.autneu.2016.04.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 03/06/2016] [Accepted: 04/11/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND The sympathetic nervous system has an important role in generating pain. Various pathomechanisms are involved that respond well to the application of local anesthetics (LA), for example to the stellate ganglion block (SGB). OBJECTIVES We wanted to know more about the effects of SGB on cardiovascular parameters. METHODS We included 15 healthy volunteers; another 15 healthy volunteers as a control group (sham injection of LA). In order to produce a more precise SGB, we employed only a small volume of LA (3mL), a LA with a lower permeability (procaine 1%), and a modified injection technique. Systolic and diastolic blood pressure (SBP, DBP), heart rate (HR), and echocardiographic parameters were recorded before and after SGB. We also investigated whether there are side differences (left and right SBG). RESULTS At baseline all parameters were within the normal range. After performing right and left SGB DBP significantly increased (on the right side from 68.73±8.61 to 73.53±11.10, p=0.015; on the left side from 70.66±13.01 to 77.93±10.40, p=0.003). In the control group no increase in DBP was observed. No side-specific differences were found, except a significant reduction in the maximum velocity of myocardial contraction during the systole with left-sided SGB. CONCLUSIONS Even with our methods we could not prevent the simultaneous occurrence of a partial parasympatholytic effect. For this reason, the SGB has only minor hemodynamic effects, which is desirable as it enhances the safety of the SGB.
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Affiliation(s)
| | - Miquel A Gómez Perez
- Cardiology Department, Hospital del Mar, Passeig Marítim 25-29, 08003 Barcelona, Spain; Medicine Department, Faculty of Medicine, Universitat Autonoma de Barcelona, Edifici W - UD de Medicina de la Vall d'Hebron, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain.
| | - Cristina Roqueta
- Medicine Department, Faculty of Medicine, Universitat Autonoma de Barcelona, Edifici W - UD de Medicina de la Vall d'Hebron, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain.
| | - Lorenz Fischer
- Department of Neural Therapy, IKOM, University of Bern, Inselspital, PH 4, 3010 Bern, Switzerland.
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155
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Smith S, Rossignol P, Willis S, Zannad F, Mentz R, Pocock S, Bisognano J, Nadim Y, Geller N, Ruble S, Linde C. Neural modulation for hypertension and heart failure. Int J Cardiol 2016; 214:320-30. [PMID: 27085120 DOI: 10.1016/j.ijcard.2016.03.078] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 03/19/2016] [Indexed: 01/08/2023]
Abstract
Hypertension (HTN) and heart failure (HF) have a significant global impact on health, and lead to increased morbidity and mortality. Despite recent advances in pharmacologic and device therapy for these conditions, there is a need for additional treatment modalities. Patients with sub-optimally treated HTN have increased risk for stroke, renal failure and heart failure. The outcome of HF patients remains poor despite modern pharmacological therapy and with established device therapies such as CRT and ICDs. Therefore, the potential role of neuromodulation via renal denervation, baro-reflex modulation and vagal stimulation for the treatment of resistant HTN and HF is being explored. In this manuscript, we review current evidence for neuromodulation in relation to established drug and device therapies and how these therapies may be synergistic in achieving therapy goals in patients with treatment resistant HTN and heart failure. We describe lessons learned from recent neuromodulation trials and outline strategies to improve the potential for success in future trials. This review is based on discussions between scientists, clinical trialists, and regulatory representatives at the 11th annual CardioVascular Clinical Trialist Forum in Washington, DC on December 5-7, 2014.
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Affiliation(s)
- S Smith
- The Ohio State University Wexner Medical Center, Department of Internal Medicine and Division of Cardiology, Columbus, OH, USA.
| | - P Rossignol
- Inserm, CIC 1433, Centre Hospitalier Universitaire, Universite´ de Lorraine, F-CRIN INI-CRCT, Nancy, France
| | - S Willis
- The Ohio State University Wexner Medical Center, Department of Internal Medicine and Division of Cardiology, Columbus, OH, USA
| | - F Zannad
- Inserm, CIC 1433, Centre Hospitalier Universitaire, Universite´ de Lorraine, F-CRIN INI-CRCT, Nancy, France
| | - R Mentz
- Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - S Pocock
- Medical Statistics Unit LSHTM, London, UK
| | - J Bisognano
- University of Rochester Medical Center, Department of Medicine, Cardiology, Rochester, NY, USA
| | - Y Nadim
- CVRx, Inc, Minneapolis, MN, USA
| | - N Geller
- Office of Biostatistics Research, Division of Cardiovascular Sciences, NHLBI, National Institutes of Health, Bethesda, MD, USA
| | - S Ruble
- Boston Scientific CRV, St. Paul, MN, USA
| | - C Linde
- Institution of Internal Medicine, Karolinska Institutet and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
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156
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Abstract
Sympathovagal imbalance contributes to progressive worsening of heart failure (HF) and is associated with untoward clinical outcomes. Based on compelling pre-clinical studies that supported the role of autonomic modulation in HF models, a series of clinical studies were initiated using spinal cord stimulation, vagus nerve stimulation, and baroreceptor activation therapy in patients with HF with a reduced ejection fraction. Whereas the phase II studies with baroreceptor activation therapy remain encouraging, the larger clinical studies with spinal cord stimulation and vagus nerve stimulation have yielded disappointing results. Here we will focus on the pre-clinical studies that supported the role of neuromodulation in the failing heart, as well provide a critical review of the recent clinical trials that have sought to modulate autonomic tone in HF patients. This review will conclude with an analysis of some of the difficulties in translating device-based modulation of the autonomic nervous system from pre-clinical models into successful clinical trials, as well as provide suggestions for how to move the field of neuromodulation forward.
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Affiliation(s)
- Mirnela Byku
- Center for Cardiovascular Research, Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St Louis, MO 63110
| | - Douglas L Mann
- Center for Cardiovascular Research, Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St Louis, MO 63110
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157
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Abstract
Autonomic regulation therapy (ART) is a rapidly emerging therapy in the management of congestive heart failure secondary to systolic dysfunction. Modulation of the cardiac neuronal hierarchy can be achieved with bioelectronics modulation of the spinal cord, cervical vagus, baroreceptor, or renal nerve ablation. This review will discuss relevant preclinical and clinical research in ART for systolic heart failure. Understanding mechanistically what is being stimulated within the autonomic nervous system by such device-based therapy and how the system reacts to such stimuli is essential for optimizing stimulation parameters and for the future development of effective ART.
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158
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Lerman I, Hauger R, Sorkin L, Proudfoot J, Davis B, Huang A, Lam K, Simon B, Baker DG. Noninvasive Transcutaneous Vagus Nerve Stimulation Decreases Whole Blood Culture-Derived Cytokines and Chemokines: A Randomized, Blinded, Healthy Control Pilot Trial. Neuromodulation 2016; 19:283-90. [PMID: 26990318 DOI: 10.1111/ner.12398] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 11/20/2015] [Accepted: 12/17/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The purpose of this study was to test the transcutaneous noninvasive vagus nerve stimulator (nVNS) (gammaCore©) device to determine if it modulates the peripheral immune system, as has been previously published for implanted vagus nerve stimulators. MATERIALS AND METHODS A total of 20 healthy males and females were randomized to receive either nVNS or sham stimulation (SST). All subjects underwent an initial blood draw at 8:00 am, followed by stimulation with nVNS or SST at 8:30 am. Stimulation was repeated at 12:00 pm and 6:00 pm. Additional blood samples were withdrawn 90 min and 24 hour after the first stimulation session. After samples were cultured using the Myriad RBM TruCulture (Austin, TX) system (WBCx), levels of cytokines and chemokines were measured by the Luminex assay and statistical analyses within and between groups were performed using the Wilcoxon Signed Ranks Test and Mann-Whitney U with the statistical program R. RESULTS A significant percent decrease in the levels of the cytokine interleukin [IL]-1β, tumor necrosis factor [TNF] levels, and chemokine, interleukin [IL]-8 IL-8, macrophage inflammatory protein [MIP]-1α, and monocyte chemoattractant protein [MCP]-1 levels was observed in the nVNS group non-lipopolysaccharide (LPS)-stimulated whole blood culture (n-WBCx) at the 24-hour time point (p < 0.05). In SST group, there was a significant percent increase in IL-8 at 90 min post-stimulation (p < 0.05). At 90 min, the nVNS group had a greater percent decrease in IL-8 concentration (p < 0.05) compared to SST group. The nVNS group had a greater percent decrease in cytokines (TNF, IL-1β) and chemokines (MCP-1 and IL-8) at 24 hour (p < 0.05) in comparison to SST. LPS-stimulated whole blood cultures (L-WBCx) did not show a significant decrease in cytokine levels in either the nVNS or SST group across any time points. The nVNS group showed a significant percent increase in LPS-stimulated IL-10 levels at the 24-hour time point in comparison to SST. CONCLUSIONS nVNS downregulates inflammatory cytokine release suggesting that nVNS may be an effective anti-inflammatory treatment.
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Affiliation(s)
- Imanuel Lerman
- Department of Psychiatry, Center of Excellence for Stress and Mental Health, San Diego, CA, USA.,Department of Psychiatry, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Anesthesiology, University of California, San Diego, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Richard Hauger
- Department of Psychiatry, Center of Excellence for Stress and Mental Health, San Diego, CA, USA.,Department of Psychiatry, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Linda Sorkin
- Department of Anesthesiology, University of California, San Diego, San Diego, CA, USA
| | - James Proudfoot
- Department of Anesthesiology, Clinical and Translational Research Institute, University of California, San Diego, San Diego, CA, USA
| | - Bryan Davis
- Department of Anesthesiology, University of California, San Diego, San Diego, CA, USA
| | - Andy Huang
- Department of Anesthesiology, University of California, San Diego, San Diego, CA, USA
| | - Katie Lam
- Department of Anesthesiology, University of California, San Diego, San Diego, CA, USA
| | - Bruce Simon
- Electrocore Research Unit, Basking Ridge, NJ, USA
| | - Dewleen G Baker
- Department of Psychiatry, Center of Excellence for Stress and Mental Health, San Diego, CA, USA.,Department of Psychiatry, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
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159
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Li-Sha G, Jing-Lin Z, Li L, Guang-Yi C, Xiao-Wei L, Yue-Chun L. Nicotine inhibits the production of proinflammatory cytokines of mice infected with coxsackievirus B3. Life Sci 2016; 148:9-16. [PMID: 26851533 DOI: 10.1016/j.lfs.2016.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 01/21/2016] [Accepted: 02/02/2016] [Indexed: 01/07/2023]
Abstract
AIMS Although excessive sympathetic activation in viral myocarditis and the protective effects of sympathetic inhibition with β-blockers are clear, the effects of enhancing vagal tone on viral myocarditis remain unclear. In several models, vagus nerve activation with the α7 nicotinic acetylcholine receptor (α7-nAChR) agonists has been demonstrated to ameliorate inflammation. This study was therefore designed to examine the effects of cholinergic stimulation with α7-nAChR agonist nicotine in a murine model of acute viral myocarditis. MATERIALS AND METHODS BALB/C mice were infected by an intraperitoneally injection with coxsackievirus B3. Nicotine and methyllycaconitine (an α7-nAChR antagonist) were administered at doses of 0.4mg/kg and 0.8mg/kg three times per day for 7 or 14 consecutive days, respectively. The effects of nicotine and methyllycaconitine on survival rate, myocardial histopathological changes, cardiac function, cytokine levels, viral RNA, malondialdehyde, and superoxide dismutase contents were investigated. KEY FINDINGS Nicotine significantly increased survival rate of the infected mice, decreased myocardial inflammation, and improved the impairment of left ventricular function in murine coxsackievirus B3-induced myocarditis compared with methyllycaconitine. The proinflammatory cytokines TNF-α, IL-1β, IL-6 and IL-17A were significantly decreased in the infected mice treated with nicotine compared with methyllycaconitine. Nicotine had no significant anti-oxidative and antiviral effects in coxsackievirus B3-infected mice. SIGNIFICANCE The results indicate that cholinergic stimulation with nicotine significantly reduced the severity of viral myocarditis in mice. The findings suggest that alpha7 nAChR agonists may be a promising new strategy for patients with myocarditis.
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Affiliation(s)
- Ge Li-Sha
- Department of Pediatrics, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Zhao Jing-Lin
- Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Liu Li
- Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Chen Guang-Yi
- Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Li Xiao-Wei
- Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Li Yue-Chun
- Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
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160
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Wang Z, Yu L, Huang B, Wang S, Liao K, Saren G, Zhou X, Jiang H. Low-level transcutaneous electrical stimulation of the auricular branch of vagus nerve ameliorates left ventricular remodeling and dysfunction by downregulation of matrix metalloproteinase 9 and transforming growth factor β1. J Cardiovasc Pharmacol 2016; 65:342-8. [PMID: 25502306 DOI: 10.1097/fjc.0000000000000201] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Vagus nerve stimulation improves left ventricular (LV) remodeling by downregulation of matrix metalloproteinase 9 (MMP-9) and transforming growth factor β1 (TGF-β1). Our previous study found that low-level transcutaneous electrical stimulation of the auricular branch of the vagus nerve (LL-TS) could be substituted for vagus nerve stimulation to reverse cardiac remodeling. So, we hypothesize that LL-TS could ameliorate LV remodeling by regulation of MMP-9 and TGF-β1 after myocardial infarction (MI). Twenty-two beagle dogs were randomly divided into a control group (MI was induced by permanent ligation of the left coronary artery, n = 8), an LL-TS group (MI with long-term intermittent LL-TS, n = 8), and a normal group (sham ligation without stimulation, n = 6). At the end of 6 weeks follow-up, LL-TS significantly reduced LV end-systolic and end-diastolic dimensions, improved ejection fraction and ratio of early (E) to late (A) peak mitral inflow velocity. LL-TS attenuated interstitial fibrosis and collagen degradation in the noninfarcted myocardium compared with the control group. Elevated level of MMP-9 and TGF-β1 in LV tissue and peripheral plasma were diminished in the LL-TS treated dogs. LL-TS improves cardiac function and prevents cardiac remodeling in the late stages after MI by downregulation of MMP-9 and TGF-β1 expression.
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Affiliation(s)
- Zhuo Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
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161
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Goldberg A, Kusunose K, Qamruddin S, Rodriguez LL, Mazgalev TN, Griffin BP, Van Wagoner DR, Zhang Y, Popović ZB. Left Atrial Size and Function in a Canine Model of Chronic Atrial Fibrillation and Heart Failure. PLoS One 2016; 11:e0147015. [PMID: 26771573 PMCID: PMC4714887 DOI: 10.1371/journal.pone.0147015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 12/28/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Our aim was to assess how atrial fibrillation (AF) induction, chronicity, and RR interval irregularity affect left atrial (LA) function and size in the setting of underlying heart failure (HF), and to determine whether AF effects can be mitigated by vagal nerve stimulation (VNS). METHODS HF was induced by 4-weeks of rapid ventricular pacing in 24 dogs. Subsequently, AF was induced and maintained by atrial pacing at 600 bpm. Dogs were randomized into control (n = 9) and VNS (n = 15) groups. In the VNS group, atrioventricular node fat pad stimulation (310 μs, 20 Hz, 3-7 mA) was delivered continuously for 6 months. LA volume and LA strain data were calculated from bi-weekly echocardiograms. RESULTS RR intervals decreased with HF in both groups (p = 0.001), and decreased further during AF in control group (p = 0.014), with a non-significant increase in the VNS group during AF. LA size increased with HF (p<0.0001), with no additional increase during AF. LA strain decreased with HF (p = 0.025) and further decreased after induction of AF (p = 0.0001). LA strain decreased less (p = 0.001) in the VNS than in the control group. Beat-by-beat analysis showed a curvilinear increase of LA strain with longer preceding RR interval, (r = 0.45, p <0.0001) with LA strain 1.1% higher (p = 0.02) in the VNS-treated animals, independent of preceding RR interval duration. The curvilinear relationship between ratio of preceding and pre-preceding RR intervals, and subsequent LA strain was weaker, (r = 0.28, p = 0.001). However, VNS-treated animals again had higher LA strain (by 2.2%, p = 0.002) independently of the ratio of preceding and pre-preceding RR intervals. CONCLUSIONS In the underlying presence of pacing-induced HF, AF decreased LA strain, with little impact on LA size. LA strain depends on the preceding RR interval duration.
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Affiliation(s)
- Adam Goldberg
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Kenya Kusunose
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Salima Qamruddin
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - L. Leonardo Rodriguez
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Todor N. Mazgalev
- Department of Molecular Cardiology, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Brian P. Griffin
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - David R. Van Wagoner
- Department of Molecular Cardiology, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Youhua Zhang
- Department of Molecular Cardiology, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Zoran B. Popović
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, United States of America
- * E-mail:
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162
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Ripplinger CM, Noujaim SF, Linz D. The nervous heart. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2016; 120:199-209. [PMID: 26780507 DOI: 10.1016/j.pbiomolbio.2015.12.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 12/29/2015] [Accepted: 12/31/2015] [Indexed: 12/23/2022]
Abstract
Many cardiac electrophysiological abnormalities are accompanied by autonomic nervous system dysfunction. Here, we review mechanisms by which the cardiac nervous system controls normal and abnormal excitability and may contribute to atrial and ventricular tachyarrhythmias. Moreover, we explore the potential antiarrhythmic and/or arrhythmogenic effects of modulating the autonomic nervous system by several strategies, including ganglionated plexi ablation, vagal and spinal cord stimulations, and renal sympathetic denervation as therapies for atrial and ventricular arrhythmias.
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Affiliation(s)
- Crystal M Ripplinger
- Department of Pharmacology, University of California Davis, 451 Health Sciences Drive, Davis, CA 95616, USA.
| | - Sami F Noujaim
- Molecular Pharmacology and Physiology, University of South Florida, 12901 Bruce B Downs Blvd, Tampa, FL 33612, USA.
| | - Dominik Linz
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, 66421 Homburg, Saar, Germany.
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163
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Agarwal R, Mokelke E, Ruble SB, Stolen CM. Vagal Nerve Stimulation Evoked Heart Rate Changes and Protection from Cardiac Remodeling. J Cardiovasc Transl Res 2016; 9:67-76. [PMID: 26746408 DOI: 10.1007/s12265-015-9668-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 12/22/2015] [Indexed: 12/20/2022]
Abstract
This study investigated whether vagal nerve stimulation (VNS) leads to improvements in ischemic heart failure via heart rate modulation. At 7 ± 1 days post left anterior descending artery (LAD) ligation, 63 rats with myocardial infarctions (MI) were implanted with ECG transmitters and VNS devices (MI + VNS, N = 44) or just ECG transmitters (MI, N = 17). VNS stimulation was active from 14 ± 1 days to 8 ± 1 weeks post MI. The average left ventricular (LV) end diastolic volumes at 8 ± 1 weeks were MI = 672.40 μl and MI + VNS = 519.35 μl, p = 0.03. The average heart weights, normalized to body weight (± std) at 14 ± 1 weeks were MI = 3.2 ± 0.6 g*kg(-1) and MI + VNS = 2.9 ± 0.3 g*kg(-1), p = 0.03. The degree of cardiac remodeling was correlated with the magnitude of acute VNS-evoked heart rate (HR) changes. Further research is required to determine if the acute heart rate response to VNS activation is useful as a heart failure biomarker or as a tool for VNS therapy characterization.
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Affiliation(s)
- Rahul Agarwal
- Boston Scientific Corporation, 4100 Hamline Ave. North, St. Paul, MN, 55112, USA
| | - Eric Mokelke
- Boston Scientific Corporation, 4100 Hamline Ave. North, St. Paul, MN, 55112, USA
| | - Stephen B Ruble
- Boston Scientific Corporation, 4100 Hamline Ave. North, St. Paul, MN, 55112, USA
| | - Craig M Stolen
- Boston Scientific Corporation, 4100 Hamline Ave. North, St. Paul, MN, 55112, USA.
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164
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Olshansky B. Vagus nerve modulation of inflammation: Cardiovascular implications. Trends Cardiovasc Med 2016; 26:1-11. [DOI: 10.1016/j.tcm.2015.03.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 03/30/2015] [Accepted: 03/30/2015] [Indexed: 12/26/2022]
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165
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Gronda E, Vanoli E. Baroreflex activation therapy for the treatment of heart failure. Interv Cardiol 2015. [DOI: 10.2217/ica.15.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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166
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Kuschyk J, Doesch C, Akin I, Borggrefe M, Roeger S. [Chronic cervical vagal stimulation. Mechanisms of action and clinical relevance for heart failure]. Herz 2015; 40:952-8. [PMID: 26555481 DOI: 10.1007/s00059-015-4364-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Increased sympathetic nerve activity and reduced vagal activity are associated with increased mortality in patients after myocardial infarction and patients with chronic heart failure; furthermore, vagal withdrawal has been documented to precede acute decompensation. Experimental studies have indicated that increased parasympathetic activity by means of vagal stimulation may reduce mortality in animal models of postinfarction sudden cardiac death and of chronic heart failure. First clinical results have demonstrated that chronic vagus nerve stimulation in heart failure patients with severe systolic dysfunction appears to be safe and tolerable and may improve the quality of life and left ventricular (LV) function. Vagus nerve stimulation gives rise to these potential clinical benefits by multiple mechanisms of action, including reduced heart rate, restoration of heart rate variability and baroreflex sensitivity, suppression of proinflammatory cytokines and antiarrhythmic effects. First clinical results suggest that vagal nerve stimulation is safe and tolerable and could lead to a marked clinical improvement but discrepancies in the findings due to different study designs warrant further discussion.
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Affiliation(s)
- J Kuschyk
- I. Medizinische Klinik, Universitätsmedizin Mannheim, Deutsches Zentrum für Herz- Kreislauferkrankungen (DZHK), Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - C Doesch
- I. Medizinische Klinik, Universitätsmedizin Mannheim, Deutsches Zentrum für Herz- Kreislauferkrankungen (DZHK), Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - I Akin
- I. Medizinische Klinik, Universitätsmedizin Mannheim, Deutsches Zentrum für Herz- Kreislauferkrankungen (DZHK), Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - M Borggrefe
- I. Medizinische Klinik, Universitätsmedizin Mannheim, Deutsches Zentrum für Herz- Kreislauferkrankungen (DZHK), Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - S Roeger
- I. Medizinische Klinik, Universitätsmedizin Mannheim, Deutsches Zentrum für Herz- Kreislauferkrankungen (DZHK), Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
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167
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Barth Z, Nomeland Witczak B, Schwartz T, Gjesdal K, Flatø B, Koller A, Sanner H, Sjaastad I. In juvenile dermatomyositis, heart rate variability is reduced, and associated with both cardiac dysfunction and markers of inflammation: a cross-sectional study median 13.5 years after symptom onset. Rheumatology (Oxford) 2015; 55:535-43. [DOI: 10.1093/rheumatology/kev376] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Indexed: 01/24/2023] Open
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168
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Roy A, Dakroub M, Tezini GCSV, Liu Y, Guatimosim S, Feng Q, Salgado HC, Prado VF, Prado MAM, Gros R. Cardiac acetylcholine inhibits ventricular remodeling and dysfunction under pathologic conditions. FASEB J 2015; 30:688-701. [PMID: 26481308 DOI: 10.1096/fj.15-277046] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/28/2015] [Indexed: 12/11/2022]
Abstract
Autonomic dysfunction is a characteristic of cardiac disease and decreased vagal activity is observed in heart failure. Rodent cardiomyocytes produce de novo ACh, which is critical in maintaining cardiac homeostasis. We report that this nonneuronal cholinergic system is also found in human cardiomyocytes, which expressed choline acetyltransferase (ChAT) and the vesicular acetylcholine transporter (VAChT). Furthermore, VAChT expression was increased 3- and 1.5-fold at the mRNA and protein level, respectively, in ventricular tissue from patients with heart failure, suggesting increased ACh secretion in disease. We used mice with genetic deletion of cardiomyocyte-specific VAChT or ChAT and mice overexpressing VAChT to test the functional significance of cholinergic signaling. Mice deficient for VAChT displayed an 8% decrease in fractional shortening and 13% decrease in ejection fraction compared with angiotensin II (Ang II)-treated control animals, suggesting enhanced ventricular dysfunction and pathologic remodeling in response to Ang II. Similar results were observed in ChAT-deficient mice. Conversely, no decline in ventricular function was observed in Ang II-treated VAChT overexpressors. Furthermore, the fibrotic area was significantly greater (P < 0.05) in Ang II-treated VAChT-deficient mice (3.61 ± 0.64%) compared with wild-type animals (2.24 ± 0.11%). In contrast, VAChT overexpressing mice did not display an increase in collagen deposition. Our results provide new insight into cholinergic regulation of cardiac function, suggesting that a compensatory increase in cardiomyocyte VAChT levels may help offset cardiac remodeling in heart failure.
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Affiliation(s)
- Ashbeel Roy
- *Robarts Research Institute, Department of Physiology and Pharmacology, Department of Medicine, and Department of Anatomy and Cell Biology, The University of Western Ontario, London, Ontario, Canada; Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil; and Department of Physiology and Biophysics, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Mouhamed Dakroub
- *Robarts Research Institute, Department of Physiology and Pharmacology, Department of Medicine, and Department of Anatomy and Cell Biology, The University of Western Ontario, London, Ontario, Canada; Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil; and Department of Physiology and Biophysics, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Geisa C S V Tezini
- *Robarts Research Institute, Department of Physiology and Pharmacology, Department of Medicine, and Department of Anatomy and Cell Biology, The University of Western Ontario, London, Ontario, Canada; Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil; and Department of Physiology and Biophysics, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Yin Liu
- *Robarts Research Institute, Department of Physiology and Pharmacology, Department of Medicine, and Department of Anatomy and Cell Biology, The University of Western Ontario, London, Ontario, Canada; Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil; and Department of Physiology and Biophysics, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Silvia Guatimosim
- *Robarts Research Institute, Department of Physiology and Pharmacology, Department of Medicine, and Department of Anatomy and Cell Biology, The University of Western Ontario, London, Ontario, Canada; Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil; and Department of Physiology and Biophysics, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Qingping Feng
- *Robarts Research Institute, Department of Physiology and Pharmacology, Department of Medicine, and Department of Anatomy and Cell Biology, The University of Western Ontario, London, Ontario, Canada; Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil; and Department of Physiology and Biophysics, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Helio C Salgado
- *Robarts Research Institute, Department of Physiology and Pharmacology, Department of Medicine, and Department of Anatomy and Cell Biology, The University of Western Ontario, London, Ontario, Canada; Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil; and Department of Physiology and Biophysics, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Vania F Prado
- *Robarts Research Institute, Department of Physiology and Pharmacology, Department of Medicine, and Department of Anatomy and Cell Biology, The University of Western Ontario, London, Ontario, Canada; Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil; and Department of Physiology and Biophysics, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Marco A M Prado
- *Robarts Research Institute, Department of Physiology and Pharmacology, Department of Medicine, and Department of Anatomy and Cell Biology, The University of Western Ontario, London, Ontario, Canada; Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil; and Department of Physiology and Biophysics, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Robert Gros
- *Robarts Research Institute, Department of Physiology and Pharmacology, Department of Medicine, and Department of Anatomy and Cell Biology, The University of Western Ontario, London, Ontario, Canada; Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil; and Department of Physiology and Biophysics, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil
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169
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Novel Interventional Therapies to Modulate the Autonomic Tone in Heart Failure. JACC-HEART FAILURE 2015; 3:786-802. [DOI: 10.1016/j.jchf.2015.05.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 04/17/2015] [Accepted: 05/01/2015] [Indexed: 01/09/2023]
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170
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Yuan Y, Jiang Z, He Y, Ding FB, Ding SA, Yang Y, Mei J. Continuous vagal nerve stimulation affects atrial neural remodeling and reduces atrial fibrillation inducibility in rabbits. Cardiovasc Pathol 2015; 24:395-8. [PMID: 26365807 DOI: 10.1016/j.carpath.2015.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 08/17/2015] [Accepted: 08/17/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The effects of continuous vagal nerve stimulation (VNS) on atrial neural remodeling during atrial fibrillation (AF) remain unclear. OBJECTIVE To test the hypothesis that VNS affects atrial neural remodeling and reduces AF inducibility. METHODS Twenty rabbits were randomly divided into two groups: rapid atrial pacing (RAP) group and RAP with VNS group. AF inducibility studies and atrial histologic analyses were performed after 4 weeks. RESULTS Five rabbits of RAP group (5/10) in the RAP group developed sustained AF. None of rabbits in RAP with VNS group had developed AF. The incidence of sustained AF in VNS group was significant lower than that in rapid pacing group (P<.01). Treatment with VNS resulted in a significant reduction in atrial neural remodeling and AF duration (P<.01). CONCLUSIONS Atrial neural remodeling plays an important role in the initiation and maintenance of AF. Modulating autonomic nerve function with VNS can contribute to AF control.
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Affiliation(s)
- Yuan Yuan
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Zhaolei Jiang
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Yi He
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Fang-Bao Ding
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Shi-Ao Ding
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Yang Yang
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Ju Mei
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
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171
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Yuan H, Silberstein SD. Vagus Nerve and Vagus Nerve Stimulation, a Comprehensive Review: Part III. Headache 2015; 56:479-90. [PMID: 26364805 DOI: 10.1111/head.12649] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2015] [Indexed: 12/23/2022]
Abstract
Vagus nerve stimulation (VNS) is currently undergoing multiple trials to explore its potential for various clinical disorders. To date, VNS has been approved for the treatment of refractory epilepsy and depression. It exerts antiepileptic or antiepileptogenic effect possibly through neuromodulation of certain monoamine pathways. Beyond epilepsy, VNS is also under investigation for the treatment of inflammation, asthma, and pain. VNS influences the production of inflammatory cytokines to dampen the inflammatory response. It triggers the systemic release of catecholamines that alleviates the asthma attack. VNS induces antinociception by modulating multiple pain-associated structures in the brain and spinal cord affecting peripheral/central nociception, opioid response, inflammation process, autonomic activity, and pain-related behavior. Progression in VNS clinical efficacy over time suggests an underlying disease-modifying neuromodulation, which is an emerging field in neurology. With multiple potential clinical applications, further development of VNS is encouraging.
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Affiliation(s)
- Hsiangkuo Yuan
- Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, USA
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172
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Annoni EM, Xie X, Lee SW, Libbus I, KenKnight BH, Osborn JW, Tolkacheva EG. Intermittent electrical stimulation of the right cervical vagus nerve in salt-sensitive hypertensive rats: effects on blood pressure, arrhythmias, and ventricular electrophysiology. Physiol Rep 2015; 3:3/8/e12476. [PMID: 26265746 PMCID: PMC4562562 DOI: 10.14814/phy2.12476] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Hypertension (HTN) is the single greatest risk factor for potentially fatal cardiovascular diseases. One cause of HTN is inappropriately increased sympathetic nervous system activity, suggesting that restoring the autonomic nervous balance may be an effective means of HTN treatment. Here, we studied the potential of vagus nerve stimulation (VNS) to treat chronic HTN and cardiac arrhythmias through stimulation of the right cervical vagus nerve in hypertensive rats. Dahl salt-sensitive rats (n = 12) were given a high salt diet to induce HTN. After 6 weeks, rats were randomized into two groups: HTN-Sham and HTN-VNS, in which VNS was provided to HTN-VNS group for 4 weeks. In vivo blood pressure and electrocardiogram activities were monitored continuously by an implantable telemetry system. After 10 weeks, rats were euthanized and their hearts were extracted for ex vivo electrophysiological studies using high-resolution optical mapping. Six weeks of high salt diet significantly increased both mean arterial pressure (MAP) and pulse pressure, demonstrating successful induction of HTN in all rats. After 4 weeks of VNS treatment, the increase in MAP and the number of arrhythmia episodes in HTN-VNS rats was significantly attenuated when compared to those observed in HTN-Sham rats. VNS treatment also induced changes in electrophysiological properties of the heart, such as reduction in action potential duration (APD) during rapid drive pacing, slope of APD restitution, spatial dispersion of APD, and increase in conduction velocity of impulse propagation. Overall, these results provide further evidence for the therapeutic efficacy of VNS in HTN and HTN-related heart diseases.
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Affiliation(s)
- Elizabeth M Annoni
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Xueyi Xie
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Steven W Lee
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | | | - Bruce H KenKnight
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA Cyberonics Inc., Houston, TX, USA
| | - John W Osborn
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN, USA
| | - Elena G Tolkacheva
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
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173
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Bianchi S, Rossi P, Schauerte P, Elvan A, Blomström-Lundqvist C, Kornet L, Gal P, Mörtsell D, Wouters G, Gemein C. Increase of Ventricular Interval During Atrial Fibrillation by Atrioventricular Node Vagal Stimulation. Circ Arrhythm Electrophysiol 2015; 8:562-8. [DOI: 10.1161/circep.114.002588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 04/08/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Stefano Bianchi
- From the Department of Cardiology, Az. Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy (S.B., P.R.); Department of Cardiology, RWTH Aachen University, Aachen, Germany (P.S.); Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands (A.E., P.G.); Department of Cardiology, Uppsala University, Uppsala, Sweden (C.B.-L., D.M.); Department of Research and Technology, Medtronic, Bakken Research Center, Maastricht, the Netherlands (L.K., G.W.); and Department of Cardiology and
| | - Pietro Rossi
- From the Department of Cardiology, Az. Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy (S.B., P.R.); Department of Cardiology, RWTH Aachen University, Aachen, Germany (P.S.); Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands (A.E., P.G.); Department of Cardiology, Uppsala University, Uppsala, Sweden (C.B.-L., D.M.); Department of Research and Technology, Medtronic, Bakken Research Center, Maastricht, the Netherlands (L.K., G.W.); and Department of Cardiology and
| | - Patrick Schauerte
- From the Department of Cardiology, Az. Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy (S.B., P.R.); Department of Cardiology, RWTH Aachen University, Aachen, Germany (P.S.); Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands (A.E., P.G.); Department of Cardiology, Uppsala University, Uppsala, Sweden (C.B.-L., D.M.); Department of Research and Technology, Medtronic, Bakken Research Center, Maastricht, the Netherlands (L.K., G.W.); and Department of Cardiology and
| | - Arif Elvan
- From the Department of Cardiology, Az. Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy (S.B., P.R.); Department of Cardiology, RWTH Aachen University, Aachen, Germany (P.S.); Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands (A.E., P.G.); Department of Cardiology, Uppsala University, Uppsala, Sweden (C.B.-L., D.M.); Department of Research and Technology, Medtronic, Bakken Research Center, Maastricht, the Netherlands (L.K., G.W.); and Department of Cardiology and
| | - Carina Blomström-Lundqvist
- From the Department of Cardiology, Az. Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy (S.B., P.R.); Department of Cardiology, RWTH Aachen University, Aachen, Germany (P.S.); Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands (A.E., P.G.); Department of Cardiology, Uppsala University, Uppsala, Sweden (C.B.-L., D.M.); Department of Research and Technology, Medtronic, Bakken Research Center, Maastricht, the Netherlands (L.K., G.W.); and Department of Cardiology and
| | - Lilian Kornet
- From the Department of Cardiology, Az. Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy (S.B., P.R.); Department of Cardiology, RWTH Aachen University, Aachen, Germany (P.S.); Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands (A.E., P.G.); Department of Cardiology, Uppsala University, Uppsala, Sweden (C.B.-L., D.M.); Department of Research and Technology, Medtronic, Bakken Research Center, Maastricht, the Netherlands (L.K., G.W.); and Department of Cardiology and
| | - Pim Gal
- From the Department of Cardiology, Az. Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy (S.B., P.R.); Department of Cardiology, RWTH Aachen University, Aachen, Germany (P.S.); Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands (A.E., P.G.); Department of Cardiology, Uppsala University, Uppsala, Sweden (C.B.-L., D.M.); Department of Research and Technology, Medtronic, Bakken Research Center, Maastricht, the Netherlands (L.K., G.W.); and Department of Cardiology and
| | - David Mörtsell
- From the Department of Cardiology, Az. Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy (S.B., P.R.); Department of Cardiology, RWTH Aachen University, Aachen, Germany (P.S.); Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands (A.E., P.G.); Department of Cardiology, Uppsala University, Uppsala, Sweden (C.B.-L., D.M.); Department of Research and Technology, Medtronic, Bakken Research Center, Maastricht, the Netherlands (L.K., G.W.); and Department of Cardiology and
| | - Griet Wouters
- From the Department of Cardiology, Az. Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy (S.B., P.R.); Department of Cardiology, RWTH Aachen University, Aachen, Germany (P.S.); Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands (A.E., P.G.); Department of Cardiology, Uppsala University, Uppsala, Sweden (C.B.-L., D.M.); Department of Research and Technology, Medtronic, Bakken Research Center, Maastricht, the Netherlands (L.K., G.W.); and Department of Cardiology and
| | - Christopher Gemein
- From the Department of Cardiology, Az. Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy (S.B., P.R.); Department of Cardiology, RWTH Aachen University, Aachen, Germany (P.S.); Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands (A.E., P.G.); Department of Cardiology, Uppsala University, Uppsala, Sweden (C.B.-L., D.M.); Department of Research and Technology, Medtronic, Bakken Research Center, Maastricht, the Netherlands (L.K., G.W.); and Department of Cardiology and
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Schwartz PJ, La Rovere MT, De Ferrari GM, Mann DL. Autonomic Modulation for the Management of Patients with Chronic Heart Failure. Circ Heart Fail 2015; 8:619-28. [DOI: 10.1161/circheartfailure.114.001964] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Peter J. Schwartz
- From the Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milan, Italy (P.J.S.); Department of Cardiology, Fondazione “Salvatore Maugeri”, IRCCS Istituto Scientifico di Montescano, Montescano, Pavia, Italy (M.T.L.R.); Department of Cardiology and Cardiovascular Clinical Research Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (G.M.D.F.); Department of Molecular Medicine, University of Pavia, Pavia, Italy (G.M.D.F.); and Cardiovascular Division,
| | - Maria Teresa La Rovere
- From the Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milan, Italy (P.J.S.); Department of Cardiology, Fondazione “Salvatore Maugeri”, IRCCS Istituto Scientifico di Montescano, Montescano, Pavia, Italy (M.T.L.R.); Department of Cardiology and Cardiovascular Clinical Research Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (G.M.D.F.); Department of Molecular Medicine, University of Pavia, Pavia, Italy (G.M.D.F.); and Cardiovascular Division,
| | - Gaetano M. De Ferrari
- From the Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milan, Italy (P.J.S.); Department of Cardiology, Fondazione “Salvatore Maugeri”, IRCCS Istituto Scientifico di Montescano, Montescano, Pavia, Italy (M.T.L.R.); Department of Cardiology and Cardiovascular Clinical Research Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (G.M.D.F.); Department of Molecular Medicine, University of Pavia, Pavia, Italy (G.M.D.F.); and Cardiovascular Division,
| | - Douglas L. Mann
- From the Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milan, Italy (P.J.S.); Department of Cardiology, Fondazione “Salvatore Maugeri”, IRCCS Istituto Scientifico di Montescano, Montescano, Pavia, Italy (M.T.L.R.); Department of Cardiology and Cardiovascular Clinical Research Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (G.M.D.F.); Department of Molecular Medicine, University of Pavia, Pavia, Italy (G.M.D.F.); and Cardiovascular Division,
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175
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Stavrakis S, Humphrey MB, Scherlag BJ, Hu Y, Jackman WM, Nakagawa H, Lockwood D, Lazzara R, Po SS. Low-level transcutaneous electrical vagus nerve stimulation suppresses atrial fibrillation. J Am Coll Cardiol 2015; 65:867-75. [PMID: 25744003 DOI: 10.1016/j.jacc.2014.12.026] [Citation(s) in RCA: 226] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 12/07/2014] [Accepted: 12/13/2014] [Indexed: 01/11/2023]
Abstract
BACKGROUND Transcutaneous low-level tragus electrical stimulation (LLTS) suppresses atrial fibrillation (AF) in canines. OBJECTIVES This study examined the antiarrhythmic and anti-inflammatory effects of LLTS in humans. METHODS Patients with paroxysmal AF who presented for AF ablation were randomized to either 1 h of LLTS (n = 20) or sham control (n = 20). Attaching a flat metal clip onto the tragus produced LLTS (20 Hz) in the right ear (50% lower than the voltage slowing the sinus rate). Under general anesthesia, AF was induced by burst atrial pacing at baseline and after 1 h of LLTS or sham treatment. Blood samples from the coronary sinus and the femoral vein were collected at those time points and then analyzed for inflammatory cytokines, including tumor necrosis factor alpha and C-reactive protein, using a multiplex immunoassay. RESULTS There were no differences in baseline characteristics between the 2 groups. Pacing-induced AF duration decreased significantly by 6.3 ± 1.9 min compared with baseline in the LLTS group, but not in the control subjects (p = 0.002 for comparison between groups). AF cycle length increased significantly from baseline by 28.8 ± 6.5 ms in the LLTS group, but not in control subjects (p = 0.0002 for comparison between groups). Systemic (femoral vein) but not coronary sinus tumor necrosis factor (TNF)-alpha and C-reactive protein levels decreased significantly only in the LLTS group. CONCLUSIONS LLTS suppresses AF and decreases inflammatory cytokines in patients with paroxysmal AF. Our results support the emerging paradigm of neuromodulation to treat AF.
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Affiliation(s)
- Stavros Stavrakis
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Mary Beth Humphrey
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Benjamin J Scherlag
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Yanqing Hu
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Warren M Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Deborah Lockwood
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Ralph Lazzara
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Sunny S Po
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
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176
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Huang WA, Shivkumar K, Vaseghi M. Device-based autonomic modulation in arrhythmia patients: the role of vagal nerve stimulation. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:379. [PMID: 25894588 DOI: 10.1007/s11936-015-0379-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OPINION STATEMENT Vagal nerve stimulation (VNS) has shown promise as an adjunctive therapy for management of cardiac arrhythmias by targeting the cardiac parasympathetic nervous system. VNS has been evaluated in the setting of ischemia-driven ventricular arrhythmias and atrial arrhythmias, as well as a treatment option for heart failure. As better understanding of the complexities of the cardiac autonomic nervous system is obtained, vagal nerve stimulation will likely become a powerful tool in the current cardiovascular therapeutic armamentarium.
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Affiliation(s)
- William A Huang
- UCLA Cardiac Arrhythmia Center, University of California, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA
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178
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Li Y, Xuan YH, Liu SS, Dong J, Luo JY, Sun ZJ. Short‑term vagal nerve stimulation improves left ventricular function following chronic heart failure in rats. Mol Med Rep 2015; 12:1709-16. [PMID: 25873055 PMCID: PMC4464404 DOI: 10.3892/mmr.2015.3597] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 03/10/2015] [Indexed: 01/01/2023] Open
Abstract
Increasing numbers of animal and clinical investigations have demonstrated the effectiveness of long-term electrical vagal nerve stimulation (VNS) on chronic heart failure (CHF). The present study investigated the effects of short-term VNS on the hemodynamics of cardiac remodeling and cardiac excitation-contraction coupling (ECP) in an animal model of CHF following a large myocardial infarction. At 3 weeks subsequent to ligation of the left coronary artery, the surviving rats were randomized into vagal and sham-stimulated groups. The right vagal nerve of the CHF rats was stimulated for 72 h. The vagal nerve was stimulated with rectangular pulses of 40 ms duration at 1 Hz, 5 V. The treated rats, compared with the untreated rats, had significantly higher left ventricular ejection fraction (54.86±9.73, vs. 45.60±5.51%; P=0.025) and left ventricular fractional shortening (25.31±6.30, vs. 15.42±8.49%; P=0.013), and lower levels of brain natriuretic peptide (10.07±2.63, vs. 19.95±5.22 ng/ml; P=0.001). The improvement in cardiac pumping function was accompanied by a decrease in left ventricular end diastolic volume (1.11±0.50, vs. 1.54±0.57 cm3; P=0.032) and left ventricular end systolic volume (0.50±0.28, vs. 0.87±0.36 cm3; P=0.007). Furthermore, the expression levels of ryanodine receptor type 2 (RyR2) and sarcoplasmic reticulum calcium adenosine triphosphatase (SERCA2) were significantly higher in the treated rats compared with the untreated rats (P=0.011 and P=0.001 for RyR2 and SERCA2, respectively). Therefore, VNS was beneficial to the CHF rats through the prevention of cardiac remodeling and improvement of cardiac ECP.
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Affiliation(s)
- Yan Li
- Department of Geriatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Yan-Hua Xuan
- Department of Cardiology Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Shuang-Shuang Liu
- Department of Cardiology Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Jing Dong
- Department of Cardiology Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Jia-Ying Luo
- Department of Cardiology Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Zhi-Jun Sun
- Department of Cardiology Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
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179
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Weise D, Adamidis M, Pizzolato F, Rumpf JJ, Fricke C, Classen J. Assessment of brainstem function with auricular branch of vagus nerve stimulation in Parkinson's disease. PLoS One 2015; 10:e0120786. [PMID: 25849807 PMCID: PMC4388709 DOI: 10.1371/journal.pone.0120786] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 01/27/2015] [Indexed: 12/04/2022] Open
Abstract
Background The efferent dorsal motor nucleus of the vagal nuclei complex may degenerate early in the course of Parkinson’s disease (PD), while efferent nucleus ambiguous, the principal source of parasympathetic vagal neurons innervating the heart, and afferent somatosensory nuclei remain intact. Objective To obtain neurophysiological evidence related to this pattern, we tested processing of afferent sensory information transmitted via the auricular branch of the vagus nerve (ABVN) which is known to be connected to autonomic regulation of cardiac rhythm. Methods In this cross-sectional observational study, we recorded (i) somatosensory evoked potentials (ABVN-SEP) and (ii) cutaneo-cardioautonomic response elicited by stimulation of the ABVN (modulation of heart-rate variability (HRV index; low frequency power, ln(LF), high frequency power, ln(HF); ln(LF/HF) ratio)) in 50 PD patients and 50 age and sex matched healthy controls. Additionally, auditory evoked potentials and trigeminal nerve SEP were assessed. Results Neither ABVN-SEP nor any of the other functional brainstem parameters differed between patients and controls. Although HRV index was decreased in PD patients, modulation of ln(LF/HF) by ABVN-stimulation, likely indicating cardiac parasympathetic activation, did not differ between both groups. Conclusions Findings do not point to prominent dysfunction of processing afferent information from ABVN and its connected parasympathetic cardiac pathway in PD. They are consistent with the known pattern of degeneration of the vagal nuclei complex of the brainstem.
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Affiliation(s)
- David Weise
- Department of Neurology, University of Leipzig, Leipzig, Germany
- * E-mail:
| | - Melanie Adamidis
- Department of Neurology, University of Leipzig, Leipzig, Germany
| | - Fabio Pizzolato
- Department of Neurology, University of Leipzig, Leipzig, Germany
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy
| | | | | | - Joseph Classen
- Department of Neurology, University of Leipzig, Leipzig, Germany
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He B, Lu Z, He W, Huang B, Jiang H. Low-intensity Atrial Ganglionated Plexi Stimulation Decreases the Serum Level of Inflammatory Factors in Canine. Heart Lung Circ 2015; 24:407-10. [DOI: 10.1016/j.hlc.2014.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 11/03/2014] [Indexed: 12/17/2022]
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Innovative devices for advanced heart failure: exploring the current state and future direction of device therapies. Curr Opin Cardiol 2015; 30:267-76. [PMID: 25807225 DOI: 10.1097/hco.0000000000000169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Despite improvements in medical and device therapies for the treatment of heart failure, the incidence and prevalence of heart failure continue to increase. Given the relative stagnation in new pharmacologic therapies, considerable attention has been given in recent years to device therapies to supplement care in patients with advanced heart failure. Recent successful clinical trial results with an angiotensin-neprilysin inhibitor are not expected to change this situation significantly; the drug has been shown to delay, not eliminate, the progression of heart failure. This review focuses on the technologies that are currently in development for the treatment of advanced heart failure. RECENT FINDINGS Novel devices that involve electrical, neurohormonal or structural remodeling of the heart that can be inserted either percutaneously or with a minimally invasive surgery are currently at various stages of clinical development. All, however, have shown promising clinical results in preclinical and early clinical studies. SUMMARY Novel device therapies for advanced heart failure continue to show promising clinical results. Randomized controlled trials are still needed to better evaluate their efficacy. Nevertheless, it can be anticipated that at least several of these devices will be among the armamentarium of treatment options for advanced heart failure in the future.
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182
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DeMazumder D, Kass DA, O'Rourke B, Tomaselli GF. Cardiac resynchronization therapy restores sympathovagal balance in the failing heart by differential remodeling of cholinergic signaling. Circ Res 2015; 116:1691-9. [PMID: 25733594 DOI: 10.1161/circresaha.116.305268] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 03/02/2015] [Indexed: 12/29/2022]
Abstract
RATIONALE Cardiac resynchronization therapy (CRT) is the only heart failure (HF) therapy documented to improve left ventricular function and reduce mortality. The underlying mechanisms are incompletely understood. Although β-adrenergic signaling has been studied extensively, the effect of CRT on cholinergic signaling is unexplored. OBJECTIVE We hypothesized that remodeling of cholinergic signaling plays an important role in the aberrant calcium signaling and depressed contractile and β-adrenergic responsiveness in dyssynchronous HF that are restored by CRT. METHODS AND RESULTS Canine tachypaced dyssynchronous HF and CRT models were generated to interrogate responses specific to dyssynchronous versus resynchronized ventricular contraction during hemodynamic decompensation. Echocardiographic, electrocardiographic, and invasive hemodynamic data were collected from normal controls, dyssynchronous HF and CRT models. Left ventricular tissue was used for biochemical analyses and functional measurements (calcium transient, sarcomere shortening) from isolated myocytes (n=42-104 myocytes per model; 6-9 hearts per model). Human left ventricular myocardium was obtained for biochemical analyses from explanted failing (n=18) and nonfailing (n=7) hearts. The M2 subtype of muscarinic acetylcholine receptors was upregulated in human and canine HF compared with nonfailing controls. CRT attenuated the increased M2 subtype of muscarinic acetylcholine receptor expression and Gαi coupling and enhanced M3 subtype of muscarinic acetylcholine receptor expression in association with enhanced calcium cycling, sarcomere shortening, and β-adrenergic responsiveness. Despite model-dependent remodeling, cholinergic stimulation completely abolished isoproterenol-induced triggered activity in both dyssynchronous HF and CRT myocytes. CONCLUSIONS Remodeling of cholinergic signaling is a critical pathological component of human and canine HF. Differential remodeling of cholinergic signaling represents a novel mechanism for enhancing sympathovagal balance with CRT and may identify new targets for treatment of systolic HF.
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Affiliation(s)
- Deeptankar DeMazumder
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - David A Kass
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Brian O'Rourke
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gordon F Tomaselli
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD.
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Abstract
"Heart failure is an increasingly prevalent disease with high mortality and public health burden. It is associated with autonomic imbalance characterized by sympathetic hyperactivity and parasympathetic hypoactivity. Evolving novel interventional and device-based therapies have sought to restore autonomic balance by neuromodulation. Results of preclinical animal studies and early clinical trials have demonstrated the safety and efficacy of these therapies in heart failure. This article discusses specific neuromodulatory treatment modalities individually-spinal cord stimulation, vagus nerve stimulation, baroreceptor activation therapy, and renal sympathetic nerve denervation."
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184
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Rodrigues FL, Silva LEV, Hott SC, Bomfim GF, da Silva CAA, Fazan R, Resstel LBM, Tostes RC, Carneiro FS. Toll-like receptor 9 plays a key role in the autonomic cardiac and baroreflex control of arterial pressure. Am J Physiol Regul Integr Comp Physiol 2015; 308:R714-23. [PMID: 25673780 DOI: 10.1152/ajpregu.00150.2014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 01/27/2015] [Indexed: 02/07/2023]
Abstract
The crosstalk between the immune and the autonomic nervous system may impact the cardiovascular function. Toll-like receptors are components of the innate immune system and play developmental and physiological roles. Toll-like receptor 9 (TLR9) is involved in the pathogenesis of cardiovascular diseases, such as hypertension and heart failure. Since such diseases are commonly accompanied by autonomic imbalance and lower baroreflex sensitivity, we hypothesized that TLR9 modulates cardiac autonomic and baroreflex control of arterial pressure (AP). Toll-like receptor 9 knockout (TLR9 KO) and wild-type (WT) mice were implanted with catheters into carotid artery and jugular vein and allowed to recover for 3 days. After basal recording of AP, mice received methyl-atropine or propranolol. AP and pulse interval (PI) variability were evaluated in the time and frequency domain (spectral analysis), as well as by multiscale entropy. Spontaneous baroreflex was studied by sequence technique. Behavioral and cardiovascular responses to fear-conditioning stress were also evaluated. AP was similar between groups, but TLR9 KO mice exhibited lower basal heart rate (HR). AP variability was not different, but PI variability was increased in TLR9 KO mice. The total entropy was higher in TLR9 KO mice. Moreover, baroreflex function was found higher in TLR9 KO mice. Atropine-induced tachycardia was increased in TLR9 KO mice, whereas the propranolol-induced bradycardia was similar to WT mice. TLR9 KO mice exhibit increased behavioral and decreased tachycardia responses to fear-conditioning stress. In conclusion, our findings suggest that TLR9 may negatively modulate cardiac vagal tone and baroreflex in mice.
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Affiliation(s)
- Fernanda Luciano Rodrigues
- Department of Pharmacology, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Luiz Eduardo V Silva
- Department of Physiology, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil; and
| | - Sara Cristina Hott
- Department of Pharmacology, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Gisele F Bomfim
- Institute of Health Sciences, Federal University of Mato Grosso, Sinop, Mato Grosso, Brazil
| | - Carlos Alberto Aguiar da Silva
- Department of Physiology, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil; and
| | - Rubens Fazan
- Department of Physiology, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil; and
| | - Leonardo B M Resstel
- Department of Pharmacology, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Rita C Tostes
- Department of Pharmacology, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Fernando S Carneiro
- Department of Pharmacology, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil;
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185
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Gold MR, van Veldhuisen DJ, Mann DL. Vagal nerve stimulation for heart failure: new pieces to the puzzle? Eur J Heart Fail 2015; 17:125-7. [DOI: 10.1002/ejhf.234] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 12/23/2014] [Indexed: 12/15/2022] Open
Affiliation(s)
- Michael R. Gold
- Cardiology Division; Medical University of South Carolina; Charleston SC USA
| | - Dirk J. van Veldhuisen
- Department of Cardiology, University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - Douglas L. Mann
- Cardiology Division; Washington University School of Medicine; St. Louis MO USA
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186
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Roy A, Guatimosim S, Prado VF, Gros R, Prado MAM. Cholinergic activity as a new target in diseases of the heart. Mol Med 2015; 20:527-37. [PMID: 25222914 DOI: 10.2119/molmed.2014.00125] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 09/09/2014] [Indexed: 12/21/2022] Open
Abstract
The autonomic nervous system is an important modulator of cardiac signaling in both health and disease. In fact, the significance of altered parasympathetic tone in cardiac disease has recently come to the forefront. Both neuronal and nonneuronal cholinergic signaling likely play a physiological role, since modulating acetylcholine (ACh) signaling from neurons or cardiomyocytes appears to have significant consequences in both health and disease. Notably, many of these effects are solely due to changes in cholinergic signaling, without altered sympathetic drive, which is known to have significant adverse effects in disease states. As such, it is likely that enhanced ACh-mediated signaling not only has direct positive effects on cardiomyocytes, but it also offsets the negative effects of hyperadrenergic tone. In this review, we discuss recent studies that implicate ACh as a major regulator of cardiac remodeling and provide support for the notion that enhancing cholinergic signaling in human patients with cardiac disease can reduce morbidity and mortality. These recent results support the idea of developing large clinical trials of strategies to increase cholinergic tone, either by stimulating the vagus or by increased availability of Ach, in heart failure.
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Affiliation(s)
- Ashbeel Roy
- Robarts Research Institute, The University of Western Ontario, London, Ontario, Canada.,Department of Physiology and Pharmacology, The University of Western Ontario, London, Ontario, Canada
| | - Silvia Guatimosim
- Department of Physiology and Biophysics, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Vania F Prado
- Robarts Research Institute, The University of Western Ontario, London, Ontario, Canada.,Department of Physiology and Pharmacology, The University of Western Ontario, London, Ontario, Canada.,Department of Anatomy and Cell Biology, The University of Western Ontario, London, Ontario, Canada
| | - Robert Gros
- Robarts Research Institute, The University of Western Ontario, London, Ontario, Canada.,Department of Physiology and Pharmacology, The University of Western Ontario, London, Ontario, Canada.,Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Marco A M Prado
- Robarts Research Institute, The University of Western Ontario, London, Ontario, Canada.,Department of Physiology and Pharmacology, The University of Western Ontario, London, Ontario, Canada.,Department of Anatomy and Cell Biology, The University of Western Ontario, London, Ontario, Canada
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187
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Zannad F, Stough WG, Mahfoud F, Bakris GL, Kjeldsen SE, Kieval RS, Haller H, Yared N, De Ferrari GM, Piña IL, Stein K, Azizi M. Design Considerations for Clinical Trials of Autonomic Modulation Therapies Targeting Hypertension and Heart Failure. Hypertension 2015; 65:5-15. [DOI: 10.1161/hypertensionaha.114.04057] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Faiez Zannad
- From the Department of Cardiology, INSERM, Center d’Investigation Clinique 9501 and Unité 961, Center Hospitalier Universitaire, Nancy University, Université de Lorraine, Nancy, France (F.Z.); Departments of Pharmacy Practice and Clinical Research, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC (W.G.S.); Klinik für Innere Medizin III, Universtitätsklinikum des Saarlandes, Homburg/Saar, Germany (F.M.); Harvard-MIT Biomedical Engineering, Institute of Medical Engineering
| | - Wendy Gattis Stough
- From the Department of Cardiology, INSERM, Center d’Investigation Clinique 9501 and Unité 961, Center Hospitalier Universitaire, Nancy University, Université de Lorraine, Nancy, France (F.Z.); Departments of Pharmacy Practice and Clinical Research, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC (W.G.S.); Klinik für Innere Medizin III, Universtitätsklinikum des Saarlandes, Homburg/Saar, Germany (F.M.); Harvard-MIT Biomedical Engineering, Institute of Medical Engineering
| | - Felix Mahfoud
- From the Department of Cardiology, INSERM, Center d’Investigation Clinique 9501 and Unité 961, Center Hospitalier Universitaire, Nancy University, Université de Lorraine, Nancy, France (F.Z.); Departments of Pharmacy Practice and Clinical Research, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC (W.G.S.); Klinik für Innere Medizin III, Universtitätsklinikum des Saarlandes, Homburg/Saar, Germany (F.M.); Harvard-MIT Biomedical Engineering, Institute of Medical Engineering
| | - George L. Bakris
- From the Department of Cardiology, INSERM, Center d’Investigation Clinique 9501 and Unité 961, Center Hospitalier Universitaire, Nancy University, Université de Lorraine, Nancy, France (F.Z.); Departments of Pharmacy Practice and Clinical Research, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC (W.G.S.); Klinik für Innere Medizin III, Universtitätsklinikum des Saarlandes, Homburg/Saar, Germany (F.M.); Harvard-MIT Biomedical Engineering, Institute of Medical Engineering
| | - Sverre E. Kjeldsen
- From the Department of Cardiology, INSERM, Center d’Investigation Clinique 9501 and Unité 961, Center Hospitalier Universitaire, Nancy University, Université de Lorraine, Nancy, France (F.Z.); Departments of Pharmacy Practice and Clinical Research, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC (W.G.S.); Klinik für Innere Medizin III, Universtitätsklinikum des Saarlandes, Homburg/Saar, Germany (F.M.); Harvard-MIT Biomedical Engineering, Institute of Medical Engineering
| | - Robert S. Kieval
- From the Department of Cardiology, INSERM, Center d’Investigation Clinique 9501 and Unité 961, Center Hospitalier Universitaire, Nancy University, Université de Lorraine, Nancy, France (F.Z.); Departments of Pharmacy Practice and Clinical Research, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC (W.G.S.); Klinik für Innere Medizin III, Universtitätsklinikum des Saarlandes, Homburg/Saar, Germany (F.M.); Harvard-MIT Biomedical Engineering, Institute of Medical Engineering
| | - Hermann Haller
- From the Department of Cardiology, INSERM, Center d’Investigation Clinique 9501 and Unité 961, Center Hospitalier Universitaire, Nancy University, Université de Lorraine, Nancy, France (F.Z.); Departments of Pharmacy Practice and Clinical Research, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC (W.G.S.); Klinik für Innere Medizin III, Universtitätsklinikum des Saarlandes, Homburg/Saar, Germany (F.M.); Harvard-MIT Biomedical Engineering, Institute of Medical Engineering
| | - Nadim Yared
- From the Department of Cardiology, INSERM, Center d’Investigation Clinique 9501 and Unité 961, Center Hospitalier Universitaire, Nancy University, Université de Lorraine, Nancy, France (F.Z.); Departments of Pharmacy Practice and Clinical Research, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC (W.G.S.); Klinik für Innere Medizin III, Universtitätsklinikum des Saarlandes, Homburg/Saar, Germany (F.M.); Harvard-MIT Biomedical Engineering, Institute of Medical Engineering
| | - Gaetano M. De Ferrari
- From the Department of Cardiology, INSERM, Center d’Investigation Clinique 9501 and Unité 961, Center Hospitalier Universitaire, Nancy University, Université de Lorraine, Nancy, France (F.Z.); Departments of Pharmacy Practice and Clinical Research, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC (W.G.S.); Klinik für Innere Medizin III, Universtitätsklinikum des Saarlandes, Homburg/Saar, Germany (F.M.); Harvard-MIT Biomedical Engineering, Institute of Medical Engineering
| | - Ileana L. Piña
- From the Department of Cardiology, INSERM, Center d’Investigation Clinique 9501 and Unité 961, Center Hospitalier Universitaire, Nancy University, Université de Lorraine, Nancy, France (F.Z.); Departments of Pharmacy Practice and Clinical Research, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC (W.G.S.); Klinik für Innere Medizin III, Universtitätsklinikum des Saarlandes, Homburg/Saar, Germany (F.M.); Harvard-MIT Biomedical Engineering, Institute of Medical Engineering
| | - Kenneth Stein
- From the Department of Cardiology, INSERM, Center d’Investigation Clinique 9501 and Unité 961, Center Hospitalier Universitaire, Nancy University, Université de Lorraine, Nancy, France (F.Z.); Departments of Pharmacy Practice and Clinical Research, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC (W.G.S.); Klinik für Innere Medizin III, Universtitätsklinikum des Saarlandes, Homburg/Saar, Germany (F.M.); Harvard-MIT Biomedical Engineering, Institute of Medical Engineering
| | - Michel Azizi
- From the Department of Cardiology, INSERM, Center d’Investigation Clinique 9501 and Unité 961, Center Hospitalier Universitaire, Nancy University, Université de Lorraine, Nancy, France (F.Z.); Departments of Pharmacy Practice and Clinical Research, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC (W.G.S.); Klinik für Innere Medizin III, Universtitätsklinikum des Saarlandes, Homburg/Saar, Germany (F.M.); Harvard-MIT Biomedical Engineering, Institute of Medical Engineering
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188
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Vanoli E, Pentimalli F, Botto G. Vagomimetic effects of fingolimod: physiology and clinical implications. CNS Neurosci Ther 2014; 20:496-502. [PMID: 24836740 PMCID: PMC4204275 DOI: 10.1111/cns.12283] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 04/17/2014] [Accepted: 04/20/2014] [Indexed: 01/01/2023] Open
Abstract
Fingolimod is a sphingosine 1-phosphate (S1P) receptor modulator approved to treat relapsing-remitting multiple sclerosis (MS). Initiation of treatment with fingolimod has been found to produce transient bradycardia and/or slowing of atrioventricular impulse conduction in a small proportion of patients. This effect is thought to be due to the interaction of fingolimod with S1P receptors on the surface membrane of atrial myocytes causing a vagomimetic effect, similar to the action of acetylcholine on muscarinic receptors. As a precaution, patients are under electrocardiogram (ECG) monitoring for 6 h after receiving their first dose. Fingolimod is contraindicated in patients with overt or concealed cardiac diseases. However, the Fingolimod Initiation and caRdiac Safety Trial (FIRST), which was designed specifically to investigate the cardiac profile of fingolimod, did not show an increased risk of clinically relevant cardiac events with fingolimod. This review examines the electrophysiology and pathophysiology of cardiac impulse formation in the context of fingolimod. It concludes that these vagomimetic effects should be considered benign and should not prevent the effective use of fingolimod in the treatment of patients with MS.
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Affiliation(s)
- Emilio Vanoli
- Cardiology Section, Department of Molecular Medicine, University of Pavia, Pavia, Italy; Cardiovascular Department, IRCCS Multimedica, Sesto San Giovanni, Italy
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189
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Kember G, Ardell JL, Armour JA, Zamir M. Vagal nerve stimulation therapy: what is being stimulated? PLoS One 2014; 9:e114498. [PMID: 25479368 PMCID: PMC4257685 DOI: 10.1371/journal.pone.0114498] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 11/10/2014] [Indexed: 11/18/2022] Open
Abstract
Vagal nerve stimulation in cardiac therapy involves delivering electrical current to the vagal sympathetic complex in patients experiencing heart failure. The therapy has shown promise but the mechanisms by which any benefit accrues is not understood. In this paper we model the response to increased levels of stimulation of individual components of the vagal sympathetic complex as a differential activation of each component in the control of heart rate. The model provides insight beyond what is available in the animal experiment in as much as allowing the simultaneous assessment of neuronal activity throughout the cardiac neural axis. The results indicate that there is sensitivity of the neural network to low level subthreshold stimulation. This leads us to propose that the chronic effects of vagal nerve stimulation therapy lie within the indirect pathways that target intrinsic cardiac local circuit neurons because they have the capacity for plasticity.
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Affiliation(s)
- Guy Kember
- Department of Engineering Mathematics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jeffrey L. Ardell
- Department of Biomedical Sciences, East Tennessee State University's Quillen College of Medicine, Johnson City, Tennessee, United States of America
| | - John A. Armour
- Department of Biomedical Sciences, East Tennessee State University's Quillen College of Medicine, Johnson City, Tennessee, United States of America
| | - Mair Zamir
- Department of Applied Mathematics, Western University, London, Canada
- Department of Medical Biophysics, Western University, London, Canada
- * E-mail:
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Schomer AC, Nearing BD, Schachter SC, Verrier RL. Vagus nerve stimulation reduces cardiac electrical instability assessed by quantitative T-wave alternans analysis in patients with drug-resistant focal epilepsy. Epilepsia 2014; 55:1996-2002. [PMID: 25470430 DOI: 10.1111/epi.12855] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The cardiac component of risk for sudden unexpected death in epilepsy (SUDEP) and alterations in cardiac risk by vagus nerve stimulation (VNS) are not well understood. We determined changes in T-wave alternans (TWA), a proven noninvasive marker of risk for sudden cardiac death in patients with cardiovascular disease, and heart rate variability (HRV), an indicator of autonomic function, in association with VNS in patients with drug-resistant focal epilepsy. METHODS Ambulatory 24-h electrocardiograms (N = 9: ages 29-63, six males) were analyzed. RESULTS Mean TWA during the interictal period was 37 ± 3.1 μV (mean ± SEM) in lead V1 for nine patients monitored following implantation of the VNS system (n = 7) or battery change (n = 2). Of these, six patients also monitored prior to implantation (n = 5) or battery change (n = 1) showed abnormally high TWA levels pre-VNS (60.0 ± 4.3 μV), which were significantly reduced by 24.3 μV (to 35.7 ± 4.8 μV, p = 0.02) after VNS settings were adjusted for desired clinical response. TWA in four (67%) of the six patients was reduced in association with VNS to levels below the 47-μV cut point of abnormality. The decrease in TWA was correlated with VNS intensity (r = 0.88, p < 0.02). In addition, low-frequency HRV was reduced by 60% (805.61 ± 253.96 to 323.49 ± 102.74 msec(2) , p = 0.05) and low-to high-frequency HRV ratio by 32% (3.34 ± 0.57 to 2.26 ± 0.31, p = 0.025), indicating a change in autonomic balance in favor of parasympathetic dominance. SIGNIFICANCE This is the first report that elevated levels of TWA in patients with drug-refractory partial-onset seizures were reduced in association with VNS, potentially by improving sympathetic/parasympathetic balance. VNS may have a cardioprotective role at stimulation settings typically used for seizure control. These findings indicate the utility of TWA for tracking improvement in cardiac status in this population.
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Affiliation(s)
- Andrew C Schomer
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, U.S.A; Harvard Medical School, Boston, Massa-chusetts, U.S.A
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191
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Autonomic Regulation Therapy via Left or Right Cervical Vagus Nerve Stimulation in Patients With Chronic Heart Failure: Results of the ANTHEM-HF Trial. J Card Fail 2014; 20:808-16. [DOI: 10.1016/j.cardfail.2014.08.009] [Citation(s) in RCA: 224] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 08/18/2014] [Accepted: 08/18/2014] [Indexed: 01/12/2023]
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192
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Blood pressure response to renal nerve stimulation in patients undergoing renal denervation: a feasibility study. J Hum Hypertens 2014; 29:292-5. [PMID: 25339295 DOI: 10.1038/jhh.2014.91] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 05/14/2014] [Accepted: 06/03/2014] [Indexed: 02/02/2023]
Abstract
During renal sympathetic denervation (RDN), no mapping of renal nerves is performed and there is no clear end point of RDN. We hypothesized high-frequency renal nerve stimulation (RNS) may increase blood pressure (BP), and this increase is significantly blunted after RDN. The aim of this study was to determine the feasibility of RNS in patients undergoing RDN. Eight patients with resistant hypertension undergoing RDN were included. A quadripolar catheter was positioned at four different sites in either renal artery. RNS was performed during 1 min with a pacing frequency of 20 Hz. After all patients successfully underwent RDN, RNS was repeated at the site of maximum BP response before RDN in either renal artery. Mean age was 66 years. During RNS, BP increased significantly from 108/55 to 132/68 mm Hg (P < 0.001). After RDN, systolic BP response at the site of maximum response to RNS was significantly blunted (+43.1 vs +9.3 mm Hg, P = 0.002). In three patients, a systolic BP increase >10 mm Hg was observed after RDN. In conclusion, RNS resulted in an acute temporary BP increase. This response was significantly blunted after RDN. RNS may potentially serve as an end point for RDN.
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193
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Wang Z, Yu L, Wang S, Huang B, Liao K, Saren G, Tan T, Jiang H. Chronic intermittent low-level transcutaneous electrical stimulation of auricular branch of vagus nerve improves left ventricular remodeling in conscious dogs with healed myocardial infarction. Circ Heart Fail 2014; 7:1014-21. [PMID: 25332149 DOI: 10.1161/circheartfailure.114.001564] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Vagus nerve stimulation attenuates left ventricular (LV) remodeling after myocardial infarction (MI). Our previous study found a noninvasive approach to deliver vagus nerve stimulation by transcutaneous electric stimulation of auricular branch of vagus nerve. So we hypothesize that chronic intermittent low-level tragus stimulation (LL-TS) could attenuate LV remodeling in conscious dogs with healed MI. METHODS AND RESULTS Thirty beagle dogs were randomly divided into 3 groups, MI group (left anterior descending artery and major diagonal branches ligation to introduce MI, n=10), LL-TS group (MI plus chronic intermittent LL-TS, n=10), and control group (sham surgery without stimulation, n=10). Tragus stimulation was delivered to bilateral tragus with ear-clips connected to a custom-made stimulator. The voltage slowing sinus rate was used as the threshold for setting LL-TS at 80% below that. LL-TS group was given 4 hours stimulation at 7-9 am and 4-6 pm on conscious dogs. At the end of 90-day follow-up, LL-TS group significantly reduced LA and LV dilatation, improved LV contractile and diastolic function, reduced infarct size by ≈50% compared with MI group. LL-TS treatment alleviated cardiac fibrosis and significantly decreased protein expression level of collagen I, collagen III, transforming growth factor β1, and matrix metallopeptidase 9 in LV tissues. The plasma level of high-specific C-reactive protein, norepinephrine, N-terminal pro-B-type-natriuretic peptide in LL-TS group was significantly lower than those in MI group from the 7th day to the end of follow-up. CONCLUSIONS Chronic intermittent low-level transcutaneous electric stimulation of auricular branch of vagus nerve can attenuate LV remodeling in conscious dogs with healed MI.
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Affiliation(s)
- Zhuo Wang
- From the Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lilei Yu
- From the Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Songyun Wang
- From the Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Bing Huang
- From the Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Kai Liao
- From the Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Gaowa Saren
- From the Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Tuantuan Tan
- From the Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hong Jiang
- From the Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.
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194
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Wang Z, Yu L, Chen M, Wang S, Jiang H. Transcutaneous electrical stimulation of auricular branch of vagus nerve: a noninvasive therapeutic approach for post-ischemic heart failure. Int J Cardiol 2014; 177:676-7. [PMID: 25449481 DOI: 10.1016/j.ijcard.2014.09.165] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 09/27/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Zhuo Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Lilei Yu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Mingxian Chen
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Songyun Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Hong Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.
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195
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Rezende-Neto JB, Alves RL, Carvalho M, Almeida T, Trant C, Kushmerick C, Andrade M, Rizoli SB, Cunha-Melo J. Vagus nerve stimulation improves coagulopathy in hemorrhagic shock: a thromboelastometric animal model study. J Trauma Manag Outcomes 2014; 8:15. [PMID: 25243020 PMCID: PMC4169132 DOI: 10.1186/1752-2897-8-15] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 09/12/2014] [Indexed: 11/17/2022]
Abstract
Introduction Inflammation plays a major role in the multifactorial process of trauma associated coagulopathy. The vagus nerve regulates the cholinergic anti-inflammatory pathway. We hypothesized that efferent vagus nerve stimulation (VNS) can improve coagulopathy by modulating the inflammatory response to hemorrhage. Methods Wistar rats (n = 24) were divided in 3 groups: Group (G1) Sham hemorrhagic shock (HS); (G2) HS w/o VNS; (G3) HS followed by division of the vagus nerves and VNS of the distal stumps. Hemorrhage (45% of baseline MAPx15 minutes) was followed by normotensive resuscitation with LR. Vagus nerves were stimulated (3.5 mA, 5 Hz) for 30 sec 7 times. Samples were obtained at baseline and at 60 minutes for thromboelastometry (Rotem®) and cytokine assays (IL-1 and IL-10). ANOVA was used for statistical analysis; significance was set at p < 0.05. Results Maximum clot firmness (MCF) significantly decreased in G2 after HS (71.5 ± 1.5 vs. 64 ± 1.6) (p < 0.05). MCF significantly increased in G3 compared to baseline (67.3 ± 2.7 vs. 71.5 ± 1.2) (p < 0.05). G3 also showed significant improvement in Alfa angle, and Clot Formation Time (CFT) compared to baseline. IL-1 increased significantly in group 2 and decrease in group 3, while IL-10 increased in group 3 (p < 0.05). Conclusions Electrical stimulation of efferent vagus nerves, during resuscitation (G3), decreases inflammatory response to hemorrhage and improves coagulation.
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Affiliation(s)
- Joao B Rezende-Neto
- Department of General Surgery, St. Michael's Hospital - University of Toronto, Toronto, ON, Canada
| | | | - Mario Carvalho
- Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Thiago Almeida
- Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Cyntia Trant
- Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Marcus Andrade
- Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Sandro B Rizoli
- Department of General Surgery, St. Michael's Hospital - University of Toronto, Toronto, ON, Canada
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196
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Zannad F, De Ferrari GM, Tuinenburg AE, Wright D, Brugada J, Butter C, Klein H, Stolen C, Meyer S, Stein KM, Ramuzat A, Schubert B, Daum D, Neuzil P, Botman C, Castel MA, D'Onofrio A, Solomon SD, Wold N, Ruble SB. Chronic vagal stimulation for the treatment of low ejection fraction heart failure: results of the NEural Cardiac TherApy foR Heart Failure (NECTAR-HF) randomized controlled trial. Eur Heart J 2014; 36:425-33. [PMID: 25176942 PMCID: PMC4328197 DOI: 10.1093/eurheartj/ehu345] [Citation(s) in RCA: 238] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Aim The neural cardiac therapy for heart failure (NECTAR-HF) was a randomized sham-controlled trial designed to evaluate whether a single dose of vagal nerve stimulation (VNS) would attenuate cardiac remodelling, improve cardiac function and increase exercise capacity in symptomatic heart failure patients with severe left ventricular (LV) systolic dysfunction despite guideline recommended medical therapy. Methods Patients were randomized in a 2 : 1 ratio to receive therapy (VNS ON) or control (VNS OFF) for a 6-month period. The primary endpoint was the change in LV end systolic diameter (LVESD) at 6 months for control vs. therapy, with secondary endpoints of other echocardiography measurements, exercise capacity, quality-of-life assessments, 24-h Holter, and circulating biomarkers. Results Of the 96 implanted patients, 87 had paired datasets for the primary endpoint. Change in LVESD from baseline to 6 months was −0.04 ± 0.25 cm in the therapy group compared with −0.08 ± 0.32 cm in the control group (P = 0.60). Additional echocardiographic parameters of LV end diastolic dimension, LV end systolic volume, left ventricular end diastolic volume, LV ejection fraction, peak V02, and N-terminal pro-hormone brain natriuretic peptide failed to show superiority compared to the control group. However, there were statistically significant improvements in quality of life for the Minnesota Living with Heart Failure Questionnaire (P = 0.049), New York Heart Association class (P = 0.032), and the SF-36 Physical Component (P = 0.016) in the therapy group. Conclusion Vagal nerve stimulation as delivered in the NECTAR-HF trial failed to demonstrate a significant effect on primary and secondary endpoint measures of cardiac remodelling and functional capacity in symptomatic heart failure patients, but quality-of-life measures showed significant improvement.
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Affiliation(s)
- Faiez Zannad
- Inserm, CIC 1433, Centre Hospitalier Universitaire, Department of Cardiology, Nancy University, Université de Lorraine, Nancy, France
| | - Gaetano M De Ferrari
- Department of Cardiology and Cardiovascular Clinical Research Center, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy
| | - Anton E Tuinenburg
- Department of Cardiology, University Medical Center, Utrecht, The Netherlands
| | - David Wright
- Department of Cardiology, Liverpool Heart and Chest, Liverpool, UK
| | | | | | - Helmut Klein
- Division of Cardiology, Otto-von-Guericke Universität Magdeburg, Magdeburg, Germany
| | - Craig Stolen
- Boston Scientific Corporation, St. Paul, MN, USA
| | - Scott Meyer
- Boston Scientific Corporation, St. Paul, MN, USA
| | | | | | | | - Doug Daum
- Boston Scientific Corporation, St. Paul, MN, USA
| | - Petr Neuzil
- Department of Cardiology, Homolka Hospital, Prague, Czech Republic
| | - Cornelis Botman
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | | | | | - Scott D Solomon
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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197
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Pyridostigmine restores cardiac autonomic balance after small myocardial infarction in mice. PLoS One 2014; 9:e104476. [PMID: 25133392 PMCID: PMC4136726 DOI: 10.1371/journal.pone.0104476] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 07/14/2014] [Indexed: 12/19/2022] Open
Abstract
The effect of pyridostigmine (PYR) - an acetylcholinesterase inhibitor - on hemodynamics and cardiac autonomic control, was never studied in conscious myocardial infarcted mice. Telemetry transmitters were implanted into the carotid artery under isoflurane anesthesia. Seven to ten days after recovery from the surgery, basal arterial pressure and heart rate were recorded, while parasympathetic and sympathetic tone (ΔHR) was evaluated by means of methyl atropine and propranolol. After the basal hemodynamic recording the mice were subjected to left coronary artery ligation for producing myocardial infarction (MI), or sham operation, and implantation of minipumps filled with PYR or saline. Separate groups of anesthetized (isoflurane) mice previously (4 weeks) subjected to MI, or sham coronary artery ligation, were submitted to cardiac function examination. The mice exhibited an infarct length of approximately 12%, no change in arterial pressure and increased heart rate only in the 1st week after MI. Vagal tone decreased in the 1st week, while the sympathetic tone was increased in the 1st and 4th week after MI. PYR prevented the increase in heart rate but did not affect the arterial pressure. Moreover, PYR prevented the increase in sympathetic tone throughout the 4 weeks. Concerning the parasympathetic tone, PYR not only impaired its attenuation in the 1st week, but enhanced it in the 4th week. MI decreased ejection fraction and increased diastolic and systolic volume. Therefore, the pharmacological increase of peripheral acetylcholine availability by means of PYR prevented tachycardia, increased parasympathetic and decreased sympathetic tone after MI in mice.
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198
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Choy JS, Zhang ZD, Pitsillides K, Sosa M, Kassab GS. Longitudinal hemodynamic measurements in swine heart failure using a fully implantable telemetry system. PLoS One 2014; 9:e103331. [PMID: 25119289 PMCID: PMC4131878 DOI: 10.1371/journal.pone.0103331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 07/01/2014] [Indexed: 11/19/2022] Open
Abstract
Chronic monitoring of heart rate, blood pressure, and flow in conscious free-roaming large animals can offer considerable opportunity to understand the progression of cardiovascular diseases and can test new diagnostics and therapeutics. The objective of this study was to demonstrate the feasibility of chronic, simultaneous measurement of several hemodynamic parameters (left ventricular pressure, systemic pressure, blood flow velocity, and heart rate) using a totally implantable multichannel telemetry system in swine heart failure models. Two solid-state blood pressure sensors were inserted in the left ventricle and the descending aorta for pressure measurements. Two Doppler probes were placed around the left anterior descending (LAD) and the brachiocephalic arteries for blood flow velocity measurements. Electrocardiographic (ECG) electrodes were attached to the surface of the left ventricle to monitor heart rate. The telemeter body was implanted in the right side of the abdomen under the skin for approximately 4 to 6 weeks. The animals were subjected to various heart failure models, including volume overload (A-V fistula, n = 3), pressure overload (aortic banding, n = 2) and dilated cardiomyopathy (pacing-induced tachycardia, n = 3). Longitudinal changes in hemodynamics were monitored during the progression of the disease. In the pacing-induced tachycardia animals, the systemic blood pressure progressively decreased within the first 2 weeks and returned to baseline levels thereafter. In the aortic banding animals, the pressure progressively increased during the development of the disease. The pressure in the A-V fistula animals only showed a small increase during the first week and remained stable thereafter. The results demonstrated the ability of this telemetry system of long-term, simultaneous monitoring of blood flow, pressure and heart rate in heart failure models, which may offer significant utility for understanding cardiovascular disease progression and treatment.
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Affiliation(s)
- Jenny S. Choy
- Department of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, United States of America
| | - Zhen-Du Zhang
- Department of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, United States of America
| | | | - Margo Sosa
- Transonic Systems Inc., Ithaca, New York, United States of America
| | - Ghassan S. Kassab
- Department of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, United States of America
- Department of Surgery, Indiana University, Indianapolis, Indiana, United States of America
- Department of Cellular and Integrative Physiology, Indiana University, Indianapolis, Indiana, United States of America
- * E-mail:
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199
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Lu X, Zhang ZD, Guo X, Choy JS, Yang J, Svendsen M, Kassab G. Response of various conduit arteries in tachycardia- and volume overload-induced heart failure. PLoS One 2014; 9:e101645. [PMID: 25127035 PMCID: PMC4134194 DOI: 10.1371/journal.pone.0101645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 06/09/2014] [Indexed: 12/14/2022] Open
Abstract
Although hemodynamics changes occur in heart failure (HF) and generally influence vascular function, it is not clear whether various HF models will affect the conduit vessels differentially or whether local hemodynamic forces or systemic factors are more important determinants of vascular response in HF. Here, we studied the hemodynamic changes in tachycardia or volume-overload HF swine model (created by either high rate pacing or distal abdominal aortic-vena cava fistula, respectively) on carotid, femoral, and renal arteries function and molecular expression. The ejection fraction was reduced by 50% or 30% in tachycardia or volume-overload model in four weeks, respectively. The LV end diastolic volume was increased from 65 ± 22 to 115 ± 78 ml in tachycardia and 67 ± 19 to 148 ± 68 ml in volume-overload model. Flow reversal was observed in diastolic phase in carotid artery of both models and femoral artery in volume-overload model. The endothelial function was also significantly impaired in carotid and renal arteries of tachycardia and volume-overload animals. The endothelial dysfunction was observed in femoral artery of volume-overload animals but not tachycardia animals. The adrenergic receptor-dependent contractility decreased in carotid and femoral arteries of tachycardia animals. The protein expressions of NADPH oxidase subunits increased in the three arteries and both animal models while expression of MnSOD decreased in carotid artery of tachycardia and volume-overload model. In conclusion, different HF models lead to variable arterial hemodynamic changes but similar vascular and molecular expression changes that reflect the role of both local hemodynamics as well as systemic changes in HF.
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Affiliation(s)
- Xiao Lu
- Department of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, United States of America
| | - Zhen-Du Zhang
- Department of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, United States of America
| | - Xiaomei Guo
- Department of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, United States of America
| | - Jenny Susana Choy
- Department of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, United States of America
| | - Junrong Yang
- Department of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, United States of America
| | - Mark Svendsen
- Department of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, United States of America
| | - Ghassan Kassab
- Department of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, United States of America
- Department of Surgery, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, United States of America
- Cellular and Integrative Physiology, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, United States of America
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Iliescu R, Tudorancea I, Lohmeier TE. Baroreflex activation: from mechanisms to therapy for cardiovascular disease. Curr Hypertens Rep 2014; 16:453. [PMID: 24899538 PMCID: PMC4364442 DOI: 10.1007/s11906-014-0453-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Recent technical advances have led to the development of a medical device that can reliably activate the carotid baroreflex with an acceptable degree of safety. Because activation of the sympathetic nervous system plays an important role in the pathogenesis of hypertension and heart failure, the unique ability of this device to chronically suppress central sympathetic outflow in a controlled manner suggests potential value in the treatment of these conditions. This notion is supported by both clinical and experimental animal studies, and the major aim of this article is to elucidate the physiological mechanisms that account for the favorable effects of baroreflex activation therapy in patients with resistant hypertension and heart failure. Illumination of the neurohormonal, renal, and cardiac actions of baroreflex activation is likely to provide the means for better identification of those patients that are most likely to respond favorably to this device-based therapy.
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Affiliation(s)
- Radu Iliescu
- Department of Physiology and Biophysics, University of Mississippi Medical Center, 2500 North State St., Jackson, MS, 39216-4505, USA,
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